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Acute Lymphoblastic Leukemia...one
Acute lymphoblastic leukemia (ALL), also known as acute lymphocytic leukemia, is a cancer of the white blood cells, characterised by the overproduction and continuous multiplication of malignant and immature white blood cells in the bone marrow.
ALL is a hematological
malignancy. It is fatal if left untreated as ALL spreads into the bloodstream
and other vital organs quickly (hence "acute"). It mainly affects
young children and adults over 50.
Symptoms
Initial symptoms of ALL are quite aspecific, but worsen to the point that medical
help is sought:
- Generalised weakness and fatigue
- Anemia
- Frequent or unexplained fever and infections
- Weight loss and/or loss of appetite
- Excessive bruising or bleeding from wounds, nosebleeds, petechiae (red pinpoints on the skin)
- Bone pain, joint pains (caused by the spread of "blast" cells to the surface of the bone or into the joint from the marrow cavity)
- Breathlessness
- Enlarged lymph nodes, liver and/or spleen
Diagnosing leukemia usually begins with a medical history and physical examination. If there is a suspicion of leukemia, the patient will then proceed to undergo a number of tests to establish the presence of leukemia and its type. Patients with this constellation of symptoms will generally have had blood tests, such as a full blood count.
These tests may include complete blood count (blasts on the blood film generally lead to the suspicion of ALL being raised). Nevertheless, 10% have a normal blood film, and clinical suspicion alone may be the only reason to perform a bone marrow biopsy, which is the next step in the diagnostic process.
Bone marrow is examined for blasts, cell counts and other signs of disease. Pathological examination, cytogenetics (e.g. presence of the Philadelphia chromosome) and immunophenotyping establish whether the "blast" cells began from the B lymphocytes or T lymphocytes.
If ALL has been established as a diagnosis, a lumbar puncture is generally required to determine whether the malignant cells have invaded the central nervous system (CNS).
Lab tests (mentioned above) and clinical information will also determined if any other medical imaging (such as ultrasound or CT scanning) may be required to find invasion of other organs such as the lungs or liver.
OUTLOK
Advancements in medical technology and research over the past four decades in the treatment of ALL has improved the overall prognosis significantly from a zero to 20-75 percent survival rate, largely due to the continuous development of clinical trials and improvements in bone marrow transplantation (BMT) and stem cell transplanation (SCT) technology.
However the prognosis for ALL differs between individuals depending on a wide variety of factors:
- Sex: females tend to fare better than males.
- Ethnicity: Caucasians are more likely to develop acute leukemia than African-Americans, Asians and Hispanics and tend to have a better prognosis than non-Caucasians. ge at diagnosis: children between 1-10 years of age are most likely to be cured.
- Lymphoblast cell count at diagnosis
- Whether the cancer has spread to the brain or spinal cord
- Morphological, immunological, and genetic subtypes
- Response of patient to initial treatment
- Genetic disorders such as Down's Syndrome
Edited by: Kevin Hart MA
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