Acute lymphocytic leukemia

Background

• Characterized by proliferation of immature lymphoblast( >20% in periphery)
• Less than 20% of acute leukemias in adults,
• Most common form in children (see also Leukemia (Peds))
• Highest incidence in 7th decade of life

Clinical Features

• Lymphocytosis, neutropenia, anemia, thrombocytopenia,
• Lymphadenopathy, hepatosplenomegaly
• CNS and testes involvement common

Differential Diagnosis

• Hodgkin and non-Hodgkin lymphomas

Diagnosis

• CXR
• CBC with peripheral smear
• Chem7, ca, mg, phos, Uric Acid, UA, LDH (to check for Tumor Lysis)
• LFTs, Coags, FDP, D-Dimer, Haptoglobin, Fibrinogen (to check for DIC)
• Get extra purple top for flow cytometry, especially before transfusion

Treatment

• Aggressive IV hydration
• If febrile, complete cultures and broad spectrum antibiotics
• Manage Complications
  • see DIC
  • see Leukostasis
  • see Tumor Lysis Syndrome

See Also

• Oncologic emergencies
• Lymphoma