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Acute Lymphoblastic Leukemia (Adult)

Aggressive hematologic malignancy of lymphoid lineage in adults, characterized by clonal proliferation of immature B- or T-lymphoblasts, classified by immunophenotype (B-ALL, T-ALL) and molecular subtype (Philadelphia-positive, Ph-like, KMT2A-rearranged), with treatment using pediatric-inspired protocols, tyrosine kinase inhibitors, blinatumomab, inotuzumab ozogamicin, and CAR T-cell therapy.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Hematoloji department. Book Appointment →

What is Acute Lymphoblastic Leukemia (Adult)?

Adult acute lymphoblastic leukemia (ALL) is a heterogeneous hematologic malignancy arising from clonal expansion of malignant lymphoid progenitor cells, with annual incidence of 1-2 per 100,000 in adults and bimodal age distribution peaking in childhood and again over age 60. Adult ALL has worse prognosis than pediatric ALL due to higher frequency of adverse cytogenetics, lower tolerance of intensive chemotherapy, and biological differences. Five-year overall survival is 30-40% in adults compared to >90% in children.

WHO 2022 classification recognizes B-cell ALL with defining genetic abnormalities (BCR::ABL1 t(9;22) in 25-30% of adults vs 3-5% of children, KMT2A rearrangements, ETV6::RUNX1, hyperdiploidy, hypodiploidy, BCR::ABL1-like/Ph-like with kinase-activating alterations) and T-cell ALL (early T-cell precursor ETP-ALL, NOTCH1 mutations in 50-60%). Diagnosis requires bone marrow biopsy with morphology (>=20% blasts), flow cytometry for immunophenotype (B-ALL: CD19+, CD22+, CD79a+; T-ALL: CD3+, CD7+), cytogenetics, FISH, and next-generation sequencing for risk stratification.

Treatment uses pediatric-inspired multi-phase protocols: induction (vincristine, anthracycline, corticosteroid, asparaginase, sometimes cyclophosphamide), consolidation (multi-agent chemotherapy with high-dose methotrexate and cytarabine, asparaginase), CNS prophylaxis (intrathecal chemotherapy +/- cranial radiation), and 2-3 year maintenance (6-mercaptopurine, methotrexate, periodic vincristine/prednisone). Philadelphia-positive ALL receives tyrosine kinase inhibitor (imatinib, dasatinib, or ponatinib) integrated throughout treatment; chemotherapy-free regimens combining ponatinib with blinatumomab show >95% complete molecular response rates. Allogeneic stem cell transplantation indicated in first remission for high-risk features (Ph+, Ph-like, KMT2A, T-ALL/ETP, MRD-positive after induction). Relapsed/refractory disease responds to blinatumomab (CD19-CD3 BiTE), inotuzumab ozogamicin (anti-CD22 antibody-drug conjugate), and CAR T-cell therapy (tisagenlecleucel for pediatric/young adult B-ALL, brexucabtagene autoleucel for adult B-ALL).

Symptoms

Fatigue and pallor from anemia
Fever and infections from neutropenia
Bleeding and bruising from thrombocytopenia
Bone or joint pain (especially in children but seen in adults)
Lymphadenopathy and hepatosplenomegaly
Mediastinal mass with airway obstruction (T-ALL)
Headache, vomiting, cranial nerve deficits from CNS involvement
Tumor lysis syndrome at presentation or with treatment
Testicular involvement in males

Risk Factors

Age over 60 years (worse prognosis)
Down syndrome (20-fold increased risk)
Prior chemotherapy or radiotherapy exposure
Hispanic ethnicity (higher Ph-like ALL frequency)
Inherited syndromes (Li-Fraumeni, Bloom, neurofibromatosis)
Ionizing radiation exposure
Pesticide exposure
Male sex (slightly higher incidence)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Unexplained cytopenias on routine CBC
  • Recurrent or severe infections with low neutrophils
  • Spontaneous bleeding or bruising
  • Profound fatigue with anemia
  • Lymphadenopathy with B-symptoms
  • Mediastinal mass with respiratory symptoms
  • CNS symptoms (headache, vomiting, cranial nerve deficits)
  • Family history of leukemia or hereditary cancer syndrome

Treatment Methods

01
Bone marrow biopsy with flow cytometry, cytogenetics, NGS
02
Pediatric-inspired multi-phase protocols (CALGB 10403, GMALL, hyperCVAD)
03
Tyrosine kinase inhibitor (imatinib, dasatinib, ponatinib) for Ph+ ALL
04
CNS prophylaxis with intrathecal chemotherapy
05
Allogeneic stem cell transplantation for high-risk features
06
Blinatumomab (CD19-CD3 BiTE) for relapsed/refractory or MRD-positive
07
Inotuzumab ozogamicin (anti-CD22 ADC) for relapsed B-ALL
08
CAR T-cell therapy (tisagenlecleucel, brexucabtagene) for relapsed B-ALL
09
Nelarabine for relapsed T-ALL
10
MRD monitoring with multiparameter flow cytometry or molecular markers
11
Tumor lysis syndrome prophylaxis (rasburicase, hydration)

Which Department to Visit?

You can visit our Hematoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Let us help you

You can make an appointment with our specialists or contact us for your concerns.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.