ACUTE LYMPHOCYTIC LEUKEMIA

MR: Mohammed mahmoud alhaj

 Acute lymphoblastic leukemia
(ALL)
• Acute lymphoblastic leukemia (ALL) is a clonal proliferation
of immature lymphocyte precursors evolving from a
mutation of lymphoid precursor cells and result in the
malignant disease, lymphoblastic leukemia.

• Disorder originates in single B or T lymphocyte progenitor

• Incidence in adults : 20% of acute leukemias
• Etiology - unknown
Acute leukemias - clinical features
1. Bleeding
2. Fever/infection
3. Bone/joint pain
4. Hepatomegaly
5. Splenomegaly
6. Lymphadenopathy
7. CNS involvement
Acute leukemias - laboratory findings (1)
1. Blood examination
- anemia,
- thrombocytopenia,
- variable leukocyte count, usually increased,
- blood morphology: presence of blast cells
2. Bone marrow morphology
- presence of blast cells,
- suppression of normal hematopoiesis
Acute leukemias - Laboratory findings (2)

3. Cytochemical stains
4. Immunophenotyping
5. Cytogenetics
6. Molecular studies
 L1
• Most common type in childhood.
• Monomorphic, small to intermediate-sized
blasts with round nuclei, scant cytoplasm (high
nucleus to cytoplasm [n–c] ratio), homogeneous
nuclear chromatin,
 L2
Most common type in adults.
Larger, more variable cells with more
abundant cytoplasm (lower n–c ratio),
irregular nuclear contours, and more
prominent nucleoli.
 Acute lymphoblastic leukemias -
reactivity with special stains

Subtype Peroxidase or Non-specific Periodic

Sudan black esterase acid-Schiff
L1 - - +++
L2 - - +++
L3 - - +++
 L3
Rare (~1–3% of ALL).
The cells are characterized by deeply
basophilic (blue) cytoplasm with prominent
clear cytoplasmic vacuoles.
L1
L2
L3
 Immunologic classification of acute
lymphoblastic leukemias
B- lineage (80%) Markers
Pro-B CD19(+),Tdt(+),CD10(-),CyIg(-),
Pre-B CD19(+),Tdt(+),CD10(+),CyIg(+),SmIg(-)
Mature-B CD19(+),Tdt(+),CD10(±),CyIg(±),SmIg(+)
T-lineage (20%)
Pre-T CD7(+), CD2(-), Tdt(+),
Mature-T CD7(+), CD2(+), Tdt(+),
 Cytogenetic Abnormalities

• Pre-B ALL(L1, L2):t(9;22), t(4;11), t(1;19)

• T cell ALL(L1, L2):14q11 or 7q34
• B cell ALL (L3) t(8;14), t(8;22), t(2;8)