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Leukemia, Acute Lymphoblastic (all) in Adults

Leukemia, Acute Lymphoblastic (all) in Adults is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • Acute lymphoblastic leukemia (ALL) in adults is the result of a clonal proliferation, survival, and impaired differentiation of immature lymphocytes. The World Health Organization (WHO) defines ALL as the presence of ≥25% lymphoblasts in the bone marrow (1). Nevertheless, the National Comprehensive Cancer Network uses a ≥20% as cutoff (2).
  • ALL and lymphoblastic lymphoma (LBL) can arise from the same precursor cell line, and therefore can be considered diseases along the same spectrum:
    • LBL presents as a mass, possibly but not limited to the mediastinum, with <25% blasts in the bone marrow.
    • ALL may present with a mass lesion but contains ≥25% bone marrow involvement.
  • Any organ can be affected

Pregnancy Considerations
Many chemotherapy (CTX) drugs are teratogenic.

Pediatric Considerations
ALL is the most common malignancy in children—it accounts for 30% of all pediatric malignancies, and 80% of pediatric leukemias (see “Acute Lymphoblastic Leukemia, Pediatric”).

Geriatric Considerations
Patients >60 years with ALL have a 42% mortality during induction CTX. The cause of death is usually CTX related complications or relapse. Survival is often reduced due to poor tolerance of CTX, thus leading to dose reductions and ineffective medication delivery.

Epidemiology

  • Incidence of ALL is 1.7/100,000 per year.
  • Higher incidence in males, whites, those with history of radiation, CTX, or certain genetic disorders
  • Bimodal distribution: early peak at 4 to 5 years of age, second peak at ~50 years
  • 80% of cases occur in children, 20% in adults.

Etiology and Pathophysiology

Unknown in most patients


Genetics
  • Higher rates in monozygotic and dizygotic twins
  • Increased risk of ALL with diseases related to chromosomal instability: Bloom syndrome, Fanconi anemia, ataxia-telangiectasia, neurofibromatosis
  • Increased risk with inherited chromosomal abnormalities: Down syndrome, Klinefelter syndrome, etc.
  • See “Follow-Up Tests & Special Considerations.”

Risk Factors

  • Age >70 years, radiation exposure, and infection with HIV are risk factors for developing ALL.
  • Human T-cell lymphotropic virus type 1 is associated with adult T-cell ALL.
  • Epstein-Barr virus is associated with mature B cell ALL.

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Citation

Stephens, Mark B., et al., editors. "Leukemia, Acute Lymphoblastic (all) in Adults." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688008/all/Leukemia__Acute_Lymphoblastic__all__in_Adults.
Leukemia, Acute Lymphoblastic (all) in Adults. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688008/all/Leukemia__Acute_Lymphoblastic__all__in_Adults. Accessed April 25, 2019.
Leukemia, Acute Lymphoblastic (all) in Adults. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688008/all/Leukemia__Acute_Lymphoblastic__all__in_Adults
Leukemia, Acute Lymphoblastic (all) in Adults [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 25]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688008/all/Leukemia__Acute_Lymphoblastic__all__in_Adults.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Leukemia, Acute Lymphoblastic (all) in Adults ID - 1688008 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688008/all/Leukemia__Acute_Lymphoblastic__all__in_Adults PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -