Protocols - Hemorio

ACUTE LYMPHOID LEUKEMIA
LABORATORIAL TESTS TO THE DIAGNOSIS
- Full hemogram
- Biochemistry with hepatic and renal functions, electrolytes, uric acid and LDH
- Serology: HBV, HCV, HIV 1 and 2, HTLV I and II, syphilis
- Myelogram
- Cytochemistry and immunophenotype of peripheral blood or bone marrow
- Karyotype (preferred bone marrow)
- RT PCR for LLA of peripheral blood or bone marrow
- BMB, if diagnosis doubt, with Immunohistochemistry
- HLA classes I, II and high resolution of the subject and brothers if candidates to TMO (in the absence of
brothers, register at REREME)
- Chest X-Ray / Abdominal ultrasound
- Echocardiogram
- Other necessary, according to the history and physical exam
IMMUNOPHENOTYPE RANK
Strain B
- Pre-pre B or pro B - HLA-DR+, TdT+,CD19+
- common LLA (CALLA) - HLA-DR+, TdT+,CD19+,CD10+
- Pre B - HLA-DR+, TdT+, CD10+/-, Ig cytoplasmic+
- B - HLA-DR+, CD19+, CD10+/-, Ig surface+
Strain T
Pre-T - TdT+, CD3 cytoplasmic+,CD7+
T - TdT+, CD3 cytoplasmic+, CD1a/2/3+
CYTOGENETICS
Good prognosis - hyperdiploid, Del 9p, t(12;21)
Worst Prognosis - t(9;22); t(4;11); t(8;14) or variants t(2;8), t(8;22); t(1;19); complex karyotype; hypodiploid
WORST PROGNOSIS FACTORS
- Age> 30 years old
- White blood cells LLA B above 30000/mm 3 ; at LLA T leukometry above 100000/mm 3
- Morphology L3 (B mature)
- Time to full remission > 4 weeks (absence of full remission at D28)
- Cytogenetics of bad prognosis, mainly Ph+
- Immunophenotype: pre T, B or B with myeloid markers, pre-pre-B
ADULT TREATMENT
General measures: anti-helminthic, allopurinol, vigorous hydration (3 l/m 2 ) with alkalinization of urine
(bicarbonate 4 meq / kg / day), oral hygiene. Prophylactic Bactrim 800/160 mg twice a day on Mondays,
Wednesdays and Fridays during all the treatment up to two months after the conclusion of the
maintenance. Evaluation by odontology.
- LLA B mature, L3: protocol of Burkitt’s lymphoma
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