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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

    • Anemia

    • Dizziness

    • Frequent or unexplained fever and infection

    • Weight loss and/or loss of appetite

    • Excessive and unexplained bruising

    • 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

    Biological therapy

    Radiation therapy

  • Acute lymphocytic leukemia

     Statistics

    Ninety-two Israeli children with acute lymphoblastic leukemia (ALL) (67 B-lineage and 25 T-lineage) were analyzed for the immunological antigen receptor gene configuration. Thirty-nine of the patients (27 B-lineage and 12 T-lineage) relapsed. The incidence of the identified rearrangements within the immunoglobulin heavy chain (IgH) and T-cell receptor (TCR)beta, gamma and delta genes, at diagnosis, was in accordance with previous studies from other countries.

    Furthermore, the clinical relevance of bi/oligoclonal status, at diagnosis, and clonal selection was determined in this long-term follow-up study (median 112 months). A similar relapse rate was observed among the B-lineage patients with bi/oligoclonal and monoclonal patterns indicated by IgH gene rearrangement. Based on our results, bi/oligoclonality has no prognostic significance (P=0.8533). Clonal variations between diagnosis and subsequent relapses were detected in 60% (12/20) of the patients; 64% (7/11) B-lineage and 55% (5/9) T-lineage. Clonal selection significantly correlated with shorter duration of remission and earlier recurrence (P=0.0025).

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