Amongst the different types of cancer, one type that is quite uncommon and can be heard and seen to have occurred only in patients of tender and young ages more is the lymphocytic leukemia. According to a study by the University of Maryland Medical Centre, acute lymphocytic leukemia or in short ALL, strikes about 6000 people in the entire United States of America, 300 in Australia and in the United Kingdom, the number is 8600 every year. Acute lymphocytic leukemia is absolutely uncommon amongst adults and can be seen mostly in children. Acute lymphocytic leukemia is an absolutely rare disease accounting only 0.3% of all cancer diagnosis.
Definition of Acute Lymphocytic Leukemia:
Acute lymphocytic leukemia is a type of cancer that originates from the bone marrow, involving the blood cells. When the bone marrow develops a type of immature white blood cells, known as the lymphocytes, and invades the blood stream to flow down through the entire body affecting the spleen, lymph nodes, liver and the central nervous system, it is known as the acute lymphocytic leukemia.
The term acute denotes that these types of leukemia cells can invade or spread in the blood quite fast and if it is left untreated in the initial stage, it will be fatal for the patient, bringing death within a few months. However, unlike most other types of cancer, the acute lymphocytic leukemia does not form any tumor in any part of the body and is associated only to the development of the lymphocytes in the bone marrow.
Signs and Symptoms of Acute Lymphocytic Leukemia:
In case of the acute lymphocytic leukemia, it is very important that the disease is diagnosed at an early stage, giving the time and opportunity to treat it at the roots as untreated acute lymphocytic leukemia will lead to death within a very short time. The best way to diagnose acute lymphocytic leukemia is through the signs and symptoms and they are:
- Weakness, fatigue, tiredness, paleness, dizziness, shortness of breath
- Anemia due to lack of red blood cells can be a symptom of acute lymphocytic leukemia
- Repeated and frequent infections
- Unexplained bleeding and increased bruising due to a very low platelet count is a symptom of acute lymphocytic leukemia.
- Pain in the bones or joints
- Fullness below the ribs, lumps in underarm, neck, stomach, groin
- Fever, nosebleeds, bleeding in gums.
Causes and Risk factors of Acute Lymphocytic Leukemia:
Acute lymphocytic leukemia is rarely seen in adults and when it occurs in adults, it has a very limited scope for treatment. However when Acute lymphocytic leukemia occurs in children, it can be treated well, if diagnosed at an early stage. But it is always better for people to know, who are at risk of developing Acute lymphocytic leukemia. It is not an infectious disease and hence, cannot be passed from one person to the other. The causes and factors that are instrumental in developing this disease are:
- Radiation exposure is a common risk for developing Acute lymphocytic leukemia. The atomic bomb explosion survivors in Japan had a high risk of developing Acute lymphocytic leukemia. Even if the foetus is exposed to radiation in its first month of development, it will likely grow Acute lymphocytic leukemia. Repeated exposure to X-ray diagnosis is also a risk, but the extent and severity is not clear in that case.
- Exposure to certain chemicals such as benzene, certain chemotherapy drugs etc. is also a reason for Acute lymphocytic leukemia. Hence, those who work in industries such as rubber industry, chemical plants, oil refineries, gasoline-related industries and shoe manufacturing are at higher risk as benzene is used in these industries.
- If one is born with some genetic conditions such as Down's syndrome, Ataxia Telangiectasia or Fanconi Anaemia, Neurofibromatosis, Klinefelter syndrome they are at risk of developing Acute lymphocytic leukemia.
Apart from these factors, there are also some other factors that need to be considered and they are:
- Obese children have a higher risk of developing acute lymphocytic leukemia
- The HTLV-1 or the human T cell leukemia virus is also cause for this disease
- According to the French ESCALE study in 2013, drinking more than 2 cups of coffee a day will slightly increase the chances of A Acute lymphocytic leukemia.
- Whites have a higher risk of acute lymphocytic leukemia than non-whites or blacks.
Prognosis and Survival Rate of Acute Lymphocytic Leukemia:
Although the acute lymphocytic leukemia is itself an uncommon or rare type of cancer and occurs only in the children, or rarely in adults, with a proper diagnosis at an early stage, the rate of survival or the life expectancy of the patient suffering from Acute Lymphocytic Leukemia can be increased. Even a few years back, the survival rate or the life expectancy for Acute Lymphocytic Leukemia was extremely low or almost zero. However, with the advancement of clinical trials and new chemotherapeutic agents the possibility of treatment for Acute Lymphocytic Leukemia has increased to 85% in children. However, despite such high rates of survival, there are more than 1,400 deaths alone in the United States of America, due to acute lymphocytic leukemia, according to the studies by the University of Maryland Medical Centre.
However, in case of adults, who are diagnosed with acute lymphocytic leukemia, complete cure can be provided to only 20 to 40%. All the patients, who are diagnosed with acute lymphocytic leukemia, are divided into three prognosis groups and they are: good risk, intermediate risk, and poor risk.
- Good risk are those, who are younger than 30 years of age, have no adverse cytogenetics, have a count of less than 30,000/μL white blood cells and within 4 weeks, can achieve complete remission of acute lymphocytic leukemia.
- Poor risk are those, who have adverse cytogenetics, are more than 60 years of age, have a count of more than 100,000/μL white blood cells and within 4 weeks, they will fail to achieve complete remission.
- People in the intermediate risk group are those, who do not fall under any of these two categories of prognosis.
The reason, why the adult people with acute lymphocytic leukemia fail to be cured with the treatment procedures is because the disease starts to affect and complicate the chromosome. Also, adults diagnosed with this disease co-expressed myeloid markers. According to a study by Preti et al, 64 out of 162 patients were seen to have this co-expression of myeloid markers and shown a trend toward a decreased remission rate. The remission rate was 64% for those with the markers compared to rate being 78% for those, who did not co-express this marker.
The very prominent time in which this disease has been seen to occur in children is when they are below the age of 5. However, 98 to 99% of all children are found to experience complete remission of acute lymphocytic leukemia within six months of treatment. In the next ten years, they are seen to be completely free from leukemia and hence, considered to be absolutely cured.
Diagnosis of Acute Lymphocytic Leukemia:
Diagnosis of acute lymphocytic leukemia is done through various procedures and they are:
Medical History and Physical Exam to Diagnose Acute Lymphocytic Leukemia:
By going through the signs and symptoms, by determining the history of the risk factors and also by listening to the medical history of the ailing person, the general diagnosis of acute lymphocytic leukemia is done. The physical test is very important because only when the doctor suspects a possible acute lymphocytic leukemia development, that he will ask for doing further tests.
Blood Test to Diagnose Acute Lymphocytic Leukemia:
Blood cell exam or peripheral blood smear and CBC or complete blood count tests are done to measure the numbers of red blood cells, white blood cells, and platelets in blood. Through this test, the very basic detection of the abnormality in the number of white blood cells or lymphocytes can be determined.
Bone Marrow Aspiration and Biopsy to Diagnose Acute Lymphocytic Leukemia:
Through this test, bone marrow samples are collected from the hip or pelvic bones through a needle and this obtained bone marrow is sent for biopsy to check the presence of lymphocytic cells. Through this test, it is also checked, whether the Leukemia is responding to the treatment or not.
Imaging Tests to Diagnose Acute Lymphocytic Leukemia:
Computed tomography or CT scan, Magnetic resonance imaging or MRI scan as well as ultrasound tests are done to determine whether the cancer has spread to the brain and spinal cord or not. In case of ALL, sometimes a 'lump' is developed in the chest and through the chest X-ray, this can be diagnosed.
Lumber Puncture to Diagnose Acute Lymphocytic Leukemia:
This is a technique through which the CSF or cerebrospinal fluid is collected and sent for biopsy. This technique is also used to send the chemotherapy drugs straight to the CSF.
Treatment for Acute Lymphocytic Leukemia:
The entire treatment of Acute Lymphocytic undergoes three stages and they are induction or killing the Leukemia cells and put it to remission or letting normal blood cell return to count, intensification or getting rid of any possible remaining Leukemia cells that might cause the disease to return, and maintenance or destroying other cells that might have survived the other two stages. The methods through which this is done are:
Chemotherapy to Treat Acute Lymphocytic Leukemia:
"Chemo" is a combination of very powerful drugs that can destroy the cancerous cells and stop them from developing more or dividing themselves. Some of the chemo drugs are given by injecting them to the bloodstream and some are given orally.
Radiation Therapy to Treat Acute Lymphocytic Leukemia:
In this process, high frequency and high energy X-ray is sent to the affected area to destroy the cancer cells and stop them from reappearing.
Stem Cell Transplant to Treat Acute Lymphocytic Leukemia:
Once the cancer cells are destroyed in the patient's bone marrow, they are removed and replaced by the donor's bone marrow samples so that new and fresh blood cells are produced.
Sometimes targeted therapy is also given in which only the cancer cells are destroyed, without affecting the normal cells. But the general treatment procedures usually destroy all the present cells and let the normal and healthy blood cells to come to use again.
Since Acute Lymphocytic Leukemia occurs more in children, it could be worse soon due to the reduced immunity power in them, however the symptoms are very evident in them. Thus, spotting it at an early stage is very important with a signs and symptoms. The moment few of the symptoms of Acute Lymphocytic Leukemia are seen, see the doctor without delay, as delaying could put the child's life at risk. Although Acute Lymphocytic Leukemia is a life threatening disease, complete cure is possible with early diagnosis and proper treatment.