Features Of Acute Lymphoblastic Leukemia Research Articles

Down's syndrome and acute lymphoblastic leukaemia: clinical features and response to treatment

AIMSTo examine the clinical and biological features of acute lymphoblastic leukaemia in children with Down's syndrome (DS), to compare their survival with other children, and to determine if entry to...

Clinical and Epidemiological Features of Acute Lymphoblastic Leukemia Following a Previous Malignancy

Secondary malignancies represent a relevant complication of chemotherapy employed for a previous cancer. Acute lcukemias represent the most frequent secondary malignaney in the first decade following primary neoplasms: Secondary leukemias are generally mycloid and can he preceeded by a myelodysplastie syndrome. The biological and epidemiological characteristics of secondary acute myeloid are well known and have been the subject of numerous reports and reviews in the last few years. The observation of a secondary acute lymphoblastic leukemia is considered rare, and the correlation with antecedent therapies is not definitive. Most of reported cases are single reports, and no large study has been performed to investigate the real importarice of this problem. In this review we report data of the current literature on secondary acute lymphoblastic leukemia, both in adults and children, in order to analyze its incidence and clinical and laboratory features.

Breakpoints at 11q23 in Infant Leukemias With the t(11;19) (q23;p13) Are Clustered

We have analyzed a series of nine infant leukemias that carry a t(11;19)(q23;p13). They had the morphologic features of acute lymphoblastic leukemia (ALL) and expressed markers typical of B-cell progenitor ALL or pre-B ALL; one coexpressed myeloid markers in addition to lymphoid markers (biphenotypic). Two probes (P/S4 and 98.40) subcloned from a yeast artificial chromosome (YAC) known to span the breakpoint in the t(4;11) were used to investigate DNA isolated from the leukemic cells of these patients. A total of approximately 15 kb of genomic DNA in the vicinity of the probes was examined by conventional Southern blot analysis using a series of restriction enzymes. In eight of the nine cases, the breakpoint could be mapped to an approximately 10-kb BamHI fragment disclosed by hybridization to the P/S4 probe.

Breakpoints at 11q23 in infant leukemias with the t(11;19)(q23;p13) are clustered

We have analyzed a series of nine infant leukemias that carry a t(11;19)(q23;p13). They had the morphologic features of acute lymphoblastic leukemia (ALL) and expressed markers typical of B-cell progenitor ALL or pre-B ALL; one coexpressed myeloid markers in addition to lymphoid markers (biphenotypic). Two probes (P/S4 and 98.40) subcloned from a yeast artificial chromosome (YAC) known to span the breakpoint in the t(4;11) were used to investigate DNA isolated from the leukemic cells of these patients. A total of approximately 15 kb of genomic DNA in the vicinity of the probes was examined by conventional Southern blot analysis using a series of restriction enzymes. In eight of the nine cases, the breakpoint could be mapped to an approximately 10-kb BamHI fragment disclosed by hybridization to the P/S4 probe.

Morphologic characteristics of acute lymphoblastic leukemia (ALL) with abnormalities of chromosome 8, band q24.

The CALGB prospectively studied 140 adult acute lymphoblastic leukemia (ALL) patients for cytogenetic abnormalities. Seven (5%) patients with adequate cytogenetic preparations had t(8;14)(q24;q32) or t(8;22)(q24;q11). Patients were compared with non-8q24 patients for clinical and laboratory characteristics, response to therapy, and survival. The median age of patients with translocations involving 8q24 (71% males) was 40 years. Forty-three percent had lymphadenopathy, 29% splenomegaly, and 29% hepatomegaly. None exhibited central nervous system (CNS), skin, or gum involvement. These features did not differ significantly from non-8q24 ALLs. Patients with 8q24 translocations had higher hemoglobins (11.5 vs. 9.8 g/dl; P = 0.04) and lower percentage of blasts in the peripheral blood (8.5% vs. 69%; P = 0.007). Although all seven were finally categorized as ALL-L3, a marked variation in the proportion of typical L3 blasts was observed that initially resulted in the diagnoses of ALL-L2 in three cases and prolymphocytic leukemia in one. In five of five patients, the blasts typed as B cells (SIg+ and CD19+). Complete remission rates for patients with 8q24 translocations were 43%, whereas they were 68% for non-8q24 ALLS (P = 0.22). Furthermore, patients with 8q24 abnormalities exhibited significantly shorter survival (4.8 vs. 18.4 mo; P less than 0.001). We conclude that ALL with translocations of 8q24 in adults shows a mature B-cell immunophenotype (SIg+), poor prognosis and morphology ranging from classical ALL-L3 to ALL with a subpopulation of L3 cells. Thus, the diagnosis of ALL-L3 should be made when blastic cells possess a mature B-cell immunophenotype (SIg+) and an 8q24 translocation, even though the number of L3 cells is low.

Renal dysfunction and hyperuricemia at presentation and relapse of acute lymphoblastic leukemia

Hyperuricemia is an unusual presenting feature of acute lymphoblastic leukemia (ALL) and is generally associated with a large leukemic cell burden. We describe three children with T-cell ALL who presented with acute renal failure and very high serum uric acid concentrations, despite a relatively small leukemic cell burden. Two of the three patients had normal complete blood counts without circulating blasts or other physical evidence of leukemia. An isolated renal relapse in one case was associated with hyperuricemia, increased renal excretion of uric acid, and renal dysfunction. An unusually high rate of purine catabolism of the lymphoblasts may cause hyperuricemia in these cases. Unexplained hyperuricemia should prompt a search for occult malignancy.

Biological and clinical features of acute lymphoblastic leukaemia with cytoplasmic granules or inclusions: description of eight cases.

We describe eight patients (four children and four adults) with an acute lymphoblastic leukaemia (ALL) with cytoplasmic granules or inclusions. The incidence of this variant of acute leukaemia in our whole series of patients with ALL is 1.8%. The granules or inclusions were usually positive for aspecific esterases (ANAE) and/or acid phosphatase, and the immunophenotype was in all cases typical of a CALLA positive B-lineage ALL (CD10+, CD19+ and/or CD24+, DR+, TdT+, anti-T-, anti-My-, SIg-). In one paediatric case, CD33 was unusually coexpressed. Ultrastructural investigations were performed in one case and demonstrated large granules containing vesicles, usually membrane bound, in the majority of blast cells. In the two cases analysed, Ig heavy chain gene rearrangement was detected. In this series of patients prognosis was poor since three never achieved a complete remission, four relapsed and only one is still in first continuous remission.

Thrombocytosis as a presenting feature of acute lymphoblastic leukemia in childhood.

To determine the incidence of thrombocytosis at presentation in acute lymphoblastic leukemia (ALL), medical records of all children diagnosed at the Children's Hospital of Pittsburgh from 1980 to 1987 were reviewed. Out of 217 such patients, 7 (3.2%) had platelet counts greater than 400,000/mm3. All of the seven were boys compared with a male:female ration of 1.4:1 in the entire ALL population. Other than sex, no characteristics were clearly associated with thrombocytosis, including white blood cell count, hemoglobin, lymphoblast morphology, and immunologic or chromosomal markers. Apart from ALL, no inflammatory or infectious process which might have caused a thrombocytosis, was detected in any of these patients. The period of induction therapy was notable for the preservation of platelet counts greater than 20,000/mm3 in all patients. However, of the seven children with thrombocytosis, two had major induction complications: one, a cavernous sinus thrombosis; and the other, gastrointestinal bleeding with duodenal perforation. We conclude that thrombocytosis at diagnosis can be seen in children, particularly boys, with ALL. Based on small numbers, this group of patients may be at risk for major events during induction therapy. Large numbers, longer follow-up, and platelet function studies on similar patients will be of interest.

Vertebral compression fracture as a presenting feature of acute lymphoblastic leukemia in children.

Twenty-four (1.6%) of 1466 children with acute lymphoblastic leukemia (ALL) treated at St. Jude Children's Research Hospital had vertebral compression fractures at diagnosis. When compared with patients without this complication, they were more likely to have good prognostic features, including a leukocyte count of greater than 25 X 10(9)/l, a leukemic cell DNA index of greater than 1.15, and hyperdiploidy (greater than 50 chromosomes). Complete remission of ALL was induced in all patients, and symptoms of vertebral compression fractures abated following antileukemia therapy. Although the diagnosis of ALL was delayed for some patients because this unusual presenting complication was not recognized as such, their treatment outcome was as good as that for other children with "standard-risk" ALL.

Characteristics of acute lymphoblastic leukemia in children with osteopenia and vertebral compression fractures

Characteristics of acute lymphoblastic leukemia in children with osteopenia and vertebral compression fractures

Clinicopathological characteristics of acute lymphoblastic leukemia with the 4; 11 chromosome translocation

Clinicopathological characteristics of acute lymphoblastic leukemia with the 4; 11 chromosome translocation

Clinicopathological characteristics of acute lymphoblastic leukemia with the 4;11 chromosome translocation

Analysis of the bone marrow karyotype in 109 consecutive untreated patients with acute lymphoblastic leukemia (ALL) by the G-banding technique revealed the presence of a translocation between specific sites on the long arms of chromosomes 4 and 11, [t(4;11) (q21;q23)] in 3 adults and 2 children. Splenomegaly was present in all patients, marked leukocytosis in 4, and retinal hemorrhages in the absence of significant mucocutaneous bleeding in 3. Complete remission defined by conventional morphological criteria was achieved with combination chemotherapy in all instances, but the duration of remission was brief in 3. Three patients were studied in relapse, and clonal evolution was found to have occurred in 2. Analysis of our data in conjunction with other published reports suggests this specific karyotypic abnormality characterizes a small subgroup of ALL in which there is a strong association with recognized clinical and laboratory indices of poor prognosis, in particular its frequent occurrence in children under the age of 2.5 yr. There is a propensity to undergo clonal evolution, and the possibility exists that such a development is associated with poor prognosis.

Utility of Monoclonal Antibodies in the Immunologie Phenotyping of Acute Lymphoblastic Leukemia

Peripheral blood and/or bone marrow lymphoblasts from 34 children and 11 adults with acute lymphoblastic leukemia (ALL) were evaluated with a monoclonal anti-Ia antibody and a monoclonal anti-pan T-cell antibody (T101) specific for a 65,000-dalton T-cell antigen (T65). Seventy-six per cent of cases were Ia+T65-, 20% were Ia-T65+ and the remaining 4% were Ia-T65-. Anti-Ia and T101 reactivity were mutually exclusive and no Ia+T65+ cases were identified. In childhood ALL, the Ia+T65- phenotype was associated with good prognostic factors and longer median disease-free survival than Ia-T65+ patients whose clinical parameters resembled those characteristic of high-risk T-cell ALL. Included in the Ia-T65+ group were three E-rosette negative cases with clinical features of T-cell disease. Our findings compare favorably with the results of other investigators utilizing polyclonal antisera and suggest that these monoclonal antibodies, which offer the advantages of monospecific standardized reagents, will prove useful in the immunologic characterization of ALL.

Adenosine Deaminase activity in Plasma of Children with Acute Lymphoblastic Leukemia

Background: Acute Lymphoblastic Leukemia is stem cell malignant disorder characterized by overproduction of Lymphoblast in Bone marrow that eventually spill into circulation. Adenosine Deaminase activity has been shown to increase in most chronic conditions especially lymphocytic proliferation and other malignancies. The objective of the study was to determine the concentration of plasma Adenosine Deaminase in children suffering from Acute Lymphoblastic Leukemia. Methods: Adenosine Deaminase activity in plasma of ALL and normal children under 14 years of age visiting was measured. Total Leukocyte count and absolute lymphocyte count were performed in hematology laboratory of Kanti Children's Hospital. Results: Adenosine Deaminase activity in plasma of children suffering from Acute Lymphoblastic Leukemia was higher than non- ALL children with leukocytosis and lymphocytosis and healthy Control groups without leukocytosis. The plasma ADA level was 48.85 ±2.42 IU/L in ALL patients, which was significantly higher by student's two-tailed t-test (P=0.002) than plasma ADA level in control subject (mean ADA=39.72 IU/L Std. error mean =1.27 IU/L). Increased plasma ADA level was found in non-ALL with leukocytosis and lymphocytosis and ALL patients. Conclusions: Adenosine Deaminase activity in plasma of children suffering from Acute Lymphoblastic Leukemia was increased. Hence plasma ADA can serve as another serum biomarker in addition to other haematological markers and clinical characteristics of acute lymphoblastic leukemia (ALL). It is easy to perform in small laboratories and will be beneficial as a non interventional prognostic marker. Key words: acute lymphoblastic leukemia; absolute lymphocyte count; adenosine deaminase. DOI: 10.3126/jnhrc.v7i2.3014 Journal of Nepal Health Research Council Vol.7(2) Apr 2009 93-97