What are the National Comprehensive Cancer Network (NCCN) diagnostic guidelines for acute lymphoblastic leukemia (ALL)?

Updated: Jul 02, 2021
  • Author: Karen Seiter, MD; Chief Editor: Emmanuel C Besa, MD  more...
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NCCN guidelines note that diagnosis of ALL generally requires the following [20] :

  • Demonstration of ≥20% bone marrow lymphoblasts
  • Morphologic assessment of Wright/Giemsa–stained bone marrow aspirate smears
  • Hematoxylin and eosin (H&E)–stained bone marrow core biopsy and clot sections
  • Comprehensive flow cytometric immunophenotyping

For optimal risk stratification and treatment planning in patients with ALL, the NCCN advises that bone marrow or peripheral blood lymphoblasts must be tested for specific recurrent genetic abnormalities, as follows [20] :

  • Cytogenetics – Karyotyping of G-banded metaphase chromosomes
  • Interphase FISH
  • Reverse transcriptase polymerase chain reaction (RT-PCR) for fusion genes (eg,  BCR-ABL)

The NCCN considers tests for hyperdiploidy and hypodiploidy to be optional.

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