Acute Lymphoblastic Leukemia (A.L.L.) is a fast-growing cancer of the white blood cells. Lymphocytes are a type of white blood cell that the body uses to fight infections. In A.L.L., the bone marrow makes a lot of unformed cells called blasts that normally would develop into lymphocytes. However, the blasts are abnormal. They do not develop and cannot fight infections. The number of abnormal cells (or leukemia cells) grows quickly. The word ‘acute’ in Acute Lymphoblastic Leukemia comes from the fact that the disease progresses rapidly and affects immature blood cells, rather than mature ones.
There are approximately over 4,000 new cases of A.L.L. in the United States each year. It appears most often in children younger than age 10. However, it can appear in people of any age – about one-third of cases are adults. Acute Lymphoblastic Leukemia may also be called Acute Lymphocytic Leukemia or Acute Lymphoid Leukemia. A.L.L. increases in people ages 45 and older. However, people can get A.L.L. at any age.
The symptoms a person with A.L.L. has depends on how many normal blood cells they collect in the body. Low numbers of red blood cells can lead to anemia – feeling tired or weak, being short of breath and looking pale. White blood cells fight infections. Low numbers of white blood cells can lead to fever and frequent infections that are hard to treat. Platelets control bleeding. A low number of platelets can lead to cuts that heal slowly, easy bruising or bleeding and tiny red spots under the skin. A high number of leukemia cells can cause pain in the bones or joints, lack of appetite, headache or vomiting. Some signs of symptoms of A.L.L. are similar to other more common and less severe illnesses. Specific blood test and bone marrow test are needed to make a diagnosis. A person with A.L.L. may have:
Aches in arms, legs, back, Black and blue marks for no apparent reason Enlarged lymph nodes Fever without obvious cause Headaches Pale-looking skin Pinhead-size red spots under the skin Prolonged bleeding from minor cuts Shortness of breath during physical activity Tiredness Vomiting The best advise for any person troubled by symptoms such as a lasting low-grade fever, unexplained weight loss, tiredness or shortness of breath is to see a healthcare provider.
Blood and bone marrow tests are done to look for leukemia cells. A CBC (complete blood count) is used to help diagnose A.L.L. A bone marrow aspirate and a bone marrow biopsy are two of the test that are done. An aspirate is done to take a close look at the cells in the marrow in order to look for abnormal cells such as leukemic blast cells. It can also be used for cytogenetic analysis, immunophenotyping and other tests. Acute Lymphocytic Leukemia (ALL) is a type of cancer of the blood and bone marrow – the spongy tissue inside the bones where blood cells are formed.
The biopsy gives information about how much disease is in the marrow. Immunophenotyping is used to find out if the patient’s leukemia cells are B cells or T cells. Most people with A.L.L. have the B-cell type. Most cases of the B-cell type are called precursor B-cell type.
The doctor uses information from these tests to decide the type of drug therapy a patient needs and how long treatment will last. Bone marrow tests are also done to see if treatment is destroying leukemic blast cells.
To decide the best treatment for the patient, the doctor may also consider;
The patient's age The number of ALL cells in the blood If ALL has spread to the covering of the brain and spinal cord If there are certain chromosomal changes.
You want to make sure you are taken care of in a center where doctors are experienced in treating patients with A.L.L.
The goal of treatment for A.L.L. is to cure the disease. Children with A.L.L. are likely to be cured of their disease. The number of adult patients who have remissions has increased. The length of remissions in adults has improved.
There are two parts of treatment for A.L.L., called induction therapy and post-induction therapy. The aim of induction therapy is to:
- Kill as many ALL cells as possible
- Get blood counts back to normal
- This is called a remission
Some drugs used to treat A.L.L. are given by mouth. Other drugs are given by placing a catheter in a vein – usually in the patient’s upper chest. During induction therapy, most patients are treated with more than one drug and they may be given several drugs in combination. Each drug type works in a different way to kill the cells. Combining drug types can strengthen the effects of the drugs. Some of the drugs used to treat A.L.L are vincristine, pegaspargase, imatinib mesylate, prednisone, and dexamethasone.
Patients with A.L.L. often have leukemic cells in the lining of the spinal cord and brain. The procedure used to check the spinal fluid for leukemic cells is called a spinal tab. The cells cannot always be found in an exam of the spinal fluid.
Ph-Positive A.L.L.-Induction/Post-Induction – about one out of five adults with A.L.L. and a Philadelphia – positive chromosome) A.L.L.
Ph-Positive A.L.L. may be treated with imatinib mesylate, also called Gleevec® or with other related drugs, such as dasatinib (Sprycel®) or nilotinib (Tasigna®). These drugs are given with chemotherapy. Gleevec and other medicines are given by mouth. Doctors are studying how well this treatment works in patients with Ph-Positive A.L.L.
During post-induction therapy, Gleevec® (or other related drugs) is given with other drugs. Usually people with Ph-Positive A.L.L. stay on Gleevec® (or other related drug) after post-induction therapy is completed.
Not all patients have treatment side effects. Patients who experience side effects should speak with their treatment teams about how to manage them.
Possible side effects of treatment for A.L.L. include:The number of red cells may decrease (called anemia). Transfusions of red cells (blood cells that are donated and given to the patient) may be needed to increase red cells. Patients also may have a drop in the number of platelets. If a patient’s platelet count is very low he or she may need a platelet transfusion to prevent bleeding.
A big drop of white cells may lead to an infection. Such infections are usually treated with antibiotics until the white cell count goes up and the infection clears up. For adults, growth factors are sometimes given to increase white cells. G-CSF(Neulasta® or Neupogen®) and GM-CSF(Leukine®) are drugs that increase the number of white cells. The doctor may talk about the absolute neutrophil count or ANC, which is the number of neutrophils, a type of white cells a person has to fight an infection. Fever or chills may be the only signs of infection.
Patients with an infection may also have:
- Sore throat
- Pain when urinating
- Frequent loose bowel movements
Chemotherapy affects the parts of the body where new cells form quickly. This includes the inside of mouth and bowel, and the skin and hair. Some other chemotherapy side effects are:
- Mouth sores
- Hair loss
Drugs and other therapies can be given to prevent or treat nausea or vomiting.
To lower the risk of infection:
- The patient, patient’s family and friends including medical staff need to wash their hands well.
- Be sensitive to mood swings
- Always bring a positive attitude
- Speak positive words to the patient
- Bring the patient encouraging notes and books to read
- Pray that God will continue to strengthen the patient and their family