Acute Lymphoblastic Leukaemia


Lymphoblastic leukaemia is a heterogeneous disease of children and adults resulting from clonal expansion of progenitor cells. Treatment with intensive cytotoxic therapy is effective in the majority of children, but treatments for adults are less effective, probably because the disease originates from relatively drug‐resistant stem cells. However, treatment of young adults according to paediatric‐based regimens has produced superior results to adults‐based regimens. Current treatment of children aged between 1 and 10 years has produced a high cure rate of >85% and continues to improve. Not only has survival improved but there are also continuing improvements in reducing toxicity of treatment. This success currently serves as a model for other types of cancer where the cure rate is not yet optimised. The advances of identifying prognostic markers and genome profiling have been instrumental in such successes and will continue serving as landmarks for progress.

Key Concepts:

  • MRD is the most important prognostic factor in ALL patients receiving chemotherapy.

  • Paediatric‐based treatment regimens produce superior results to adults‐based regimens in treating teenagers and young adults.

  • Febrile neutropenia/susceptibility to infection is a life‐threatening complication of chemotherapy that is potentially treatable.

  • The variability in presentation and response to treatment reflects the heterogeneity of acute lymphoblastic leuakaemia.

  • The current success in minimising the morbidity of managing childhood leukaemia serves as a model for other oncological conditions.

Keywords: leukaemia; clinical trials; bone marrow transplantation; molecular genetics; MRD; relapse; immunophenotyping; gene rearrangement; karyotyping

Figure 1.

Bone marrow aspirate reveals increased blasts and immature lymphocytes (400X MacNeal tetrachrome). Maslak P. ASH Image Bank 2011; 2011–1692. © 2011 American Society of Hematology.

Figure 2.

Peripheral smear from a patient with a diagnosis of adult T‐cell leukaemia/lymphoma is shown, illustrating the morphologic heterogeneity of the leukaemic T cells. Numerous smudge cells are also present on this smear. Lazarchick J. ASH Image Bank 2011; 2011–4188. © 2011 American Society of Hematology.

Figure 3.

Normal (46 XY(7cells)) and near tetraploid (92 XXYY(13 cells)) metaphases were present. This hyperdiploid karyotype is not specific for myeloid or lymphoid malignancy. Lazarchick J. ASH Image Bank 2011; 2011–1425. © 2011 American Society of Hematology.

Figure 4.

Diagrammatic representation of the balanced translocation that results in the Philadelphia chromosome. Maslak P. ASH Image Bank 2011; 2011–1697. © 2011 American Society of Hematology.

Figure 5.

CXR shows a mediastinal mass, which is more common in T‐cell leukaemia. Maslak P. and Frattini M. ASH Image Bank 2011; 2011–4144. © 2011 American Society of Hematology.



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Further Reading

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Heslop HE, Brenner MK and Krance RA (1999) Bone marrow transplantation. In: Hoffbrand AV, Lewis SM and Tuddenham EGD (eds) Postgraduate Haematology, 4th edn, pp. 430–549. London: Butterworths.

Secker‐Walker LM (1999) Cytogenetics. In: Hoffbrand AV, Lewis SM and Tuddenham EGD (eds) Postgraduate Haematology, 4th edn, pp. 336–354. London: Butterworths.

Wickremasinghe RG and Hoffbrand AV (1999) The molecular basis of leukaemia. In: Hoffbrand AV, Lewis SM and Tuddenham EGD (eds) Postgraduate Haematology, 4th edn, pp. 354–373. London: Butterworths.

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Morsi, Hisham, and Jewell, Andy(May 2014) Acute Lymphoblastic Leukaemia. In: eLS. John Wiley & Sons Ltd, Chichester. [doi: 10.1002/9780470015902.a0002172.pub2]