Acute lymphoblastic leukemia (ALL) is a cancer of the blood and bone marrow. Lymphocytes are a type of white blood cell. With ALL, the bone marrow makes too many of these cells. ALL begins in immature lymphocytes. It progresses very quickly. It may occur at any age, but is most common in children. It is also common as the end stage of a chronic leukemia of adults called chronic lymphocytic leukemia . Childhood ALL was one of the first cancers for which effective chemotherapy was developed. ALL remains highly curable today.
Cancer occurs when cells in the body become abnormal. They divide without control or order. Leukemia is cancer of the white blood cells and their parent cells. Leukemia cells do not function normally. They cannot do what normal blood cells do. In this case they can not fight infections. This means that the person is more likely to become infected with viruses or bacteria. The cancerous cells also overgrow the bone marrow. This forces other normal components, like platelets out. Platelets are needed to help the blood clot. As a result, people with leukemia may bleed more easily.
The cause of ALL is unknown. Research shows that certain risk factors are associated with the disease.
The following factors increase your chance of developing ALL:
The following risk factors are specific to childhood ALL:
These may be caused by other, less serious health conditions. You should see a doctor if you or your child is experiencing:
Your doctor will ask about your symptoms and medical history. A physical exam will be done. The doctor may also check for swelling of the liver, spleen, or lymph nodes. You will likely be referred to an oncologist. This is a doctor who specializes in treating cancer.
Tests may include the following:
Talk with your doctor about the best plan for you. Treatment of ALL is done is two phases. First remission induction therapy to kill leukemia cells. Then maintenance therapy to kill any remaining leukemia cells. Cells left behind could grow and cause a relapse. Treatment options include:
Chemotherapy is the use of drugs to kill cancer cells. It may be given by pill, injection, and via a catheter. The drugs enter the bloodstream and travel through the body. It kills mostly cancer cells, but also some healthy cells.
Clinical trials are now underway to test drugs. One drug is imatinib (Gleevec). This drug is used to treat chronic myelogenous leukemia (CML) . It helps to prevent the function of genes associated with ALL.
Some ALL may spread to the brain and spinal cord. In this case, intrathecal chemotherapy may be used. Chemotherapy drugs are placed directly into the spinal column.
Radiation therapy is the use of radiation to kill cancer cells and shrink tumors. For ALL, external radiation therapy is used. The radiation is directed at the tumor from outside the body. This type of treatment is used for ALL that has or may spread to the brain and spinal cord.
Chemotherapy is followed by a transplantation of stem cells (immature blood cells). These will replace blood-forming cells destroyed by cancer treatment. Stem cells are removed from the blood or bone marrow of the patient or donor. They are then infused into the patient.
This process is still being tested in clinical trials. This is the use of medications or substances made by the body. The substance is used to increase or restore the body's natural defenses against cancer. This type of therapy is also called biological response modifier therapy. Sometimes, very specific (monoclonal) antibodies are developed to target the leukemia cells specifically. Currently, monoclonal antibody therapy is restricted to clinical trails and not generally available.
People treated for ALL in their youth may have a risk of cancer later in life. A recent study found that they are more likely than the general population to develop a secondary cancer. The exact type of cancer can vary. It is important that people that have had ALL are carefully watched for new cancer development. These screenings should be carried out through their lifetime. *
RESOURCES:
American Cancer Society
http://www.cancer.org
The Leukemia and Lymphoma Society
http://www.leukemia-lymphoma.org/hm_lls
National Cancer Institute
http://www.cancer.gov
CANADIAN RESOURCES
BC Cancer Agency
http://www.bccancer.bc.ca/default.htm
Cancer Care Ontario
http://www.cancercare.on.ca/
Childhood Cancer Foundation
http://www.candlelighters.ca/index.html
References:
Adult acute lymphoblastic leukemia (PDQ): treatment. National Cancer Institute website. Available at: http://www.cancer.gov/cancerinfo/pdq/treatment/adultALL/patient . Accessed November 23, 2005.
Childhood acute lymphoblastic leukemia (PDQ): treatment. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/childALL/patient . Accessed November 26, 2005.
Detailed guide: leukemiaµacute lymphocytic (ALL). American Cancer Society website. Available at: http://www.cancer.org/docroot/CRI/CRI_2_3x.asp?rnav=cridg&dt=57 . Accessed November 23, 2005.
*Updated Treatment section on 3/29/2007 according to the following study, as cited by DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Hijiya N, Hudsdon MM, Lensing S, et al. Cumulative incidence of secondary neoplasms as a first event after childhood acute lymphoblastic leukemia. JAMA. 2007;297:1207-1215.
Last reviewed January 2009 by Igor Puzanov, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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