Acute lymphoblastic leukemia other diagnostic studies
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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
- 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.[1]
- On biopsy the following is seen:[2]
- High number of lymphoblast
- Hypercellular marrow with subtotal depletion of fat cells[2]
- 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[3]
Flow cytometry
Flow cytometry should be performed to characterize expression of lineage-defining antigens and allow determination of the specific acute lymphoblastic leukemia subtype.[3]
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.[3]
References
- ↑ Harrison's Principles of Internal Medicine, 16th EditioN, Chapter 97. Malignancies of Lymphoid Cells. Clinical Features, Treatment, and Prognosis of Specific Lymphoid Malignancies.
- ↑ 2.0 2.1 Kröber SM, Greschniok A, Kaiserling E, Horny HP (2000). "Acute lymphoblastic leukaemia: correlation between morphological/immunohistochemical and molecular biological findings in bone marrow biopsy specimens". Mol Pathol. 53 (2): 83–7. PMC 1186910. PMID 10889907.
- ↑ 3.0 3.1 3.2 "National Cancer Institute".