Acute Lymphoblastic Leukemia

Acute lymphoblastic leukemia, also called acute lymphocytic leukemia or acute lymphoid leukemia, is the most common type of childhood cancer. It can appear in any age, though, not only children. It appears mostly in children age ten and younger or in adults forty-five and older. However, it is more common to find it in men than in women. One third of all cases of A.L.L. occur in adults, which is approximately one thousand new adults diagnosed within the United States every year. The yearly incident of acute lymphoblastic leukemia is approximately 9-10 cases per 100,000 children (Satake, Noriko) or about one of every 29,000 children in the United States (National Cancer Institute). A.L.L. is a very common cancer that is known for it’s affectation of children, but can in fact occur in anybody.

A.L.L. is a fast growing cancer of the white blood cells. Normally, unformed cells called blasts would make lymphocytes, which are a white blood cell that fights infections. When a person has acute lymphoblastic leukemia, bone marrow makes many blasts that are abnormal and don’t develop, therefore they can’t fight infections. The numbers of abnormal cells grow fast and crowd out normal red cells, white cells, and platelets. Abnormal cells might collect in the brain and/or spinal cord, which are known as the central nervous system, resulting in headaches and vomiting. Most children will not have such things happen to them. The signs and symptoms of A.L.L. can vary depending on how many normal blood cells the person has, how many leukemia cells there are, and where they collect. Red blood cells are used to carry oxygen throughout the body, and low numbers of red blood cells might lead to anemia, feeling tired or weak, being short of breath and being pale. White blood cells, the infection fighters as stated previously, in low numbers can lead to often hard to treat infections and fever. Platelets are the cells that control bleeding, and a low amount of them can lead to slowly healing cuts, easy bruising or bleeding, and small red spots under the skin called petechiae. The leukemia cells can also collect in the testicles of males and cause swelling. Other symptoms may include swollen or tender lymph nodes, swollen liver or spleen, and bone or joint pain.

Although there are many cases of acute lymphoblast leukemia, there is a fairly high cure rate. According to the National Cancer Institute, “The improvement in survival for children with ALL over the past 35 years is one of the great success stories of cancer treatment. In the 1960s, less than 5 percent of children with ALL survived for more than five years. Today, about 85 percent of children with ALL live five years or more.” Children ages one to nine have an overall higher survival rate than infants, older children, and adults. There are some conflicting numbers of survival rates, though. Noriko Satake, MD, the assistant professor in the department of pediatrics at the University of California’s Davis School of Medicine says that the four-year ‘event-free’ survival rate for even high-risk patients is around sixty-five percent. That means that sixty-five percent of people with high-risk A.L.L. will go four years without something happening, such as a relapse. A relapse is when a person with cancer starts having symptoms or signs of cancer after a period of improvement of the person’s condition. Overall, A.L.L. is a very curable yet very common cancer.

When acute lymphoblastic leukemia is diagnosed, blood and bone marrow samples show a large number of abnormal lymphocyte blasts (Acute Lymphoblastic Leukemia (ALL)). Doctors might take samples for testing to learn the size and number of leukemia cells, the type of lymphocyte affected - B cells or T cells - and what changes appear in the chromosomes of the leukemia cells, which is called cytogenetics. They might also do a lumbar puncture - spinal tap - to find out if there are leukemia cells in the fluid around the brain and spinal cord. Once doctors have taken those tests, they can categorize the person’s A.L.L. into one of the following types: early pre-B, common, pre-B-cell, mature B-cell or Burkitt leukemia, pre-T-cell, mature T-cell. The type of A.L.L. that a person has is only one of a few factors that doctors will then use to plan treatments.

Doctors mostly begin treatment immediately because A.L.L. can get worse very quickly. Risk factors are patient and disease traits that clinical research studies have linked to better or poorer outcomes from treatment. Examples of risk factors are a patient's age and the type of ALL he or she has (Acute Lymphoblastic Leukemia (ALL)). Treatments might include chemotherapy, radiation, bone marrow transplants, and cord blood transplants. Chemotherapy is the use of drugs that either destroy cancer cells or stop them from growing. For children, the overall survival rate after chemotherapy is around eighty percent, and for adults, it’s nearly forty percent. Radiation therapy is the use of a form of energy called radiation to stop cancer cells from growing and multiplying. The National Marrow Donor Program says, “Most patients do not receive radiation therapy. However, children who have signs of disease in the central nervous system (brain and spinal cord) or have a high risk of the disease spreading to this area may receive radiation therapy to the brain.” Transplants can offer cancer patients the best chance for a “long-term remission”, or a long time without cancer returning, though transplants are very risky. Side effects of treatments can range from sore throat to hair loss to frequent loss of control of bowel movements and can include such as coughing, pain when urinating, mouth sores, diarrhea, rashes, nausea, and vomiting. After a time of remission, some patients might go through a relapse, where the cancer returns. If a patient relapses soon after remission or while they’re going through treatment, they are said to have a high-risk disease. That is when treatments might change to a transplant of sorts, which is more likely to be effective. Treatments for any stage of acute lymphoblastic leukemia will start almost as soon as the disease is found.

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