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Acute lymphoblastic leukemia (ALL) in children

Childhood acute lymphoblastic leukemia (also called acute lymphocytic leukemia or ALL) is a cancer of the blood and bone marrow. This type of cancer usually gets worse quickly if it is not treated. It is the most common type of cancer in children.
ALL is a leukemia occurring mostly in children under age four, although older children and adults can also be affected; Caucasian boys are most likely to develop ALL. ALL accounts for 23 percent of cancers in those under age 15,
The causes of ALL are unknown, but the disease is more common in those with Down Syndrome and who were exposed to radiation prenatally.

Symptoms of ALL in Children

– ALL starts suddenly, often after a four to six week illness characterized by bone pain, joint swelling, and easy bruisability.
– Symptoms of ALL include fatigue and pallor from anemia, a decrease in red blood cells, and excessive bleeding and bruising from a decrease in platelets.
– Bone and joint pain are caused by excess lymphocytes in the bone marrow.
– If leukemia affects the brain, headaches, irritability and vomiting may occur.

Diagnosis of ALL in children

– Diagnosing ALL begins with a medical history and physical examination, complete blood count, and blood smears.
– Pathological examination, cyto-genetics and immunophenotyping, establish whether the “blast” cells began from the B lymphocytes or T lymphocytes.
– DNA testing can establish how aggressive the disease is; different mutations have been associated with shorter or longer survival.
– Medical imaging (such as ultrasound or CT scanning) can find invasion of other organs commonly the lung, liver, spleen, lymph nodes, brain, kidneys and reproductive organs.

Treatment of ALL in children

Treatment for acute leukemia can include chemotherapy, steroids, radiation therapy, intensive combined treatments (including bone marrow or stem cell transplants), and growth factors.
Chemotherapy treatment is very effective and starts with an induction phase, where the fast growing cancer cells are destroyed over several weeks. The consolidation phase of chemotherapy may last as long as several years. Chemotherapy drugs may be injected into the fluid around the brain, followed by radiation, because the cancer cells so often spread to the brain.
If relapse occurs, stem cell transplant may offer the best chance for a cure, but has serious risks and side effects that can be fatal. Siblings or other family members or donors with compatible tissue, or HLA match, can be used.

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