ACUTE LYMPHOBLASTIC LEUKEMIA (ALL)
Acute lymphoblastic leukemia is a type of cancer of the blood and bone marrow, the spongy tissue inside bones where blood cells are made.
- This type of leukemia starts from the white blood cells in the bone marrow.
- White blood cells help fight infection and protect the body against disease.
- Acute lymphoblastic leukemia develops from white blood cells called lymphocytes or from lymphoblasts, an immature type of lymphocytes.
- The condition can affect different types of lymphocytes (B-cells or T-cells), and it is divided into subtypes based on the type of lymphocytes involved.
- Most kids have a B-cell subtype.
- Because it is an acute, or aggressive, form of cancer, the disease progresses rapidly and is fatal within weeks or months if left untreated.
- This type of cancer is the most common childhood cancer, particularly those between the ages of two and five, and treatment results in a good chance for a cure.
- It can also occur in adults, though the chance of a cure is greatly reduced.
- In 2015, it affected about 876,000 people globally resulting in about 111,000 deaths.
CAUSES
The cause of the condition is not known. It is believed that ALL occurs when something triggers a genetic mutation within the cells in the bone marrow. These cause healthy cells to multiply rapidly and divide when it would normally stop dividing and eventually die. When this happens, blood cells production becomes abnormal, and these abnormal cells are unable to function properly. Eventually, they can build up and crowd out healthy cells.
Risk factors for the condition may include:
- Certain genetic disorders such as Down syndrome, Li-Fraumeni Syndrome, neurofibromatosis.
- Prolonged exposure to certain chemicals such as benzene, chemotherapy drugs, detergents, paint strippers
- Being male
- Prolonged exposure to high levels of radiation to treat other types of cancer
- Infection with T-cell leukemia virus-1 (HTLV-1)
- Epstein-Barr virus (EBV)
- A family history of the condition especially having a sibling, including a twin with the condition
SYMPTOMS
- Bone and joint pain
- fever
- shortness of breath
- night sweats
- fatigue
- bleeding from the gums
- pale skin color
- easy bleeding or bruising
- enlarged lymph nodes
- frequent infections
- testicular enlargement
- weight loss or loss of appetite
- dizziness
- enlarged liver or spleen
- cranial nerve palsies
DIAGNOSIS AND TREATMENT
To make a diagnosis, the doctor will carry out the following tests:
Blood tests to determine the number of normal blood cells, and also the presence of immature cells normally found in the bone marrow.
Bone marrow aspiration where a needle is used to remove a sample of bone marrow from your pelvis or breastbone. This sample is then sent to the lab to test for leukemia cells. The doctors will look for changes in cancer cells and determine whether the leukemia cells began from the B or T lymphocytes.
Imaging tests such as X-ray, CT scan or ultrasound to help determine if cancer has metastasized to the brain or other parts of the body.
Spinal fluid test where a sample of the spinal fluid is collected and tested to see whether cancer cells have spread to the spinal fluid. The spinal fluid is the fluid that surrounds the brain and spinal cord.
TREATMENT
Treatment options fall into separate phases, this may include:
- Induction therapy where the goal is to kill as many leukemia cells in the bone and blood marrow and to restore blood counts to normal.
- Post-remission therapy where the goal is to completely rid the body of any remaining leukemia cells in the body that have not been found by common blood or marrow tests.
- Maintenance therapy which is used to keep cancer from coming back or regrowing.
You may have one or more of the following treatments:
- Chemotherapy
- Targeted therapy
- Radiation therapy
- A bone marrow transplant or stem cell transplant
- Clinical trials which are experiments to test new cancer treatment