Acute lymphocytic leukemia - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Acute lymphoblastic leukemia (ALL) is a malignant clonal disease that develops when a lymphoid progenitor cell becomes genetically altered and undergoes uncontrolled proliferation. Early lymphoid precursor cells replace the normal hematopoietic cells of the bone marrow and further infiltrate various body organs.
Most patients have signs and symptoms related to cytopenias (e.g., fatigue, easy bruising) at initial presentation and diagnosis. Enlarged lymph nodes can be an initial presenting cause.
Physical exam 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.
A definitive diagnosis of ALL requires cytomorphology assessment, immunophenotyping, molecular studies, and cytogenetic analysis of the bone marrow (or peripheral blood if there are sufficient numbers of circulating lymphoblasts).
Treatment uses multiagent chemotherapy-based regimens in induction, consolidation, and maintenance phases. Allogeneic stem cell transplantation (SCT) is considered in selected patients. Salvage chemotherapy, immunotherapy, and SCT are options for relapsed, refractory, or residual disease.

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History & Exam
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Definition

Epidemiology

Etiology

Pathophysiology

Images

BCR::ABL1 translocation
Lymphoblasts in bone marrow smear from 3-year-old male with ALL (Wright-Giemsa stain)
Chest x-ray of patient presenting with dyspnea, showing widened mediastinum and tracheal displacement

Citations

Key Articles

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.[Abstract][Full Text]
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.[Abstract][Full Text]
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: acute lymphoblastic leukemia [internet publication].[Full Text]
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.[Abstract][Full Text]
National Comprehensive Cancer Network. NCCN practice guidelines in oncology: pediatric acute lymphoblastic leukemia [internet publication].[Full Text]

Other Online Resources

Children's oncology group: long-term follow-up guidelines for survivors of childhood, adolescent, and young adult cancers

Referenced Articles

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