Acute Lymphoblastic Leukaemia

Acute Lymphoblastic Leukaemia (ALL) is cancer affecting bone marrow and blood, wherein the white blood cells are targeted. The lymphocytes in the bone marrow are primarily affected by this cancer.

Symptoms Related to Acute Lymphoblastic Leukaemia

The following are the common signs or symptoms to look out for:

• Fatigue, or an overwhelming feeling of tiredness
• High fever that takes longer to abate
• Lack of energy to function normally
• Shortness of breath, or a feeling of acute breathlessness
• Swollen lymph nodes in the neck, armpits, groin, or abdomen
• Paleness with a constant feeling of dizziness
• Pain in the bones and joints
• Frequent nosebleeds and bleeding gums
• Blood in stool and urine
• Heavy periods
• Night sweats
• A feeling of fullness in the abdomen

Causes of Acute Lymphoblastic Leukaemia

ALL can be caused due to multiple reasons:

• Genetic conditions like down's syndrome and bloom syndrome
• Previous sessions of chemotherapy. People who have had exposure to other types of cancer or those who may have been treated with certain drugs during the chemotherapy sessions.
• Exposure to high radiation due to nuclear reactor accidents and exposure during CT scans and radiation therapy
• Weak immune system due to underlying conditions like HIV, AIDS, organ transplant patients, long-term diabetes, and autoimmune disorders

Additional Types of Acute Lymphoblastic Leukaemia

Since ALL does not cause tumours, but forms in the blood and bone marrow, by the time the disease is detected through different tests, it may have already spread through the blood to several internal organs like the liver, spleen, lungs, and others.

ALL can be divided into 3 types:

• B-cell Acute Lymphoblastic Leukaemia has genetic abnormalities regarding the chromosomes.
• T-cell Acute Lymphoblastic Leukaemia
• Acute undifferentiated Leukaemia may have both lymphocytic as well as myeloid traits.

Stages of Acute Lymphoblastic Leukaemia

Stages of Acute Lymphoblastic Leukaemia can be identified as follow:

• Untreated Acute Lymphoblastic Leukaemia
• Acute Lymphoblastic Leukaemia in remission - there have been no further signs of cancer after treatment
• Minimal Residue Disease - although the patient is in remission, a few cancerous cells have been identified in the bone marrow
• Refractory Acute Lymphoblastic Leukaemia - although the patient is being treated, there has been no reduction in the cancerous cells
• Relapsed ALL - after treatment for Leukaemia, cancer has come back

Treatment plan for Acute Lymphoblastic Leukaemia

Several tests need to be performed to identify if a person has Acute Lymphoblastic Leukaemia. The treatment plan needs to be determined once the blood and other tests have determined that the prognosis is ALL.

The treatment plan is determined based on the type and stage of cancer. Other factors that can affect treatment are age and general fitness level. The preliminary treatment plan for ALL is chemotherapy. However, other options may include:

• Radiotherapy - use of high doses of radiation to target and destroy cancerous cells
• Cancer drugs - used during chemotherapy to prevent cancer cells from growing and multiplying
• Steroids - to help reduce bouts of nausea and vomiting
• Immunotherapy - this therapy supports and helps the immune system fight cancer
• Bone marrow transplant - replaces the diseased bone marrow in the body with healthy blood-forming stem cells either from the patient's body or through another donor.

Medical Tests for Acute Lymphoblastic Leukaemia

After noting down the complete medical history of a patient, the following tests may be suggested for further diagnosis:

• Blood tests
• Biopsies of the bone
• Immunophenotyping to evaluate blood cells under the microscope
• Cytogenetic analysis by studying bone marrow tissue under the microscope for abnormalities
• X-rays, CT scans, and a spinal tap or lumbar puncture to check if cancer has spread to the spinal cord or the brain.

Preventive Actions for Acute Lymphoblastic Leukaemia

There are no typical, identifiable causes of Acute Lymphoblastic Leukaemia that can help prevent the disease. Therefore there is no definite way to prevent ALL.

However, treatment for other types of cancer through chemotherapy or high radiation levels may cause Acute Lymphoblastic Leukaemia. Another way to reduce the occurrence of Leukaemia is to avoid long-term exposure to cancer-causing chemicals in factories.

Expected prognosis of Acute Lymphoblastic Leukaemia

Recovery after treatment depends on several factors, biological or otherwise. However, studies conducted on the topic of cervical and recovery of patients with ALL state that:

• In general, over 60% of people with Leukaemia survive for 5 years or more. However, the number again differs if you differentiate by age as kids recover faster than the elderly.
• Almost 90% of children treated for ALL recover and stay cancer-free for 5 years or more, and the numbers fall to 20% in adults aged 40 and more.

After Treatment For Acute Lymphoblastic Leukaemia

After-treatment for the disease varies from person to person. If the patient is completely cured and the cancer is in remission, the oncologist may provide suggestions and overall change in existing lifestyle to help the patient recover faster.

If the treatments are not successful or are partially successful, oncologists may recommend palliative or supportive care that can make a patient's life easier during the after-treatment period.

The Natural Progression of Acute Lymphoblastic Leukaemia

Acute Lymphoblastic Leukaemia starts in immature white blood cells called lymphocytes. It is challenging to identify ALL based on the signs and symptoms of the disease. More often than not, ALL has already spread to major internal organs by the time it is detected. If the treatment is insufficient or the illness is ignored, it could be fatal to the patient, resulting in death.

Pathophysiology of Acute Lymphoblastic Leukaemia

The disease forms in developing stem cells, in the bone marrow, due to a genetic injury in the DNA. The damaged cell gradually multiplies uncontrollably and overcomes the number of healthy blood cells, leading to reduced white blood cells, platelets, and even red blood cells.

Risk factor or Epidemiology

The risk factor or epidemiology for ALL includes:

• Age - Children below 15 years of age and adults older than 50 are more susceptible to the disease. However, recent research suggests that most children who get the disease may have had the propensity for it in their genes since or before birth.
• Gender - the disease usually affects men more than women
• Race - ALL is usually found to be occurring more in Caucasian people than any other race
• Genetic conditions - People with certain genetic conditions may be more prone to ALL

Possible complications of Acute Lymphoblastic Leukaemia

One possible complication of ALL is a compromised immune system, which makes one susceptible to infections. In addition, frequent bleeding from the nose, blood in urine, and bruising of the skin are possible complications of ALL.

The treatment of ALL may also cause certain complications like infertility, bouts of depression, and even anxiety.