Acute lymphocytic leukemia

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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How is Leukemia diagnosed ?

Leukemia can be diagnosed with a variety of tests, and understanding what each test is and what it looks for can make the tests a little less confusing. Doctors sometimes find leukemia after a routine blood test. If you have symptoms that suggest leukemia, your doctor will try to find out what’s causing the problems. Your doctor may ask about your personal and family medical history.

- Physical Examination
An exam is much like any doctor’s appointment; the doctor will take a detailed medical history and thoroughly examine the whole body.
- Blood Tests
To diagnose leukemia, a number of blood tests are performed. These tests are used to evaluate the type and quantity of blood cells that are present, the blood chemistry, and other factors.
- Full blood count
It is used to establish the numbers of different blood cell types in the circulation. A low number of red or white blood cells is described as anemia or leukopenia, respectively.
- Bone Marrow Biopsy
A biopsy takes a small sample of bone marrow tissue from the body. The doctor asks the patient to lie on his or her side and nurses clean the biopsy site with iodine or alcohol. After the site is cleaned, the biopsy site is numbed with a local anesthetic. The doctor uses either a very fine needle to draw out only bone marrow tissue, or a thicker needle to take a small sample of bone and bone marrow. The bone marrow sample is examined under a microscope to check for leukemia cells.
- Cytogenetics
It is a newer type of testing for leukemia. Cytogenetic testing uses a sample taken from a blood draw or a bone marrow or lymph node biopsy. The sample’s chromosomes are microscopically examined for abnormalities that indicate damage to the cells’ DNA.
- Spinal tap
The doctor uses a long, thin needle to remove fluid from the lower spine. The procedure takes about 30 minutes and is performed with local anesthesia. You must lie flat for several hours afterward to keep from getting a headache.
- Chest x-ray
An x-ray can show swollen lymph nodes or other signs of disease in your chest.
- CT scan of the head, chest, and belly, to find out whether leukemia has spread there.
- Lumbar puncture is to find out whether leukemia cells are in your cerebrospinal fluid (CSF).
- Differential blood count (DBC)
It is used to determine the relative proportion of blood cell types within the bloodstream. In particular, the percentage of immature leukemic “blast” cells is noted.
- Hematocrit assay
It is used to determine the proportion of the blood that is occupied by erythrocytes (red blood cells). In adult men, normal is about 46% (39.8–52.2) and in adult women, it is about 40.9% (34.9–46.9).

Acute lymphocytic leukemia (ALL)

Acute lymphocytic leukemia (ALL) 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 ALL, the bone marrow makes lots 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. They crowd out the normal red blood cells, white blood cells and platelets the body needs.

Causes and Risk Factors

There are some factors that are known to increase a person’s risk of developing ALL, including previous treatment with chemotherapy or radiation therapy, exposure to large amounts of radiation (such as an atomic bomb), or the presence of a genetic disorder (i.e. Down’s syndrome, Klinefelter’s syndrome). Research has identified viruses, such as Epstein-Barr, HTLV1, and HIV, as potential causes in some cases.

Symptoms of ALL

- 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.

Diagnosis of ALL

ALL is diagnosed when blood and bone marrow samples show a large number of abnormal lymphocyte blasts. To find out the type of ALL and how well it might respond to treatment, doctors test samples taken from the blood and bone marrow to learn:
- The size and number of leukemia cells.
- The type of lymphocyte affected — the leukemia cells can begin from one of two types of lymphocytes, B cells or T cells.
- What changes appear in the chromosomes of the leukemia cells. This is called cytogenetics.
Doctors also use a test called a lumbar puncture (or spinal tap) to find out whether there are leukemia cells in the fluid around the brain and spinal cord.