Acute lymphoblastic leukemia other diagnostic studies

Acute lymphoblastic leukemia Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Differentiating Acute lymphoblastic leukemia from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
Chest X Ray
Bone X Ray
Echocardiograph and Ultrasound
CT
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Acute lymphoblastic leukemia other diagnostic studies On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Acute lymphoblastic leukemia other diagnostic studies All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Acute lymphoblastic leukemia other diagnostic studies
CDC on Acute lymphoblastic leukemia other diagnostic studies
Acute lymphoblastic leukemia other diagnostic studies in the news
Blogs on Acute lymphoblastic leukemia other diagnostic studies
Directions to Hospitals Treating Acute lymphoblastic leukemia
Risk calculators and risk factors for Acute lymphoblastic leukemia other diagnostic studies

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2] Carlos A Lopez, M.D. [3]

Overview

Other diagnostic studies for acute lymphoblastic leukemia include cytogenetics, bone marrow biopsy, flow cytometry, RT-PCR and FISH.

Cytogenetics

• In Cytogenetics the following establishes whether the "blast" cells began from the B lymphocytes or T lymphocytes
  • Philadelphia chromosome)
  • immunophenotyping
• DNA testing can establish how aggressive the disease is; different mutations have been associated with shorter or longer survival.

Biopsy

• A biopsy is the only sure way to know whether leukemia cells are in the bone marrow
• Before the sample is taken, local anesthesia is used to numb the area. This helps reduce the pain.
• Bone marrow from your hipbone or another large bone is taken as biopsy.
• On biopsy the following is seen:
  • High number of lymphoblast
  • Hypercellular marrow with subtotal depletion of fat cells
  • Normal blood cell precursors

A bone marrow biopsy and aspirate are routinely performed even in T-cell acute lymphoblastic leukemia to determine the extent of marrow involvement. Malignant cells should be sent for conventional cytogenetic studies, as detection of the Ph1 t(9;22), myc gene rearrangements (in Burkitt leukemia), and MLL gene rearrangements add important prognostic information

Flow cytometry

Flow cytometry should be performed to characterize expression of lineage-defining antigens and allow determination of the specific acute lymphoblastic leukemia subtype.

RT-PCR and FISH

• In addition, for B-cell disease the malignant cells should be analyzed using RT-PCR and FISH for evidence of the bcr-abl fusion gene. This last point is of utmost importance, as timely diagnosis of Ph1 acute lymphoblastic leukemia will significantly change the therapeutic approach.