Acute Lymphoblastic Leukaemia

• ALL is the most common malignancy of childhood
• ALL arises from a clone of lymphoid progenitor cells that undergo malignant transformation. Most are B-cell in origin though ALL may arise from T-cell precursors.
• Proliferating malignant cells replace normal lines of haematopoietic cells resulting in their suppression. This leads to anaemia, thrombocytopenia (low platelets) and neutropenia (low neutrophils)
• Infiltration and proliferation are not limited to the bone marrow. It may affect other body tissues, especially lymph nodes, the liver and the spleen.
• Patients often present with a short history of features consistent with marrow suppression or lymphadenopathy
• Marrow failure:

  • Anaemia - fatigue, breathlessness and angina
  • Neutropenia - recurrent infections
  • Thrombocytopenia - petechiae, nose bleeds and bruising
• Signs of tissue infiltration:

  • Lymphadenopathy
  • Hepatosplenomegaly - causes anorexia and discomfort
  • Bone pain
• Leucocytosis may occur due to large numbers of white cells entering the blood stream

  • Altered mental state
  • headache
  • Breathlessness
  • Visual changes
• Bone marrow aspiration and biopsy is the definitive diagnostic test.
• Full blood count in ALL:

  • Haemoglobin - low - anaemia
  • Platelets - low - thrombocytopenia
  • Neutrophils - low - neutropenia
  • WCC/leucocytes - can be very raised - leucocytosis
• Other investigative tests:

  • Uric acid and LDH - non specific markers of tumour burden
  • U&Es - electrolyte imbalance - hypercalcaemia from bony involvement
  • Coagulation screen
  • LFTs
  • Bone profile
  • Blood Bourne virus screen
• Imaging:

  • CXR - may show mediastinal mass
  • CT TAP