Description

Acute lymphocytic leukemia (ALL) is a type of cancer of the blood and bone marrow, the spongy tissue inside bones where blood cells are made.

The word "acute" in acute lymphocytic leukemia comes from the fact that the disease progresses rapidly and creates immature blood cells, rather than mature ones. The word "lymphocytic" in acute lymphocytic leukemia refers to the white blood cells, called lymphocytes, which ALL affects. Acute lymphocytic leukemia is also known as acute lymphoblastic leukemia.

Acute lymphocytic leukemia is the most common type of cancer in children, and treatments result in a good chance of cure. Acute lymphocytic leukemia can also occur in adults, although the probability of cure is very low.

Symptoms

The signs and symptoms of acute lymphocytic leukemia may include:

  • Bleeding gums
  • Pain in the bones
  • Fever
  • Frequent infections
  • Frequent or severe nosebleeds
  • Bumps caused by inflammation of the lymph nodes in and around the neck, armpits, abdomen, or groin
  • Pale skin
  • Shortness of breath
  • Weakness, fatigue, or a general decrease of the energy

When to see a doctor

Make an appointment with your doctor or your child's doctor if you notice any persistent signs and symptoms that worry you.

Many of the signs and symptoms of acute lymphocytic leukemia mimic those of the flu. However, influenza signs and symptoms eventually improve. If signs and symptoms do not improve as expected, make an appointment with your doctor.

Causes

Acute lymphocytic leukemia occurs when the bone marrow cells develop changes (mutations) in their genetic material, or DNA. A cell's DNA contains the instructions that tell a cell what to do. Typically, the DNA tells the cell to grow at a set rate and to die at a set time. In acute lymphocytic leukemia, mutations tell the bone marrow cells to continue to grow and divide.

When this happens, the production of blood cells becomes out of control. The bone marrow produces immature cells that develop into leukemic white blood cells called lymphoblasts. These abnormal cells are not able to function properly, and can build up and crowd out healthy cells.

It is not clear what causes mutations in the DNA that may lead to acute lymphocytic leukemia.

Risk factors

Factors that may increase the risk of acute lymphocytic leukemia include:

  • Previous cancer treatment. Children and adults who have had certain types of chemotherapy and radiation therapy for other types of cancer may have an increased risk of developing acute lymphocytic leukemia.
  • The exposure to radiation. People exposed to very high levels of radiation, such as survivors of a nuclear reactor accident, have a higher risk of developing acute lymphocytic leukemia.
  • Genetic disorders. Certain genetic disorders, such as Down syndrome, are associated with an increased risk of acute lymphocytic leukemia.

Diagnosis

Tests and procedures used to diagnose acute lymphocytic leukemia include:

  • Blood tests. Blood tests may reveal too many or too few white blood cells, not enough red blood cells and not enough platelets. A blood test may also show the presence of blast cells — immature cells normally found in the bone marrow.
  • Examination of bone marrow.During the bone marrow aspiration and biopsy, a needle is used to remove a sample of bone marrow from the hip bone or the sternum. The sample is sent to a laboratory to look for leukemia cells. Doctors in the laboratory to classify blood cells into specific types based on their size, shape, and other genetic or molecular characteristics. You can also see some changes in the cancer cells and to determine if leukemia cells are initiated from B lymphocytes or t lymphocytes. This information will help your doctor develop a treatment plan.
  • Imaging tests. Imaging tests such as a chest x-ray, computed tomography (CT) or ultrasound can help determine if the cancer has spread to the brain and the spinal cord, or other parts of the body.
  • The spinal fluid of the test. A lumbar puncture test, also called a spinal tap, can be used to collect a sample of cerebrospinal fluid (the fluid that surrounds the brain and the spinal cord. The sample is checked to see if cancer cells have spread to the cerebrospinal fluid.

Examination of bone marrow. During the bone marrow aspiration and biopsy, a needle is used to remove a sample of bone marrow from the hip bone or the sternum. The sample is sent to a laboratory to look for leukemia cells.

Doctors in the laboratory to classify blood cells into specific types based on their size, shape, and other genetic or molecular characteristics. You can also see some changes in the cancer cells and to determine if leukemia cells are initiated from B lymphocytes or t lymphocytes. This information will help your doctor develop a treatment plan.

Determine your prognosis

Your doctor uses the information obtained from these tests and procedures to determine the prognosis and to decide on their treatment options. Other types of cancer of the use of numerical stages to indicate how far the cancer has spread, but there are no stages of acute lymphocytic leukemia.

In its place, the seriousness of their condition is determined by:

  • The type of lymphocytes involved — B cells or T cells
  • The specific genetic changes present in their leukemia cells
  • Age
  • The results of laboratory tests, such as the number of white blood cells was detected in a blood sample

Treatment

In general, the treatment for acute lymphocytic leukemia falls in different phases:

  • The induction therapy. The purpose of the first phase of treatment is to kill the majority of leukemia cells in the blood and the bone marrow and restore normal production of blood cells.
  • Consolidation therapy. Also called post-remission therapy, this phase of treatment is aimed at the destruction of any remaining leukemia in the body.
  • The maintenance therapy. The third phase of treatment prevents leukemia cells from renewables. The treatments used in this stage are usually given in much lower doses over a long period of time, often years.
  • The preventive treatment of the spinal cord. During each phase of the therapy, people with acute lymphocytic leukemia may receive additional treatment to kill the leukemia cells found in the central nervous system. In this type of treatment, chemotherapy drugs are often injected directly into the fluid that covers the spinal cord.

Depending on your situation, the phases of treatment for acute lymphocytic leukemia may span of two to three years.

Treatments may include:

  • Chemotherapy. Chemotherapy, the use of drugs to kill cancer cells, is typically used as an induction therapy for children and adults with acute lymphocytic leukemia. Chemotherapy drugs can also be used in the consolidation and maintenance phases.
  • The targeted therapy. Targeted drug treatments focus on specific abnormalities present within cancer cells. By blocking these abnormalities, targeted drug treatments can cause cancer cells to die. Their leukemia cells will be tested to see if the targeted therapy may be useful to you. Targeted therapy may be used alone or in combination with chemotherapy for induction therapy, consolidation therapy or maintenance therapy.
  • The radiation therapy. Radiation therapy uses high-powered beams, such as X-rays or protons, to kill cancer cells. If the cancer cells have spread within the central nervous system, your doctor may recommend radiation therapy.
  • Bone marrow transplant.A bone marrow transplant, also known as stem cell transplant, can be used as consolidation therapy or for the treatment of relapse if it occurs. This procedure allows someone with leukemia to restore healthy bone marrow by the substitution of leukemic bone marrow with leukemia free of the marrow of a healthy person. A bone marrow transplant begins with high doses of chemotherapy or radiation therapy to kill any leukemia-the production of the bone marrow. The marrow is replaced by the bone marrow from a compatible donor (allogeneic transplant).
  • Engineering of cells of the immune system to fight against leukemia.A specialized treatment called chimeric antigen receptor (CAR)-T cell therapy takes your body the seed of the fight against T-cells, the engineers of them to fight against the cancer and infused into the body. CAR-T cell therapy could be an option for children and young adults. It can be used for consolidation therapy or for the treatment of relapse.
  • Clinical trials. Clinical trials are experiments to test new treatments for cancer and new ways of using existing treatments. While the clinical trials give you or your child with an opportunity to test the new developments in the treatment of cancer, the benefits and risks of treatment can be uncertain. Discuss the benefits and risks of clinical trials with their physician.

Bone marrow transplant. A bone marrow transplant, also known as stem cell transplant, can be used as consolidation therapy or for the treatment of relapse if it occurs. This procedure allows someone with leukemia to restore healthy bone marrow by the substitution of leukemic bone marrow with leukemia free of the marrow of a healthy person.

A bone marrow transplant begins with high doses of chemotherapy or radiation therapy to kill any leukemia-the production of the bone marrow. The marrow is replaced by the bone marrow from a compatible donor (allogeneic transplant).

Engineering of cells of the immune system to fight against leukemia. A specialized treatment called chimeric antigen receptor (CAR)-T cell therapy takes your body the seed of the fight against T-cells, the engineers of them to fight against the cancer and infused into the body.

CAR -T cell therapy could be an option for children and young adults. It can be used for consolidation therapy or for the treatment of relapse.

The treatment for older adults

Older adults, such as those older than 65 years, tend to experience more complications of the treatments. And older adults generally have a worse prognosis than children receiving treatment for acute lymphocytic leukemia.

Discuss your options with your doctor. Based on your general state of health and their goals and preferences, you can decide to undergo treatment for leukemia.

Some people may choose to forego treatment for the cancer, instead of focusing on treatments that improve your symptoms and help you make the most of the time you have left.

Alternative medicine

There are No alternative treatments have been shown to cure acute lymphocytic leukemia. But some alternative treatments may help relieve the side effects of cancer treatment and make you or your child more comfortable. Discuss your options with your doctor, as some alternative treatments that could interfere with cancer treatments, such as chemotherapy.

Alternative treatments that can relieve the symptoms, which include:

  • Acupuncture
  • Exercise
  • Massage
  • Meditation
  • Relaxation activities such as yoga and tai chi

Coping and support

The treatment for acute lymphocytic leukemia may be a long way. Often, the treatment lasts from two to three years, although the first few months are the most intense.

During the maintenance phase, the children can usually lead a relatively normal life and return to the school. And the adults may be able to continue working. To help deal with the situation, try the following:

  • Learn enough about the leukemia feel comfortable making treatment decisions.Ask your doctor to write down as much information about your specific condition as possible. To restrict your search for information as appropriate. Write down the questions you want to ask your doctor prior to each appointment, and searching for information in the local library and on the internet. Good sources include the National Cancer Institute, the American Cancer Society, and the Leukemia and Lymphoma Society.
  • Lean on all of your health care team. In major medical centers and the centers of pediatric cancer, your health care team may include psychologists, psychiatrists, recreation therapists, child life workers, teachers, dietitians, chaplains and social workers. These professionals can help with a whole range of issues, including explaining the procedures to the children, the search for financial assistance and the organization of the home during the treatment. Do not hesitate to rely on your experience.
  • Explore programs for children with cancer. Major medical centers and non-profit groups offer numerous activities and services specifically for children with cancer and their families. Examples include summer camps, support groups for siblings and the wish-granting programs. Ask your health care team about programs in your area.
  • Help family and friends understand your situation. Set up a free, personalized on the website of the nonprofit web site CaringBridge. This allows you to tell the whole family about the appointments, treatments, setbacks and reasons to celebrate, without the stress of call all around the world every time there's something new to report.

Learn enough about the leukemia feel comfortable making treatment decisions. Ask your doctor to write down as much information about your specific condition as possible. To restrict your search for information as appropriate.

Write down the questions you want to ask your doctor prior to each appointment, and searching for information in the local library and on the internet. Good sources include the National Cancer Institute, the American Cancer Society, and the Leukemia and Lymphoma Society.

Preparing for your appointment

Make an appointment with your family doctor if you or your child has signs and symptoms that worry you. If your doctor suspects an acute lymphocytic leukemia, probably refers to a doctor who specializes in the treatment of diseases and conditions of the blood and bone marrow (hematologist).

Because appointments can be brief, and because there is often a large amount of information to discuss, it is a good idea to be prepared. Here's some information to help you prepare, and what to expect from your doctor.

What you can do

  • Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there is anything that you need to do in advance, such as restrict your diet.
  • Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
  • Write down key personal information, including any major stresses or recent life changes.
  • Make a list of all medications, vitamins or supplements you are taking.
  • Consider the possibility of a family member or friend. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
  • Write questions to ask their doctor.

Your time with your doctor is limited, so preparing a list of questions can help you make the most of their time together. A list of questions from most important to least important in case time runs out. For acute lymphocytic leukemia, some basic questions to ask the doctor include:

  • What is likely the cause of these symptoms?
  • What are other possible causes of these symptoms?
  • What kind of tests are needed?
  • It is this condition likely temporary or chronic?
  • What is the best course of action?
  • What are the alternatives to the primary approach you're suggesting?
  • How can other existing health conditions are best handled with ALL?
  • There are restrictions that must be followed?
  • It is necessary to see a specialist? What will that cost, and will my insurance cover it?
  • Is there a generic alternative to the medicine you're prescribing me?
  • Are there brochures or other printed material that I can take with me? What sites do you recommend?
  • What is going to determine whether I should plan for a follow-up visit?

In addition to the questions that you've prepared to ask your doctor, do not hesitate to ask other questions.

What to expect from your doctor

The doctor will ask a series of questions. Be ready to answer them may allow time to cover other points you want to address. Your doctor may ask:

  • When did symptoms begin?
  • Have these symptoms been continuous or occasional?
  • How severe are your symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?

What you can do in the meantime

Avoid the activity that seems to worsen signs and symptoms. For example, if you or your child feels tired, let it rest more. To determine which of the activities of the day are the most important, and focus on the achievement of the tasks.

Symptoms and treatment of Acute lymphocytic leukemia