Acute lymphocytic leukemia

Enlarged lymph nodes are frequently the initial cause for seeking medical attention by the patient. Over 90% of patients have clinically evident hematologic 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 leukemia (ALL). Initial peripheral blood smear may show leukemic lymphoblasts.

Treatment uses multiagent 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 leukemia (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, characterized by early lymphoid precursors replacing the normal hematopoietic 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