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Among 36 live offspring of survivors, two congenital problems occurred. In adults, French-American-British (FAB) L1 morphology (more mature-appearing lymphoblasts) is present in fewer than 50% of patients, and L2 morphology (more immature and pleomorphic) predominates. L3 (Burkitt) acute lymphoblastic leukemia (ALL) is much less common than the other two FAB subtypes.
It is characterized by blasts with cytoplasmic vacuolizations and surface expression of immunoglobulin, and the bone marrow often has an appearance described as a “” owing to the presence of numerous apoptotic cells.
It is the most common type of cancer in children, and treatment results in a good chance for a cure. The disease is characterized by the accumulation of lymphoblasts in the marrow or in various extramedullary sites, frequently accompanied by suppression of normal hematopoiesis.
B- and T-cell lymphoblastic leukemia cells express surface antigens that parallel their respective lineage developments.
Immunophenotypic analysis is essential because leukemias that do not express myeloperoxidase include M0 AML, M7 AML, and ALL.
The examination of bone marrow aspirates and/or biopsy specimens should be done by an experienced oncologist, hematologist, hematopathologist, or general pathologist who is capable of interpreting conventional and specially stained specimens.
Malignant cells should be sent for conventional cytogenetic studies, as detection of the Ph1 t(9;22), gene rearrangements add important prognostic information.
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Treatment is divided into the following three phases: The average length of treatment for ALL varies between 1.5 and 3 years in the effort to eradicate the leukemic cell population.