eMedicine Specialties > Hematology > Stem Cells and Disorders

Acute Lymphoblastic Leukemia

Author: Karen Seiter, MD, Professor, Department of Internal Medicine, Division of Oncology/Hematology, New York Medical College
Contributor Information and Disclosures

Updated: Feb 3, 2009

Introduction

Background

Acute lymphoblastic leukemia (ALL) is a malignant (clonal) disease of the bone marrow in which early lymphoid precursors proliferate and replace the normal hematopoietic cells of the marrow. Acute lymphoblastic leukemia (ALL) may be distinguished from other malignant lymphoid disorders by the immunophenotype of the cells, which is similar to B- or T-precursor cells. Immunochemistry, cytochemistry, and cytogenetic markers may also aid in categorizing the malignant lymphoid clone.

For excellent patient education resources, visit eMedicine's Blood and Lymphatic System Center and Cancer and Tumors Center. Also, see eMedicine's patient education article Leukemia.

Related eMedicine topics:
Acute Lymphoblastic Leukemia
Lymphoma, Lymphoblastic

Pathophysiology

The malignant cells of acute lymphoblastic leukemia (ALL) are lymphoid precursor cells (ie, lymphoblasts) that are arrested in an early stage of development. This arrest is caused by an abnormal expression of genes, often as a result of chromosomal translocations. The lymphoblasts replace the normal marrow elements, resulting in a marked decrease in the production of normal blood cells. Consequently, anemia, thrombocytopenia, and neutropenia occur to varying degrees. The lymphoblasts also proliferate in organs other than the marrow, particularly the liver, spleen, and lymph nodes.

Frequency

United States

Acute lymphoblastic leukemia (ALL) is the most common type of leukemia in children. In adults, it is less common than acute myelogenous leukemia (AML). In the United States, approximately 1000 new cases of acute lymphoblastic leukemia (ALL) occur in adults each year.

International

The highest incidence of acute lymphoblastic leukemia (ALL) occurs in Italy, the United States, Switzerland, and Costa Rica.

Mortality/Morbidity

Only 20-40% of adults with acute lymphoblastic leukemia (ALL) are cured with current treatment regimens.

Sex

Acute lymphoblastic leukemia (ALL) is slightly more common in men than in women.

Age

Acute lymphoblastic leukemia (ALL) is the most common cancer in children. However, due to the fact that there are more adults than children, the number of cases seen in adults is comparable to that seen in children.

Clinical

History

  • Patients with acute lymphoblastic leukemia (ALL) present with either (1) symptoms relating to direct infiltration of the marrow or other organs by leukemic cells or (2) symptoms relating to the decreased production of normal marrow elements.
  • Fever is one of the most common symptoms of acute lymphoblastic leukemia (ALL).
  • Patients with acute lymphoblastic leukemia (ALL) often have decreased neutrophil counts, regardless of whether their total white blood cell (WBC) count is low, normal, or elevated. As a result, they are at increased risk of infection. The prevalence and severity of infections are inversely correlated with the absolute neutrophil count (ANC), which is defined as the number of mature neutrophils plus bands per unit of volume. Infections are common when the absolute neutrophil count is less than 500/µL, and they are especially severe when it is less than 100/µL.
  • Patients with acute lymphoblastic leukemia (ALL) often have fever without any other evidence of infection. However, in these patients, one must assume that all fevers are from infections until proven otherwise, because a failure to treat infections promptly and aggressively can be fatal. Infections are still the most common cause of death in patients undergoing treatment for ALL.
  • Symptoms of anemia are common and include fatigue, dizziness, palpitations, and dyspnea upon even mild exertion.
  • Other patients present with signs of bleeding. Bleeding can be the result of thrombocytopenia due to marrow replacement. Additionally, approximately 10% of patients with acute lymphoblastic leukemia (ALL) have disseminated intravascular coagulation (DIC) at the time of diagnosis. These patients may present with hemorrhagic or thrombotic complications.
  • Some patients present with palpable lymphadenopathy. Others, particularly those with T-cell ALL, present with symptoms related to a large mediastinal mass, such as shortness of breath.
  • Infiltration of the marrow by massive numbers of leukemic cells frequently manifests as bone pain. This pain can be severe and is often atypical in distribution.
  • Uncommonly (10-20%), patients may present with left upper quadrant fullness and early satiety due to splenomegaly.
  • Although patients may present with symptoms of leukostasis (eg, respiratory distress, altered mental status) because of the presence of large numbers of lymphoblasts in the peripheral circulation, leukostasis is much less common in people with ALL than those with AML, and it occurs only in patients with the highest WBC counts (ie, several hundred thousand per μL).
  • Patients with a high tumor burden, particularly those with severe hyperuricemia, can present in renal failure.

Physical

  • Patients with acute lymphoblastic leukemia (ALL) commonly have physical signs of anemia, including pallor and a cardiac flow murmur.
  • Fever and other signs of infection, including lung findings of pneumonia, can occur. Fever should be interpreted as evidence of infection, even in the absence of other signs.
  • Patients with thrombocytopenia usually demonstrate petechiae, particularly on the lower extremities. A large number of ecchymoses is usually an indicator of a coexistent coagulation disorder such as DIC.
  • Signs relating to organ infiltration with leukemic cells and, to a lesser degree, lymphadenopathy may be present.
  • Occasionally, patients have rashes that result from infiltration of the skin with leukemic cells.

Causes

  • Less is known about the etiology of acute lymphoblastic leukemia (ALL) in adults compared with AML. Most adults with ALL have no identifiable risk factors.
  • An increased prevalence of acute lymphoblastic leukemia (ALL) was noted in survivors of the Hiroshima atomic bomb but not in those who survived the Nagasaki atomic bomb. Most leukemias occurring after exposure to radiation are AML rather than ALL.
  • Rare patients have an antecedent hematologic disorder (AHD) such as myelodysplastic syndrome (MDS) that evolves to acute lymphoblastic leukemia (ALL). However, most patients with MDS that evolves to acute leukemia develop AML rather than ALL.
  • Increasingly, cases of acute lymphoblastic leukemia (ALL) with abnormalities of chromosome band 11q23 following treatment with topoisomerase II inhibitors for another malignancy have been described. However, most patients who develop secondary acute leukemia after chemotherapy for another cancer develop AML rather than ALL.

More on Acute Lymphoblastic Leukemia

Overview: Acute Lymphoblastic Leukemia
Differential Diagnoses & Workup: Acute Lymphoblastic Leukemia
Treatment & Medication: Acute Lymphoblastic Leukemia
Follow-up: Acute Lymphoblastic Leukemia
Multimedia: Acute Lymphoblastic Leukemia
References
[ CLOSE WINDOW ]

References

  1. Bogni A, Cheng C, Liu W, et al. Genome-wide approach to identify risk factors for therapy-related myeloid leukemia. Leukemia. Feb 2006;20(2):239-46. [Medline]. [Full Text].

  2. Fiere D, Archimbaud E, Extra JM, et al. Treatment of adult acute lymphoblastic leukemia. Preliminary results of a trial from the French Group. Haematol Blood Transfus. 1987;30:125-9. [Medline].

  3. Fiere D, Extra JM, David B, et al. Treatment of 218 adult acute lymphoblastic leukemias. Semin Oncol. Jun 1987;14(2 suppl 1):64-6. [Medline].

  4. Hoelzer D, Thiel E, Loffler H, et al. Intensified therapy in acute lymphoblastic and acute undifferentiated leukemia in adults. Blood. Jul 1984;64(1):38-47. [Medline]. [Full Text].

  5. Durrant IJ, Prentice HG, Richards SM, and the Medical Research Council Working Party on Leukaemia in Adults. Intensification of treatment for adults with acute lymphoblastic leukaemia: results of U.K. Medical Research Council randomized trial UKALL XA. Br J Haematol. Oct 1997;99(1):84-92. [Medline].

  6. Cuttner J, Mick R, Budman DR, et al. Phase III trial of brief intensive treatment of adult acute lymphocytic leukemia comparing daunorubicin and mitoxantrone: a CALGB Study. Leukemia. May 1991;5(5):425-31. [Medline].

  7. Dekker AW, van't Veer MB, Sizoo W, et al. Intensive postremission chemotherapy without maintenance therapy in adults with acute lymphoblastic leukemia. Dutch Hemato-Oncology Research Group. J Clin Oncol. Feb 1997;15(2):476-82. [Medline].

  8. Mandelli F, Annino L, Rotoli B, and the GIMEMA Cooperative Group, Italy. The GIMEMA ALL 0183 trial: analysis of 10-year follow-up. Br J Haematol. Mar 1996;92(3):665-72. [Medline].

  9. Cortes J, O'Brien SM, Pierce S, et al. The value of high-dose systemic chemotherapy and intrathecal therapy for central nervous system prophylaxis in different risk groups of adult acute lymphoblastic leukemia. Blood. Sep 15 1995;86(6):2091-7. [Medline]. [Full Text].

  10. Arlin ZA, Feldman EJ, Finger LR, et al. Short course high dose mitoxantrone with high dose cytarabine is effective therapy for adult lymphoblastic leukemia. Leukemia. Aug 1991;5(8):712-4. [Medline].

  11. Weiss M, Maslak P, Feldman E, et al. Cytarabine with high-dose mitoxantrone induces rapid complete remissions in adult acute lymphoblastic leukemia without the use of vincristine or prednisone. J Clin Oncol. Sep 1996;14(9):2480-5. [Medline].

  12. Hoelzer D, Ludwig WD, Thiel E, Gassmann W, Löffler H, Fonatsch C, et al. Improved outcome in adult B-cell acute lymphoblastic leukemia. Blood. Jan 15 1996;87(2):495-508. [Medline]. [Full Text].

  13. Thomas TA, Kantarjian H, Faderl S, et al. Update of the modified hyper-CVAD regimen with or without rituximab as frontline therapy of adults with acute lymphocytic leukemia (ALL) or lymphoblastic lymphoma (LL) [abstract]. Blood. 2007;110:2824a. [Full Text].

  14. Ludwig WD, Rieder H, Bartram CR, et al. Immunophenotypic and genotypic features, clinical characteristics, and treatment outcome of adult pro-B acute lymphoblastic leukemia: results of the German multicenter trials GMALL 03/87 and 04/89. Blood. Sep 15 1998;92(6):1898-909. [Medline]. [Full Text].

  15. Thomas DA, Faderl S, Cortes J, et al. Treatment of Philadelphia chromosome-positive acute lymphocytic leukemia with hyper-CVAD and imatinib mesylate. Blood. Jun 15 2004;103(12):4396-407. [Medline]. [Full Text].

  16. Kantarjian H, Giles F, Wunderle L, et al. Nilotinib in imatinib-resistant CML and Philadelphia chromosome-positive ALL. N Engl J Med. Jun 15 2006;354(24):2542-51. [Medline]. [Full Text].

  17. Talpaz M, Shah NP, Kantarjian H, et al. Dasatinib in imatinib-resistant Philadelphia chromosome-positive leukemias. N Engl J Med. Jun 15 2006;354(24):2531-41. [Medline]. [Full Text].

  18. Boissel N, Auclerc MF, Lheritier V, et al. Should adolescents with acute lymphoblastic leukemia be treated as old children or young adults? Comparison of the French FRALLE-93 and LALA-94 trials. J Clin Oncol. Mar 1 2003;21(5):774-80. [Medline]. [Full Text].

  19. Stock W, Sather H, Dodge RK, et al. Outcome of adolescents and young adults with ALL: a comparison of Children's Cancer Group (CCG) and Cancer and Leukemia Group B (CALGB) regimens [abstract]. Blood. 2000;96 (suppl):476a.

  20. Ribera JM, Ortega JJ, Oriol A, et al. Late intensification chemotherapy has not improved the results of intensive chemotherapy in adult acute lymphoblastic leukemia. Results of a prospective multicenter randomized trial (PETHEMA ALL-89). Spanish Society of Hematology. Haematologica. Mar 1998;83(3):222-30. [Medline]. [Full Text].

  21. Hunault M, Harousseau JL, Delain M, et al, for the GOELAMS (Groupe Ouest-Est des Leucemies Airgues et Maladies du Sang) Group. Better outcome of adult acute lymphoblastic leukemia after early genoidentical allogeneic bone marrow transplantation (BMT) than after late high-dose therapy and autologous BMT: a GOELAMS trial. Blood. Nov 15 2004;104(10):3028-37. [Medline]. [Full Text].

  22. Rowe JM, Buck G, Burnett AK, et al. Induction therapy for adults with acute lymphoblastic leukemia: results of more than 1500 patients from the international ALL trial: MRC UKALL XII/ECOG E2993. Blood. Dec 1 2005;106(12):3760-7. [Medline]. [Full Text].

  23. Martino R, Bellido M, Brunet S, et al. Allogeneic or autologous stem cell transplantation following salvage chemotherapy for adults with refractory or relapsed acute lymphoblastic leukemia. Bone Marrow Transplant. May 1998;21(10):1023-7. [Medline]. [Full Text].

  24. Weisdorf DJ, Billett AL, Hannan P, et al. Autologous versus unrelated donor allogeneic marrow transplantation for acute lymphoblastic leukemia. Blood. Oct 15 1997;90(8):2962-8. [Medline]. [Full Text].

  25. Kantarjian H, Gandhi V, Cortes J, et al. Phase 2 clinical and pharmacologic study of clofarabine in patients with refractory or relapsed acute leukemia. Blood. Oct 1 2003;102(7):2379-86. [Medline]. [Full Text].

  26. Kurtzberg J, Ernst TJ, Keating MJ, et al. Phase I study of 506U78 administered on a consecutive 5-day schedule in children and adults with refractory hematologic malignancies. J Clin Oncol. May 20 2005;23(15):3396-403. [Medline]. [Full Text].

  27. Geissler K, Koller E, Hubmann E, et al. Granulocyte colony-stimulating factor as an adjunct to induction chemotherapy for adult acute lymphoblastic leukemia--a randomized phase-III study. Blood. Jul 15 1997;90(2):590-6. [Medline]. [Full Text].

  28. Larson RA, Dodge RK, Linker CA, et al. A randomized controlled trial of filgrastim during remission induction and consolidation chemotherapy for adults with acute lymphoblastic leukemia: CALGB study 9111. Blood. Sep 1 1998;92(5):1556-64. [Medline]. [Full Text].

  29. Bassan R, Lerede T, Di Bona E, et al. Granulocyte colony-stimulating factor (G-CSF, filgrastim) after or during an intensive remission induction therapy for adult acute lymphoblastic leukaemia: effects, role of patient pretreatment characteristics, and costs. Leuk Lymphoma. Jun 1997;26(1-2):153-61. [Medline].

  30. Ifrah N, Witz F, Jouet JP, et al. Intensive short term therapy with granulocyte-macrophage-colony stimulating factor support, similar to therapy for acute myeloblastic leukemia, does not improve overall results for adults with acute lymphoblastic leukemia. GOELAMS Group. Cancer. Oct 15 1999;86(8):1496-505. [Medline]. [Full Text].

  31. Thomas X, Boiron JM, Huguet F, et al, and the Groupe d'Etude et de Traitement de la Leucemie Aigue Lymphoblastique de l'Adulte (GET-LALA Group). Efficacy of granulocyte and granulocyte-macrophage colony-stimulating factors in the induction treatment of adult acute lymphoblastic leukemia: a multicenter randomized study. Hematol J. 2004;5(5):384-94. [Medline].

  32. Czuczman MS, Dodge RK, Stewart CC, et al. Value of immunophenotype in intensively treated adult acute lymphoblastic leukemia: cancer and leukemia Group B study 8364. Blood. Jun 1 1999;93(11):3931-9. [Medline]. [Full Text].

  33. Preti HA, Huh YO, O'Brien SM, et al. Myeloid markers in adult acute lymphocytic leukemia. Correlations with patient and disease characteristics and with prognosis. Cancer. Nov 1 1995;76(9):1564-70. [Medline].

  34. Andersen MK, Christiansen DH, Jensen BA, et al. Therapy-related acute lymphoblastic leukaemia with MLL rearrangements following DNA topoisomerase II inhibitors, an increasing problem: report on two new cases and review of the literature since 1992. Br J Haematol. Sep 2001;114(3):539-43. [Medline].

  35. Attal M, Blaise D, Marit G, et al. Consolidation treatment of adult acute lymphoblastic leukemia: a prospective, randomized trial comparing allogeneic versus autologous bone marrow transplantation and testing the impact of recombinant interleukin-2 after autologous bone marrow transplantation. BGMT Group. Blood. Aug 15 1995;86(4):1619-28. [Medline]. [Full Text].

  36. Druker BJ, Sawyers CL, Kantarjian H, et al. Activity of a specific inhibitor of the BCR-ABL tyrosine kinase in the blast crisis of chronic myeloid leukemia and acute lymphoblastic leukemia with the Philadelphia chromosome. N Engl J Med. Apr 5 2001;344(14):1038-42. [Medline]. [Full Text].

  37. Ellison RR, Mick R, Cuttner J, et al. The effects of postinduction intensification treatment with cytarabine and daunorubicin in adult acute lymphocytic leukemia: a prospective randomized clinical trial by Cancer and Leukemia Group B. J Clin Oncol. Nov 1991;9(11):2002-15. [Medline].

  38. Fiere D, Lepage E, Sebban C, et al, for the French Group on Therapy for Adult Acute Lymphoblastic Leukemia. Adult acute lymphoblastic leukemia: a multicentric randomized trial testing bone marrow transplantation as postremission therapy. J Clin Oncol. Oct 1993;11(10):1990-2001. [Medline].

  39. Giona F, Annino L, Rondelli R, et al. Treatment of adults with acute lymphoblastic leukaemia in first bone marrow relapse: results of the ALL R-87 protocol. Br J Haematol. Jun 1997;97(4):896-903. [Medline].

  40. Group Francais de Cytogenetique Hematologique. Cytogenetic abnormalities in adult acute lymphoblastic leukemia: correlations with hematologic findings outcome. A collaborative study of the Group Francais de Cytogenetique Hematologique. Blood. Apr 15 1996;87(8):3135-42. [Medline]. [Full Text].

  41. Han X, Bueso-Ramos CE. Advances in the pathological diagnosis and biology of acute lymphoblastic leukemia. Ann Diagn Pathol. Aug 2005;9(4):239-57. [Medline].

  42. Kantarjian H, Thomas D, O'Brien S, et al. Long-term follow-up results of hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (Hyper-CVAD), a dose-intensive regimen, in adult acute lymphocytic leukemia. Cancer. Dec 15 2004;101(12):2788-801. [Medline]. [Full Text].

  43. Kiehl MG, Kraut L, Schwerdtfeger R, et al. Outcome of allogeneic hematopoietic stem-cell transplantation in adult patients with acute lymphoblastic leukemia: no difference in related compared with unrelated transplant in first complete remission. J Clin Oncol. Jul 15 2004;22(14):2816-25. [Medline]. [Full Text].

  44. Koller CA, Kantarjian HM, Thomas D, et al. The hyper-CVAD regimen improves outcome in relapsed acute lymphoblastic leukemia. Leukemia. Dec 1997;11(12):2039-44. [Medline].

  45. Larson RA, Dodge RK, Burns CP, et al. A five-drug remission induction regimen with intensive consolidation for adults with acute lymphoblastic leukemia: cancer and leukemia group B study 8811. Blood. Apr 15 1995;85(8):2025-37. [Medline]. [Full Text].

  46. Mancini M, Scappaticci D, Cimino G, et al. A comprehensive genetic classification of adult acute lymphoblastic leukemia (ALL): analysis of the GIMEMA 0496 protocol. Blood. May 1 2005;105(9):3434-41. [Medline]. [Full Text].

  47. Redaelli A, Laskin BL, Stephens JM, Botteman MF, Pashos CL. A systematic literature review of the clinical and epidemiological burden of acute lymphoblastic leukaemia (ALL). Eur J Cancer Care (Engl). Mar 2005;14(1):53-62. [Medline].

  48. Ribera JM, Oriol A, Sanz MA, et al. Comparison of the results of the treatment of adolescents and young adults with standard-risk acute lymphoblastic leukemia with the Programa Espanol de Tratamiento en Hematología pediatric-based protocol ALL-96. J Clin Oncol. Apr 10 2008;26(11):1843-9. [Medline].

  49. Rizzieri DA, Johnson JL, Niedzwiecki D, et al. Intensive chemotherapy with and without cranial radiation for Burkitt leukemia and lymphoma: final results of Cancer and Leukemia Group B Study 9251. Cancer. Apr 1 2004;100(7):1438-48. [Medline]. [Full Text].

  50. Sarris A, Cortes J, Kantarjian H, et al. Disseminated intravascular coagulation in adult acute lymphoblastic leukemia: frequent complications with fibrinogen levels less than 100 mg/dl. Leuk Lymphoma. Mar 1996;21(1-2):85-92. [Medline].

  51. Sebban C, Browman GP, Lepage E, Fière D. Prognostic value of early response to chemotherapy assessed by the day 15 bone marrow aspiration in adult acute lymphoblastic leukemia: a prospective analysis of 437 cases and its application for designing induction chemotherapy trials. Leuk Res. Nov 1995;19(11):861-8. [Medline].

  52. Sebban C, Lepage E, Vernant JP, et al, for the French Group of Therapy of Adult Acute Lymphoblastic Leukemia. Allogeneic bone marrow transplantation in adult acute lymphoblastic leukemia in first complete remission: a comparative study. J Clin Oncol. Dec 1994;12(12):2580-7. [Medline].

  53. Secker-Walker LM, Prentice HG, Durrant J, et al. Cytogenetics adds independent prognostic information in adults with acute lymphoblastic leukaemia on MRC trial UKALL XA. MRC Adult Leukaemia Working Party. Br J Haematol. Mar 1997;96(3):601-10. [Medline].

  54. Testi AM, Moleti ML, Giona F, et al. A single high dose of idarubicin combined with high-dose ARA-C (MSKCC ALL-3 protocol) in adult and pediatric patients with acute lymphoblastic leukemia. Experience at the University "La Sapienza" of Rome. Haematologica. Nov-Dec 1997;82(6):664-7. [Medline]. [Full Text].

  55. Thomas DA, Cortes J, O'Brien S, et al. Hyper-CVAD program in Burkitt's-type adult acute lymphoblastic leukemia. J Clin Oncol. Aug 1999;17(8):2461-70. [Medline]. [Full Text].

  56. Thomas DA, Kantarjian HM, Ravandi F, et al. Long-term Follow-up after frontline therapy with the hyper-CVAD and imatinib mesylate regimen in adults with Philadelphia (Ph) positive acute lymphocytic leukemia (ALL) [abstract]. Blood. November 2007;110:9a.

  57. Thomas X, Boiron JM, Huguet F, et al. Outcome of treatment in adults with acute lymphoblastic leukemia: analysis of the LALA-94 trial. J Clin Oncol. Oct 15 2004;22(20):4075-86. [Medline]. [Full Text].

  58. Towatari M, Yanada M, Usui N, et al, for the Japan Adult Leukemia Study Group. Combination of intensive chemotherapy and imatinib can rapidly induce high-quality complete remission for a majority of patients with newly diagnosed BCR-ABL-positive acute lymphoblastic leukemia. Blood. Dec 1 2004;104(12):3507-12. [Medline]. [Full Text].

  59. Weiss MA, Drullinsky P, Maslak P, Scheinberg D, Golde DW. A phase I trial of a single high dose of idarubicin combined with high-dose cytarabine as induction therapy in relapsed or refractory adult patients with acute lymphoblastic leukemia. Leukemia. Jun 1998;12(6):865-8. [Medline].

  60. Weiss MA, Heffner L, Lamanna N, et al. A randomized trial demonstrating the superiority of cytarabine with high-dose mitoxantrone compared to a standard vincristine/prednisone-based regimen as induction therapy for adult patients with ALL [abstract]. Presented at: Annual Meeting of the American Society of Clinical Oncology; May 13-15, 2005; Orlando, Fla. J Clin Oncol. 2005;25:6516a.

  61. Yanada M, Takeuchi J, Sugiura I, et al, for the Japan Adult Leukemia Study Group. High complete remission rate and promising outcome by combination of imatinib and chemotherapy for newly diagnosed BCR-ABL-positive acute lymphoblastic leukemia: a phase II study by the Japan Adult Leukemia Study Group. J Clin Oncol. Jan 20 2006;24(3):460-6. [Medline]. [Full Text].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

acute lymphoblastic leukemia, ALL, lymphoid precursor cells, lymphoblasts, malignant lymphoid disorder, cancer, bone marrow malignancy, bone marrow cancer, leukemia, bone marrow failure, lymphoma, bone marrow carcinoma, anemia, thrombocytopenia, neutropenia, leukemia in children,

bone pain, splenomegaly, mediastinal mass, leukostasis, dizziness, palpitations, dyspnea, disseminated intravascular coagulation, DIC, pneumonia, petechiae, ecchymoses, hepatosplenomegaly, lymphadenopathy, Philadelphia chromosome, Ph chromosome, myeloproliferative disorder

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Karen Seiter, MD, Professor, Department of Internal Medicine, Division of Oncology/Hematology, New York Medical College
Karen Seiter, MD is a member of the following medical societies: American Association for Cancer Research, American College of Physicians, and American Society of Hematology
Disclosure: Novartis Honoraria Speaking and teaching; Celgene Honoraria Speaking and teaching; Schering Honoraria Speaking and teaching

Medical Editor

Clarence Sarkodee-Adoo, MD, Consulting Staff, Department of Bone Marrow Transplantation, City of Hope Samaritan BMT Program
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Ronald A Sacher, MB, BCh, MD, FRCPC, Director of the Hoxworth Blood Center, Professor, Departments of Internal Medicine and Pathology, University of Cincinnati Medical Center
Ronald A Sacher, MB, BCh, MD, FRCPC is a member of the following medical societies: American Society of Hematology
Disclosure: Glaxo Smith Kline Honoraria Speaking and teaching; Talecris Honoraria Board membership

CME Editor

Rajalaxmi McKenna, MD, FACP, Consulting Staff, Department of Medicine, Southwest Medical Consultants, SC, Good Samaritan Hospital, Advocate Health Systems
Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis
Disclosure: Nothing to disclose.

Chief Editor

Emmanuel C Besa, MD, Professor, Department of Medicine, Division of Hematologic Malignancies, Kimmel Cancer Center, Thomas Jefferson University
Emmanuel C Besa, MD is a member of the following medical societies: American Association for Cancer Education, American College of Clinical Pharmacology, American Federation for Medical Research, American Society of Hematology, and New York Academy of Sciences
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.