Welcome to the fourteenth part of a series on Hemato-oncology.
Question: Dr. Chiragbhai, thank you for explaining about first type of “Blood Attack” i.e. Acute Myeloid Leukemia. It was good to know that up to 70% of AML can actually be cured. This sounds better than many of the solid tumors cure rates.
What about the second type of Blood Attack i.e. ALL – Acute Lymphoid Leukemia?
Answer: Yes, you are right. Most of the blood cancers have better cure rates than many solid tumors e.g. lung, brain, pancreas, gall bladder, liver. Yet traditionally people are more scared of blood cancers, as it worsens faster if not diagnosed or treated in time.
ALL is another type of acute leukemia with even better cure rates, especially in children where 60-90% cure rates are routinely seen in most parts of world.
In adults, cure rates are lower at about 40%. Adolescents also have lower cure rates compared to children.
Presentation is essentially same as in AML, with more incidence of lymphadenopathy, hepatosplenomegaly, mediastinal mass, whereas leucostasis is rare.
Que: What are the subtypes of ALL? And how do you make diagnosis?
Ans: Diagnosis is same as in AML, using blood and bone marrow examination for morphology, cytochemistry such as TdT and myeloperoxidase, immunophenotyping by flow cytometry.
Earlier ALL was classified using morphology i.e. L1, L2, L3 types. However, with availability of flow cytometry it is no longer used, as biological behavior does not correlate with morphology as much.
Based on flow cytometry, WHO classification now divides ALL as
- Early B or T cell ALL
- Precursor B or T cell ALL
- Burkitt lymphoma/leukemia.
Cytogenetics helps in further evaluation of prognosis e.g. presence of Philadelphia chromosome confers poor prognosis.
One very powerful prognostic marker in ALL is rapidity of response to primary therapy e.g. peripheral blood blast count <1000 at Day 8 is a very good predictor of better prognosis in BFM protocols. A newer test used for same purpose is MRD i.e. minimal residual disease detection, using various methods.
Dr. Chirag A. Shah; M.D. Oncology/Hematology (USA), 98243 12144, 98988 31496
Diplomate American Board of Oncology and Hematology. Ahmedabad. firstname.lastname@example.org
Shyam Hem-Onc Clinic. 402 Galaxy, Near Shivranjani, Opp Jhansi ki Rani BRTS, Ahmedabad.