Among the different types of leukemia, acute lymphocytic leukemia is the one that is most commonly seen in children and they account for about 67% of all the total cases [1, 2].
Acute Lymphocytic Leukemia
Leukemia is the malignancy that involves the white blood cells. In acute lymphocytic leukemia (ALL), the lymphocytes fail to mature and accumulate in the bone marrow. Lymphocytes are a type of white blood cells that has a major role in the production of antibodies and antigens. These cells develop in the bone marrow and thymus gland. They are further categorized as either T-cells or B-cells. ALL may arise from either T-cells or B-cells but all cases involves B-cells [1, 2, 3].
The bone marrow is unable to produce normal lymphocytes in ALL. These immature cells are unable to function like normal lymphocytes and accumulate in the bone marrow. This condition rapidly progresses and replace the functioning lymphocytes of the blood. Although this is most common type that affects children, any individual may develop ALL at any age. The prognosis for this condition is better for children than in adults [3, 4].
Causes
All occurs when the cells of the bone marrow develop DNA errors. This error will make the cell to continuously grow and divide unlike the normal ones which stops diving and die eventually. This will lead to the production of abnormal cells. These cells will not be able to function properly and crowd out the healthy cells in the bone marrow. The cause of the DNA error is still unknown but researchers have identified that ALL isn’t inherited [1].
Risk Factors
Similar to other malignancies, the direct cause for ALL is still unknown but there are factors that are associated with the development of this condition [4, 5].
Age
The diagnosis of ALL is most common in children especially those who are under 5 years old. It is also found to be slightly more common in boys than in girls [3, 5].
Genetic disorders
Those who are diagnosed with genetic conditions such as Down’s syndrome are found to have increased risk for developing ALL [1, 2, 5].
Having a sibling with ALL
Individuals who have a brother or sister that have developed ALL are more likely to develop this type of leukemia [1, 5].
Radiation exposure
People who are exposed to high levels of radiation such as those who are working with x-ray equipment have a higher likelihood of developing this type of leukemia compared to the normal population [1, 5].
Previous cancer treatment
Those that have received chemotherapy or radiation treatment for a different type of cancer in the past may have an increased risk for this leukemia [1, 5].
Signs and Symptoms
Some of the general symptoms that are found in patients with ALL are: fever, loss of appetite, bone or joint pin, headaches, frequent infections, appearance of petechiae or small red spots under the skin and easy bruising or bleeding. These patients may also develop anemia due to the low number of red blood cells, leukopenia or a low amount of white blood cells and thrombocytopenia due to a low blood platelet count [1, 3, 6].
Diagnosis
Health history and physical examination
The focus of the health history and physical examination is to identify all the symptoms that are present in the patient. Any previous infection or treatment must be noted by the physician as well [1, 6].
Complete blood count with differential count
A blood sample will be obtained from the patient and its components will be analyzed. In this diagnostic test, the amount of hemoglobin, platelets, RBCs the number and types of WBCs of the patient will be known [1, 6].
Peripheral blood smear
This test is different from a complete blood count in such that the changes in the shape of blood cells will be visualized in this test [1, 6].
Bone marrow aspiration and biopsy
In this procedure, a hollow needle will be used to get a sample from of bone marrow either the hipbone or breastbone. This sample will be anayzed to identify the presence of cancer cells [1, 6].
Treatment
The treatment for acute lymphocytic leukemia has 2 distinct phases [1, 2, 5, 6].
Remission induction therapy
In the 1 first phase of the treatment regimen, the leukemia cells found in the blood and bone marrow are eliminated. If this phase is successful, the malignancy will go into remission [1, 2, 5, 6].
Post-remission therapy
The second phase of the therapy is only initiated if the cancer has gone into remission. This phase will not only kill active cancer cells but also those that may regrow and possible cause a leukemia relapse in the future. This stage is also known as the remission continuation therapy phase [1, 2, 5, 6].
Treatment standards
There are a few treatment standards being used in the treatment of ALL [1, 6].
Chemotherapy
Chemotherapy uses antineoplastic drugs to either stop the cells from further dividing or eliminate them completely. These drugs are introduced into the body either orally or intravenously [1, 6].
Radiation therapy
Radiation therapy uses high energy beams to kill cancer cells or stop them from dividing. The source of radiation may be a machine outside of the body or an implant placed near the source of the malignancy [1, 6].
Chemotherapy with stem cell therapy
Stem cells obtained from a donor can be transplanted in a patient with ALL to replace the cancer cells. This option is done in combination with chemotherapy to ensure that no cancer cells will remain in the body [1, 6].
Survival Rate and Prognosis
The prognosis for patients with acute lymphocytic leukemia is good especially that the survival rate is at an all-time high. Approximately 95% of children with ALL are expected to attain remission after completing the treatment. Adults have a lower rate because they experience a more severe variation of ALL than children. The remission rate of adults is about 60-80% and around 35-40% survive for more than 2 years after receiving aggressive treatments.
Aside from age, other factors that may affect an ALL patient’s outcome include the white blood cell count before receiving therapy, the subtype of ALL that is present and the patient’s response to chemotherapy.
References
- Mayo Clinic Staff. (2016, January 28). Acute lymphocytic leukemia. Retrieved from Mayo Clinic: http://www.mayoclinic.org/diseases-conditions/acute-lymphocytic-leukemia/basics/risk-factors/con-20042915
- Simon, H. (2013, March 8). Acute lymphocytic leukemia. Retrieved from University of Maryland Medical Center: http://umm.edu/health/medical/reports/articles/acute-lymphocytic-leukemia
- Cancer Treatment Centers of America. (2016). Acute lymphocytic leukemia. Retrieved from Cancer Treatment Centers of America: http://www.cancercenter.com/leukemia/types/tab/acute-lymphocytic-leukemia/
- Medline Plus. (2016, May 24). Acute Lymphocytic Leukemia. Retrieved from Medline Plus: https://www.nlm.nih.gov/medlineplus/acutelymphocyticleukemia.html
- National Cancer Institute . (2016, February 5). Adult Acute Lymphoblastic Leukemia Treatment (PDQ®)–Patient Version. Retrieved from National Cancer Institute : http://www.cancer.gov/types/leukemia/patient/adult-all-treatment-pdq
- Cancer.Net. (2016, January). Leukemia – Acute Lymphocytic – ALL: Introduction. Retrieved from Cancer.Net: http://www.cancer.net/cancer-types/leukemia-acute-lymphocytic-all/introduction
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