Acute Lymphoblastic Leukemia (ALL)-L2 in an adult woman: a case report

Ni Luh Ayu Suwandari; Anak Agung Wiradewi Lestari; I Nyoman Wande; Ida Ayu Putri Wirawati; I Putu Yuda Prabawa

doi:10.15562/bmj.v12i1.3934

Acute Lymphoblastic Leukemia (ALL)-L2 in an adult woman: a case report

Ni Luh Ayu Suwandari ,

Anak Agung Wiradewi Lestari ,

I Nyoman Wande ,

Ida Ayu Putri Wirawati ,

I Putu Yuda Prabawa ,

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DOI: https://doi.org/10.15562/bmj.v12i1.3934 |
Published: 2023-02-09

Abstract

Background: Acute lymphoblastic leukemia (ALL) is a malignant disease of the bone marrow in which early lymphoid precursors proliferate and replace normal hematopoietic cells without developing into normal B and T cells. Acute lymphoblastic leukemia (ALL) is the most common leukemia in pediatric patients, accounting for up to 80% of cases in children and less frequently in adults.

Case Presentation: A 47-year-old woman complained of fever, feeling weak and dizzy, and also complained that if she spits, there has been blood since 7 days ago. A complete blood count showed leukocytosis, anemia, and thrombocytopenia. Bone marrow appearance corresponds to Acute Lymphoblastic Leukemia (ALL-L2) with 60% lymphoblast infiltration and heterogeneous size into the bone marrow. The immunophenotyping results showed a population of blasts expressing CD79a positive, CD19 positive, and CD34 positive with an ALL-B Lineage effect. During treatment, the patient experienced a worsening and was declared dead.

Conclusion: We report a case of an adult woman with a diagnosis of ALL L2. The diagnosis is based on clinical symptoms, laboratory examination, peripheral blood smear, bone marrow aspiration, and immunophenotyping examination.

References

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Pambudi B. Leukemia limfoblastik akut. In: Buku Saku Hematologi, Leukosit dan kelainannya, 2nd ed. Penerbit Atma Jaya, Yogyakarta. 2017:361–379.
Roquiz W, Gandhi PKA. Chapter 35: Acute leukemias in Rodak's Hematology Clinical Principles and Applications, Keohane EM. Elsevier: Dutch. 2016:604–618.
Alvarnas JC, Brown PA, Aoun P, Ballen KK, Barta SK, Borate U, et al. Acute lymphoblastic leukemia, version 2.2015. Journal of the comprehensive cancer network. 2015;13(10):1240-1279.
Emadi AKJ. Acute Leukemia: An Illustrated Guide to Diagnosis and Treatment. Springer: New York. 2018.
Pattnaik J, Kayal S, Dubashi B, Basu D, Vinod KV, Nandeesha H, et al. Profile of anemia in acute lymphoblastic leukemia patients on maintenance therapy and the effect of micronutrient supplementation. Support Care Cancer. 2020;28(2):731–738.
Kong SG, Seo JH, Jun SE, Lee BK, Lim YT. Childhood acute lymphoblastic leukemia with hyperleukocytosis at presentation. Blood Res. 2014;49(1):29–35.
Lora HE. Chapter 13: Diseases of White Blood Cells, Lymph Nodes, and Spleen. In: Robbins and Cotran Pathologic Basis of Disease. Elsevier, Dutch. 2015.
Ladines-Castro W, Barragán-Ibañez G, Luna-Pérez MA, Santoyo-Sánchez A, Collazo-Jaloma J, Mendoza-García E, et al. Morphology of leukaemias. Rev Médica del Hosp Gen México. 2016;79(2):107–113.
Walaa Fikry ME. Lactate Dehydrogenase (LDH) as Prognostic Marker in Acute Leukemia Quantitative Method. J Blood Disord Transfus. 2017;8(375):1-7.
Chiaretti S, Zini G, Bassan R. Diagnosis and subclassification of acute lymphoblastic leukemia. Mediterr J Hematol Infect Dis 6. 2014;6(1):e2014073
Barbara J, Bain ML. Immunophenotyping for Haematologists: Principles and Practice. Wiley-Blackwell, New York. 2021.
Paul S, Kantarjian H, Jabbour EJ. Adult Acute Lymphoblastic Leukemia. Mayo Clin Proc 91. 2016;91(11):1645–1666.
Bhojwani DWA. Acute lymphoblastic leukemia. In: The Bethesda Handbook of Clinical Hematology, 4th ed. Wolters Kluwer Health, Amsterdam. 2019:285–302.
Prabawa IPY, Mahartini NN, Herawati S, Mulyantari NK. Acute Erythroleukemia (AML-M6) in one-year-old boy: a case report. Bali Medical Journal. 2022;11(3):1420–1425.
Huh YO, Ibrahim S. Immunophenotypes in adult acute lymphocytic leukemia. Role of flow cytometry in diagnosis and monitoring of disease. Hematol Oncol Clin North Am. 2000;14(6):1251 1265.
Pulte D, Gondos A, Brenner H. Improvement in survival in younger patients with acute lymphoblastic leukemia from the 1980s to the early 21st century. Blood. 2009;113(7):1408–1411.
Graus F, Rogers LR, Posner JB. Cerebrovascular complications in patients with cancer. Medicine (Baltimore). 1985;64(1):16-35.
Pomeranz S, Naparstek E, Ashkenazi E, Nagler A, Lossos A, Slavin S, et al. Intracranial haematomas following bone marrow transplantation. J Neurol. 1995;241(4):252-256.

[1] Terwilliger T, Abdul-Hay M. Acute lymphoblastic leukemia: a comprehensive review and 2017 update. Blood Cancer J. 2017;7(6):e577-e577.

[2] Pambudi B. Leukemia limfoblastik akut. In: Buku Saku Hematologi, Leukosit dan kelainannya, 2nd ed. Penerbit Atma Jaya, Yogyakarta. 2017:361–379.

[3] Roquiz W, Gandhi PKA. Chapter 35: Acute leukemias in Rodak's Hematology Clinical Principles and Applications, Keohane EM. Elsevier: Dutch. 2016:604–618.

[4] Alvarnas JC, Brown PA, Aoun P, Ballen KK, Barta SK, Borate U, et al. Acute lymphoblastic leukemia, version 2.2015. Journal of the comprehensive cancer network. 2015;13(10):1240-1279.

[5] Emadi AKJ. Acute Leukemia: An Illustrated Guide to Diagnosis and Treatment. Springer: New York. 2018.

[6] Pattnaik J, Kayal S, Dubashi B, Basu D, Vinod KV, Nandeesha H, et al. Profile of anemia in acute lymphoblastic leukemia patients on maintenance therapy and the effect of micronutrient supplementation. Support Care Cancer. 2020;28(2):731–738.

[7] Kong SG, Seo JH, Jun SE, Lee BK, Lim YT. Childhood acute lymphoblastic leukemia with hyperleukocytosis at presentation. Blood Res. 2014;49(1):29–35.

[8] Lora HE. Chapter 13: Diseases of White Blood Cells, Lymph Nodes, and Spleen. In: Robbins and Cotran Pathologic Basis of Disease. Elsevier, Dutch. 2015.

[9] Ladines-Castro W, Barragán-Ibañez G, Luna-Pérez MA, Santoyo-Sánchez A, Collazo-Jaloma J, Mendoza-García E, et al. Morphology of leukaemias. Rev Médica del Hosp Gen México. 2016;79(2):107–113.

[10] Walaa Fikry ME. Lactate Dehydrogenase (LDH) as Prognostic Marker in Acute Leukemia Quantitative Method. J Blood Disord Transfus. 2017;8(375):1-7.

[11] Chiaretti S, Zini G, Bassan R. Diagnosis and subclassification of acute lymphoblastic leukemia. Mediterr J Hematol Infect Dis 6. 2014;6(1):e2014073

[12] Barbara J, Bain ML. Immunophenotyping for Haematologists: Principles and Practice. Wiley-Blackwell, New York. 2021.

[13] Paul S, Kantarjian H, Jabbour EJ. Adult Acute Lymphoblastic Leukemia. Mayo Clin Proc 91. 2016;91(11):1645–1666.

[14] Bhojwani DWA. Acute lymphoblastic leukemia. In: The Bethesda Handbook of Clinical Hematology, 4th ed. Wolters Kluwer Health, Amsterdam. 2019:285–302.

[15] Prabawa IPY, Mahartini NN, Herawati S, Mulyantari NK. Acute Erythroleukemia (AML-M6) in one-year-old boy: a case report. Bali Medical Journal. 2022;11(3):1420–1425.

[16] Huh YO, Ibrahim S. Immunophenotypes in adult acute lymphocytic leukemia. Role of flow cytometry in diagnosis and monitoring of disease. Hematol Oncol Clin North Am. 2000;14(6):1251 1265.

[17] Pulte D, Gondos A, Brenner H. Improvement in survival in younger patients with acute lymphoblastic leukemia from the 1980s to the early 21st century. Blood. 2009;113(7):1408–1411.

[18] Graus F, Rogers LR, Posner JB. Cerebrovascular complications in patients with cancer. Medicine (Baltimore). 1985;64(1):16-35.

[19] Pomeranz S, Naparstek E, Ashkenazi E, Nagler A, Lossos A, Slavin S, et al. Intracranial haematomas following bone marrow transplantation. J Neurol. 1995;241(4):252-256.

Acute Lymphoblastic Leukemia (ALL)-L2 in an adult woman: a case report

Abstract

References

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