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Acute lymphocytic leukaemia (ALL): Causes, Symptoms, Diagnosis and Treatment

What is Acute lymphocytic leukaemia?

Acute lymphocytic leukaemia (ALL), also referred as acute lymphoblastic leukaemia is a form of cancer of the bone marrow and the blood. Bone marrow is a spongy structure present in the centre of some long bones, where the blood cells are formed.

Acute lymphocytic leukaemia

‘Acute’ here refers to the rapid progression of leukaemia and the formation of blood cells that are immature than the ones that are mature.

‘Lymphocytic’ word here refers to the lymphocytes or the white blood cells affected by leukaemia.

ALL is commonly reported in children who stand a good chance of cure. Though ALL is reported in adults also, the probabilities of cure are very much lower in them.

Causes and risk factors

The primary cause of ALL is defective or damaged DNA.  The exact causes of the DNA damage are not known. Damaged DNA leads to faulty signalling in the cells, resulting in the formation of atypical blood cells.  The lymphoblasts (immature white blood cells) in this condition, mature into leukemic white blood cells instead of healthy cells, which crowd out the healthier ones.

Risk Factors

The risk factors for ALL are not known. However, some of the important ones are as follows:

  • Certain genetic disorders like Down’s syndrome
  • Exposure to radiation
  • Benzene exposure

Symptoms and signs

Numerous lymphoblasts in the bone marrow and too little of blood cells typical of the white blood cell characterise ALL.

The symptoms and signs of acute lymphocytic leukaemia can include:

  • Fever
  • Fatigue
  • Repeated infections
  • Severe and recurrent nose bleeding
  • Gum bleeding
  • Shortness of breath
  • Pain in bones
  • Swelling of lymph nodes in abdomen, underarms, groin and the neck region

Blood group matching and incompatibility

Sometimes, ALL is diagnosed when routine blood tests are done, before the manifestation of the symptoms.

Diagnosis

Physician will first do a physical examination to check for signs of swelling of glands, and the following tests may be recommended:

Blood tests

Blood is drawn to check for the different white blood cells and lowered number of red blood cells and the reduced platelet count.

Imaging tests

The spread of the disease is determined by a variety of imaging tests: X-rays, computed tomography (CT) scan, Magnetic resonance imaging (MRI) scan, Gallium scan, ultrasound and bone scan.

Biopsy of bone marrow

Under local anaesthesia, using a needle a bone marrow sample is taken, usually from the hip bone. It is tested for the presence of leukemic cells.

Lumbar puncture

Also known as the spinal tap or spinal fluid test, it can be performed to detect the spread of leukaemia to the spinal cord. A sample of the spinal fluid is taken and analysed in the laboratory for the presence of leukemic cells.

Treatment and prevention

ALL is a cohort of linked diseases. Individuals with ALL at different stages will respond differently to the treatment.

The key treatment for ALL includes:

Chemotherapy

Here drugs are used to destroy the cancerous cells. The usual therapy is classified as:

  • Induction therapy: It is aimed at the destruction of leukemic cells in the bone marrow and the blood and bringing up the production of regular blood cells.
  • Consolidation therapy: It aims at killing the left out leukemic cells which could be in the spinal cord and the brain.
  • Maintenance Therapy: It includes low-dose treatments spanning for years to address the regrowth of leukemic cells.
  • Preventive treatment: In every phase of the treatment, drugs are injected into the spinal cord. It is aimed at destroying cancerous cells that enter the nervous system.

Targeted therapy

Specific medicines are used to attack the leukemic cells based on certain intracellular functional anomalies found in those leukemic cells.

Radiation therapy

Powerful beams like X-rays are utilised for killing the leukemic cells especially if they have invaded the nervous system.

Stem cell transplantation

Transplanting new bone marrow cells, referred as stem cell transplantation is done to reintroduce healthy stem cells to replace the unhealthy cells present in the bone marrow.

Higher doses of radiation or chemotherapy aimed at destroying the bone marrow that produces the cancerous cells are used before initiation of the stem cell transplantation.

Prevention

There are no definite ways of preventing the majority of the leukaemias.

Read more

Complications

  • A weakened immune system making one prone to infections
  • Bleeding due to low platelet count
  • Infertility
  • Stress, anxiety and depression

Next steps

On noticing any of the signs and symptoms of acute lymphocytic leukaemia, visit your doctor, who can recommend you to a cancer specialist or haematologist.

Make a note of the medications you are currently taking. You can note down the questions to ask the physician, about the cause of the disease, type of tests required,  treatment and care plan, support, etc.

Red Flags

One must immediately visit the physician on noticing:

  • Blood in vomit or stools
  • Any symptoms of infection like high fever (38C/100.4F or more), headache or diarrhoea

Consult a top Oncology

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References

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  • Acute lymphoblastic leukaemia (ALL). Leukaemia Foundation Australia. Accessed 27 Jan. 16. http://www.leukaemia.org.au/blood-cancers/leukaemias/acute-lymphoblastic-leukaemia-all
  • Acute Lymphoblastic Leukaemia (ALL). Accessed 27 Jan. 16. MacMillan http://www.macmillan.org.uk/information-and-support/leukaemia/acute-lymphoblastic-all
  • Acute lymphoblastic leukaemia. NHS. Accessed 27 Jan. 16. http://www.nhs.uk/conditions/Leukaemia-acute-lymphoblastic/Pages/Introduction.aspx
  • Adult acute lymphoblastic leukemia treatment (PDQ). National Cancer Institute. Accessed 27 Jan. 16. http://www.cancer.gov/types/leukemia/hp/adult-all-treatment-pdq#section/all.
  • Leukemia – Acute Lymphocytic (Adults). American Cancer Society. Accessed 27 Jan. 16. http://www.cancer.org/acs/groups/cid/documents/webcontent/003109-pdf.pdf
  • Signs and Symptoms of Childhood Cancer: A Guide for Early Recognition. Am Fam Physician. 2013 Aug 1;88 (3):185-192.

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