Clonal proliferation and accumulation of blast cells from lymphoid series in blood, bone marrow and other organs
Disorder originates in single B or T lymphocyte progenitor
B cell type – 80% T cell type – 20%
Common age group – 5 to 15 yrs
Etiology - unknown
Acute leukemias - clinical features
1. Bleeding
2. Fever/infection
3. Fatiguability and pallor
4. Hepatomegaly
5. Splenomegaly
6. Lymphadenopathy
7. CNS involvement
8. Testicular involvement in males
Acute leukemias - laboratory findings
1. Blood examination
- anemia,
- thrombocytopenia,
- variable leukocyte count, usually increased from 10,000 to 500,000/cmm
- blood morphology: presence of blast cells
2. Bone marrow morphology
- presence of blast cells (>20%)
- suppression of normal hematopoiesis
3. Cytochemical stains
4. Immunophenotyping
5. Cytogenetics
Immune phenotyping
Cytogenetics
Subtype Morphology Occurrence (%)
L1 Small round blasts 75
clumped chromatin
L2 Pleomorphic larger blasts 20
clefted nuclei, fine chromatin
L3 Large blasts, nucleoli, 5
vacuolated cytoplasm
Better prognosis
- normal karyotype
- hyperdiploidy
Poor prognosis
- t (8; 14)
- t (4; 11)
Very poor prognosis
- t (9; 22); BCR/ABL (+)
Treatment strategy in ALL
Remission induction therapy in ALL
1. Antineoplastic treatment
a.Drugs: L-asparaginase, Daunorubicin, Prednisolone, Vincristine
b/Treatment duration: 4-8 weeks
c/ No of courses: 1- 2
2. CNS prophylaxis – Methotrexate (intrathecal)
3. Supportive care
4. Treatment of complications
Drugs – Etoposide, cytarabine, and Daunorubicn, Methotrexate(I.v.)
+/-
Stem Cell transplantation
- Prednisolone, Vincristine, Mercaptopurine and Methotrexate (oral)
- May need to be continued for 2-3 years
Adults
Complete remission (CR) 80-85%
Leukemia-free survival (LFS) 30-40%
Children
Complete remission (CR) 95-99%
Leukemia-free survival (LFS) 70-80%
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