Overview

What is Acute Lymphoblastic Leukaemia (ALL)?

Acute lymphatic or lymphoblastic leukaemia, known as ALL, is the most common childhood leukaemia, accounting for 80% of all acute leukaemias in children. ALL is most common in children between the ages of 3 and 7. It occurs when too many immature lymphocyte cells (lymphoblasts) are produced and multiply rapidly, crowding out normal blood cells and making the child susceptible to bleeding and infection. These cells are found in the blood, bone marrow, lymph nodes, spleen and other organs.

There are two types of lymphocytes: T cells and B cells. Leukaemia often starts in the immature lymphocytes. Less often, leukaemia cells develop in T or B cells before they become cancerous. This type of lymphocytic leukaemia is called T-cell or B-cell leukaemia.

Symptoms

Symptoms of acute lymphoblastic leukaemia (ALL)

These are the most common symptoms of acute lymphoblastic leukaemia. However, each person's symptoms may be different.

Symptoms may include：

·Bleeding

·Bruising

·Fever

·Infections

·Persistent weakness

·Tiredness

·Loss of appetite

·Pain in bones and joints

·Swollen lymph nodes

·Weight loss

·Night sweats

·Swelling in the abdomen

·Difficulty breathing

The symptoms of acute lymphoblastic leukaemia may be similar to other blood disorders or medical problems. Always check with your doctor for a diagnosis.

Causes

Risk factors for acute lymphoblastic leukaemia (ALL)

Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor doesn't mean you will get cancer, and not having a risk factor doesn't mean you won't get cancer. People who think they may be at risk should discuss this with their doctor.

Most cases of ALL seem to have no obvious cause.

Possible risk factors include:

- Exposure to radiation, chemicals and medicines

- Having a sibling with leukaemia

- Having a certain genetic disorder, such as Down's syndrome

Chromosomal abnormalities may also play a role in the development of acute lymphoblastic leukaemia.

Staging

Acute Lymphoblastic Leukaemia (ALL) Staging

• How leukaemia staging differs from that of other cancers

Most cancers are staged to tell how big the tumour is and how far the cancer has spread. But leukaemia rarely causes tumours. Because it is in your bone marrow and blood, it has already spread throughout your body. In ALL, doctors use different terms to describe how leukaemia responds to treatment.

• Phases of ALL:

• Untreated ALL

Your doctor has just diagnosed you with ALL. Your complete blood count (CBC) is abnormal. You have more than 5% immature white blood cells called blasts in your bone marrow. You are likely to have symptoms of leukaemia, such as pain, fever and bleeding.

• ALL in Remission

You have been treated for ALL. In this phase, your CBC is normal, you have less than 5% blasts, and you have no signs or symptoms of leukaemia anywhere in your body. 

• Minimal Residual Disease

Your ALL appears to be in remission, but very sensitive laboratory tests can still detect leukaemia cells in your bone marrow. Your ALL may be more likely to come back, so you may benefit from further treatment to try to kill the remaining cells.

• Refractory ALL

The leukaemia has not disappeared and is not responding to treatment.

• Relapsed ALL (also called Recurrent ALL)

Your leukaemia has come back after a period of remission. Your symptoms may return, your blood count may become abnormal again, and you may have at least 5% blasts. Because you have already had treatment, your doctor may need to consider a new treatment plan to get you back into remission.

Diagnosis

How is Acute Lymphocytic Leukaemia Diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for acute lymphoblastic leukaemia may include the following

• Blood Tests

• Bone marrow aspiration and biopsy

• Cytogenetic analysis

• Immunophenotyping

• Lumbar puncture (spinal tap)

Additional blood tests and other evaluation procedures may also be performed.

Treatments

Treatment options for acute lymphoblastic leukaemia (ALL)

Specific treatment for acute lymphoblastic leukaemia will be determined by your doctor based on

·Your age, general health and medical history

·The extent of your illness

·Your ability to tolerate certain medications, procedures, or therapies

·Expectations for the course of the disease

·Your opinions or preferences

You may have one type of treatment or a combination of treatments. Different types of treatment have different aims. Here are some of the types of treatment and their goals for adults with ALL.

• What treatment may include

Chemotherapy

The use of anti-cancer drugs to shrink or kill cancer cells and reduce the spread of cancer to other parts of the body.

Radiotherapy

The use of high-energy radiation to kill or shrink cancer cells, tumours and non-cancerous diseases.

A specialized therapy in which healthy bone marrow cells are transferred to a patient after their own unhealthy bone marrow has been removed.

Immunotherapy

Targeted therapies

Targeted therapies can attack cancer cells without affecting healthy tissue, unlike radiation and chemotherapy.

Some newer drugs specifically target abnormal proteins, such as those caused by the Philadelphia chromosome. Drugs such as imatinib (Glivec) and dasatinib (Sprycel) may be helpful in treating ALL with this chromosome. These drugs are taken as pills every day. 

(The above content is extracted from stanfordhealthcare.org)