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  1. Accounts for 70 – 80% of all leukemias.
  2. Incidence is 1:2000 live birth
  3. Peak age of onset is 3-7 yr; more common in males.
  4. Precursor B/ Precursor T
  5. They react to common acute lymphocytic leukemia antigen (CALLA)
  6. All lymphoblasts also have high level of terminal nucleotidyl deoxyu-ansferase (TdT)
  7. May demonstrate hyperploidy (>50 chromosomes) or hyperploidy (<45 chromosomes).
  8. It has three subtypes L1, L2, L3.
  9. L1 carries the best prognosis.
  10. L3 is associated with FBV
  11. Cytochemically all takes PAb stain and coarse granules are seen in positive cells, Tdt is present in 90% of leukenic lymphoblasts.
  12. Tdt is not found in L3 subtype.
  13. The cells may be CALLA +ve or CALLA-VA, 90% or 10%
  14. Patient may demonstrate hyperdiploidy or once ploidy.  Hyperdiploidy is associated with good prognosis.
  15. Patient may demonstrate hyperdiploidy once ploidy. Hyperdiploidy is associate with good prognosis.
  16. Patients with 9:22; 8: 14 or 4: 11 translocation cary poor prognosis.
  17. Children less <2yrs or >10 yrs carry poor prognosis
  18. Other poor prognostic makers are:
    1. WBC > 25,000 cumm                          
    2. Mediastinal Widening
    3. Hypogammaglobulinemia                            
    4. Platelet count <40, 000/ cmm
    5. Presence of T or B cell marker                      
    6. Massive organomegaly
    7. Extramedullary disease at diagnosis.

Best prognosis is seen with CALLA +ve subtype. Q

C/F in order of frequency

  1. Fever (60%)
  2. (M.C. site oral and GIT mucosa) bleeding (48%) when platelet count < 20,000
  3. Anorexia
  4. Malaise and decreased activity
  5. Bone pain
  6. Arthralgia hepatosplenomegaly and rarely lymphadenopathy
  7. Anterior media final mass is common with T cell subtype ALL. Q
  8. Metabolic complication are commonest with ALL – L3 common kalemia.
  9. Testicular involvement may also be seen more T-cell type Q
  10. Neurological complications is less common at time of diagnosis but meninges at common site at relapse. Q
  11. Presenting foremost symptom of leukemic meningitis is headache, malaise of third to 7th cranial nerve palsies. 
  12. CNS meningitis shown leukemic blast cell, decreased glucose and increased protein.


  1. Complete remission is achieved in 90% patient of ALL in weeks by combination of vincristine and prednisolone with either L-asparaginase or daunorubicin.
  2. CNS prophylaxis of includes whole cranium radiation to 2000 rads and time intrathecal treatments using methotrexate.
  3. In maintenance phase of 2-3 yrs; 6 mercaptopurine a methotrexate is commonly used.
  4. Testicular relapse is treated by irradiation to affected test.  

Complication’s to treatment of ALL

  1. myelosuppression and immunosuppression.
  2. Pneumocystic pneumonia
  3. Viral infections as herpes simplex; zoster meals and CMV
  4. Sterlity
  5. Secondary malignancy and myeloid leukemia (late)

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