Acute Lymphocytic Leukemia

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Acute Lymphocytic Leukemia Overview

Acute lymphocytic leukemia is a cancer of the blood and bone marrow, where blood cells are produced.
The term “acute” in acute lymphocytic leukemia refers to the disease’s rapid progression and production of immature rather than mature blood cells. 
The term “lymphocytic” in acute lymphocytic leukemia refers to the white blood cells known as lymphocytes that are affected by the disease. 
Additionally known as acute lymphoblastic leukemia, acute lymphocytic leukemia is a form of acute lymphoblastic leukemia.

Acute Lymphocytic Leukemia Symptoms

Signs and symptoms of acute lymphocytic leukemia may include:

  • Bleeding from the gums
  • Bone pain
  • Fever
  • Frequent infections
  • Frequent or severe nosebleeds
  • Lumps caused by swollen lymph nodes in and around the neck, armpits, abdomen or groin
  • Pale skin
  • Shortness of breath
  • Weakness, fatigue or a general decrease in energy

Acute Lymphocytic Leukemia Causes

Acute lymphocytic leukemia is caused by mutations in the genetic material or DNA of bone marrow cells. The DNA of a cell contains the instructions that tell it what to do. Typically, the DNA instructs the cell to grow and die at a predetermined rate and time. In acute lymphocytic leukemia, mutations instruct bone marrow cells to continue dividing and growing.

When this occurs, the production of blood cells becomes out of control. The bone marrow produces immature cells that mature into lymphoblasts, which are leukemic white blood cells. These abnormal cells are incapable of proper function, and they can accumulate and crowd out healthy cells.

What causes the DNA mutations that can lead to acute lymphocytic leukemia is unknown.

Among the risk factors for acute lymphocytic leukemia are the following:

  • Previous treatment for cancer. Acute lymphocytic leukemia may be more likely to develop in children and adults who have received certain types of chemotherapy and radiation therapy for other forms of cancer
  • Radiation exposure. Acute lymphocytic leukemia is more likely to develop in individuals exposed to extremely high levels of radiation, such as survivors of nuclear reactor accidents.
  • Genetic disorders. A higher risk of acute lymphocytic leukemia is associated with certain genetic disorders, such as Down syndrome.

Acute Lymphocytic Leukemia Diagnostics

Included among the diagnostic procedures and tests for acute lymphocytic leukemia are:

  • Blood tests. Blood tests may reveal an excess or deficiency of white blood cells, an insufficiency of red blood cells, and an insufficiency of platelets. A blood test may also reveal the presence of blast cells, which are immature cells that are normally found in bone marrow.
  • Bone marrow analysis. A needle is used to extract a sample of bone marrow from the hipbone or breastbone during a bone marrow aspiration and biopsy. The sample is sent to a laboratory for testing in order to identify leukemia cells. Blood cells will be categorized by size, shape, and other genetic or molecular characteristics by laboratory physicians. In addition, they search for specific changes in the cancer cells and determine whether the leukemia cells originated from B or T lymphocytes. This information aids your physician in developing a treatment plan.
  • Imaging tests. Imaging tests, such as an X-ray, a computed tomography (CT) scan, or an ultrasound scan, can help determine whether cancer has spread to the brain and spinal cord or other parts of the body.
  • Spinal fluid test. A lumbar puncture test, also known as a spinal tap, may be performed to collect a sample of spinal fluid, the fluid that surrounds the brain and spinal cord. The sample will be examined to determine if cancer cells have spread to the spinal fluid.

Acute Lymphocytic Leukemia Treatment

In general, acute lymphocytic leukemia treatment consists of distinct phases:

  • Induction treatment. The first phase of treatment aims to eliminate the majority of leukemia cells in the blood and bone marrow and restore normal blood cell production.
  • Reconstruction therapy. This phase of treatment, also known as post-remission therapy, aims to eradicate any remaining leukemia in the body.
  • Maintenance treatment. The third phase of treatment prevents the regrowth of leukemia cells. In this phase, treatments are typically administered in much lower doses over an extended period of time, often years.
  • Preventative care for the spinal cord. People with acute lymphocytic leukemia may receive additional treatment to eliminate leukemia cells located in the central nervous system during each phase of therapy. Chemotherapy drugs are frequently injected directly into the fluid that surrounds the spinal cord in this type of therapy.

The phases of treatment for acute lymphocytic leukemia can last between two and three years, depending on the patient’s condition.

Possible treatments include:

  • Chemotherapy. For children and adults with acute lymphocytic leukemia, chemotherapy, which employs drugs to kill cancer cells, is typically administered as an induction therapy. In the consolidation and maintenance phases, chemotherapy drugs can also be used.
  • Targeted treatment. Targeted drug therapies concentrate on specific abnormalities within cancer cells. By inhibiting these abnormalities, targeted drug therapies can cause the death of cancer cells. Your leukemia cells will be evaluated to determine if targeted therapy could be beneficial. Targeted therapy can be used alone or in conjunction with chemotherapy for induction, consolidation, and maintenance treatments.
  • Radiation treatment. To eradicate cancer cells, radiation therapy employs high-energy beams, such as X-rays or protons. If cancer cells have spread to the central nervous system, your physician may suggest radiation therapy.
  • Marrow transplantation. A transplant of bone marrow, also known as a stem cell transplant, may be used as consolidation therapy or to treat relapse, if it occurs. This procedure enables a person with leukemia to regain healthy bone marrow by replacing leukemic bone marrow with leukemia-free marrow from a healthy individual. High doses of chemotherapy or radiation are administered prior to a bone marrow transplant in order to destroy any leukemia-producing bone marrow. The bone marrow is then replaced with compatible donor bone marrow (allogeneic transplant).
  • Immune cells engineered to combat leukemia. A specialized treatment known as chimeric antigen receptor (CAR)-T cell therapy modifies your body’s T cells to fight cancer and then reinfuses them into your body. CAR-T cell therapy may be a treatment option for children and adolescents. It may be used for both consolidation therapy and relapse treatment.