please help me by providing full information about ACUTE LYMPHOBLASTIC LEUKEMIA!


Question: I need to know about ACUTE LYMPHOBLASTIC LEUKEMIA L1.All the details of the ailment, please. Causes, symptoms, treatment and prognosis. I'd be grateful to whoever will provide enlightenment on the matter, THANK YOU very much!
Answers:
Direct from the National Cancer Institute:

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Childhood acute lymphoblastic leukemia (ALL) is a type of cancer in which the bone marrow makes too many lymphocytes (a type of white blood cell).

Childhood acute lymphoblastic leukemia (also called acute lymphocytic leukemia or ALL) is a cancer of the blood and bone marrow. This type of cancer usually gets worse quickly if it is not treated. It is the most common type of cancer in children.

Normally, the bone marrow produces stem cells (immature cells) that develop into mature blood cells. There are 3 types of mature blood cells:

1) Red blood cells that carry oxygen to all tissues of the body.

2) White blood cells that fight infection and disease.

3) Platelets that help prevent bleeding by causing blood clots to form.

In ALL, too many stem cells develop into a type of white blood cell called lymphocytes. These lymphocytes may also be called lymphoblasts or leukemic cells. There are 3 types of lymphocytes:

1) B lymphocytes that make antibodies to help fight infection.

2) T lymphocytes that help B lymphocytes make the antibodies that help fight infection.

3) Natural killer cells that attack cancer cells and viruses.

In ALL, the lymphocytes are not able to fight infection very well. Also, as the number of lymphocytes increases in the blood and bone marrow, there is less room for healthy white blood cells, red blood cells, and platelets. This may lead to infection, anemia, and easy bleeding.

Possible risk factors for ALL include the following:

1) Having a brother or sister with leukemia.
2) Being white or Hispanic.
3) Living in the United States.
4) Being exposed to x-rays before birth.
5) Being exposed to radiation.
6) Past treatment with chemotherapy or other drugs that weaken the immune system.
7) Having certain genetic disorders, such as Down syndrome.

Possible signs of childhood ALL include fever and bruising. These and other symptoms may be caused by childhood ALL or by other conditions. A doctor should be consulted if any of the following problems occur:

1) Fever.
2) Easy bruising or bleeding.
3) Petechiae (flat, pinpoint spots under the skin caused by bleeding).
4) Bone or joint pain.
5) Painless lumps in the neck, underarm, stomach, or groin.
6) Pain or feeling of fullness below the ribs.
7) Weakness or feeling tired.
8) Loss of appetite.

Tests that examine the blood and bone marrow are used to detect (find) and diagnose childhood ALL. The following tests and procedures may be used:

1) Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient's health habits and past illnesses and treatments will also be taken.

2) Complete blood count(CBC) with differential: A procedure in which a sample of blood is drawn and checked for the following:

The number of red blood cells and platelets.
The number and type of white blood cells.
The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
The portion of the sample made up of red blood cells.

3) Bone marrow aspiration and biopsy: The removal of a small piece of bone and bone marrow by inserting a needle into the hipbone or breastbone. A pathologist views the bone and bone marrow samples under a microscope to look for signs of cancer.

4) Cytogenetic analysis: A test in which the cells in a sample of blood or bone marrow are looked at under a microscope to find out if there are certain changes in the chromosomes in the lymphocytes. For example, in ALL, part of one chromosome is moved to another chromosome. This is called the “Philadelphia chromosome.”

5) Immunophenotyping: A test in which the cells in a sample of blood or bone marrow are looked at under a microscope to find out if malignant lymphocytes (cancer) began from the B lymphocytes or the T lymphocytes.

6) Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that produces it.

7) Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.

Certain factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery) and treatment options depend on:

1) Age and white blood cell count at diagnosis.

2) How quickly and how low the white blood cell count drops after initial treatment.

3) Gender and race.

4) Whether the leukemia cells began from the B lymphocytes or the T lymphocytes.

5) Whether there are certain changes in the chromosomes of lymphocytes.

6) Whether the leukemia has spread to the brain and spinal cord.

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I'm sure all of this sounds extremely scary. Now for the good news Pediatric ALL is the most treatable of all childhood cancers. The long term survival rate is between 80-90%, depending on which statistics you look at. That still means 10-20% of pediatric patients die from ALL, but the prognosis is definitely better than it is for Pediatric AML (Acute Myelogenous Leukemia) (which has a 40-50% survival rate) or Adult AML (which has a ~20% survival rate).

If you need any further info you can contact me through my daughter Alex's website:

http://www.alexupdate.com

Alex was diagnosed with AML when she was 10 months old. Hope this helps.

-- T

Other Answers:
Most patients feel a loss of well-being. They tire more easily and may feel short of breath when physically active. They may have a pale complexion from anemia. Signs of bleeding because of a very low platelet count may be noticed. These include black-and-blue marks occurring for no reason or because of a minor injury, the appearance of pinhead-sized, red spots under the skin, called petechiae, or prolonged bleeding from minor cuts. Discomfort in the bones and joints may occur. Fever in the absence of an obvious cause is common. Leukemic lymphoblasts may accumulate in the lymphatic system, and the lymph nodes can become enlarged. The leukemia cells can also collect on the lining of the brain and spinal cord and lead to headache or vomiting.
Acute lymphoblastic leukemia (ALL), also known as acute lymphocytic leukemia, is a cancer of the white blood cells, characterised by the overproduction and continuous multiplication of malignant and immature white blood cells (referred to as lymphoblasts) in the bone marrow. It is a hematological malignancy. It is fatal if left untreated as ALL spreads into the bloodstream and other vital organs quickly (hence "acute"). It mainly affects young children and adults over 50.

Symptoms

Initial symptoms of ALL are quite aspecific, but worsen to the point that medical help is sought:

* Generalised weakness and fatigue
* Anemia
* Frequent or unexplained fever and infections
* Weight loss and/or loss of appetite
* Excessive bruising or bleeding from wounds, nosebleeds, petechiae (red pinpoints on the skin)
* Bone pain, joint pains (caused by the spread of "blast" cells to the surface of the bone or into the joint from the marrow cavity)
* Breathlessness
* Enlarged lymph nodes, liver and/or spleen

The signs and symptoms of ALL result from the lack of normal and healthy blood cells because they are crowded out by malignant and immature white blood cells. Therefore, people with ALL experience symptoms from their red blood cells, white blood cells, and platelets not functioning properly. Laboratory tests which might show abnormalities include blood counts, renal functions, electrolytes and liver enzymes.
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Diagnosis

Diagnosing leukemia usually begins with a medical history and physical examination. If there is a suspicion of leukemia, the patient will then proceed to undergo a number of tests to establish the presence of leukemia and its type. Patients with this constellation of symptoms will generally have had blood tests, such as a full blood count.

These tests may include complete blood count (blasts on the blood film generally lead to the suspicion of ALL being raised). Nevertheless, 10% have a normal blood film, and clinical suspicion alone may be the only reason to perform a bone marrow biopsy, which is the next step in the diagnostic process.

Bone marrow is examined for blasts, cell counts and other signs of disease. Pathological examination, cytogenetics (e.g. presence of the Philadelphia chromosome) and immunophenotyping establish whether the "blast" cells began from the B lymphocytes or T lymphocytes.

If ALL has been established as a diagnosis, a lumbar puncture is generally required to determine whether the malignant cells have invaded the central nervous system (CNS).

Lab tests (mentioned above) and clinical information will also determined if any other medical imaging (such as ultrasound or CT scanning) may be required to find invasion of other organs such as the lungs or liver.
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Pathophysiology

The etiology of ALL remains uncertain although some doctors believe that ALL develops from a combination of genetic and environmental factors. However, there is no definite way of determining the cause of leukemia.

Scientific research has shown that all malignancies are due to subtle or less subtle changes in DNA that lead to unimpaired cell division and breakdown of inhibitory processes. In leukemias, including ALL, chromosomal translocations occur regularly. It is thought that most translocations occur before birth during fetal development. These translocations may trigger oncogenes to "turn on", causing unregulated mitosis where cells divide too quickly and abnormally, resulting in leukemia. There is little indication that propensity for ALL is passed on from parents to children.

There have been indications that excessive exposure to high dose radiation (such as that of nuclear reactors, notably Chernobyl, and the atomic bombs in Hiroshima, Japan 1945) increases the risk of developing acute leukemia. There has also been inconclusive evidence suggesting that chemicals such as benzene have an increased risk of developing acute leukemia.
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Classification

Subtyping of the various forms of ALL is done according to the FAB (French-American-British) classification, which is used for all acute leukemias (including acute myelogenous leukemia, AML). As ALL is not a solid tumour, the TxNxMx notation used in those cancers is of little use.

The FAB classification is:

* ALL-L1: small uniform cells
* ALL-L2: large varied cells
* ALL-L3: large varied cells with vacuoles (bubble-like features)

Note: The recent WHO International panel on ALL recommends that this classification be abandoned, since the morphological classification has no clinical or prognostic relevance. It instead, advocates the use of the immunophenotypic classification mentioned below.

Each subtype is then further classified by determining the surface markers of the abnormal lymphocytes, called immunophenotyping. There are three main immunologic types: B-cell, pre-B cell and T-cell. Subtyping helps determine the prognosis and most appropriate treatment in treating ALL.

Some cytogenetic subtypes have a worse prognosis than others. These include:

* A translocation between chromosomes 9 and 22, known as the Philadelphia chromosome, occurs in about 20% of adult and 5% in pediatric cases of ALL.
* A translocation between chromosomes 4 and 11 occurs in about 4% of cases and is most common in infants under 12 months.
* Not all translocations of chromosomes carry a poorer prognosis. Some translocations are relatively favourable.

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Treatment

The earlier acute lymphocytic leukemia is detected, the more effective the treatment. The aim is to induce a lasting remission, defined as the absence of detectable cancer cells in the body (usually less than 5% blast cells on the bone marrow).

Treatment for acute leukemia can include chemotherapy, steroids, radiation therapy, intensive combined treatments (including bone marrow or stem cell transplants), and growth factors.
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Chemotherapy

Chemotherapy is the initial treatment of choice. Most ALL patients end up receiving a combination of different treatments. There are no surgical options, due to the body-wide distribution of the malignant cells.

As the chemotherapy regimens can be intensive and protracted (often about 2 years in case of the GMALL or UKALL protocols; about 3 years for males on COG protocols), many patients have an intravenous catheter inserted into a large vein (termed a central venous catheter or a Hickman line).
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Radiation therapy

Radiation therapy is used on painful bony areas, in high disease burden, or as part of the preparations for a bone marrow transplant (total body irradiation). Radiation in the form of whole brain radiation is also used for central nervous system prophylaxis, to prevent recurrence of leukemia in the brain.
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Epidemiology

ALL accounts for approximately 80 per cent of all childhood leukemia cases, making it the most common type of childhood cancer. It has a peak incident rate of 2-5 years old, decreasing in incidence with increasing age before increasing again at around 50 years old. ALL is slightly more common in males than females.
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Prognosis

Advancements in medical technology and research over the past four decades in the treatment of ALL has improved the overall prognosis significantly from a zero to 20-75 percent survival rate, largely due to the continuous development of clinical trials and improvements in bone marrow transplantation (BMT) and stem cell transplanation (SCT) technology.

However the prognosis for ALL differs between individuals depending on a wide variety of factors:

* Sex: females tend to fare better than males.
* Ethnicity: Caucasians are more likely to develop acute leukemia than African-Americans, Asians and Hispanics and tend to have a better prognosis than non-Caucasians.
* Age at diagnosis: children between 1-10 years of age are most likely to be cured.
* Lymphoblast cell count at diagnosis
* Whether the cancer has spread to the brain or spinal cord
* Morphological, immunological, and genetic subtypes
* Response of patient to initial treatment
* Genetic disorders such as Down's Syndrome
Source(s):
wikipedia.org

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