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Leukemia - Acute

PreB ALL

B lymphoblastic leukemia / lymphoma with t(9;22)(q34;q11); BCR-ABL1


Reviewer: Daniela Mihova, M.D. (see Reviewers page)
Revised: 20 March 2013, last major update September 2012
Copyright: (c) 2001-2013, PathologyOutlines.com, Inc.

General
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● ALL with BCR-ABL1 fusion transcript (Philadelphia chromosome)
● 30% of adults with ALL, 4% of children but 80% of infants
● Excluding infants, older age and higher WBC at presentation than other B ALL
● May have more organomegaly or CNS involvement than other B ALL
● Poor prognosis

Treatment
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● Tyrosine kinase inhibitors (Imatinib) cause some complete responses (Cancer 2007;110:1178), but change in overall survival is minimal (Cancer 2007;109:2068, Hematology Am Soc Hematol Educ Program 2007:435)

Micro description
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● No defining morphology, but large blasts with prominent nucleoli and cytoplasmic granules are more common than other B ALL

Micro images
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Leukemic cells resemble early erythroblasts

Cytology images
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CSF-Contributed by Dr. Julia Braza, Beth Israel Deaconess Medical Center, Boston, Massachusetts (USA)

Positive stains
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● Myeloid antigens in 71% (Am J Clin Pathol 1999;111:467)

Flow cytometry images
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B-ALL associated with t(9;22); lymphoblasts express B-lineage markers CD19, CD20, CD22, immature markers CD34, TdT, CD10, and aberrant CD25. They are aberrantly dim for CD38 and CD81. This pattern is useful in identifying minimal residual disease

Molecular description
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● Translocation involves abl on #9q34 (tyrosine kinase) and bcr on #22q11 (breakpoint cluster region)
● Most childhood cases associated with p190 kd BCR-ABL1 fusion protein
● In 50% of adults, has p210 kd fusion protein that is present in CML, the rest is p190 kd; no definitive clinical difference

Molecular images
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Drawing of translocation  Karyotype


FISH-Contributed by Dr. Julia Braza, Beth Israel Deaconess Medical Center, Boston, Massachusetts (USA)

End of Leukemia - Acute > PreB ALL > B lymphoblastic leukemia / lymphoma with t(9;22)(q34;q11); BCR-ABL1


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