L1 Subtype of Acute Lymphocytic Leukemia ALL

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PREPARED BY:

MOHD KHAIRUL AMRAN BIN MOHAMMAD

Bsc. In MEDICAL LABORATORY TECHNOLOGYFACULTY OF HEALTH SCIENCE

UNIVERSITY TEKNOLOGI MARA UiTM

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p

Complete blood count

presence of circulatory leukemic blastcells.

The presence and severity of anemia. The count of a variety of blood cell types. Thrombocytopenia

Peripheral blood smear

Precursor B-cell lymphoblastic leukemia

Blasts are heterogeneous in size, haveround or convoluted nuclei, have a high

nuclear/cytoplasmic ratio, and lack

cytoplasmic granules.ATL

Leukemia cells are typical CD4+ cellswith cloven hoof or flower-shaped

nuclei.

Burkitts leukemia

Typical monotonous mass of medium-sized cells with round nuclei, multiple

nucleoli, and basophilic cytoplasm with

cytoplasmic vacuoles

Imaging

Not indicated

Diagnostic procedures

Bone marrow biopsy with geneticand immunologic studies

o Diagnosis of ALL requires 30%lymphoblasts in the bonemarrow.

Lumbar puncture, to rule out occultCNS involvement

Classification

French-American-British (FAB)

classification for ALL

Immunologic subtype: preB-cellALL

Immunologic subtype: T-cell ALL Immunolo ic subt e: B-cell ALL

Treatment

Intensive induction phaseo Usually a combination

ofvincristine, prednisone, an

anthracycline andcytarabine,

usually with L-asparaginase CNS prophylaxis Maintenance chemotherapy that

extends for about 2 years

Long-term survival of 6575% ofpatients may be achieved.

Philadelphia chromosomepositiveALL management includes imatinib.

Bone marrow transplantation

ACUTE LYMPHOCYTIC LEUKEMIA, ALL

Description

A progressive cancer of immaturelymphocytes, with primary

involvement of bone marrow and

blood.

Acute lymphoid leukemias (ALLs)include:

o Precursor lymphoblastic leukemia(20% B cell, 80% T cell)

o Burkitts leukemia(100% B cell)o Adult T-cell

leukemia/lymphoma (ATL) (100%

T cell)

Lymphoblastic lymphoma, a cancerinvolving bone marrow and causing a

mediastinal mass, is related to T-cell

ALL.

Sign and symptoms

Fever Anemia Bleeding and/or bruishing Persistent weakness or tireness Achiness in the bones or joins Recurrent infections Difficulty breathing or swollen lymph

nodes

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Cytologic features

Cell size small cell predominate Nuclear chromatin homogenous Nuclear shape regular Nucleoli not visible or small and

inconspicuous

Amount of cytoplasm scanty Basophilia of cytoplasm slightly or

moderate, rarely intense

Cytoplasmic vacuolation - variable

Impression:

Acute lymphocytic leukemia subtype L1

L2 subtype of ALL

Impression:

Acute lymphocytic leukemia subtype L2

Cytologic features

Cell size large, heterogenous in size Nuclear chromatin heterogenous Nuclear shape irregular, clefting and

indentation common.

Nucleoli one or more present, oftenlarge

Amount of cytoplasm variable, oftenmoderately abundant

Basophilia of cytoplasm variable, deepin some

Cytoplasmic vacuolation - variable

L3 subtype of ALL

Impression:

Acute lymphocytic leukemia subtype L3

Cytologic features

Cell size large, heterogenous in size Nuclear chromatin finely slippled and

homogenous

Nuclear shape regular, oval to round Nucleoli prominent, one or more

vesicular

Amount of cytoplasm moderatelyabundant

Basophilia of cytoplasm very deep Cytoplasmic vacuolation often

prominent

L1 subtype of ALL