Acute Lymphoblastic Leukemia

Epidemiology:
– peak 2-5 years old
– boys > girls
– associated with Down syndrome; neurofibromatosis; ataxia/telangiectasia
– most cases sporadic – no need for family screening
Presentation:
– non-specific:  fever, lethargy, hepatosplenomegaly
– musculoskeletal pain **
– HA
– LAD
– mediastinal mass
– testicular enlargement
– peripheral blood abnormalities **
Diagnosis
– initially with CBC and peripheral smear
– bone marrow aspiration and biopsy
– flow cytometry
DDx:
– JIA (juvenile idiopathic arthritis)
– osteomyelitis
– EBV
– ITP
– aplastic anemia
– other bone marrow malignancies
Pathology:
– Philadelphia chromosome 9;22 translocation!
Tx is complex – based on a lot of factors.
Resource:  AFP May 1, 2014 review
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