Acute lymphocytic leukaemia

Enlarged lymph nodes are frequently the initial cause for seeking medical attention by the patient. Over 90% of patients have clinically evident haematological abnormalities at the time of initial diagnosis.

Physical examination may reveal pallor, ecchymoses, lymphadenopathy, or hepatosplenomegaly. There may also be evidence of tissue infiltration such as bone pain, testicular enlargement, and cranial nerve palsies.

Definitive diagnosis requires a bone marrow aspiration and trephine biopsy. Presence of 20% or more lymphoblasts in the bone marrow confirms the diagnosis of acute lymphocytic leukaemia (ALL). Initial peripheral blood smear may show leukaemic lymphoblasts.

Treatment uses multi-agent dose-intense chemotherapy regimens in induction, consolidation, and maintenance phases. Early stem cell transplantation (SCT) is considered in selected patients. Salvage chemotherapy, immunotherapy, and SCT are options for relapsed, refractory, or residual disease.

Despite the aggressive management methods, less than 30% of adults with ALL can be cured. Long-term adverse effects of treatment include heart failure, sterility, secondary malignancies, and neurotoxicity.

Acute lymphocytic leukaemia (ALL) is a malignant clonal disease that develops when a lymphoid progenitor cell becomes genetically altered through somatic changes and undergoes uncontrolled proliferation. This progressive clonal expansion eventually leads to ALL, characterised by early lymphoid precursors replacing the normal haematopoietic cells of the bone marrow and further infiltrating various body organs.[1]Pui CH, Relling MV, Downing JR. Acute lymphoblastic leukemia. N Engl J Med. 2004 Apr 8;350(15):1535-48. http://www.ncbi.nlm.nih.gov/pubmed/15071128?tool=bestpractice.com [2]Hoelzer D, Gökbuget N, Ottmann O, et al. Acute lymphoblastic leukemia. Hematology Am Soc Hematol Educ Program. 2002 Jan;(1):162-92. http://asheducationbook.hematologylibrary.org/cgi/content/full/2002/1/162 http://www.ncbi.nlm.nih.gov/pubmed/12446423?tool=bestpractice.com [3]Jabbour EJ, Faderl S, Kantarjian HM. Adult acute lymphoblastic leukemia. Mayo Clin Proc. 2005 Nov;80(11):1517-27. http://www.ncbi.nlm.nih.gov/pubmed/16295033?tool=bestpractice.com