Acute Lymphoblastic Leukemia Differential Diagnoses

  • Author: Karen Seiter, MD; Chief Editor: Emmanuel C Besa, MD   more...
 
Updated: Mar 9, 2012
 
 

Diagnostic Considerations

As noted earlier, patients with acute lymphoblastic leukemia (ALL) may present with fever without any other evidence of infection. In these patients, all fevers must be assumed to be due to infections until proven otherwise. Failure to treat infections promptly and aggressively can be fatal; infections are still the most common cause of death in patients undergoing treatment for ALL.

Other conditions that should be considered in the evaluation of suspected acute lymphoblastic leukemia (ALL) include acute biphenotypic leukemia and natural killer (NK)-cell leukemia.

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Karen Seiter, MD  Professor, Department of Internal Medicine, Division of Oncology/Hematology, New York Medical College

Karen Seiter, MD is a member of the following medical societies: American Association for Cancer Research, American College of Physicians, and American Society of Hematology

Disclosure: Novartis Honoraria Speaking and teaching; Novartis Consulting fee Speaking and teaching; Eisai Honoraria Speaking and teaching; Celgene Honoraria Speaking and teaching

Specialty Editor Board

Clarence Sarkodee-Adoo, MD  Consulting Staff, Department of Bone Marrow Transplantation, City of Hope Samaritan BMT Program

Disclosure: Takeda Millenium Honoraria Speaking and teaching

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Ronald A Sacher, MB, BCh, MD, FRCPC  Professor, Internal Medicine and Pathology, Director, Hoxworth Blood Center, University of Cincinnati Academic Health Center

Ronald A Sacher, MB, BCh, MD, FRCPC is a member of the following medical societies: American Association for the Advancement of Science, American Association of Blood Banks, American Clinical and Climatological Association, American Society for Clinical Pathology, American Society of Hematology, College of American Pathologists, International Society of Blood Transfusion, International Society on Thrombosis and Haemostasis, and Royal College of Physicians and Surgeons of Canada

Disclosure: Glaxo Smith Kline Honoraria Speaking and teaching; Talecris Honoraria Board membership

Chief Editor

Emmanuel C Besa, MD  Professor, Department of Medicine, Division of Hematologic Malignancies, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson University

Emmanuel C Besa, MD is a member of the following medical societies: American Association for Cancer Education, American College of Clinical Pharmacology, American Federation for Medical Research, American Society of Clinical Oncology, American Society of Hematology, and New York Academy of Sciences

Disclosure: Nothing to disclose.

References

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Diagnostic workup of a patient with pre–B-cell acute lymphoblastic leukemia. Bone marrow aspiration revealed French-American-British L2 morphology.
Diagnostic workup of a patient with pre–B-cell acute lymphoblastic leukemia. Flow cytometry shows that the cells were positive for CD10, CD19, CD22, CD34, and terminal deoxynucleotidyl transferase.
Table 1. Effect of Chromosome Number on Prognosis
Chromosome Number3-Year Event-Free Survival
Near tetraploidy46-56%
Normal karyotype34-44%
Hyperdiploidy >5032-59%
Hyperdiploidy 47-5021-53%
Pseudodiploidy12-25%
Hypodiploidy11%
Table 2. Common Cytogenetic Abnormalities in ALL
AbnormalityGenes Involved3-Year Event-Free Survival
t(10;14)(q24;q11)HOX11/TCRA75%
6qUnknown47%
14q11TCRA/TCRD42%
11q23MLL18-26%
9pUnknown22%
12TEL20%
t(1;19)(q23;p13)PBX1/E2A20%
t(8;14)(q24;q32)



t(2;8)(p12;q24)



t(8;22)(q24;q11)



c-myc/IGH



IGK/c-myc



c-myc/IGL



17%*



80%†



t(9;22)(q34;q11)bcr-abl5-10%*



66%‡



t(4;11)(q21;q23)AF4-MLL0-10%
* Traditional regimens.



† Hyper-CVAD (cyclophosphamide, vincristine, doxorubicin [Adriamycin], dexamethasone) with rituxan.



‡ Hyper-CVAD with imatinib.



Table 3. Immunophenotyping of ALL Cells – ALL of B-Cell Lineage (85% of cases of adult ALL)
ALL CellsTdTCD19CD10CyIgSIg
Early B-precursor ALL++---
Pre–B-cell ALL (see the image below)++++-
B-cell ALL-++/-+/-+
ALL = acute lymphoblastic leukemia; Cylg = Cytoplasmic immunoglobulin; SIg =Surface immunoglobulin; TdT = terminal deoxynucleotidyl transferase.
Table 4. Immunophenotyping of ALL Cells – ALL of T-Cell Lineage (15% of cases of adult ALL)
ALL CellsTdTSurface CD3CD4/CD8
Early T-precursor ALL+-+/+ or -/-
T-cell ALL+++/- or -/+
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