Acute lymphoblastic leukemia

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Sections available in full article Introduction, Presenting signs, Acute presentation, Age predisposition, Special risks (e.g. anesthetic), Pathogenesis, Etiology, Pathophysiology, Timecourse (incubation, duration), Diagnosis, Presenting problems, Client history, Clinical signs, Diagnostic investigation, Confirmation of diagnosis, Gross autopsy findings, Histopathology findings, Differential diagnosis, Treatment, Initial symptomatic treatment, Standard treatment, Monitoring, Sequelae, Prognosis, Expected response to treatment, Reasons for treatment failure, Sources, Publications, Vetstream contributor(s),
Contributors Dr Laura Garrett DVM DACVIM (Oncology)
Dr Jo Morris BVSc PhD BSc Dip ECVIM-CA (Onc) FRCVS
Synonyms ALL, Lymphoproliferative disease

Introduction

  • Cause : acute onset of progressive, malignant infiltration of bone marrow and lymphatic organs by immature, poorly differentiated lymphoblasts which are commonly present in blood. Most cases are FeLV positive.
  • Signs : non-specific but often severe, eg anorexia, weakness, vomiting, diarrhea, pyrexia and occasionally neurological signs.
  • Diagnosis : numerous lymphoblasts in bone marrow and similar cells in peripheral circulation.
  • Treatment : supportive and cytotoxic agents may be tried.
  • Prognosis : poor due to severe cytopenias.

Diagnosis

Clinical signs

  • Pyrexia.
  • Pallor.
  • Petechial hemorrhages.
  • Hepatosplenomegaly.
  • Mild lymphadenopathy.
  • Tachypnea, dyspnea.
  • Cranial nerve abnormalities, ataxia.
  • Ocular abnormalities.

Diagnosis

Differential diagnosis

  • Same as leukemia  Leukemia  .
  • Lymphoma  Lymphoma  : lymphoma usually slowly progressive, marked lymphadenopathy, better physical condition than acute lymphoblastic leukemia; bone marrow in lymphoma may have some neoplastic cells but fewer than acute lymphoblastic leukemia; lymphoma usually does not show significant cytopenias.

Sequelae

Prognosis

  • Guarded: ~60% may respond, median remission 7 months.

Expected response to treatment

  • Hematology and bone marrow biopsy: decreasing immature lymphoid cells in bone marrow and peripheral circulation, return to normal numbers of other cell lines.

Reasons for treatment failure

  • Failure to induce and maintain remission.
  • Organ failure enhanced by cytotoxic effects of drugs.
  • Septicemia secondary to disease or treatment.
  • Inability to preserve sufficient numbers of normal blood cells is a constant problem.

Sources

Publications

Refereed papers

  • Recent references fromPubMed.
  • Roccabianca Pet al(2006)Feline large granular lymphocyte (LGL) lymphoma with secondary leukemia: primary intestinal origin with predominance of a CD3/CD8(alpha)(alpha) phenotype.Vet Pathol43(1), 15-28PubMed.
  • Louwerens Met al(2005)Feline lymphoma in the post-feline leukemia virus era.J Vet Intern Med19, 329-335.
  • Stockham S Let al(2003)Clinical assessment of leukocytosis: distinguishing leukocytoses caused by inflammatory, glucocorticoid, physiologic, and leukemic disorders or conditions.Vet Clin North Am Small Anim Pract33, 1335-1357PubMed.
  • Shelton G Het al(1989)Feline leukemia virus and feline immunodeficiency virus infections in a cat with lymphoma.J Am Vet Med Assoc194(2) 249-252PubMed.
  • Cotter S M (1983)Treatment of lymphoma and leukemia with cyclophosphamide, vincristine and prednisone: II Treatment of cats.J Am Anim Hosp Assoc19, 166-172.

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