Synonyms in a broader sense
Leukemia, white blood cancer, HTLV I and HTLV II viruses, Human t-cell leukemia virus I and II, German : Human T Zell Leukemia Virus I und II, Philadelphia Chromosome
Definition
The degenerated cells of this type belong to the preliminary stages of lymph cells (lymphocytes). This type of leukaemia is also expected to have an acute, i.e. rapid, course of disease. Early stages of cell development are particularly affected.
Frequency
It is the most common white blood cancer in children. In adults it is only the fifth most common leukemia. However, from the age of 80 onwards, the incidence of new cases is similar to that of childhood. You can find more information on this topic here: Leukaemia in children
Causes
Most causes can be read in the general leukemia chapter. In ALL (acute lymphatic leukaemia), viruses also play an important role in its development. The viruses HTLV I and HTLV II (Human t-cell leukemia virus I and II) are believed to be responsible for the development of this type of leukemia in Japan and the Caribbean.
Further causes are again irregularities (aberrations) in the gene carriers (chromosomes). An atypical connection (translocation) between chromosomes 9 and 22, which leads to the formation of the so-called Philadelphia chromosome, ensures unchecked growth of the affected cells. This above described formation of the Philadelphia chromosome is responsible for 1/5 of ALL (Acute Lymphatic Leukemia) in adults and for about 5% of ALL (Acute Lymphatic Leukemia) in children.
Symptoms
The symptoms of ALL vary widely and are difficult to isolate precisely. In principle, they are the symptoms (anemia, susceptibility to infection, paleness, etc.) as they occur in AML (acute myeloid leukaemia).
However, symptoms such as headaches or paralysis are more frequent, because this type of leukaemia often affects the meninges. The lymph nodes are also more frequently palpable enlarged than in AML (acute myeloid leukaemia). In certain regions, e.g. the neck, armpit or groin, roundish oval lymph nodes are then palpable. Without a blood test, the disease cannot be diagnosed with certainty. In the blood, changes in all three blood cell lines can be detected: 1. decrease in red blood cells (anaemia) 2. decrease in platelets (thrombocytopenia) 3. increase (leucocytosis) and decrease (leucocytopenia) in white blood cells As you can see, leukaemia can cause many unspecific symptoms that can raise suspicion of the disease.
Diagnosis
These are the same procedures as those described for AML (acute myeloid leukaemia). Therefore, after a blood sample has been taken, a differential blood count should be made from which the exact numbers of platelets and red and white blood cells can be read. The enormous importance of gene analyses should be emphasised here in order to determine irregularities in the gene carriers (chromosomal aberrations), as these are very important for the prognosis.
One difference to AML (acute myeloid leukaemia) in diagnostics is that in ALL (acute lymphatic leukaemia), special attention should be paid to the infestation of the central nervous system. Punctures of the cerebrospinal fluid (liquor punctures) or computer tomography of the head (so-called CCT) should therefore be carried out to detect an infestation of the meninges or the cerebrospinal fluid. In order to detect lymph node enlargements in places invisible to the eye, computer tomography images of the abdomen should be taken, also to see any enlargement of the spleen (splenomegaly) or liver (hepatomegaly).
In contrast to chronic leukemias, the symptoms of acute leukemias develop within a short period of time. The symptoms often progress rapidly within a few days. At the beginning, the symptoms are mainly due to the increasing restriction of normal blood formation.
Those affected then suffer from anaemia with conspicuous skin pallor and reduced performance. At the time of diagnosis, about one third of patients suffer from bleeding (e.g. gum and nose bleeding) and recurrent, severe infections. In almost 60%, painless swelling of the lymph nodes or an enlarged spleen can be found at the beginning of the disease.
In the course of the disease, the leukaemia cells “migrate” to various organs and thus spread throughout the body. Possible symptoms can include bone pain (if the bone is affected) and headaches (if the nervous system is affected). However, infiltration into organs usually only occurs in advanced stages.
For example, only about 9% of those affected suffer from leukaemia of the organs at the beginning of ALL. In the course of the disease, weight loss and loss of appetite continue to occur frequently. Since untreated acute lymphatic leukaemia is always fatal, a quick start to therapy is essential.
Because it is a very aggressive disease, the treatment must also be correspondingly intensive. For this purpose, various chemotherapeutic agents are combined to form a so-called “polychemotherapy”. Various side effects can be observed in the course of therapy.
In the beginning, nausea and vomiting are often in the foreground. Frequently an inflammation of the oral mucosa (mucositis) occurs. Later, patients often suffer from severe, sometimes life-threatening infections. In the later course, temporary nerve or kidney damage may occur. As a rule, the duration of treatment is about one and a half to two years.
