Exam 24: Acute Lymphoblastic Leukemias

Which markers are found on lymphoblasts?

Explain the molecular and cytogenetic profile of a patient with Burkitt's ALL.

Which phase of leukemia treatment is considered to induce complete remission of the disease, eradicating the leukemic blast population?

What cytochemical stains are negative in ALL but positive in AML?

Which of the following patient populations is most commonly afflicted with ALL?

Use the case below to answer the following questions: A mother takes her 6-year-old boy to see the pediatrician because of tiny pinpoint spots that appeared on his upper torso 3 days prior. The pediatrician orders a CBC, and it comes back abnormal. There are 70% blasts present, with a platelet count of 18 x 10⁹/L. A bone marrow aspirate and biopsy are performed, and confirm ALL. Cytogenetic and molecular testing was also ordered, but no results were present yet. -Cytogenetic analysis confirms the presence of t (1, 14).This verifies which of the following types of ALL?

Which leukemia reveals the laboratory findings of TdT+, CD7+, and CD3+?

Patients with ALL are at risk for developing which types of symptoms? Explain your answer.

Use the case below to answer the following questions: A mother takes her 6-year-old boy to see the pediatrician because of tiny pinpoint spots that appeared on his upper torso 3 days prior. The pediatrician orders a CBC, and it comes back abnormal. There are 70% blasts present, with a platelet count of 18 x 10⁹/L. A bone marrow aspirate and biopsy are performed, and confirm ALL. Cytogenetic and molecular testing was also ordered, but no results were present yet. -Which of the following cytochemical stains would be positive in this case?

ALL most often arises from a defect in which of the following?

Large cells with abundant, intensely basophilic cytoplasm with prominent cytoplasmic vacuolization are identified on a peripheral smear.Multiple basophilic nucleoli are present.A starry sky appearance is seen with fields of basophilic leukemic blasts with benign macrophages that have ingested tumor cells.What leukemia should be suspected with this morphology?

Name at least five classifications of ALL, and explain how they are different.

A peripheral blood smear of an ALL patient is displaying a homogeneous population of small blasts with scanty cytoplasm.Based on this information, what FAB classification of ALL is it?

Which of the following cytochemical stains would be most helpful in differentiating AML from ALL?

A patient with ALL underwent chemotherapy.Results from hematologic, cytogenetic, and molecular analyses indicated that he entered complete remission.Four years later, on his routine follow-up, the peripheral blood results were in the normal range, and cytogenetic analysis revealed no abnormalities, but molecular analysis showed BCR/ABL transcripts that were found in the blasts at diagnosis 4 years ago.This patient can be said to:

A phenotype workup is performed on a suspected ALL patient.The results come back indeterminate based on evaluation of all common ALL antigens.What is the most likely reason for this occurrence?

A technologist is reviewing a blood smear of a patient.She notices 85% blasts present, but is having a difficult time identifying the lineage.Cytochemical staining is subsequently performed, and the results for MPO, SBB, and NSE come back negative.Based on this information, what is the most likely lineage of the unknown blasts?

Acute lymphoblastic leukemia is defined by the WHO as having a blast count that is which of the following?

Morphological differences between ALL and Burkitt-type ALL include which of the following?

A patient has been confirmed with B cell ALL.Confirmation of ALL subtype has been inconclusive based on the tests conducted.Immunophenotyping has been ordered as a last means of confirming the subtype.Which markers would be ideal to help differentiate Pre-B cell ALL from Pro-B cell ALL?