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Acute Lymphocytic Leukemia

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  • Acute lymphocytic leukemia

     Acute lymphoblastic leukemia, also known as acute lymphocytic leukemia or acute lymphoid leukemia (ALL), is an acute form ofleukemia, or cancer of the white blood cells, characterized by the overproduction and accumulation of cancerous, immature white blood cells, known as lymphoblasts.

    ALL, lymphoblasts are overproduced in the bone marrow and continuously multiply, causing damage and death by inhibiting the production of normal cells (such as red and white blood cells and platelets) in the bone marrow and by spreading (infiltrating) to other organs. ALL is most common in childhood, with a peak incidence at 2–5 years of age and another peak in old age.

    The signs and symptoms of ALL are

    • Generalized weakness and fatigue

    • Bone pain, joint pain (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

    • Pitting edema (swelling) in the lower limbs and/or abdomen

    • Petechiae, which are tiny red spots or lines in the skin due to low platelet levels

    Tests and Diagnosis

    • Physical examination

    Complete blood count

    • Blood smear

    Bone marrow biopsy

    • Spinal tap

  • Acute lymphocytic leukemia

     Treatment and Medication

    Chemotherapy

    Remission induction: Combination of prednisolone or dexamethasone, vincristine, asparaginase (better tolerance in pediatric patients), and daunorubicin (used in Adult ALL) is used to induce remission. Central nervous system prophylaxis can be achieved via irradiation, cytarabine and methotrexate, or liposomal cytarabine.In Philadelphia chromosome-positive ALL, the intensity of initial induction treatment may be less than has been traditionally given.

    Consolidation: Typical consolidiation protocols use vincristine, cyclophosphamide, cytarabine, daunorubicin, etoposide, thioguanine or mercaptopurine given as blocks in different combinations. For CNS protection, intrathecal methotrexate or cytarabine is usually used combined with or without cranio-spinal irradiation (the use of radiation therapy to the head and spine). Central nervous system relapse is treated with intrathecal administration of hydrocortisone, methotrexate, and cytarabine.

    Maintenance therapy: oral mercaptopurine, once weekly oral methotrexate, once monthly 5-day course of intravenous vincristine and oral corticosteroids are usually used. The length of maintenance therapy is 3 years for boys, 2 years for girls and adults.

    And the other include

    Immunotherapy: Chimeric antigen receptors (CARs) have been developed as a promising therapy for ALL. This technology uses a single chain variable fragment (scFv) designed to recognize the cell surface marker CD19 as a method of treating ALL. CD19 is a molecule found on all B-cells and can be used as a means of distinguishing the potentially malignant B-cell population in the patient.

    Biological therapy: ALL, aiming at biological targets such as the proteasome, in combination with chemotherapy, has given promising results in clinical trials.Selection of biological targets on the basis of their combinatorial effects on the leukemic lymphoblasts can lead to clinical trials for improvement in the effects of all treatments.

    Radiation therapy: Radiation therapy (or radiotherapy) is used on painful bony areas, in high disease burdens, or as part of the preparations for a bone marrow transplant.

  • Acute lymphocytic leukemia

     Statistics

    A nationwide cooperative incidence survey of leukemia was carried out from 1986 to 1988 in a cooperative survey network covering 46 investigating areas. More than 60 million person-years were supervised and 1670 new cases identified. The annual incidence of leukemia was 2.76/10(5), and the 95% confidence interval of the population rate ranged from 2.63/10(5) to 2.89/10(5). The incidences in oil fields and polluted areas were significantly higher than those in other areas.

    The incidence of acute nonlymphocytic leukemia (ANLL) was 1.62/10(5); acute lymphocytic leukemia (ALL), 0.69/10(5); chronic myelocytic leukemia (CML), 0.36/10(5); chronic lymphocytic leukemia (CLL), 0.05/10(5); and special types, 0.03/10(5).

    The incidence and constituent ratio of CLL were significantly lower than those in Europe and America. A peak of ALL incidence before age 10 was seen; this rate then declined with increasing age until 30. However, the incidences of other leukemias rose with age, reaching peaks at old age (50-70). The leukemia rate in males was significantly higher than in females, both in youth (10-29) (caused by ALL) and at age old (mainly caused by ANLL).

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