ACUTE LYMPHOBLASTIC LEUKAEMIA

Acute Lymphoblastic Leukaemia

How ALL Develops

▪ ALL results from an acquired or a genetic injury to the DNA of
a single cell in the marrow.
▪ The effects of ALL include uncontrolled and exaggerated
growth and accumulation of lymphoblasts.
▪ The presence of the leukaemic blasts blocks the production
of normal cells.
Incidence, Causes and Risk Factors
▪ ALL occurs most often in the first decade of life but increases
in frequency again in older individuals.
▪ The causes of ALL are not clear; exposure to high doses of
radiation is one such factor.
▪ There are higher leukaemia rates in more developed
countries and in higher socioeconomic groups.
▪ A child who has had multiple diagnostic x-rays may be at a
slightly increased risk for ALL.
▪ Previous chemotherapy and radiation treatment may be a
cause of ALL in adults.
▪ Some cases of ALL relate to a mutation in a lymphocyte
that occurs during the prenatal period (in utero).
▪ Usually the leukaemia is diagnosed in infancy or in the first
few years after birth.
Signs and Symptoms
▪ It is common for a person with ALL to feel a loss of well-
being; the person may tire more easily and have shortness
of breath during normal physical activities.
▪ FBC; low numbers of RBCs, WBCs and platelets are common
in patients with newly diagnosed ALL.
▪ Other signs and symptoms that a person with ALL may have
include
o Pale skin coloring from anaemia
o Signs of bleeding caused by a very low platelet count, including
• Black-and-blue marks or bruises occurring for no reason or because of a minor
injury
• The appearance of pinhead-sized red spots on the skin, called “petechiae”
• Prolonged bleeding from minor cuts
o Mild fever
o Frequent minor infections
o Discomfort in bones or joints
o Enlarged spleen, liver or lymph nodes.
Bleeding
▪ A low platelet count predisposes patients to bleeding;
bleeding in the brain or lung is serious and can be fatal.
Infection
▪ If the neutrophil count becomes or remains low because of
ALL or its treatment, serious infection may occur and can
be life threatening.
 Diagnosis and Cell Classification

▪ An accurate diagnosis of the type of

leukaemia helps to
o Estimate how the disease will progress
o Determine the appropriate treatment.

Blood and Bone Marrow Tests

▪ Blood and bone marrow cells are examined Acute lymphoblastic leukaemia
(CSF x1000).

to diagnose ALL and identify the ALL

subtype.
▪ Peripheral blood film examination will often
show the presence of leukaemic blast cells.
▪ A bone marrow examination is preferred to Acute lymphoblastic leukaemia
(CSF x1000).

diagnose ALL.
ALL Subtypes
▪ ALL has many subtypes and can be classified
by immunologic, cytogenetic and molecular
genetic tests.
▪ Immunophenotyping is necessary to A B

establish the diagnosis of either B-cell ALL, T-

cell ALL or acute myeloid leukaemia (AML).
▪ Flow cytometry may be used to do
immunophenotyping.
▪ ALL is divided into two major subtypes based D
C
on the physical characteristics and the level Acute lymphocytic leukaemias. (A) Screening
of development of the leukaemia cells. view: blasts (1) and lymphocytes (2) in ALL.
(B) Same case as a . The blasts show a dense,
irregular nuclear structure and narrow

▪ The principal ALL subtypes are cytoplasm. Lymphocyte (2). (C) ALL blasts.
(D) Bone marrow: large, vacuolated blasts,
typical of B-cell ALL. The image shows residual
o B lymphoblastic leukaemia dysplastic erythropoietic cells (arrow).

o T lymphoblastic leukaemia
▪ B-cell leukemia (Burkitt leukaemia); it
accounts for 2%-3% of ALL patients.
ALL Principal Cytogenetic Abnormalities Associated

▪ The treatment for Burkitt leukaemia is

based on therapy for NHL and is
completely different than the
treatment used for ALL.
▪ Karyotyping and cytogenetic analysis
FISH and PCR assays may be
performed.
▪ Translocations are the most common
type of DNA change that is associated
with ALL; deletions and inversions are
less common.
▪ In many cases of ALL, the genetic
changes are not known.
END