ALL for children
About 80% of childhood leukemias belong to the group of acute lymphatic leukemias. This makes the disease the most common type of blood cancer in children. Overall, it accounts for about one third of all childhood cancers!
With about 500-600 new cases per year, it is nevertheless one of the rare disease patterns. Within a few weeks, those affected develop the first signs of the disease. Thus, many children initially stand out due to rather unspecific symptoms.
These include increased tiredness, fever or conspicuous skin pallor. Small children in particular often lose the desire to play and appear “dull”. It is not uncommon for small, punctiform skin bleedings to be discovered.
The doctor then speaks of “petechiae“. As the leukaemia cells also affect the immune system, many of the young patients suffer from recurring, sometimes severe infections. In principle, ALL, especially in small children, is a real “chameleon” with many different symptoms.
These include, for example, bone pain or upper abdominal pain. If, for example, blood tests reveal evidence of ALL, the diagnosis is confirmed by bone marrow puncture. At this point at the latest, affected children are referred to a specialized pediatric clinic (pediatric oncology/hematology).
Subsequent examinations, such as ultrasound or MRI, are essential for future treatment planning and can rule out infestation of other organs. It is essential to start the therapy as soon as possible, as ALL progresses rapidly and, if left untreated, leads to death within a short time. Chemotherapy is at the centre of the treatment.
By combining different substances, the leukaemia cells can very often be suppressed. Additionally, radiation, antibodies or bone marrow transplants can be used. Fortunately, the prognosis of acute lymphatic leukaemia in children has improved considerably over the last decades. Thus, five years after diagnosis, about 90% are disease-free!
These are also the same schemes as for AML (acute myeloid leukaemia), i.e. chemotherapy, foreign or autologous stem cell donation (still experimental). One difference to AML (acute myeloid leukaemia) is that ALL (acute lymphatic leukaemia) requires additional consideration of the meningitis. In this case, therefore, one should additionally administer drugs that are administered directly on the spot and have an effect on the spot, such as methotrexate, or think about irradiating the affected spot. Here, too, the drug imatinib plays an important role if the Philadelphia chromosome described above is responsible for the tumour. In recent years, chemotherapy has produced excellent results in the treatment of ALL (acute lymphatic leukaemia).
Chances of recovery
Since acute lymphatic leukaemia (ALL) is a very mixed clinical picture overall, no generally valid statements can be made about the prognosis or life expectancy. Over time, however, some so-called “risk factors” have been identified. In simple terms, these factors allow an approximate assessment of how well the disease responds to therapy and the risk of a relapse.
In principle, the better the response to therapy, the better the chances of recovery. Before therapy is started, possible risk factors are carefully assessed and the treatment is adjusted accordingly. The following risk factors play a role in acute lymphatic leukaemia: Children between the ages of 2 and 10 have the best prognosis in the case of the disease.
In addition, acute lymphatic leukaemia is the most common form of leukaemia in this age group! Rather unfavourable to evaluate is a disease before the 1st year of life and after the 50th year of life. In addition, the number of other pre-existing conditions, such as high blood pressure or diabetes, increases with age.
Such possible pre-existing conditions can reduce the tolerability of the aggressive leukemia therapy. There are numerous subgroups within the clinical picture of acute lymphatic leukaemia. In order to make this exact classification, an immunotyping is carried out.
In this complex procedure, the leukaemia cells are assigned to an exact level of the blood cell series. For example, there are leukemias originating in the B-lymphocytes, the so-called “B-cell leukemia“. On the other hand, the malignant cancer cells can also originate from the T-lymphocytes.
Then one speaks of a “T-cell leukemia“. The further classifications of acute lymphatic leukaemias are complicated and multi-layered and make some physicians sweat. In principle, however, the following subtypes are considered less good:
- Early T-ALL
- Mature T-ALL
During the course of the disease, leukaemia cells can in principle attack all organs and regions of the body.
The less the disease has spread in the body at the time of initial diagnosis, the better the chances of cure. For example, if the leukaemia has already affected parts of the nervous system, such as the meninges (meningeosis leucaemica), the prognosis is rather unfavourable. Leukocytes, better known as “white blood cells“, play an important role in the course of acute lymphatic leukaemia.
If they are massively elevated at the beginning, this indicates an aggressive form of the disease and in the long term a worse prognosis. In summary, however, it must be noted that the prognosis of ALL must be determined in each individual case. It is hardly possible to make sweeping statements about life expectancy in such a complex disease and can only be considered by taking numerous aspects into account on an individual basis.