Acute Leukemias MCQ — NEET PG Practice Question | NEETPGAI
Acute Leukemias
hard
microscope Pathology
A 28-year-old woman presents with fever, petechiae, and a white blood cell count of 85,000/μL with 78% blasts. Bone marrow shows predominantly lymphoid blasts with strong CD19 and CD10 positivity. All of the following are true regarding her condition EXCEPT:
A. Philadelphia chromosome t(9;22) is the most common cytogenetic abnormality in this age group
B. The presence of CD10 positivity indicates common ALL (cALL) with a generally favorable prognosis
C. The high white blood cell count at presentation is an adverse prognostic factor
D. Induction chemotherapy with vincristine, daunorubicin, and L-asparaginase is standard initial treatment
Explanation
Acute Lymphoblastic Leukemia (ALL): Prognostic and Treatment Features
Key Point
Philadelphia chromosome t(9;22) is the MOST COMMON cytogenetic abnormality in adult ALL (present in 20–25% of adult ALL), NOT in young adults aged 28 years. In pediatric ALL, t(9;22) is less common (3–5%), and other translocations like t(12;21) are more frequent.
Cytogenetic Abnormalities in ALL by Age
Table
Abnormality
Frequency in Children
Frequency in Adults
Prognosis
t(12;21) ETV6-RUNX1
20–25%
<5%
Favorable
Hyperdiploidy (>50 chr)
25–30%
10%
Favorable
t(9;22) Philadelphia
3–5%
20–25%
Unfavorable
t(1;19) TCF3-PBX1
5%
<5%
Intermediate
t(4;11) KMT2A-AFF1
5–10%
10%
Unfavorable
High-YieldNEET PG
In a 28-year-old woman with ALL, t(12;21) and hyperdiploidy are MORE common favorable-risk features than t(9;22). The statement that t(9;22) is "the most common" in this age group is INCORRECT.
CD10 Positivity: Common ALL (cALL)
CD19+ CD10+ = common ALL (cALL)
Represents ~80% of pediatric B-ALL
Generally favorable prognosis in children
Better response to chemotherapy
High WBC Count as Adverse Prognostic Factor
Clinical Pearl
WBC >30,000/μL (or >100,000/μL in some systems) at presentation is an independent adverse prognostic factor in ALL, associated with:
Higher tumor burden
Increased risk of leukostasis
Worse event-free survival
Standard Induction Therapy for ALL
1.
Vincristine (weekly IV)
2.
Daunorubicin (or doxorubicin) (IV)
3.
L-asparaginase (IV or IM)
4.
Corticosteroids (prednisone or dexamethasone)
Mnemonic
VALD = Vincristine, Asparaginase, Leukeran (chlorambucil), Daunorubicin (though modern regimens use corticosteroids instead of chlorambucil).
This is the backbone of ALL induction therapy worldwide.
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