Acute Lymphoblastic Leukemia in Children

1. Professor Hala Al-Rimawi
JUST & KAUH
2016

2.  Over view of childhood leukemia
 Discussion of a case of acute lymphoblastic
leukemia
 The common signs and symptoms of ALL
 The methods of diagnosis of ALL
 Outline the treatment of ALL

3.  Acute leukemia is the most common form of childhood cancer,
representing 32% of all cancers
ALL is most
commonly
originate from
early stage of B
lymphocytes
(pre-B)
There are 2 type
of lymphoblastic
leukemia, B-cells
and T-cells.
ALL (80%)
AML (20%)
The peak incidence occurs between 2-5 years of age
Acute Leukemia is defined as uncontrolled proliferation of immature
blood cells, which called blasts

4.  His physical examination
revealed, pallor, multiple
bruises and petechial
rash were noticed on his
face and extremities,
spleen is enlarged 6 cm
BCM, and has generalized
lymphadenopathy.
 The cardiac and chest
examination were normal
 Mohammad is 2.5 year old
boy who presented with
general weakness, bone
pain and fever of 4 weeks
duration.

5.  As Lymphoblasts reproduce out of control, crowd out
normal cells in the bone marrow
 Decrease in red cells  anemia , pallor, lethargy, general
weakness,
 Decrease platelets  bleeding tendency, bruises
petechial rash
 Decrease neutrophils  recurrent infection , fever
 Increased pressure inside Bone marrow by malignant cells
 bone pain
 It can go into peripheral bloodstream and invade any
organ/tissue  enlarged lymph nodes, enlarged
liver and spleen, mediastinal mass
Usually symptoms become clear after 2-4 weeks

6. Mohammad Laboratory investigation showed
 CBC: WBCs 50 X 109 /L , with neutrophils of 1%,
platelets count of 16 X 109 /L , and a Hb of 7 gm/dl.
And a suspicious cells is seen in peripheral smear
(lymphoblast)
 Bone marrow aspirate done
Confirm B-lineage ALL
 Chest X ray no mediastinal mass
 lumber puncture for spinal fluids showed
presence of few lymphoblast

7.  Complete blood counts (CBC)
 Increased total number ofWBCs (blasts) to more than 10 ×
109/L with low numbers of normal white blood cells
(neutropenia),
 decrease in hemoglobin, decrease in platelets count
 Blood film may show presence of abnormal cells (blasts)
 Bone marrow sample ( aspirate and trephine) is needed
to confirm the diagnosis
no
 lumber puncture to examine spinal fluid for malignant cells
 Chest x ray or CT: for mediastinal mass
Bone marrow examination
Morphology: confirm presence of blast cells
(L1-L3)
Immune-phenotype: to define the type of
cells
▪B cells: CD10+, CD19+, CD34 and CD20+.
OR
▪T cells: CD2+, CD4+, CD5+, CD6+, CD7+ and
CD8+
Cytogenetics: find any chromosomal
abnormality, for prognosis
▪t(4,11), t(9,22) Ph. Chromosome  poor
prognosis in ALL
▪ t(12;21) in B-precursor ALL  favorable
prognosis
▪Hyperdiploidy (54 to 58 chromosomes)
good prognosis,

8. We put central venous line to Mohammad which allow us to
give chemotherapy , and we started intensive chemotherapy :

9.  Induction phase : intensive chemotherapy :
aimed to destroy all malignant cells. 4-6 weeks by the end the BM will be
clear for blast cells
 Consolidation and CNS prophylaxis phase:
aimed to maintain the remission and preventing the spread of blasts into the
brain and spinal cord, duration 8-12 weeks
 Maintenance phase:
aimed to maintain the remission and eliminating any residual disease,
duration up to total (2 years for girls and 3 years for boys)
 CNS radiotherapy
 Bone marrow transplant
 Cure rate in childhood ALL now > 80%