Leukemia or blood cancer may be acute or chronic. Leukemia includes acute lymphobalstic leukemia (ALL), acute myeloid leukemia (AML leukemia), chronic lymphocytic leukemia (CLL Leukemia) and chronic myeloid leukemia (CML).The acute promyelocytic leukemia (APL leukemia) is a sub type of AML leukemia.

What is ALL?

Acute lymphoblastic leukemia (ALL) is a common pediatric cancer. Their exact causes are unknown. ALL is characterized by deregulated multiplication of the lymphoid progenitor cell after it undergoes genetic changes. In ALL leukemia blasts may originate in the bone marrow, liver, thymus, spleen, testes, lymph nodes and CNS.

Signs and Symptoms

ALL releases a huge amount of abnormal bone marrow cells and leads to low blood counts. This causes anemia. The patient hence feels symptoms like fatigue. Low white blood cells count makes the patient vulnerable to infections whereas low platelet count causes him to bruise and bleed easily. Other symptoms include enlarged spleen, liver and lymph nodes as well as bone and joint pain.

Diagnosis

Blood tests are performed to detect leukemia cells and abnormal blood counts which are indication of ALL acute lymphocytic leukemia. Thereafter a bone marrow test helps establish the diagnosis. Additional tests required include immunophenotyping or flow cytometry to ensure that the cells are ALL acute leukemia (lymphoid) cells not myeloid cells. Immunophenotyping tests check whether the lymphoid cells are T or B lymphocytes. Cytogenetics which is a test of chromosomes is also performed.

Treatment

The first phase of ALL treatment is induction chemotherapy. Aunorubicin, prednisone, vin-cristine, cyclophosphamide (Cytoxan) and asparaginase are the drugs that are administered. Supportive care consisting of red blood cells and platelets’ transfusion is also provided to the ALL patient. Antibiotics are taken to fight infections. G-CSF (Neupogen) helps to increase white blood cell count. A bone marrow biopsy is then used to check if remission is complete. The second phase of treatment is consolidation chemotherapy characterized by intensive chemotherapy and supportive care. The third phase is maintenance therapy wherein oral chemotherapy tablets are taken for around 2 years. Regular blood tests are required. To prevent the relapse of ALL in the cerebro spinal fluid chemotherapy is infused straight into this fluid by intrathecal chemotherapy. Stem cell or bone marrow transplantation is done for patients in whom abnormal cytogenetics is detected.

Prognosis

The patients who do not have abnormal cytogenetics, are younger than 30, have white blood cell count lower than 30,000/µL and obtain full remission in 4 weeks have a favorable prognosis. The patients with precursor Bcell white blood cells(WBC) and a whose WBC count is above 100,000/µL, patients with abnormal cytogenetics or age greater than 60 years as well as those who don’t obtain full remission in 4 weeks have a poor prognosis.

Prevention

ALL cannot be prevented as such. The risk of its occurrence can be diminished by avoiding exposure to toxins like chloramphenicol-an antibiotic, arsenic compounds, toluene and benzene. Radiation from radioactive compounds can cause ALL and should be avoided.

ALL is an uncommon and serious form of leukemia and apart from good medical treatment it requires consistent monitoring and post treatment health care like routine checkups.