48 Monte Carlo Crescent Kyalami Business Park Kyalami, Johannesburg, 1684, RSA Tel: +27 (0)11 463 3260 Fax: + 27 (0)86 557 2232 Email: [email protected] www.thistle.co.za

Please read this section first The HPCSA and the Med Tech Society have confirmed that this clinical case study, plus your routine review of your EQA reports from Thistle QA, should be documented as a “Journal Club” activity. This means that you must record those attending for CEU purposes. Thistle will not issue a certificate to cover these activities, nor send out “correct” answers to the CEU questions at the end of this case study.

*Kindly take note that we have applied to become an accredited CEU points provider from SMLTSA and are currently awaiting our CEU accreditation certificate for the year 2017. This means that we cannot award a CEU point for this legend with immediate effect. This legend and all legends going forward will only carry 1 CEU point as per the new regulations from SMLTSA. We will notify you as soon as our certificate is issued to us and you may claim 1 CEU point for this legend thereafter. We apologize if any inconvenience will be caused due to this and sincerely thank you for your understanding, patience and support.

DIFFERENTIAL SLIDES LEGEND

CYCLE 49 SLIDE 6

T - Lymphoblastic /

T – Lymphoblastic Leukemia/Lymphoma, previously labelled Precursor T – Lymphoblastic Leukemia/Lymphoma and also known as Precursor T-cell Lymphoblastic Lymphoma and Precursor T–Acute Lymphoblastic Leukemia/Lymphoma is a form of lymphoid leukemia and lymphoma in which too many T-cell (immature white blood cells) are found in the blood, bone marrow and tissues, particularly mediastinal lymph nodes. It is highly aggressive and progresses quickly.

Labelling it as leukemia or lymphoma depends on which feature is more pronounced in a given situation but has no biological or treatment implication. It is uncommon in adults but represents 15% of childhood acute lymphoblastic leukemia and 90% of lymhoblastic lymphoma. Males are more affected than females at all ages.

The 2008 terminology dropped “precursor” to avoid linguistic redundancy because the is an immature precursor cell by definition.

Signs and Symptoms

There are no specific signs or symptoms which will allow a diagnosis to be officially made. The most common signs and symptoms are caused by the bone marrow being unable to produce enough normal blood cells which may include:

- Anaemia – Due to the lack of red blood cells - Infections – Due to the lack of normal white blood cells - Weakness, tiredness, shortness of breath, light-headedness, palpitations - Fever, malaise (general feeling of illness), sweating - Purpura (small bruises in skin), nose bleeds, bleeding gums - Bleeding and bruising – Due to the lack of platelets

Diagnosis

Although a doctor may suspect a patient has T – Lymphoblastic Leukemia/Lymphoma, it can only be diagnosed by laboratory tests. The result of a simple blood count will usually show an indication of the disease, although rarely a blood count may be normal. Virtually all patients with T – Lymphoblastic Leukemia/Lymphoma have

Page 1 of 3

48 Monte Carlo Crescent Kyalami Business Park Kyalami, Johannesburg, 1684, RSA Tel: +27 (0)11 463 3260 Fax: + 27 (0)86 557 2232 Email: [email protected] www.thistle.co.za bone marrow samples taken to confirm the diagnosis and to help to determine exactly what type of leukemia a patient has. More specialised tests are often done at the same time.

Usually a chest x-ray will be taken as well as scans, to look for swollen lymph nodes or other affected sites. Blood samples will be taken to test for any problems with the liver, kidneys or other organs. Samples of cerebrospinal fluid are also taken to test if any cancerous cells have entered the nervous system. Some blood tests and scans will be repeated to check for the response to treatment for any complications. Other tests are usually done only at diagnosis.

Staging

Staging is not used for T – Lymphoblastic Leukemia/Lymphoma because it is spread throughout the body when first diagnosed. There is a system to classify it as a high-risk, standard or low-risk. It is important to stress that this refers to the chance of a good response giving standard treatment. If treatment is selected according to risk group, many patients with high-risk disease will do very well. It is also unfortunately not always true that a patient with low-risk disease will do well. The risk group is only of the factors which affects the outcome of treatment. Most cases are classified as high-risk, with appropriate treatment; they have a very good chance of successful treatment.

T – Lymphoblastic Leukemia/Lymphoma

Page 2 of 3

48 Monte Carlo Crescent Kyalami Business Park Kyalami, Johannesburg, 1684, RSA Tel: +27 (0)11 463 3260 Fax: + 27 (0)86 557 2232 Email: [email protected] www.thistle.co.za

Treatment

Virtually all patients with T – Lymphoblastic Leukemia/Lymphoma will start treatment immediately. The main exception would be if a patient is very ill with other medical problems and is not fit enough to receive treatment. T – Lymphoblastic Leukemia/Lymphoma is often curable with standard treatments, in younger and/or fitter patients. Older or less fit patients will usually have a good initial response to treatment but the condition will most often come back, this is known as a relapse.

The main ways in which T – Lymphoblastic Leukemia/Lymphoma is treated are: 1. Chemotherapy – Cell-killing drugs, steroids are normally used along with chemotherapy 2. Radiation Therapy – Usually only given as part of a stem cell transplant 3. Stem Cell Transplant – Younger/fitter patients may be given a stem cell transplant. This is done using healthy stem cells from a donor.

The details of treatment will vary depending on the specific features of the disease, age and general fitness.

References

1. http://www.leukaemiacare.org.uk/t-cell-acute-lymphoblastic-leukaemia

Questions

1. Name three signs and symptoms that occur in patients with T – Lymphoblastic Leukemia/Lymphoma 2. What sample is tested to see if any cancerous cells have entered the nervous system? 3. Why is there no official staging for T – Lymphoblastic Leukemia/Lymphoma?

Page 3 of 3