Therapeutic decision making in BMT/SCT for acute lymphoblastic leukemia

Classification of acute lymphoblastic leukemia page 41 FAB classification 41 Immune phenotype classification 42 Prognostic factors 43 Results with conventional therapy in adults 43 Results with allogeneic transplant 48 CIBMTR data 48 Indications for transplant 53 HLA-identical family member transplant 53 Autologous blood/marrow stem cell transplant 53 HLA-identical unrelated donor transplant 54 Special aspects of transplant in children 54 Contraindications to transplant 54 Pretransplant workup 54 Monitoring posttransplant 55 Further Reading 55 Classification of acute lymphoblastic leukemia FAB classification Acute lymphoblastic leukemia (ALL)-L1: Myeloperoxidase (MPO)-negative, with small cells predominating. Cells have a high nuclear–cytoplasmic (N/C) ratio (scant amount of cytoplasm), regular nuclear borders, and inconspicuous nucleoli. Terminal deoxynucleotidyltransferase (Tdt) is usually positive. ALL-L2: MPO-negative heterogeneous population, often with larger blasts. The cells have a low N/C ratio (moderate amount of cytoplasm), with irregular nuclear borders and prominent nucleoli. Tdt is usually positive. ALL-L3: Burkitt type: MPO-negative, homogeneous population of large blasts. The cells have a moderate amount of deeply basophilic cytoplasm and prominent cytoplasmic vacuolation. The nuclei are regular, with one or more prominent nucleoli. The blasts are Tdt-negative and may be associated with t(2;8), t(8;14), or t(8;22) chromosomal abnormalities.