Acute Lymphoblastic Leukemia

 

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Original Editors -  Erin Foster from Bellarmine University's Pathophysiology of Complex Patient Problems project.

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Definition/Description

Acute lymphoblastic leukemia (ALL) is a cancer of the blood and bone marrow. Bone marrow is spongy tissue that fills the cavity of the long bones consisting of fat, red blood cells, and white blood cells. ALL affects the immature white blood cells. This type of cancer is classified by one of two subtypes.

The two subtypes include:

B-cell

• Common ALL (50% of cases)
• Early Pre-B ALL (10% of cases)
• Pre-B ALL (10% of cases)
• Mature B-cell ALL (4% of cases)

T-cell

• Pre-T ALL (5-10% of cases)
• Mature T-cell (15-20% of cases)

Prognostic factors include:

• Age
• White blood cell count
• ALL subtype
• Certain test results
• Response to treatment

Prevalence

ALL is the most common cancer occurring in children today and can occur in some adult cases. Children are at the highest risk between 2 and 4 years of age. This risk decreases from age 4 to mid-20s, increasing again after age 50. The average person has a 1 in 1,000 chance of getting ALL. The American Cancer Society estimated the following statistics for 2010:

• Approximately 43,050 new cases of all types of leukemia.
• Approximately 5,330 new cases of acute lymphoblastic leukemia (1 out of 3 were adult cases).
• Approximately 1,420 deaths from ALL (3 out of 4 were adult cases).
  

Characteristics/Clinical Presentation

Most signs and symptoms of ALL mimic those of the flu. However, with ALL these signs and symptoms will not improve. Signs and symptoms include:

• Bleeding from the gums
• Nosebleeds
• Pale skin
• Shortness of breath
• Fever
• Frequent infections
• Weakness
• Fatigue
• Swollen lymph nodes (neck, underarm, groin, stomach)
  

Associated Co-morbidities

The following co-morbidities are linked to ALL:

• Anemia
• Diabetes
• Lupus
• Rheumatoid Arthritis
• Multiple Sclerosis
  
  

Medications

Medications involved with ALL include:

• Gleevec
• Adriamycin
• Purinethol
• Sprycel
• Trexall
• Oncaspar
• Arranon
• Clolar
• Vumon
  
  

Diagnostic Tests/Lab Tests/Lab Values

Diagnostic tests and results for ALL include:

• Blood test

These tests reveal increased number of white blood cells, decreased number of red blood cells and platelets. A blood test may also reveal blast cells. Blast cells are immature blood cells in bone marrow.

• Bone marrow test

A needle is used to remove a sample of bone marrow from the hipbone to look for cancerous cells. Through this process, doctors can determine if the cells originated from the B lymphocytes or T lymphocytes according to certain changes in the cancer cells.

• Lumbar puncture or spinal tap

A sample of spinal fluid is collected to determine if the cancerous cells have spread.

• Imaging

X-ray and computerized tomography (CT) scan can help determine if the cancer has spread to other parts of the body.

Etiology/Causes

The exact causes are unknown. However, there are some risk factors thought to be linked to ALL. These risk factors include:

• Chemical
• Radiation exposure
• Viral infection
• Certain inherited disorders
  o Down syndrome
  o Klinefelter syndrome
  o Fanconi anemia
  o Bloom syndrome
  o Ataxia-telangiectasia
  o Neurofibromatosis
  

Systemic Involvement

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Medical Management (current best evidence)

Treatment for ALL can span from 2 ½ to 3 ½ years depending on each individual situation. General treatment for ALL is broken down into the following 4 phases:

• Induction therapy

The purpose of this phase is to kill most of the cancer cells in the blood and bone marrow.

• Consolidation therapy/ Post- remission therapy

During this phase, the goal is to destroy any remaining leukemia cells in the central nervous system.

• Maintenance therapy

This low dose treatment is given to prevent cancer cell re-growth. 

• Preventive treatment to the spinal cord

Some cancer cells in the central nervous system can not be destroyed by chemotherapy drugs given by oral or intravenous means. During this phase, chemotherapy drugs are injected directly into the spinal cord fluid.

During these 4 phases the specific types of treatments include:

• Chemotherapy

Chemotherapy is normally used in the induction therapy stage to kill the cancer cells. This drug can also be used in the consolidation and maintenance phases.

• Targeted drug therapy

These drugs attack specific abnormalities that cause the cancer cell growth.

• Radiation therapy

This treatment uses high-powered beams to destroy cancer cells. This is typically used when the cancer has spread to the central nervous system.

• Stem cell transplant

This transplant may be used for patients at risk or currently going through a relapse. This procedure replaces cancer bone marrow through chemotherapy or radiation with healthy bone marrow from a compatible donor allowing re-establishment of healthy stem cells.

Physical Therapy Management (current best evidence)

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Alternative/Holistic Management (current best evidence)

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Differential Diagnosis

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Case Reports/ Case Studies

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Resources

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Recent Related Research (from Pubmed)

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References

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