Acute lymphocytic leukemia

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at January 13, 2016
StartDiseasesAcute lymphocytic leukemia

Acute lymphocytic leukemia (ALL) is a bone marrow cancer and blood cancer which causes mutated blood cells to develop and overcome healthy blood cells in the body. This form of leukemia is more treatable in children and often fatal in adults. Doctors do not know what causes the mutations to first develop.

Contents

Definition & Facts

Acute lymphocytic leukemia (ALL) is a type of cancer affecting bone marrow, the sponge-like tissue in the bones responsible for making blood cells and blood. ALL progresses very rapidly. The disease interferes with the process of blood cell generation, causing the body to produce immature blood cells. It also affects white blood cells, called lymphocytes. The disease is sometimes referred to as acute lymphoblastic leukemia.

ALL is the most common type of childhood cancer. Properly treated, it can be cured. When the disease occurs in adulthood, the chances of a cure are much lower.

Symptoms & Complaints

Acute lymphocytic leukemia causes shortages of normal blood cells. The shortage occurs when leukemia cells overcrowd the normal blood-producing cells in bone marrow. This effect is responsible for most symptoms of the disease and include:

Abnormal cells of leukemia can build up in the spleen and liver. This causes these organs to enlarge, making the abdomen feel full or swollen. When acute lymphocytic leukemia spreads to lymph nodes, it causes them to swell and feel like marbles under the skin. This can occur in the neck, groin, underarms or in nodes where the effects cannot be felt and must be detected by CT scans or MRIs, such as in the chest or abdomen. ALL leukemia cells accumulate at the surface of the bones or in joints and cause these areas to feel painful.

When occurring in the brain and spinal cord, symptoms may include headaches, weakness, vomiting, balance problems, numbness of the face, blurred vision and seizures. When spreading to the chest cavity, symptoms can involve fluid accumulation and breathing problems.

When the T-cell subtype of acute lymphocytic leukemia affects the thymus, this organ can become enlarged and presses on the trachea, causing trouble breathing or coughing. An enlarged thymus can also press on the superior vena cava (SVC), causing the blood to build up in the veins. In superior vena cava syndrome (SVCS), this problem in turn causes facial swelling and swelling of the neck, arms and chest. Headaches, dizziness and problems associated with consciousness result when the brain is affected. SVC syndrome can be fatal if treatment is not rapidly provided.

Causes

Acute lymphocytic leukemia is the result of DNA errors which develop within a bone marrow cell. That cell is directed by the faulty DNA to continue growing and dividing, whereas a healthy cell would stop dividing and die at the end of its regular life cycle. As an effect of this altered pattern, abnormalities occur in blood cell production and bone marrow creates immature cells which become leukemic white blood cells. These resulting lymphoblasts, as they are called, cannot properly function. They build up and overcome healthy cells.

Why these DNA mutations occur is a mystery. It is known that it is not usually an inherited condition, however. Risk of acute lymphocytic leukemia can be increased by the following:

Diagnosis & Tests

Diagnostic procedures associated with acute lymphocytic leukemia include:

Treatment & Therapy

Treatments for ALL include:

Acute lymphocytic leukemia treatment occurs in four separate phases over the course of two to three years:

  • Induction therapy - A process of killing the leukemia cells to restore normal blood cell production
  • Consolidation therapy - After remission, this treatment destroys any remaining leukemia in the brain, spinal cord or elsewhere
  • Maintenance therapy - Prevention of regrowth of leukemia cells
  • Preventive spinal cord treatment - Additional treatment throughout all phases of treatment for ALL, this kills leukemia cells in the central nervous system using chemotherapy drugs injected into spinal fluid

Adults over the age of 60 often experience greater complications than younger patients with ALL. They also experience more problems from treatments. Their prognosis is generally worse than for children with the disease. Because of the pervasive nature of this disease, some older adults opt for palliative care or hospice care in lieu of trying to treat the disease.

Prevention & Prophylaxis

Scientists are aware of the DNA defect which kicks off acute lymphocytic leukemia. At this time they are not able to discern what causes those DNA mutations in the first place. This means that there is no manner of prevention of the disease. However, patients undergoing treatment for ALL can utilize two types of therapies to help prevent recurrence:

  • Maintenance therapy - Lower doses of ALL treatment medications provided for years to prevent regrowth of the ALL cells
  • Spinal cord preventive treatments - Direct injection of chemotherapy drugs into the spinal fluid to kill ALL cells in the central nervous system