acute lymphoblastic leukaemia


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acute lymphoblastic leukaemia

A malignant lymphoproliferative process, which commonly affects children and young adults, affecting ± 1800/year (US); ± 650/year (UK).

Aetiology
ALL has a hereditary component; it is 20-fold increased in patients with Down syndrome; it is linked to benzene exposure, radiation therapy in ankylosing spondylitis.
 
Clinical findings
Abrupt onset, often ± 3-month history of fatigue, fever, haemorrhage from multiple sites, lymphadenopathy, hepatomegaly, splenomegaly.
 
Molecular pathology
Most are B cells and express CD19; 60% have karyotypic abnormalities; the most common cytogenetic abnormality is the cryptic t(12;21) translocation, resulting in TEL-AML fusion (25% of cases), followed by the t(1;19)(q23;p13.3) translocation, seen in 5% of cases.
 
Prognosis
90–95% achieve remission; improved cure rate is attributed to prophylaxis for meningeal leukaemia and more intense systemic chemotherapy. The current survival ranges from 20% to 75%.

FAB classification, acute leukaemias
Acute lymphocytic leukaemia (ALL)
L1—Small monotonous lymphocytes.
L2—Mixed L1- and L3-type lymphocytes.
L3—Large homogeneous blast cells.
References in periodicals archive ?
Pulmonary function after treatment for acute lymphoblastic leukaemia in childhood.
New definition of remission in childhood acute lymphoblastic leukaemia.
Treatment reduction for children and young adults with low-risk acute lymphoblastic leukaemia defined by minimal residual disease (UKALL 2003): a randomized controlled trial.
Minimal residual disease after induction is the strongest predictor of prognosis in intermediate risk relapsed acute lymphoblastic leukaemia - Long-term results of trial ALL-REZ BFM P95/96.
Six-year experience with a comprehensive approach to the treatment of recurrent childhood acute lymphoblastic leukaemia (ALL-REZ BFM 85).
Temporal changes in the incidence and pattern of central nervous system relapses in children with acute lymphoblastic leukaemia treated on four consecutive Medical Research Council trials, 1985-2001.
Bone Marrow relapse in pediatric acute lymphoblastic leukaemia.
Acute lymphoblastic leukaemia in India: an analysis of prognostic factors using a single treatment regimen.
The clinical value of follow-up examinations in childhood T-cell acute lymphoblastic leukaemia and T-cell non-Hodgkin's lymphoma.
Studies of children with acute lymphoblastic leukaemia (ALL) who relapsed.
Prognostic factors in childhood acute lymphoblastic leukaemia in Japan.
Prognostic factors in children with acute lymphoblastic leukaemia.

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