Test your knowledge of B-cell ALL with uncommon symptoms

Which of the following monitoring strategies is most critical for early detection of treatment response and risk stratification?

Monthly bone marrow biopsies to reassess marrow cellularity and trilineage hematopoiesis.

Weekly complete blood counts and metabolic panels, along with daily monitoring of tumor lysis markers

MRD assessment by flow cytometry/PCR at the end of induction and intensification for risk stratification

Frequent lumbar punctures with intrathecal cytarabine alternating with IT methotrexate to prevent CNS relapse

The presence of rare clinical features such as hypercalcemia and osteoarticular involvement in adult ALL independently classifies the patient as high-risk, regardless of underlying cytogenetic findings.

True

False

Which of the following diagnostic findings was essential for definitively diagnosing B-cell acute lymphoblastic leukemia (B-ALL) in this patient, given the initial atypical presentation?

MRI of the lumbar spine revealing heterogeneous marrow signal changes

Bone marrow aspiration/biopsy showing >20% lymphoblasts

Elevated LDH and creatinine levels on repeat laboratory evaluation

Flow cytometry confirming B-cell lineage ALL

Despite the patient's progressive fatigue and new-onset hypercalcemia, the absence of circulating blasts on repeat laboratory evaluation prevented a hematologic malignancy from being considered until bone marrow biopsy.

True

False