From the Perspective of a Small Fighter: Defeating B-ALL
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- From the Perspective of a Small Fighter: Defeating B-ALL
Who are we talking about?
An 18-month-old boy with intermittent fever, weakness, some vomiting, and facial puffiness. There was no history of jaundice, bleeding, or transfusions.
Step 1: Clues in the blood (15 November 2022)
Initial labs showed:
- Haemoglobin: 5.6 g/dL (low)
- Total white cell count (TLC): 16,100/µL
- Neutrophils: 13%
- Platelets: 27,000/µL (low)
On the peripheral smear, we saw occasional blast cells, immature cells that can point to a blood cancer. That raised a careful question: Could this be leukaemia?
Step 2: Looking inside the marrow
We performed a bone marrow aspiration and biopsy with a full leukaemia work-up. The marrow showed sheets of uniform blasts—cells with scant bluish cytoplasm, fine “open” chromatin, and typically 0–1 tiny nucleolus; a few showed nuclear grooves. Taken together, these features indicated B-cell Acute Lymphoblastic Leukaemia (B-ALL).
Plain English: the marrow was crowded with baby-like blood cells that hadn’t matured, classic for childhood B-ALL.
Step 3: Confirming the type (20 November 2022)
Flow cytometry (a detailed cell “fingerprint”) showed ~85.7% blasts with CD45 dim expression. The blasts were positive for CD10, CD19, HLA-DR, CD38, sCD22 and negative for CD20—a pattern that confirms B-ALL.
Plain English: the cancer cells wore the badge set typical of B-cell origin.
Step 4: The treatment plan
We started a standard BFM-2002–based chemotherapy regimen using Vincristine, Doxorubicin, Daunorubicin, L-asparaginase (Leunase), Methotrexate, 6-mercaptopurine, and Cytarabine.
After 1 month (end of induction):
The highly sensitive MRD test was negative—meaning remission. We proceeded to consolidation chemotherapy per NCCN guidance, and the child is now on oral maintenance.
Plain English: the first month hit the disease hard; the “deep-clean” test saw no detectable leukaemia cells, so we moved into phases designed to lock in the win and prevent a comeback.
Step 5: Where we stand—and what it means
- Diagnosis: B-cell Acute Lymphoblastic Leukaemia (B-ALL)
- Current status: MRD-negative remission after induction; on planned therapy (consolidation → maintenance)
- Outlook: In children, ALL has an excellent prognosis about 80% are cured and ~80% 5-year overall survival with appropriate treatment.
Plain English: most children do very well with today’s treatments—and our patient’s path is very encouraging.
Quick glossary (no jargon)
- Blasts: very young blood cells; too many suggest leukaemia.
- Flow cytometry: a lab test that identifies cells by their “ID badges” (markers like CD10/CD19).
- MRD-negative: even the most sensitive tests can’t find leukaemia cells, a strong sign treatment is working.
The human story, in one line
A toddler arrived tired and unwell; careful testing named the problem, modern chemo hit it hard, and one month later the deepest tests showed no trace, a small fighter firmly on the road to recovery.