Acute Lymphoblastic Leukaemia

Acute Lymphoblastic Leukaemia

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Acute lymphoblastic leukaemia (ALL) is a malignant proliferation of haematopoietic precursor blast cells of lymphoid lineage.


The aetiology of ALL is currently unknown, although certain predisposing factors, such as ionising radiation and congenital chromosomal abnormalities, may play a role.


ALL is the most commonly observed leukaemia in children, with a median age of diagnosis of 3.5 years, although it is rare in adults.

Philadelphia Chromosome:

The Philadelphia Chromosome is a chromosomal abnormality, seen in approximately 25% of cases, which results from the translocation of genetic material between chromosomes 9 and 22. This forms a hybrid gene combining BCR and ABL, and leads to increased tyrosine kinase activity.


The most common symptoms associated with ALL are anaemia, infection, haemorrhage, failure to thrive, and bone or joint pain.


  • Enlargement of the spleen and liver (hepato-splenomegaly).
  • Lymphadenopathy.


  • Bloods: A full blood count (FBC) can show normochromic normocytic anaemia, as well as increased white blood cells and decreased platelets and reticulocytes.
  • Blood Film: A blood film would identify the presence of the lymphoblasts.
  • Bone Marrow Aspirate: An aspirate can also be used to identify the lymphoblasts, which can make up 20% or more of the aspirate.
  • Imaging: A chest X-Ray can also be used to assess for any mediastinal mass, which can be present in cases of T-lineage ALL.
  • Cytogenetics: Cytogenetic analysis can be used to identify the presence of the Philadelphia Chromosome.


Medical: Treatment of ALL can involve the use of antibiotics and other medications to treat and prevent infections; transfusions to replace lost blood; chemotherapy to kill cancerous cells; immunotherapy to boost the body's natural defences; and stem cell transplantation.


  • Infection.
  • Bleeding.
  • Organ damage.
  • Hair loss.
  • Gastrointestinal (GI) toxicity.
  • Infertility.


The outlook is positive for children with ALL, with over 80% cure rates. Unfortunately, the prognosis for adults is poorer, as relapse rates tend to be higher.

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