Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- lymphadenopathy
- hepatosplenomegaly
- pallor, ecchymoses, or petechiae
- fever
- fatigue, dizziness, palpitations, and dyspnoea
- epistaxis, menorrhagia
Other diagnostic factors
- papilloedema, nuchal rigidity, and meningismus
- focal neurological signs
- painless unilateral testicular enlargement
- renal enlargement
- bony pain
- abdominal pain
- mediastinal or abdominal mass
- pleural effusion
- skin infiltrations
Risk factors
- children less than 6 years of age
- age in mid to late 30s
- age in mid 80s
- genetic factors
- family history of acute lymphocytic leukaemia (ALL)
- viruses
- environmental factors
- history of malignancy
- treatment with chemotherapy
- male sex
- white population
Diagnostic investigations
1st investigations to order
- full blood count (FBC) with differential
- peripheral blood smear
- serum electrolytes
- renal function
- liver function
- lactic dehydrogenase
- coagulation profile
- bone marrow aspiration and trephine biopsy
- immunophenotyping (on bone marrow, or peripheral blood if cell count is raised)
- thiopurine methyltransferase (TPMT) phenotype
- cytogenetics
- molecular studies
Investigations to consider
- HLA-typing
- chest x-ray
- lumbar puncture (LP)
- pleural tap
- CT/MRI brain
- CT
- minimal residual disease molecular samples
Treatment algorithm
Contributors
Authors
Consultant
Department of Haematology-Oncology
National University Cancer Institute
Singapore
Disclosures
MO declares that she has no competing interests.
Senior Consultant
Department of Haematology-Oncology
National University Cancer Institute
Singapore
Disclosures
None declared.
Consultant
Department of Haematology-Oncology
National University Cancer Institute
Singapore
Disclosures
EC declares that she has no competing interests.
Consultant
Department of Haematology-Oncology
National University Cancer Institute
Singapore
Disclosures
CHN declares that he has no competing interests.
Dr Melissa Ooi, Dr Michelle Poon, Dr Esther Chan, and Dr Chin Hin Ng would like to gratefully acknowledge Dr Arati V. Rao, Dr Matthew Smith, Dr Samer Bleibel, and Dr Robert Leonard, previous contributors to this monograph. AVR, MS, SB, and RL declare that they have no competing interests.
Peer reviewers
Staff Physician
Department of Hematology and Oncology
New England Medical Center
Tufts University
Boston
MA
Disclosures
OK declares that she has no competing interests.
Consultant Haematologist
Department of Haematology and Stem Cell Transplantation
Heartlands Hospital
Birmingham
UK
Disclosures
SP declares that he has no competing interests.
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