Bone marrow: 100 blasts

Gene: hyperploidy , ETV6-RUNX1

2. Classification: WHO Classification

   • *B ALL

   • * T ALL

   • 3.Precursor bcell origin

Headache, tenderness on long bone palpation, hepatosplenomegaly, lymphadenopathy, petechiae

Labs:

Anemia, thrombocytopenia, elevated WBC

Smear: PAS+, TdT−

Flow: CD19+, CD3−, sIg−

Marrow: Hypercellular

Genetics: ETV6-RUNX1

Classification Schemes of ALL

1)WHO Classification

2)FAB Classification

3)Immunophenotypic (B-ALL, T-ALL)

4)Genetic subtypes (e.g., ETV6-RUNX1, BCR-ABL1)

Cell of Origin

B-cell precursor (B-lymphoblast)

Additional question

What is the role of minimal residual disease (MRD) in ALL prognosis ?

# signs and symptoms:

headache, tenderness on long bones, hepatosplenomegaly, generalized lymphadenopathy, petechiae

# lab investigations:

anemia, thrombocytopenia, leukocytosis

peripheral smear shows blasts (PAS+,Tdt-)

CD19+ in flow cytometry,

molecular- ETV6-RUNX1

diagnosis: B cell Acute Lymphoblastic Leukaemia(ALL)

2. CLASSIFICATION SCHEMES

   WHO classification

   FAB classification

3. cell of origin : B cell precursor

✓Key Clinical Findings:

• severe headache for one week

• Bone tenderness

• Hepatosplenomegaly

• Generalized lymphadenopathy

• Petechial hemorrhages

2)Laboratory Findings:

•Anemia

• Thrombocytopenia 

• Elevated WBC (14,800/mm³)

• Peripheral smear: Blasts without myeloperoxidase granules, PAS+ aggregates, TdT–

• Flow cytometry: CD19+, CD3–, sIg–

• Bone marrow: 100% cellularity, replaced by blasts

3)Diagnosis:

• B-cell Acute Lymphoblastic Leukemia (B-ALL)

4) Classification Schemes of ALL

• Two major classification systems:

✓ WHO Classification 

✓ FAB(French-American-British) classification 

4)Cell of Origin of ALL

•ALL arises from immature lymphoid progenitor cells:

B-cell precursor lymphoblasts 

1. Age factor

2. Headache for one week- acute origin

3. Hepatosplenomegaly

4. Bone tenderness

5. Generalized lymphadenopathy

6. Petechial hemorrhages-indicates internal Subcutaneous bleeding

Laboratory Findings

Elevated WBC (14,800/mm³)

Anemia

Thrombocytopenia-leading to bleeds

Peripheral smear: Blasts without myeloperoxidase granules

Bone marrow: 100% cellularity, replaced by blasts(large cells lacking granules)

Diagnosis

Acute Lymphoblastic Leukemia (B-ALL)

Classification Schemes of ALL

WHO Classification 

FAB(French-American-British)

Phenotypic

Genotypic

Cell of Origin

B-cell precursor lymphoblasts

Laboratory studies :-

hemoglobin 8.8 g/dL(low)

hematocrit 26.5%(low)

platelet count 34,700/mm3(low)

WBC count, 14,800/mm3( high)

peripheral blood smear:-

PAS-positive aggregates

Genetic analysis:-

hyperdiploidy and ETV6-RUNX1 translocation.

Diagnosis:- acute B cell ALL

Classification:-

1.WHO

2.FAB

3.genotypic

4.phenotypic

Cell of orgin:- B cell precursor

✓Clinical findings-

Headache, Tenderness on palpating long bones, Hepatosplenomegaly, Generalised Lymphadenopathy, Petechial hemorrhages

✓Laboratory findings-

Total Leukocyte count increased

✓Peripheral Smear-

Blasts are myeloperoxidase- negative,

PAS- positive aggregates, TdT- negative

✓Bone marrow-

Lymphoblasts hypercellularity

✓Flow cytometry-

CD19+ , CD3- , sIg-

✓Genetic analysis-

Hyperdiploidy, ETV6-RUNX1 translocation

DIAGNOSIS: B cell Acute Lymphoblastic

Leukemia

2) Classification schemes of ALL:

• FAB classification

• WHO classification

• Based on Philadelphia Chromosome .

3) Cell of origin- B cell precursors.

Clinical -

* Tenderness on palpation of long bone

* hepatosplenomegaly

* generalised lymphadenopathy

* petechial hemorrhages

Lab -

* Hemoglobin - 8.8 % - Anemia

* Platelete - 34,700cells/mm3 - Thrombocytopenia

* WBC count - 14,800/mm3 - Leucocytosis

PBS -

* Blasts lacking peroxidase positive granules

* PAS positive aggregates

* Stain positive for deoxynucleotidyl

* Transferase negative

Flow cytometry -

* CD19+

* CD3-

* sIg -

Bone marrow biopsy -

* Scanty cytoplasm lack granules

* Delicate nuclear chromatin

* Rare nucleoli

Genetic analysis -

* Hyperploidy

* ETV6-RUNX1 translocation

Diagnosis - B cell Acute Lymphoblastic Leukemia

2. Schemes of classification -

* FAB classification

* WHO classification

* Immunophenotypic

* Cytogenetic

3. Cell of origin -

B cell precursor lymphoblasts

Headache , tenderness , palpating on long bones , hepatosplenomegaly , generalised lymphadenopathy , petechial hemmorrhage

LAB FINDINGS

Total leukocyte count increased

Peripheral smear

Blasts are myeloperoxidase- negative

PAS - Positive aggregates Tdt - negative

Bone marrow - hypercellular

Flow cytometry

CD19+ CD3- sIg

Genetic analysis

Hyperploidy , ETV6-RUNX1 translocation

DIAGNOSIS - B cell acute lymphoblastic leukemia

2. Classification schemes of ALL

   FAB classification

   WHO classification

   Based on Philadelphia chromosome

   3. cell origin - b cell precursor