Acute lymphoblastic leukemia, or ALL, is an acute form of leukemia caused by malignant lymphocyte precursor cells. It mostly affects children. The cure rate is approximately 50% in adults and 80% in children.
What is acute lymphoblastic leukemia?
Acute lymphoblastic leukemia, or ALL, is an acute form of leukemia caused by malignant lymphocyte precursor cells. Acute lymphoblastic leukemia is one of the four forms of leukemia in which the blood cancer cells are caused by malignant degeneration of the lymphocytes. With this degeneration, there is decreased formation of healthy lymphocytes, erythrocytes and platelets. This causes general weakness, increased bleeding tendency, and immunodeficiency with severe to life-threatening infections. ALL is a rare disease with approximately 500 new cases per year in adults and children. However, it must be mentioned that new cases in adults are inadequately recorded due to the lack of a central cancer registry. While acute lymphoblastic leukemia is rare in adults, with an increased risk of disease only at an advanced age, it is the most common malignant disease in children.
Causes
Acute lymphoblastic leukemia is caused by genetic changes in lymphocytes that trigger the alteration of these cells. These genetic changes occur during life, and the causes have not yet been adequately studied. It has not yet been possible to define which factors trigger ALL; moreover, no specific cause has been identified. However, general risk factors of leukemia can be assessed, including radioactive and X-ray radiation, contact with dangerous chemicals and certain medications, including especially agents that suppress the immune system, and defects of the immune system. Another risk factor of any type of cancer is smoking. It is now known for certain that acute lymphoblastic leukemia is neither inherited nor hereditary, since the oocytes and sperm are not affected.
Symptoms, complaints, and signs
Acute lymphoblastic leukemia is characterized by a variety of symptoms. It is a rapidly progressing disease that, without treatment, leads to death within a short time. The initial stage of the disease may initially be asymptomatic. However, the disorder of blood formation then leads to anemia and general weakness with fatigue, pallor, fatigue, fever, reduced performance, malaise and shortness of breath. Since the number of functional white blood cells is also reduced, susceptibility to infections is generally increased. However, the immature lymphocytes multiply uncontrollably. In one third of patients (especially children), these spread to the bones and joints. This results in joint and bone pain. The organs of the lymphatic system swell. These organs include the spleen, liver, thymus gland, and especially the lymph nodes of the chest. The enlargement of the spleen causes pressure in the left upper abdomen. The feeling of pressure in the right upper abdomen is caused by the liver enlargement. Swelling of the lymph nodes in the chest area causes shortness of breath. In rare cases, the brain, spinal cord or meninges are affected. Neurological symptoms such as nerve paralysis, sensitivity disorders, headaches, double vision, and drooping corners of the mouth and eyelids may develop. Infestation of the skin, mucosa, breast and testicles is even rarer. This usually occurs only in recurrences. At times, a tumor may also form in the space between the thoracic spine and sternum (mediastinum).
Diagnosis and course
If acute lymphocytic leukemia is suspected, the physician will order a differential blood count to determine the proportions of different cell types in the blood and the maturation stages of leukocytes and erythrocytes. If there are further indications of suspected leukemia, a bone marrow biopsy from the hip bone or sternum is the next diagnostic step. If leukemia is present, a large number of immature blood cells will be found. Imaging techniques such as X-ray, ultrasound and computed tomography are recommended for accurate diagnosis of the affected lymph nodes. Acute lymphoblastic leukemia develops rapidly with severe symptoms and a high susceptibility to infection as a result of the weakened immune system.Prognosis for progression can only be made on an individual basis, as ALL responds differently to therapy depending on the patient and individual risk factors.
Complications
A wide variety of complications occur with acute lymphoblastic leukemia (ALL), which can further worsen the disease. Due to the fact that in this type of cancer, among other things, the formation of white blood cells, which are responsible for immune defense, is disturbed, the risk of infection is greatly increased. Infections can spread to a wide variety of organs and cause secondary damage there. In some cases, the infection can also spread systemically, resulting in sepsis. Combined with ALL, this can lead to a life-threatening condition that requires immediate medical attention. In addition, this can lead into septic shock. This can be accompanied by a severe drop in blood pressure, leading to a lack of blood flow to multiple organs, which may die as a result. The number of blood platelets also shows changes. A reduced number of platelets can lead to heavy and unstoppable bleeding, and the risk of hemorrhage is increased. Too many platelets increase the risk of thrombosis, which occurs mainly in the veins of the legs. The blood clots can detach from the vein wall in the course and be carried away with the bloodstream. In the process, they can enter the pulmonary vessels and cause pulmonary embolism, which is characterized by shortness of breath and chest pain. Strokes are also conceivable due to the consequences of thrombosis.
When should you go to the doctor?
Lymphocytic leukemia must be treated by a physician in every case. It is not possible to predict a positive course of the disease in every case. Children are more likely to be cured than adult patients. A doctor should always be consulted when the typical complaints and symptoms of lymphatic leukemia occur. In this case, the affected person suffers from a general feeling of weakness and a reduced ability to cope with stress. A doctor should always be consulted, especially if symptoms persist for a long time. Lymphocytic leukemia may also be present in cases of weight loss or fever. Furthermore, night sweats or paleness all over the body can be an indication of this disease. A doctor should also be consulted if the immune system is weakened and the affected person therefore falls ill more often and more easily with various infections. If this disease also causes psychological discomfort or upset, a psychologist can treat it.
Treatment and therapy
Acute lymphoblastic leukemia is treated using various methods of chemotherapy tailored to the course of the disease and individual risk factors. Chemotherapy involves the administration of cytostatic drugs, usually a combination of several preparations, as this significantly enhances the antileukemic effect. Classical chemotherapy is administered in four phases: Induction therapy, consolidation therapy and re-induction therapy as intensive treatment over an individually defined treatment duration and later maintenance therapy. In induction therapy over one to three months, cytostatic drugs are administered in a precisely defined schedule of treatment times and dosage. The goal of this phase of therapy is the regression of ALL to the point where it is undetectable in the bone marrow. Induction therapy requires a high intensity of treatment to prevent resistance and to clear the immune system of tumor burden as quickly as possible. In some cases, it appears reasonable to administer induction therapy as a double induction. Induction therapy is followed by consolidation therapy, which is intended to prevent relapses, since ALL is no longer detectable diagnostically but is still present in the body. This is followed by re-induction with renewed intensification of treatment. Between the individual treatment cycles of the intensive phase, the patient can stay at home with regular medical diagnosis, and chemotherapy is administered as an inpatient. The intensive phase is followed by outpatient maintenance with oral chemotherapy, which can last up to 18 months.
Prevention
Because no causes or precipitating factors of ALL are known, there is no specific prevention. A healthy lifestyle, avoidance of risk factors, and regular medical checkups are advised.
You can do it yourself
Everyday life during the disease is usually very dependent on the respective current condition due to the different therapy phases. It is important for those affected that they arrange their times appropriately in the first place. Depending on what is physically possible at the time, one should neither overload the body nor demand anything of it. It does the body and the soul good if it is supported by a little movement to become active. Fatigue phases can also be minimized in this way. As a supplement to conventional therapy, dietary supplements that support the metabolism are suitable (these are particularly recommended if food intake is restricted by nausea or loss of appetite during treatment) and stabilize the immune system. In some cases, however, drugs are also administered in the therapy to activate the immune system. Which nutritional supplements are ultimately useful, however, can be very well discussed with the oncologist. Psychosocial contact in everyday life is also very important for patients. It is not uncommon for those affected to become isolated due to the effects of the disease, since, for example, certain hygiene regulations must also be observed and they do not want to burden anyone with this. This should be avoided at all costs through regular contact with friends and family, as mental balance and enjoyment of life can support the recovery path and have a positive effect.
