Acute lymphoblastic leukemia
小结
定义
病史和体格检查
关键诊断因素
- lymphadenopathy
- hepatosplenomegaly
- pallor, ecchymoses, or petechiae
- constitutional symptoms (fevers, night sweats, weight loss)
- recurrent infections
- fatigue, dizziness, palpitations, and dyspnea
- bruising, epistaxis, heavy menstrual bleeding
其他诊断因素
- mental status changes, focal neurologic signs/deficits, headache, papilledema, nuchal rigidity, and meningismus
- renal enlargement
- bone pain
- painless unilateral testicular enlargement
- abdominal pain
- mediastinal or abdominal mass
- pleural effusion
- skin infiltrations
危险因素
- children <5 years of age
- genetic factors
- family history of ALL
- viral infections
- environmental factors
- history of malignancy
- treatment with chemotherapy
- male sex
- Hispanic populations
- folate metabolism polymorphisms
- poor maternal diet
诊断性检查
首要检查
- CBC with differential
- peripheral blood smear
- serum electrolytes
- serum uric acid
- serum lactate dehydrogenase (LDH)
- renal function tests
- liver function tests
- coagulation profile
- bone marrow evaluation (cytomorphology)
- immunophenotyping
- cytogenetic analysis (karyotyping and fluorescence in situ hybridization [FISH])
- molecular testing (reverse transcriptase polymerase chain reaction [RT-PCR])
- next-generation sequencing (NGS) assay
- blood group and antibody screening
- antibody testing for infection
需考虑的检查
- lumbar puncture
- chest radiograph
- pleural tap
- CT/MRI of head
- CT neck, thorax, abdomen, pelvis
- scrotal ultrasound
- baseline measurable residual disease (MRD) testing
- thiopurine methyltransferase (TPMT) phenotyping
- nudix hydrolase 15 (NUDT15) phenotyping
- HLA-typing
- echocardiogram or multigated acquisition (MUGA) scan
治疗流程
adolescents and adults: newly diagnosed Ph+ B-ALL
adolescents and adults: newly diagnosed Ph-negative B-ALL or T-ALL
complete remission: Ph+ B-ALL
complete remission: Ph-negative B-ALL
complete remission: T-ALL
relapsed or refractory disease
撰稿人
作者
Ryan D. Cassaday, MD
Associate Professor
Division of Hematology and Oncology, University of Washington School of Medicine
Clinical Research Division, Fred Hutchinson Cancer Center
Seattle
WA
Divulgaciones
RDC has received research funding from Amgen, Jazz Pharmaceuticals, Incyte, Kite/Gilead, Merck, Pfizer, Servier, and Vanda Pharmaceuticals; honoraria/consulting from Amgen, Jazz, Kite/Gilead, and Pfizer; serves on a board/advisory committee for Autolus and PeproMene Bio; and his spouse has been employed by and owned stock in Seagen. RDC is an author of several articles cited in the topic.
Agradecimientos
Dr Ryan D. Cassaday would like to gratefully acknowledge Dr Melissa Ooi, Dr Michelle Poon, Dr Esther Chan, Dr Chin Hin Ng, Dr Arati V. Rao, Dr Matthew Smith, Dr Samer Bleibel, and Dr Robert Leonard, previous contributors to this topic.
Divulgaciones
MO, MP, EC, CHN, AVR, MS, SB, and RL declare that they have no competing interests.
Revisores por pares
Olga Kozyreva, MD
Staff Physician
Department of Hematology and Oncology
New England Medical Center
Tufts University
Boston
MA
Divulgaciones
OK declares that she has no competing interests.
Shankaranarayana Paneesha, MD, MRCP, FRCPath
Consultant Haematologist
Department of Haematology and Stem Cell Transplantation
Heartlands Hospital
Birmingham
UK
Divulgaciones
SP declares that he has no competing interests.
Agradecimiento de los revisores por pares
Los temas de BMJ Best Practice se actualizan de forma continua de acuerdo con los desarrollos en la evidencia y en las guías. Los revisores por pares listados aquí han revisado el contenido al menos una vez durante la historia del tema.
Divulgaciones
Las afiliaciones y divulgaciones de los revisores por pares se refieren al momento de la revisión.
Referencias
Artículos principales
Alaggio R, Amador C, Anagnostopoulos I, et al. The 5th edition of the World Health Organization classification of haematolymphoid tumours: lymphoid neoplasms. Leukemia. 2022 Jul;36(7):1720-48.Texto completo Resumen
Arber DA, Orazi A, Hasserjian RP, et al. International consensus classification of myeloid neoplasms and acute leukemias: integrating morphologic, clinical, and genomic data. Blood. 2022 Sep 15;140(11):1200-8.Texto completo Resumen
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: acute lymphoblastic leukemia [internet publication].Texto completo
Hoelzer D, Bassan R, Dombret H, et al. Acute lymphoblastic leukaemia in adult patients: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2016 Sep;27(suppl 5):v69-82.Texto completo Resumen
National Comprehensive Cancer Network. NCCN practice guidelines in oncology: pediatric acute lymphoblastic leukemia [internet publication].Texto completo
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
Diferenciales
- Acute myeloid leukemias (AML)
- Lymphoblastic lymphoma (LBL)
- Myeloid/lymphoid neoplasms with eosinophilia and tyrosine kinase fusion genes (MLNE)
Más DiferencialesGuías de práctica clínica
- NCCN practice guidelines in oncology: pediatric acute lymphoblastic leukemia
- NCCN practice guidelines in oncology: hematopoietic cell transplantation
Más Guías de práctica clínicaFolletos para el paciente
Leukemia (acute lymphocytic)
Más Folletos para el pacienteVideos
Diagnostic lumbar puncture in adults: animated demonstration
Más vídeos
Inicie sesión o suscríbase para acceder a todo el BMJ Best Practice
El uso de este contenido está sujeto a nuestra cláusula de exención de responsabilidad