all

the total entity of: All of us are going.; whole number or amount: giving it all away
Not to be confused with:awl – a pointed tool for boring holes: The carpenter used an awl to make a hole for the doorknob.

all

A0205200 (ôl) adj. 1. Being or representing the entire or total number, amount, or quantity: All the windows are open. Deal all the cards. See Synonyms at whole.2. Constituting, being, or representing the total extent or the whole: all Christendom. 3. Being the utmost possible of: argued the case in all seriousness. 4. Every: got into all manner of trouble. 5. Any whatsoever: beyond all doubt. 6. Pennsylvania Consumed; used up; gone: The apples are all. 7. Informal Being more than one: Who all came to the party? See Note at y'all. n. The whole of one's fortune, resources, or energy; everything one has: The brave defenders gave their all. pron. 1. The entire or total number, amount, or quantity; totality: All of us are sick. All that I have is yours. 2. Everyone; everything: justice for all. adv. 1. a. Wholly; completely: a room painted all white. b. So much: I am all the better for that experience. c. Used as an intensive: Then he got all mad and left. 2. Each; apiece: a score of five all. Idioms: all along From the beginning; throughout: saw through the disguise all along. all but Nearly; almost: all but crying with relief. all in 1. Tired; exhausted. 2. Games Staking all of one's chips, as in poker. 3. Putting all of one's available resources into an effort: The governor mounted a halfhearted campaign for the presidency but didn't go all in. all in all Everything being taken into account: All in all, the criticism seemed fair. all of Informal Not more than: a conversation that took all of five minutes. all one Of no difference; immaterial: Whether we go out or stay in, it's all one to me. all over 1. Completely ended or finished: Their marriage is all over. 2. In every part; everywhere: The storm swept across the island and left damage all over. 3. Typical of the person or thing just mentioned: Making wisecracks like that—that's Jim all over. 4. Showing much romantic interest or being in close contact: He was all over her during the slow dance. 5. Persistently or harshly critical or scolding: The coach was all over me about missing practice. all out With all one's strength, ability, or resources. all that Informal To the degree expected. all there Mentally unimpaired or competent. all told With everything considered; in all: All told, we won 100 games. and all 1. And other things of the same type: "The only thing they seemed to have in common was their cowboy gear, ten-gallon hats and all" (Edward Chen). 2. Being included: devoured the peanuts, shells and all. at all 1. In any way: unable to walk at all. 2. To any extent; whatever: not at all sorry. be all Informal To say or utter. Used chiefly in verbal narration: He's all, "What did you do that for?" in all Considering everything; all together: In all, it rained for two hours. I bought four hats, in all.

[Middle English al, from Old English eall; see al-³ in the Appendix of Indo-European roots.] Usage Note: The construction all that is used informally in questions and negative sentences to mean "to the degree expected." In the late 1960s, the Usage Panel rejected its use, but resistance to all that has waned dramatically. In our 2016 survey, 87 percent of the Panel found the construction acceptable in the sentence The movie is not all that interesting. Some stigma lingers, however; many of the Panelists who accepted this example sentence commented that this use of all that would be much less acceptable in formal writing than in colloquial speech. · Sentences of the form All X's are not Y may be ambiguous. All of the departments did not file a report may mean that some departments did not file, or that none did. The first meaning can be expressed unambiguously by the sentence Not all of the departments filed a report. The second meaning can be more clearly phrased as None of the departments filed a report or All of the departments failed to file a report. The same problem can arise with other universal terms such as every in negated sentences, as in the ambiguous Every department did not file a report. See Usage Note at every.Word History: In the late 17th and early 18th centuries, groups of immigrants from southwestern Germany, Alsace, and Switzerland settled in Pennsylvania. The groups spoke closely related dialects of German that eventually merged into a new, distinctly American variety of German that came to be known as Pennsylvania Dutch. (The word Dutch in this expression comes from Deitsch, the Pennsylvania German equivalent of Deutsch, the standard German word for "German." The spelling of the word as Dutch has undoubtedly been influenced by the English word Dutch. English Dutch comes from the Middle Dutch word Dūtsch, meaning "Dutch" or "German," that is the Dutch equivalent of the German word Deutsch.) Pennsylvania Dutch, which is still spoken in some communities in Pennsylvania today—notably by the Amish—has contributed a number of words to American English, including dunk, hex, smearcase, snollygoster, spritz, and perhaps snickerdoodle. The dialect has also left other traces in the grammar and usage of English in Pennsylvania. For instance, in German, the word alle, literally meaning "all," can be used idiomatically to mean "all gone, used up, at an end." The standard German sentence Der Kaffee ist alle (word for word, "The coffee is all") means "The coffee is all gone" or "The coffee has been used up," for example. Some Pennsylvanians, too, may say The coffee is all to mean "The coffee is all gone"—the use of the English word all to mean "all gone" reflects the influence of Pennsylvania Dutch and reminds us of the days when many Pennsylvanians were bilingual in English and Pennsylvania Dutch and would switch back and forth between them in their daily lives.

all

(ɔːl) determiner1. a. the whole quantity or amount of; totality of; every one of a class: all the rice; all men are mortal. b. (as pronoun; functioning as sing or plural): all of it is nice; all are welcome. c. (in combination with a noun used as a modifier): an all-ticket match; an all-amateur tournament; an all-night sitting. 2. the greatest possible: in all earnestness. 3. any whatever: to lose all hope of recovery; beyond all doubt. 4. above all most of all; especially5. after all See after¹¹6. all along all the time7. all but almost; nearly: all but dead. 8. all of no less or smaller than: she's all of thirteen years. 9. all over a. finished; at an end: the affair is all over between us. b. over the whole area (of something); everywhere (in, on, etc): all over England. c. typically; representatively (in the phrase that's me (you, him, us, them,etc) all over). Also (Irish): all out d. unduly effusive towardse. sport in a dominant position over10. See all in11. all in all a. everything considered: all in all, it was a great success. b. the object of one's attention or interest: you are my all in all. 12. all that that (usually used with a negative) informal (intensifier): she's not all that intelligent. 13. all the (foll by a comparative adjective or adverb) so much (more or less) than otherwise: we must work all the faster now. 14. all too definitely but regrettably: it's all too true. 15. and all a. Brit informal as well; too: and you can take that smile off your face and all. b. South African a parenthetical filler phrase used at the end of a statement to make a slight pause in speaking16. and all that informal a. and similar or associated things; et cetera: coffee, tea, and all that will be served in the garden. b. used as a filler or to make what precedes more vague: in this sense, it often occurs with concessive force: she was sweet and pretty and all that, but I still didn't like her. c. See that⁴17. as all that as one might expect or hope: she's not as pretty as all that, but she has personality. 18. at all a. (used with a negative or in a question) in any way whatsoever or to any extent or degree: I didn't know that at all. b. even so; anyway: I'm surprised you came at all. 19. be all for informal to be strongly in favour of20. be all that informal chiefly US to be exceptionally good, talented, or attractive21. for all a. in so far as; to the extent that: for all anyone knows, he was a baron. b. notwithstanding: for all my pushing, I still couldn't move it. 22. for all that in spite of that: he was a nice man for all that. 23. in all altogether: there were five of them in all. adv24. (General Sporting Terms) (in scores of games) apiece; each: the score at half time was three all. 25. completely: all alone. 26. be all … informal used for emphasis when introducing direct speech or nonverbal communication: he was all, 'I'm not doing that'. n27. (preceded by: my, your, his, etc) (one's) complete effort or interest: to give your all; you are my all. 28. totality or whole[Old English eall; related to Old High German al, Old Norse allr, Gothic alls all]

all

(ɔl)

adj. 1. the whole or full amount of: all the cake; all year. 2. the whole number of: all students; all kinds. 3. the greatest possible: with all speed. 4. any; any whatever: beyond all doubt. 5. entirely; purely: The coat is all wool. 6. dominated by a particular feature: The colt was all legs. 7. Pennsylvania German Area. consumed; finished: The pie is all. pron. 8. the whole quantity or amount: Did you eat all of the peanuts? 9. the whole number; every one: all of us. 10. everything: Is that all you've got to say? n. 11. one's whole interest, energy, or property: Give it your all. 12. the entire area, place, environment, or the like: all is calm. adv. 13. wholly; entirely: all alone; all for a better government. 14. each; apiece: The score was one all. Idioms: 1. all but, almost; very nearly: These batteries are all but dead. 2. all in, very tired; exhausted. 3. all in all, everything considered; in general: All in all, her health is improved. 4. all out, energetically and enthusiastically: to go all out to win the game. 5. all the better, so much the better. 6. all there, mentally competent. 7. and all, and so forth: What with the late hour and all, we must leave. 8. at all, a. in the slightest degree. b. for any reason: Why bother at all? 9. for all (that), in spite of (that); notwithstanding: For all that, it was a good year. 10. in all, all included; all together. 11. as all get-out, Informal. to an extreme degree, condition, etc. [before 900; Middle English al, pl. alle; Old English eal(l), c. Old Frisian al, Old Saxon, Old High German al(l), Old Norse allr, Gothic alls] usage: Expressions like all the farther and all the higher occur chiefly in informal speech: This is all the farther the bus goes. That's all the higher she can jump. Elsewhere as far as and as high as are generally used: as far as the bus goes; as high as she can jump. The construction all of (all of the students; all of the contracts) is entirely standard. Some people object to it, however, and omit the of. See also already, alright, altogether.

all-

var. of allo- before a vowel: allonym.

all

1. used as a determiner

You use all immediately in front of the plural form of a noun to talk about every thing or person of a particular kind. When you use all in front of the plural form of a noun, you use a plural form of a verb after it.

There is built-in storage space in all bedrooms.All boys like to eat.

You can use all immediately in front of an uncountable noun when you are making a general statement about something. When you use all in front of an uncountable noun, you use a singular form of a verb after it.

All research will be done by experts.All crime is serious.2. used with other determiners

If you want to say something about every thing or person in a group, you use all or all of, followed by the, these, those, or a possessive determiner, followed by the plural form of a noun.

Staff are checking all the books to make sure they are suitable.All my friends came to my wedding.All of the defendants were proved guilty.

If you want to say something about the whole of a particular thing, you use all or all of, followed by the, this, that, or a possessive determiner, followed by an uncountable noun or the singular form of a countable noun.

They carried all the luggage into the hall.I want to thank you for all your help.I lost all of my money.3. used in front of pronouns

You can use all or all of in front of the pronouns this, that, these, and those.

Oh dear, what are we going to do about all this?Maybe all of that is true, but that's not what I asked.

However, in front of personal pronouns you must use all of. Don't use 'all'.

Listen, all of you.It would be impossible to list all of it in one programme.

Don't use 'we' or 'they' after all of. Instead you use us or them.

He discussed it with all of us.All of them were tired.4. used after the subject

All can also be used after the subject of a clause. For example, instead of saying 'All our friends came', you can say 'Our friends all came'.

When there is no auxiliary verb, all goes in front of the verb, unless the verb is be.

We all felt guilty.

If the verb is be, all goes after be.

They were all asleep.

If there is an auxiliary verb, you put all after it.

It will all be over soon.

If there is more than one auxiliary verb, you put all after the first one.

The drawers had all been opened.

All can also come after the direct or indirect object of a verb when this object is a personal pronoun.

We treat them all with care.I admire you all.5. used as a pronoun

All can be a pronoun meaning 'everything' or 'the only thing'. It is often used like this in front of a relative clause.

It was the result of all that had happened previously.All I remember is his first name.6. 'every'

Every has a similar meaning to all. 'Every teacher was at the meeting' means the same as 'All the teachers were at the meeting'.

However, there is a difference between all and every when you use them with expressions of time. For example, if you spend all day doing something, you spend the whole of one day doing it. If you do something every day, you keep doing it each day.

The airport was closed all morning after the accident.She goes running every morning.

Thesaurus

Adj.

all - quantifier; used with either mass or count nouns to indicate the whole number or amount of or every one of a class; "we sat up all night"; "ate all the food"; "all men are mortal"; "all parties are welcome"no - quantifier; used with either mass nouns or plural count nouns for indicating a complete or almost complete lack or zero quantity of; "we have no bananas"; "no eggs left and no money to buy any"; "have you no decency?"; "did it with no help"; "I'll get you there in no time"some - quantifier; used with either mass nouns or plural count nouns to indicate an unspecified number or quantity; "have some milk"; "some roses were still blooming"; "having some friends over"; "some apples"; "some paper"

all - completely given to or absorbed by; "became all attention"complete - having every necessary or normal part or component or step; "a complete meal"; "a complete wardrobe"; "a complete set of the Britannica"; "a complete set of china"; "a complete defeat"; "a complete accounting"

Adv.

all - to a complete degree or to the full or entire extent (`whole' is often used informally for `wholly'); "he was wholly convinced"; "entirely satisfied with the meal"; "it was completely different from what we expected"; "was completely at fault"; "a totally new situation"; "the directions were all wrong"; "it was not altogether her fault"; "an altogether new approach"; "a whole new idea"altogether, completely, entirely, totally, whole, whollycolloquialism - a colloquial expression; characteristic of spoken or written communication that seeks to imitate informal speech

all

pronoun1. the whole amount, everything, the whole, the total, the sum, the total amount, the aggregate, the totality, the sum total, the entirety, the entire amount, the complete amount I'd spent all I had, every last penny.2. every, each, every single, every one of, each and every There is built-in storage space in all bedrooms.3. the whole lot, every one, each and every one All are based on herbal recipes.determiner1. each and every one, each one, every one, the whole lot He was talking to all of us.adjective1. complete, greatest, full, total, perfect, entire, utter In all fairness, she isn't dishonest.adverb1. completely, totally, fully, entirely, absolutely, altogether, wholly, utterly I ran away and left her all alone.all along the whole time, from start to finish I've been fooling myself all along.all in (Informal)1. tired, exhausted, spent, done in (informal), flagging, drained, fatigued, weary, sleepy, fagged (informal), whacked (Brit. informal), worn out, drooping, knackered (slang), drowsy, clapped out (Brit., Austral., & N.Z. informal), enervated, ready to drop, dog-tired (informal), zonked (slang), dead beat (informal), asleep or dead on your feet (informal) Have you eaten? You look all in.2. in total, in all, on aggregate, in sum, in entirety Dinner is about £25 all in.all there (Informal) rational, normal, sane, lucid, of sound mind, compos mentis, in your right mind, mentally sound, in possession of all your faculties They get senile. They're not all there.Related words
prefixes pan-, panto-

all

adjectiveIncluding every constituent or individual:complete, entire, gross, total, whole.nounAn amount or quantity from which nothing is left out or held back:aggregate, entirety, everything, gross, sum, total, totality, whole.Informal: work (used in plural).Idioms: everything but the kitchen sink, lock, stock, and barrel, the whole ball of wax.adverbTo the fullest extent:absolutely, altogether, completely, dead, entirely, flat, fully, just, perfectly, quite, thoroughly, totally, utterly, well, wholly.Informal: clean, clear.Idioms: in toto, through and through.

Translations

大家所有的更加完全十分

all

(oːl) adjective, pronoun1. the whole (of). He ate all the cake; He has spent all of his money.所有的2. every one (of a group) when taken together. They were all present; All men are equal.大家 adverb1. entirely. all alone; dressed all in white. 完全，十分 2. (with the) much; even. Your low pay is all the more reason to find a new job; I feel all the better for a shower.更加ˌall-ˈclear noun (usually with the) a signal or formal statement that a time of danger etc is over. They sounded the all-clear after the air-raid.解除警报ˈall-out adjective using the greatest effort possible. an all-out attempt.竭尽全力的ˈall-round adjective1. including or applying to every part, person, thing etc. an all-round pay rise.全面的2. good at all parts of a subject etc. an all-round sportsman.全能的ˌall-ˈrounder noun a person who is good at many kinds of work, sport etc. 全能的人all-terrain vehicle (ˌoːl təˈrein ˈviːəkl) noun (also ATV) a small vehicle, looking like a small tractor, that can travel fast on rough ground. 全地型车辆all along the whole time (that something was happening). I knew the answer all along.始终all at once1. all at the same time. Don't eat those cakes all at once!同时2. suddenly. All at once the light went out.突然all in with everything included. Is that the price all in?包括一切的all in all considering everything. We haven't done badly, all in all.总的说来all over1. over the whole of (a person, thing etc). My car is dirty all over.整个2. finished. The excitement's all over now.全部结束3. everywhere. We've been looking all over for you!到处all right1. unhurt; not ill or in difficulties etc. You look ill. Are you all right? 好，平安无恙，不要紧 2. an expression of agreement to do something. `Will you come?' `Oh, all right.'可以in all in total, when everything is added up. I spent three hours in all waiting for buses last week.总计

Write all right (not alright).

all

→

All one word

All lower case

Are you all right? (US)
Are you alright? (UK)

All through June (US)
For the whole of June (UK)

All together, please

ALL

leukemia

[loo-ke´me-ah] a progressive, malignant neoplasm of the blood-forming organs, marked by diffuse replacement of the bone marrow development of leukocytes and their precursors in the blood and bone marrow. It is accompanied by a reduced number of erythrocytes and blood platelets, resulting in anemia and increased susceptibility to infection and hemorrhage. Other typical symptoms include fever, pain in the joints and bones, and swelling of the lymph nodes, spleen, and liver. adj., adj leuke´mic.Types of Leukemia. Leukemia is classified clinically in several ways: (1) acute versus chronic, terms that have become altered from their usual meanings and refer to the degree of cell differentiation; (2) the predominant proliferating cells: myelocytic, granulocytic, or lymphocytic; and (3) increase in or maintenance of the number of abnormal cells in the blood—preleukemic.
Acute leukemia is characterized by fatigue, headache, sore throat, and dyspnea, followed by symptoms of acute tonsillitis, stomatitis, bleeding from the mucous membranes of the mouth, alimentary canal, and rectum, and pain in the bones and joints. There eventually is enlargement of the lymph nodes, liver, and spleen. Common to all leukemias are the tendency to bleed and the resultant anemia and increased susceptibility to infection. The diagnosis of leukemia requires confirmation of leukemic cells in the bone marrow by bone marrow biopsy and aspiration. Abnormalities may also be seen in peripheral blood smears.Treatment. The treatment of choice is systemic combination chemotherapy with a variety of antineoplastic drug regimens. The disease can also be treated by a bone marrow transplant after a remission is achieved with chemotherapy.Patient Care. Leukemia affects almost every system within the body and can present a variety of patient care problems. Of primary concern are those symptoms attendant to suppression of normal bone marrow function, particularly susceptibility to infection due to the predominance of immature and abnormally functioning white blood cells, bleeding tendency owing to decreased platelet count, and anemia due to decreased erythrocyte count. Chronic abnormal tissue perfusion, increased need for rest, and decreased sensitivity to heat and cold require careful planning and intervention. Additionally, the patient will need relief from pain and discomfort arising from enlargement of the lymph nodes and distention of the liver and spleen.
Because of the malignant nature of leukemia and the fear and anxiety created by the knowledge that one has a form of cancer, patients and their families and significant others will need help in coping with anxiety, mental depression, and realistic fears about dying and death. The financial burden of the illness and disruption of the life of the individual and the family also impose a special burden on them. Referral to appropriate persons and agencies that can help meet their needs is an essential part of the holistic care of the patient with leukemia.acute leukemia leukemia in which the involved cell line shows little or no differentiation, usually consisting of blast cells; two types are distinguished, acute lymphoblastic leukemia and acute myelogenous leukemia.acute granulocytic leukemia acute myelogenous leukemia.acute lymphoblastic leukemia (ALL) (acute lymphocytic leukemia) acute leukemia of the lymphoblastic type, one of the two major categories of acute leukemia, primarily affecting young children. Symptoms include anemia, fatigue, weight loss, easy bruising, thrombocytopenia, granulocytopenia with bacterial infections, bone pain, lymphadenopathy, hepatosplenomegaly, and sometimes spread to the central nervous system (meningism) or to other organs. There are three major subtypes: The pre–B-cell is the most common, consisting of small uniform lymphoblasts that do not synthesize complete functional immunoglobulins" >immunoglobulins or synthesize heavy chains only. The B-cell type is rare and consists of lymphoblasts that express surface immunoglobulins and have a surface translocation similar to that of lymphoma" >Burkitt's lymphoma. The T-cell type has cells that express surface antigens characteristic of T cells.acute megakaryoblastic leukemia (acute megakaryocytic leukemia) a form of acute myelogenous leukemia in which megakaryocytes" >megakaryocytes are predominant and platelets are increased in the blood, often with fibrosis; it can occur at any age. Called also megakaryoblastic or megakaryocytic leukemia.acute monocytic leukemia an uncommon form of acute myelogenous leukemia in which the predominating cells are identified as monocytes" >monocytes; a few myelocytes" >myelocytes may also be present. It can affect any age group. Called also monocytic leukemia.acute myeloblastic leukemia 1. a common kind of acute myelogenous leukemia, in which myeloblasts" >myeloblasts predominate; it usually occurs in infants and middle-aged to older adults. Two types are distinguished; those that have minimal cell differentiation or maturation and those that have more advanced differentiation. Called also myeloblastic leukemia and acute myeloid leukemia.2. acute myelogenous leukemia.acute myelocytic leukemia acute myelogenous leukemia.acute myelogenous leukemia (AML) acute leukemia of the myelogenous type, one of the two major categories of acute leukemia; most types affect primarily middle-aged to elderly people. Symptoms include anemia, fatigue, weight loss, easy bruising, thrombocytopenia, and granulocytopenia that leads to persistent bacterial infections. Several types are distinguished, named according to the stage in which abnormal proliferation begins: acute undifferentiated l., acute myeloblastic l., acute promyelocytic l., acute myelomonocytic l., acute monocytic l., acute erythroleukemia, and acute megakaryocytic l. Called also acute myelocytic l. and acute nonlymphocytic l.acute myeloid leukemia 1. acute myeloblastic leukemia (def. 1).2. acute myelogenous leukemia.acute myelomonocytic leukemia one of the more common types of acute myelogenous leukemia, characterized by both malignant monocytes and myeloblasts; it usually affects middle aged to older adults. See also chronic myelomonocytic leukemia. Called also myelomonocytic or Naegeli's leukemia.acute nonlymphocytic leukemia acute myelogenous leukemia.acute promyelocytic leukemia acute myelogenous leukemia in which more than half the cells are malignant promyelocytes" >promyelocytes, often associated with abnormal bleeding secondary to thrombocytopenia, hypofibrinogenemia, and decreased levels of coagulation factor V; it usually occurs in young adults. Called also promyelocytic leukemia.acute undifferentiated leukemia acute myelogenous leukemia in which the predominating cell is so immature and primitive that it cannot be classified. Called also stem cell leukemia and undifferentiated cell leukemia.adult T-cell leukemia (adult T-cell leukemia/lymphoma) a form of leukemia with onset in adulthood, leukemic cells with T-cell properties, frequent dermal involvement, lymphadenopathy and hepatosplenomegaly, and a subacute or chronic course; it is associated with human T-cell leukemia-lymphoma virus.aleukemic leukemia leukemia in which the leukocyte count is normal or below normal; it may be lymphocytic, monocytic, or myelocytic.basophilic leukemia a rare type of leukemia in which basophils" >basophils predominate; both acute and chronic varieties have been observed.blast cell leukemia acute undifferentiated leukemia.chronic leukemia leukemia in which the involved cell line is well-differentiated, usually lymphocytes" >B-lymphocytes, but immunologically incompetent; types distinguished include chronic granulocytic, chronic lymphocytic, chronic myelomonocytic, eosinophilic, and hairy cell leukemia.chronic granulocytic leukemia chronic leukemia of the myelogenous type, occurring mainly between the age of 25 and 60, usually associated with a unique chromosomal abnormality. The major clinical manifestations of malaise, hepatosplenomegaly, anemia, and leukocytosis are related to abnormal, excessive, unrestrained overgrowth of granulocytes" >granulocytes in the bone marrow. Called also chronic myelocytic or chronic myeloid leukemia.chronic lymphocytic leukemia chronic leukemia of the lymphoblastic type, a common form mainly seen in the elderly; symptoms include lymphadenopathy, fatigue, renal involvement, and pulmonary leukemic infiltrates. Circulating malignant cells are usually differentiated lymphocytes" >B-lymphocytes; a minority of cases have mixed T and B lymphocytes or entirely lymphocytes" >T-lymphocytes.chronic myelocytic leukemia (chronic myelogenous leukemia,) (chronic myeloid leukemia) chronic granulocytic leukemia.chronic myelomonocytic leukemia a slowly progressing form of chronic leukemia that usually affects the elderly and sometimes progresses to acute myelomonocytic leukemia. Symptoms include splenomegaly, monocytosis with granulocytosis, and thrombocytopenia.leukemia cu´tis leukemia with leukocytic invasion of the skin marked by pink, reddish brown, or purple macules, papules, and tumors.eosinophilic leukemia a form of leukemia in which the eosinophil" >eosinophil is the predominating cell. Although resembling chronic granulocytic leukemia in many ways, this form may follow an acute course despite the absence of predominantly blast forms in the peripheral blood.granulocytic leukemia myelogenous leukemia.hairy cell leukemia a form of chronic leukemia marked by splenomegaly and by an abundance of abnormal large mononuclear cells covered by hairlike villi (hairy cells) in the bone marrow, spleen, liver, and peripheral blood. Called also leukemic reticuloendotheliosis.leukopenic leukemia aleukemic leukemia.lymphatic leukemia (lymphoblastic leukemia) leukemia associated with hyperplasia and overactivity of the lymphoid tissue; there are increased numbers of circulating malignant lymphocytes and lymphoblasts. See also acute lymphoblastic leukemia and chronic lymphocytic leukemia.lymphocytic leukemia (lymphogenous leukemia) (lymphoid leukemia) lymphoblastic leukemia.lymphosarcoma cell leukemia the B-cell type of acute lymphoblastic leukemia.mast cell leukemia a rare type marked by overwhelming numbers of tissue mast cells in the peripheral blood.megakaryoblastic leukemia acute megakaryocytic leukemia.megakaryocytic leukemia 1. hemorrhagic thrombocythemia.2. acute megakaryocytic leukemia.micromyeloblastic leukemia a form of myelogenous leukemia in which the immature, nucleoli-containing cells are small and are distinguishable from lymphocytes only by special staining.monocytic leukemia acute monocytic leukemia.myeloblastic leukemia 1. myelogenous leukemia.2. acute myeloblastic leukemia.myelocytic leukemia (myelogenous leukemia) (myeloid granulocytic leukemia) a form arising from myeloid tissue in which leukocytes" >polymorphonuclear leukocytes and their precursors predominate.myelomonocytic leukemia (Naegeli's leukemia) acute myelomonocytic leukemia.plasma cell leukemia (plasmacytic leukemia) a rare type in which the predominating cell in the peripheral blood is the plasma cell; it is often seen in asociation with multiple myeloma" >multiple myeloma.prolymphocytic leukemia a type of chronic leukemia marked by large numbers of circulating lymphocytes, predominantly prolymphocytes, with massive splenomegaly and occasionally lymphadenopathy; prognosis is often poor.promyelocytic leukemia acute promyelocytic leukemia.Rieder cell leukemia a form of acute myelogenous leukemia in which the blood contains the abnormal cells called lymphocytes" >Rieder's lymphocytes, asynchronously developed lymphocytes that have immature cytoplasm and a lobulated, indented, comparatively more mature nucleus.stem cell leukemia acute undifferentiated leukemia.subleukemic leukemia aleukemic leukemia.undifferentiated leukemia acute undifferentiated leukemia.

ALL

Abbreviation for acute lymphocytic leukemia.

ALL

abbr.1. acute lymphoblastic leukemia2. antilymphocyte serum

acute lymphoblastic leukaemia

A malignant lymphoproliferative process, which commonly affects children and young adults, affecting ± 1800/year (US); ± 650/year (UK).
Aetiology
ALL has a hereditary component; it is 20-fold increased in patients with Down syndrome; it is linked to benzene exposure, radiation therapy in ankylosing spondylitis.

Clinical findings
Abrupt onset, often ± 3-month history of fatigue, fever, haemorrhage from multiple sites, lymphadenopathy, hepatomegaly, splenomegaly.

Molecular pathology
Most are B cells and express CD19; 60% have karyotypic abnormalities; the most common cytogenetic abnormality is the cryptic t(12;21) translocation, resulting in TEL-AML fusion (25% of cases), followed by the t(1;19)(q23;p13.3) translocation, seen in 5% of cases.

Prognosis
90–95% achieve remission; improved cure rate is attributed to prophylaxis for meningeal leukaemia and more intense systemic chemotherapy. The current survival ranges from 20% to 75%.
FAB classification, acute leukaemias
Acute lymphocytic leukaemia (ALL)
L1—Small monotonous lymphocytes.
L2—Mixed L1- and L3-type lymphocytes.
L3—Large homogeneous blast cells.

ALL

1. Acute lymphocytic leukemia, see there.2. Allergy.

ALL

Abbreviation for acute lymphocytic leukemia.

leukemia

, leucemia (loo-ke'me-a) [ leuko- + -emia] Any of a class of hematological malignancies of bone marrow cells in which immortal clones of immature blood cells multiply at the expense of normal blood cells. As normal blood cells are depleted from the body, anemia, infection, hemorrhage, or death result. The leukemias are categorized as chronic or acute; by the cell type from which they originate; and by the genetic, chromosomal, or growth factor aberration present in the malignant cells.

Chronic leukemias, which have a relatively slow course, include chronic lymphocytic (CLL), chronic myelogenous or granulocytic (CML), and hairy cell leukemia (a subtype of CLL). Median survival in these illnesses is about 4 yr.

Acute leukemias include acute lymphocytic (ALL) and acute myeloid (myelogenous) (AML) leukemia. If untreated, these diseases are fatal within weeks or months. Each of these types of leukemia is discussed in subentries, below.

Etiology

All the different molecular events leading to the development of unchecked cellular reproduction in the leukemias result from genetic or chromosomal lesions in blood-forming cells. Duplications of genetic material (hyperdiploidy), loss of genetic information (hypodiploidy), inactivation of genes that normally suppress tumor development, chromosomal translocations, and the release of abnormal fusion proteins can all cause leukemia. These genetic lesions in turn can be produced by viruses, ionizing radiation, chemotherapeutic drugs, and toxic chemicals. Rarely, leukemias are caused by familial genetic syndromes (e.g., as ataxia telangiectasia, Bloom's syndrome, or Fanconi's syndrome).

Symptoms

Clinical findings such as anemia, fatigue, lethargy, fever, and bone and joint pain may be present. Physical findings include combinations of pallor, petechiae, or purpura; mucous membrane bleeding; enlarged liver, spleen, and kidneys; and tenderness over the sternum and other bones.

Diagnosis

Microscopic examination of peripheral blood and specimens of bone marrow are used to establish the diagnosis. These studies are followed by cytochemical and cytogenetic studies of abnormal cells found in the marrow or the peripheral blood to confirm the diagnosis with special stains and chromosomal analysis. Leukemic cells can also be identified by flow cytometry and immunocytochemistry, which rely on antibodies binding to and helping to identify malignant cells. The spread of leukemias to internal organs (e.g., the brain, the kidneys, or the lungs) may be evaluated with imaging tests (e.g., MRI studies, CT scans, or ultrasound).

Treatment

Chemotherapy, bone marrow transplantation, or both are used to treat leukemias. Regimens are devised regularly and are tailored to specific illnesses. Treatment is often given in several phases, with a period of induction chemotherapy to induce remission by completely eliminating leukemic cells from the bone marrow, followed by consolidation and maintenance phases. This multiphase treatment is designed to further deplete malignant cells from the bone marrow and to achieve complete cure.

Patient care

Patient care measures focus on eradicating the illness; managing complications; minimizing the effects of chemotherapy; preserving veins (often an indwelling port is inserted to administer chemotherapy); and providing comfort, education, and psychological support. The specific needs of patients (many of whom are children) and their families must be considered. Instruction is provided about drugs the patient will receive, including any adverse reactions and measures that will be taken to prevent or alleviate these effects. Prescribed chemotherapy is administered with special precautions when indicated for infusion and drug disposal. If the chemotherapy causes weight loss or anorexia, nutritional guidance is provided. Oral, skin, and rectal care must be meticulous, e.g., the nurse must thoroughly clean the skin before all invasive procedures, inspect the patient for perirectal erosions, use strict aseptic technique when starting an intravenous line, and change sets (i.e., intravenous tubing and associated equipment) according to chemotherapeutic protocols. Ports are irrigated according to agency protocol. If the patient is receiving intrathecal chemotherapy, the lumbar puncture site is checked frequently for bleeding or oozing. The patient and family are taught to recognize signs of infection (fevers, chills, sore throat, cough, urinary difficulties) and are urged to report these to the oncologist/hematologist promptly. To prevent infection in neutropenic patients, strict hand hygiene protocols, special diets, and (in hospitalized patients) laminar airflow or other reverse isolation measures are instituted. The patient is monitored for bleeding. If bleeding occurs, compresses are applied and the bleeding site is elevated. Transfusions of platelets and other blood cells are often needed. Complications associated with specific chemotherapeutic regimens (e.g., hair loss, nausea and vomiting, anemia, neutropenia, and low platelets) are explained to the patient, along with management strategies that will be employed. Prescribed analgesics are administered as needed, and noninvasive pain relief techniques and comfort measures (e.g., position changes, cutaneous stimulation, distraction, relaxation breathing, and imagery) may be used. Gentle oral hygiene measures and protective skin care are explained. Fluid intake should be increased to eliminate chemotherapy metabolites, and the patient advised to void more frequently to prevent cystitis. Dietary fiber is important, and stool softeners may be used to ensure normal bowel movements. Antidiarrheals usually control diarrhea, but the patient should be monitored for signs of dehydration. Fatigue is an anticipated adverse effect of treatment; therefore the patient is encouraged to alternate activity with rest periods and to obtain assistance with daily activities as necessary. Reproductive issues should be discussed with the patient. Patient care routines and visiting times should be flexible when hospitalization is required. The patient and family are encouraged to participate in care as much as possible. Referrals are made to social service agencies, home health care agencies, and support groups. If the patient does not respond to treatment and has reached the terminal phase of the disease, supportive nursing, palliative care, or hospice care should be discussed sensitively with patients and their caregivers.

acute lymphoblastic leukemia

Acute lymphocytic leukemia.

ACUTE LYMPHOCYTIC LEUKEMIA: Peripheral blood smear

acute lymphocytic leukemia

Abbreviation: ALL
A hematological malignancy marked by the unchecked multiplication of immature lymphoid cells in the bone marrow, blood, and body tissues. In 2008 the American Cancer Society estimated about 5400 Americans would be diagnosed with ALL. It is rapidly fatal if left untreated. Synonym: acute lymphoblastic l. See: illustration; leukemia

Etiology

Any of a wide range of acquired or congenital chromosomal abnormalities can cause ALL, including lesions that result in the release of excess growth factors from cells and those that cause the loss of cancer-suppressing genes.

Symptoms

Fatigue, lethargy, bleeding, bone and joint pain, and a predisposition to fever and infection are characteristic of ALL and other leukemias.

Diagnosis

The disease is suggested by the presence of abnormalities on the complete blood count or peripheral blood smear and is confirmed by immunophenotyping.

Treatment

In childhood, ALL induction chemotherapy often begins with steroids, vinca alkaloids, and asparaginase. This is followed, after bone marrow recovery, by consolidation chemotherapy with multidrug regimens, including high-dose methotrexate. Maintenance therapies, which may last 2 years or longer, include methotrexate, mercaptopurines, and other cytotoxic agents. Prophylaxis against central nervous system disease is accomplished by intrathecal drug administration. In referral hospitals, allogeneic stem cell transplantation is sometimes used for refractory disease. About 90% of treated children achieve remission. The 5-year survival of children with ALL is about 85%. Adult ALL is much less responsive to therapy; only about a third of adult patients are cured. In both childhood and adult ALL, allopurinol and hydration precede induction chemotherapy to prevent hyperuricemia caused by tumor lysis.

Prognosis

Late complications of therapy are not uncommon.

acute myelogenous leukemia

Abbreviation: AML
Acute myeloid leukemia.

acute myeloid leukemia

Abbreviation: AML
Any of a group of hematological malignancies in which neoplastic cells develop from myeloid, monocytic, erythrocytic, or megakaryocytic precursors. AML is four times more common in adults than acute lymphocytic leukemia (ALL). In 2008, the American Cancer Society estimated about 13,300 Americans would be diagnosed with AML, and that the disease would cause 8,800 deaths. It occasionally follows a myelodysplastic disorder or aplastic anemia and sometimes occurs as a consequence of a familial disorder of fragile chromosomes (e.g., Fanconi's syndrome).

All forms of AML are marked by neoplastic replacement of normal bone marrow and circulation of immature cells (“blasts”) in the peripheral blood. Anemia and thrombocytopenia commonly occur. The central nervous system and other organs are occasionally invaded. Complete remissions occur in approximately 65% of treated patients; responses to treatment lasting 5 years are achieved in 15% to 25% of treated patients. Synonym: acute myelogenous l.; acute nonlymphocytic l.

Etiology

Genetic and chromosomal aberrations, such as are found in other leukemias, are characteristic.

Symptoms

Exertional fatigue as a result of anemia, bleeding due to thrombocytopenia, and infections due to a lack of normal white blood cells are common.

Treatment

Cytotoxic chemotherapies, with an induction phase followed by consolidation, are used. Typically, cytosine arabinoside and an anthracycline are used during induction for AML. Allogeneic bone marrow transplantation is used when a matching donor is available; stem cell transplantation is an option for some patients with specific cytogenetic abnormalities.

acute nonlymphocytic leukemia

Abbreviation: ANLL
Acute myeloid leukemia.

aleukemic leukemia

Leukemia cutis.

CHRONIC LYMPHOCYTIC LEUKEMIA: Peripheral blood smear

chronic lymphocytic leukemia

Abbreviation: CLL
A malignancy in which abnormal lymphocytes (usually B cells) proliferate and infiltrate body tissues, often causing lymph node enlargement and immune dysfunction. Infectious complications are common. Median life expectancy is about 4 years. Chronic lymphocytic leukemia is the most common leukemia in industrialized nations. It usually occurs in people (older men) above age 60. Its incidence rises to 20 cases per 100,000 in people over 80. In 2008 the American Cancer Society estimated that 15,100 people would be diagnosed with CLL and that 4,400 would die of the disease. The timing of treatment and the prognosis in CLL depend on the stage of the disease. Staging includes such factors as the number of abnormal lymphocytes in the bloodstream, how quickly they double, and the presence of lymphadenopathy, organomegaly, or cytopenias. See: illustration

Treatment

Patients with advanced stages of the illness are often treated with chlorambucil, fludarabine, or other cytotoxic agents, often with rituximab (a monoclonal antibody) added to enhance response. Patients with early-stage disease are not usually given therapy.

chronic myelogenous leukemia

Abbreviation: CML
Chronic myeloid leukemia.

chronic myeloid leukemia

Abbreviation: CML
A hematological malignancy marked by a sustained increase in the number of granulocytes, splenic enlargement, and a specific cytogenetic anomaly (the “Philadelphia chromosome”) in the bone marrow of more than 90% of patients. The disease affects one or two people per 100,000. In 2008 the American Cancer Society estimated that 4830 people would be diagnosed with CML and that 450 would die of the disease. The course of the disease has three phases: a chronic one in which blood counts are relatively easy to control with medications; an accelerated phase in which granulocyte counts become more resistant to chemotherapy; and a “blast” crisis, which resembles acute leukemia. Median survival is about 4 years. It generally occurs between ages 40 and 50, affecting slightly more men than women (4600 adults in the U.S. in 2005). Synonym: chronic myelogenous l See: leukemia

Etiology

CML results from a translocation of genetic material between chromosomes 9 and 22. The translocation results in the production of an abnormal tyrosine kinase that makes affected cells immortal.

Symptoms

CML often is diagnosed in asymptomatic patients who are found to have an unexplained leukocytosis when their complete blood counts are checked. Subsequent evaluation, including bone marrow aspiration and biopsy with cytogenetic analysis, reveal the Philadelphia chromosome.

Treatment

Imatinib mesylate (a drug that blocks an abnormal kinase made by Philadelphia chromosome positive CML cells) effectively reduces the number of tumor cells in the chronic phase of CML to normal in nearly 90% of patients. An alternative is stem cell transplantation.

leukemia cutis

An invasion of the dermis and subcutaneous fat by leukemic cells. The invasion often happens before these cells proliferate in the bone marrow or are detectable in the peripheral blood. The cells may cause several different types of skin rashes, including blue nodules (giving the skin a “blueberry muffin” appearance), papules, plaques, and ulcers. Synonym: aleukemic l

HAIRY CELL LEUKEMIA: Bone marrow aspirate

LYMPHOCYTES IN HAIRY CELL LEUKEMIA

hairy cell leukemia

Abbreviation: HCL
A chronic, low-grade hematological malignancy of abnormally shaped B lymphocytes (“hairy cells”). The disease is marked by pancytopenia and splenomegaly. Median survival in untreated patients is about 5 years. The disease is rare, being only 1% to 2% of all leukemias. The median age of patients is 50 years; men are affected more commonly than women by a 4-to-1 ratio. See: illustration

Symptoms

Weight loss, hypermetabolism, infectious complications, and abdominal discomfort due to splenic enlargement are common.

Treatment

Cladribine, pentostatin, interferon alfa, and rituximab (a monoclonal antibody) are representative chemotherapeutic options.

illustration

mixed-lineage leukemia

Abbreviation: MLL
An aggressive, primarily childhood leukemia caused by the translocation of a gene from chromosome 11 to a region that overproduces fusion proteins.

ACUTE LYMPHOCYTIC LEUKEMIA: Peripheral blood smear

acute lymphocytic leukemia

Abbreviation: ALL
A hematological malignancy marked by the unchecked multiplication of immature lymphoid cells in the bone marrow, blood, and body tissues. In 2008 the American Cancer Society estimated about 5400 Americans would be diagnosed with ALL. It is rapidly fatal if left untreated. Synonym: acute lymphoblastic l. See: illustration; leukemia

Etiology

Symptoms

Fatigue, lethargy, bleeding, bone and joint pain, and a predisposition to fever and infection are characteristic of ALL and other leukemias.

Diagnosis

The disease is suggested by the presence of abnormalities on the complete blood count or peripheral blood smear and is confirmed by immunophenotyping.

Treatment

Prognosis

Late complications of therapy are not uncommon.

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leukemia

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acute lymphoblastic leukaemia

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leukemia

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acute lymphoblastic leukemia

acute lymphocytic leukemia

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acute myelogenous leukemia

acute myeloid leukemia

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acute nonlymphocytic leukemia

aleukemic leukemia

chronic lymphocytic leukemia

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chronic myelogenous leukemia

chronic myeloid leukemia

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Treatment

leukemia cutis

hairy cell leukemia

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mixed-lineage leukemia

acute lymphocytic leukemia

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