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Acute lymphoid leukemia (ALL) develops rapidly. The symptoms include anemia, fever, bleeding, loss of appetite, swelling of the lymph nodes, anxiousness, panting, or pica, vomiting, pale gums, weight loss, shifting limb lameness, incoordination, infections caused by not having enough healthy, fully functional white blood cells, which results in rapid death if left untreated. Clinical examination reveals fever and enlargement of the liver and spleen. Acute lymphoid leukemia in the dog is most frequently reported in mature animals. This is in contrast to humans, where acute leukemia is one of the most common childhood cancers. Dogs with acute myelogenous leukemia may develop ocular lesions Introduction Leukemias are malignant neoplasms of hematopoietic stem cells arising in the bone marrow.1 Acute lymphocytic leukemia (also known as ALL, acute lymphoblastic leukemia, or acute lymphoid leukemia) is a proliferation of undifferentiated lymphocytes and is the most common cancer in children. The disease affects 25-30% of all pediatric oncology patients. Even though the specific etiology is largely unknown, ALL is considered to be one of the most curable cancers in children.2 Although there are many similarities between the human and animal forms of the disease, the clinical course and outcome are very different. The prognosis with chemotherapy treatment is poor in canine and feline patients, and the average survival time is only a few months. Untreated, the estimated survival time from diagnosis is less than two weeks.1 ALL is more common in cats than in dogs, however neither is very common compared to lymphoma. ALL can occur at any age in animals, although it is more prevalent in young and middle-age populations.4 Pathogenesis ALL begins with the malignant transformation of an undifferentiated lymphoblast in the bone marrow. The progeny of this single transformed cell are clones which proliferate rapidly. Varying numbers of these neoplastic cells can be found in the peripheral blood. As such, ALL is characterized by high numbers of lymphoblasts in the bone marrow and varying numbers of lymphoblasts in the blood. Leukemic profile stages include aleukemic (neoplastic blast cells in the bone marrow only – early stages), subleukemic (few blast cells in the blood) and leukemic (many blast cells in the blood). Therefore the peripheral white blood cell count (WBC) in these patients may be above, below, or within the reference range depending on the stage of the disease at diagnosis. The cell of origin in ALL can be a B-cell, T-cell or NK-cell.3,4 Leukemias from all three cell types have been reported in dogs and cats and most cases in dogs are T-cell or NKcell.4 Despite the origin, once a cell begins to proliferate the progeny typically do not mature and remain in the blast form in the marrow as well as in peripheral circulation. These cells do not function as normal lymphocytes. Instead, they compromise the normal function of the remaining hematopoietic precursors in the animal’s bone marrow. This is called myelophthisis and may manifest as anemia, granulocytopenia, thrombocytopenia,
splenomegaly. if not impossible. small amount of basophilic cytoplasm (arrowhead) and visible nucleolus (arrow). Shifting leg lameness. The neoplastic lymphocytes can also involve the liver and spleen. vomiting. Fine needle aspirates of the liver and spleen can be helpful if these organs are enlarged and their involvement is suspected. cachexia. Dogs and cats can be afflicted with other forms of acute leukemia besides ALL. such as Down’s Syndrome.3 Clinical Signs Most of the clinical signs associated with ALL are non-specific. Neurologic signs are less commonly reported.1 However. thrombocytopenia leads to petechiae and epistaxis. anorexia. Figure 2. Numerous lymphoblasts were found in this blood smear. mild lymphadenopathy.or T-cell based on morphology alone. the correlation has become less common after the routine increase in FeLV testing and vaccination of cats. to differentiate ALL from other forms of acute leukemia based on visual inspection alone (Figure 3). Classically. Anemia leads to lethargy and pallor. It may be difficult. some toxins and specific diseases have been indicated as predisposing factors. Definitive diagnosis. It is also unreliable to attempt to classify ALL as B. ALL is often suspected after discovering moderate to high numbers of lymphoblasts in the blood (Figure 2). Diagnosis Lymphoblasts are large lymphocytes (larger than a neutrophil) with a round nucleus and a scant to small amount of basophilic cytoplasm. and persistent fever have all been commonly reported with the disease. however. requires bone marrow examination. Lethargy.2 FeLV has been implicated as a potential cause for ALL in cats. diarrhea. epistaxis. Acute lymphoblastic leukemia in a dog. Note the large size compared to the red blood cells. as well as radiation exposure. For instance. Human risk factors include specific genetic diseases. Other clinical signs are the result of tissue infiltration by leukemic cells and subsequent organ dysfunction. All acute leukemias present with similar clinical signs and all undifferentiated hematopoietic cells have similar morphology. and petechiae may be evident. dyspnea. Although no exact cause for ALL has been isolated. pallor of the mucous membranes. as well as occasionally the lymph nodes. in the later stages of the disease. and granulocytopenia leads to fever and infections. acute monocytic leukemia is a proliferation of undifferentiated monocytes/monoblasts and acute myeloid leukemia is a proliferation of undifferentiated granulocytes/myeloblasts. tachycardia and recurrent infections have also been associated with ALL. Lymphoblast in the blood of a dog.or a combination thereof in the peripheral blood. however they can be seen in ALL patients with meningeal metastasis of the lymphoblasts. On physical exam. Immunophenotyping and/or immunohistochemistry is .5 Many clinical signs observed in ALL are the result of myelophthisis and the resulting cytopenias. They have a fine granular chromatin pattern and a visible nucleolus (Figure 1). Figure 1. greater than 30% of the nucleated bone marrow cells must be lymphoblasts to diagnose ALL. hepatomegaly.
often necessary to correctly classify an acute leukemia (Table 1). CD3 4 B-Cell ALL T-Cell ALL Acute Myeloid Leukemia Acute Monocytic Leukemia + + + + C CD7 D3 9 + + - CD1 4 - Myeloperoxidase + .
Treatment of patients with ALL may be challenging. Consultation with a veterinary oncologist is highly recommended. leukemia means white (“leuk”) blood (“emia”).6 Literally. Veterinarians should consult the current literature and current pharmacological formularies before initiating any treatment protocol. The bone marrow from where the white blood cells are produced is involved in producing cancerous cells rather than producing other blood cells that are necessary for survival. will be needed for most patients as well. including nutritional support and blood transfusions. Leukemia is one of the four major types of cancer. Chemotherapy agents typically used in the treatment of ALL include prednisone. Supportive care. and that is the reason why the WBC count shoots up in cases of infection. Acute lymphoblastic (lymphoblast is an immature leukocyte) or lymphocytic leukemia (ALL) is a malignant neoplasm of blood-forming tissues. allergy and stress. Acute lymphoblastic leukemia is a less common type of dog cancer.Treatment Note: Treatment of animals should only be performed by a licensed veterinarian. and the incident of the same is relatively higher in cats (though less common as compared to lymphoma in cats). vincristine and l-asparaginase. . It is characterized by an abnormal growth of leukocytes. Drug choice should be made on the basis of agents with the least amount of myelosuppressive side effects. White blood cells (also known as leukocytes) are actually an important part of the body’s defense mechanism. Prophylactic antibiotics are often used in cases with significant granulocytopenia or other risk factors for sepsis. The blood is flooded with a particular white blood cell.
In cats. The acute condition in this case refers to abnormal multiplication of immature leukocytes and chronic conditions to that of developed cells.000 (3500 is normal in dogs). Exposure to radiation and benzene has been linked to ALL in humans. Acute lymphoblastic leukemia is more malignant than chronic. as well. Clinical signs like lethargy.The condition starts in the bone marrow. there are some other symptoms that can be considered as a confirmation of a more serious condition. the survival time is only a few weeks. . Even aggressive chemotherapy. liver and lymph nodes Paling of mucous membranes Minute red or purple spots on the surface of the skin (as the result of tiny hemorrhages of blood vessels) The exact cause of ALL in dogs has not been established. eating disorders. however. the feline leukemia virus is involved in development of the condition. This single transformed cell then rapidly starts forming genetically identical cells by some kind of asexual reproduction. Acute lymphocytic leukemia (or ALL) is indicated when abnormally high numbers of lymphoblast. as these symptoms are similar to symptoms of various other diseases. Prognosis for dogs with this type of fatal cancer in dogs is very poor. patients of ALL are not likely to survive for more than a few months after diagnosis. Without treatment. are seen in the bone marrow and an increased number in the blood. Some believe that the condition can be caused due to toxins or specific dog ailments that lead to abnormal proliferation of immature lymphoblast-like cells in bone marrow. and there is a strong possibility that similar factors affect dogs as well. as high as or more than 100. However. where an undifferentiated immature leukocyte begins to turn malignant. diarrhea. vomiting and a general loss of vitality are confusing. The prefix ‘acute’ in the case of leukemia has nothing to do with the normal understanding of the term (a sudden development of a disease). These are: • • • Inflammation and abnormal enlargement of spleen.