Acute lymphocytic leukemia (ALL) is cancer of the lymph cells, a type of white blood cell. While ALL is known as the childhood form of leukemia, 20% of the people who develop the disease are adults.
When the body has an infection, the number of lymph cells often rises sharply. These cells play a role in fighting off infection. When a person has ALL, the lymph cells do not mature enough to do their job. The cells become malignant, and their growth is unchecked. The abnormal cells can build up in the bone marrow, blood, and other tissues.
Generally, the abnormal cells crowd out normal blood cells and cause the following problems: anemia, or a low red blood cell countbleeding problems due to poorly working blood-clotting cells, called plateletsloss of normal white blood cell function, which increases the risk of infectiona need for red blood cell transfusions
Other white blood cells help in immune monitoring and healing. ALL can compromise or even stop all of these functions. The buildup of abnormal lymph cells can enlarge or infiltrate any organ in the body, including lymph nodes and the brain.
ALL can cause blood-clotting problems in any part of the body. These problems include: easy bruisinggastrointestinal bleedingnosebleedspetechiae, or tiny red splotches in the skin
Other symptoms of ALL include: dizzinessfatigue and weaknessheadacheshypersensitivity to coldloss of appetite and nausea and/or constipationpalpitations, or an unusual sensation of the heart beating within the chestshortness of breath at rest or with activityunexplained fevers or night sweatsweight loss
People with ALL often get infections due to the breakdown of the immune system. Signs of this are: infectious diarrheakidney infectionpneumoniasinus infectionskin boilsoral thrush, a yeast infection in the mouthunusual parasite infections
ALL is thought to have many causes, including: exposure to radiationexposure to toxinsgene or chromosome abnormalities that are passed on from parent to childa poorly working immune systemviruses that affect the immune system
It is known that people: who have AIDS are at higher risk for lymphatic cancers, including ALL.who have been treated for other cancers can get ALL. This is called a secondary leukemia.who have Down syndrome may be at higher risk for ALL.
In most cases, ALL cannot be prevented. People can avoid exposure to toxins, such as: the antibiotic chloramphenicolarsenic compoundsbenzenetoluene
Radiation from highly radioactive compounds is clearly dangerous. This does not involve household appliances. A person who has had chemotherapy or radiation is at risk for ALL. He or she should be monitored for life.
Occasionally, family clusters of acute leukemia occur. Genetic counseling may be helpful in this situation. Whether or not nutrition and generally avoiding infections are of benefit in preventing ALL is actively being researched.
Diagnosis of ALL begins with a medical history and physical exam. Samples of blood and bone marrow cells taken during a biopsy are examined for a buildup of immature cells, called lymphoblasts, and abnormal lymph cells.
Afterward, other tests are done to evaluate the extent of the disease, such as: blood testsscans of the brain and body to check for any tumor masses, bone weakness, or bleeding sitesspinal taptests to check the functions of organs such as the kidneys, liver, heart, and lungs
Some people live an entirely normal, healthy life after ALL has been treated and cured. However, ALL can be lethal even with good treatment. People who survive often have many chronic health problems. Any organ, including the brain, can be damaged before treatment starts. The treatments can have serious permanent side effects, too.
It is not clear if a leukemia virus might spread ALL. It is an uncommon cancer, and any risk of it spreading from one person to another is very low. However, a person with ALL might have an unusual or aggressive infection that could possibly spread to others. This is more likely to happen when AIDS or another disorder weakens a person's immune system.
Treatment for ALL may include: bone marrow transplant from a matched donorchemotherapy for months or occasionally up to a yearintravenous feeding for people who cannot eat, swallow, or digest foodradiation therapy of the brain and spine to kill even tiny, hidden leukemia cellssurgery to implant a tube into a major vein to deliver medicine or gain quick access to the bloodstream
People are treated in a hospital at first, then later as outpatients. Treatment can go on for several months to a couple of years depending on the case. The goal of treatment is a cure, or at least remission. Remission is the disappearance of symptoms and signs of ALL. If the cancer returns, a bone marrow transplant or salvage therapy may be done. Salvage therapy is chemotherapy used to try to get a second remission or to extend life.
Side effects of treatments can include some of the same signs and symptoms as the leukemia, such as: allergic reactions to medicinesbleeding problems that may require transfusionscommon or unusual infectionsdiarrhea or poor food absorptionirritation of the gastrointestinal tractmouth soresnausea and vomitingnumbness or burning pain in the extremitiesweakness and fatigueweight loss
When treatment involves the brain and nervous system, the following temporary side effects may occur: drowsinessfeverhair lossheadachevomiting
Infertility and impaired memory and math and motor skills can be permanent with this type of treatment.
People often need long-term care for complications from leukemia or its treatments. Children may have more neurological or psychological problems. Developing bones can be affected, too. Adults have fewer of these complications but have a lower rate of remission and cure.
People who have been treated for ALL are often monitored for several years. The healthcare provider may order regular blood tests and biopsies. Sometimes spinal taps are done. The fluid is tested for signs of cancer. Genetic testing of the bone marrow may be done, too. It may find traces of residual leukemia before other tests do. Any new or worsening symptoms should be reported to the healthcare provider.
