Acute lymphoblastic leukemia

The acute lymphocytic leukemia , short ALL , is an acute form of leukemia caused by malignant modified precursor cells of lymphocytes. Mostly children are affected. The cure rate is around 50% for adults and 80% for children.

What is Acute Lymphocytic Leukemia?

Acute lymphoblastic leukemia, or ALL for short, is a form of acute leukemia caused by malignant lymphocyte precursor cells.

Acute lymphoblastic leukemia is one of the four forms of leukemia in which the blood cancer cells arise from malignant degeneration of the lymphocytes . This degeneration leads to a reduced formation of healthy lymphocytes, erythrocytes and platelets . This causes general weakness , an increased tendency to bleed and an immunodeficiency with severe to life-threatening infections.

ALL is a rare disease that is suspected to have around 500 new cases per year in adults and children. It must be mentioned, however, that new cases in adults are insufficiently recorded due to the lack of a central cancer registry.

While acute lymphoblastic leukemia is rare in adults and there is an increased risk of developing the disease only in old age, it is the most common malignant disease in children.

Causes

Acute lymphoblastic leukemia is caused by genetic changes in the lymphocytes that trigger changes in these cells. These genetic changes occur in the course of life, although the causes have not yet been adequately researched. So far it has not been possible to define which factors trigger ALL, and no specific cause could be identified.

However, general risk factors for leukemia can be assessed, including radioactive radiation and X-rays , contact with dangerous chemicals and certain medications, including above all agents used to suppress the immune system , and defects in the immune system . Another risk factor for any cancer is smoking .

Today we know for sure that acute lymphoblastic leukemia is neither hereditary nor hereditary because the egg cells and sperm are not affected.

Symptoms, ailments & signs

Acute lymphoblastic leukemia is characterized by a variety of symptoms. It is a rapidly progressing disease that, if left untreated, leads to death within a short period of time. The initial stage of the disease can initially be symptom-free. However, the blood formation disorder then leads to anemia and general weakness with exhaustion , paleness, tiredness, fever , reduced performance, malaise and shortness of breath .

Since the number of functional white blood cells is also reduced, the susceptibility to infection is generally increased. However, the immature lymphocytes multiply in an uncontrolled manner. In a third of patients (especially children), these spread to the bones and joints. This causes joint and bone pain . The organs of the lymphatic system swell.

These organs include the spleen, liver, thymus and especially the lymph nodes of the chest. The enlargement of the spleen creates pressure in the left upper abdomen. The feeling of pressure in the right upper abdomen is caused by the enlarged liver . Swelling of the lymph nodes in the chest area leads to shortness of breath . In rare cases, the brain, spinal cord or meninges are affected.

Neurological complaints such as nerve paralysis, sensitivity disorders , headaches , double vision as well as drooping corners of the mouth and eyelids can arise . Infestation of the skin, mucous membrane, breast and testicles is even rarer. This usually only occurs with relapses. Sometimes a tumor can also form in the space between the thoracic spine and the breastbone (mediastinum).

Diagnosis & course

If acute lymphoblastic leukemia is suspected, the doctor will order a differential blood count to determine the proportions of the different cell types in the blood and the stages of maturation of leukocytes and erythrocytes.

If further evidence of the suspicion of leukemia emerges, a bone marrow biopsy from the hipbone or sternum is the next diagnostic step. If there is leukemia, a large number of immature blood cells are found. Imaging methods such as x-rays, ultrasound and computed tomography are recommended for the precise diagnosis of the affected lymph nodes .

Acute lymphoblastic leukemia develops quickly with severe symptoms and a high susceptibility to infections as a result of the weakened immune system. A progression prognosis can only be made on an individual basis, since ALL responds differently to therapy depending on the patient and individual risk factors.

Complications

Acute lymphoblastic leukemia (ALL) has a wide variety of complications that can make the disease worse. Because this type of cancer disrupts the formation of white blood cells, which are responsible for the immune system, the risk of infection is greatly increased. Infections can spread to a wide variety of organs and cause consequential damage there.

In some cases, the infection can also spread systemically, causing sepsis. Combined with ALL, this can lead to a life-threatening condition that requires immediate medical treatment. It can also lead to septic shock.

This can be accompanied by a sharp drop in blood pressure and thus to a lack of blood flow to multiple organs, which can die as a result. There are also changes in the number of blood platelets. If the number is reduced, it can lead to heavy and insatiable bleeding, and the risk of bleeding to death is increased.

Too many platelets increase the risk of thrombosis, which mainly occurs in the leg veins. The blood clots can detach themselves from the vein wall and be carried away with the bloodstream. These can get into the pulmonary vessels and cause pulmonary embolism, which is characterized by shortness of breath and chest pain. Strokes are also conceivable as a result of a thrombosis.

When should you go to the doctor?

Lymphocytic leukemia must always be treated by a doctor. A positive course of the disease cannot be predicted in every case. Children are more likely to be cured than adults. A doctor should always be consulted when it comes to the typical complaints and symptoms of lymphatic leukemia. Those affected suffer from a general feeling of weakness and decreased resilience.

A doctor should always be consulted, especially in the event of long-term complaints. Lymphocytic leukemia can also be caused by 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 there is a weakened immune system and the person concerned therefore falls ill more often and more easily from various infections. If this illness also causes psychological complaints or moods, a psychologist can treat them.

Treatment & Therapy

Acute lymphoblastic leukemia is treated using various chemotherapy methods that are tailored to the course of the disease and the individual risk factors . Chemotherapy means the administration of cytostatics , usually a combination of several preparations, as this significantly increases the antileukemic effect.

Classical chemotherapy takes place in four phases: induction therapy, consolidation therapy and re-induction therapy as intensive treatment over a duration of treatment to be determined individually and subsequent maintenance therapy. In induction therapy over one to three months, cytostatics are administered in a precisely defined schedule of treatment times and dosage.

The aim of this therapy phase is to suppress ALL until it cannot be detected in the bone marrow. Induction therapy requires high treatment intensity in order to prevent resistance and to free the immune system from a tumor burden as quickly as possible. In some cases it makes sense to administer induction therapy as a double induction. The induction therapy is followed by consolidation therapy, which is intended to avoid relapses, since ALL can no longer be diagnosed, but is still present in the body.

Re-induction follows with renewed intensification of the treatment. Between the individual treatment cycles of the intensive phase, the patient can stay at home with regular medical diagnosis, the chemotherapy is inpatient. The intensive phase is followed by outpatient maintenance with oral chemotherapy, which can last up to 18 months.

Prevention

Since there are no known causes or triggering factors for ALL, there is no specific prevention. A healthy lifestyle, the avoidance of risk factors and regular medical check-ups are advisable.

You can do that yourself

Everyday life during the illness is usually very dependent on the current state of health due to the various therapy phases. It is important for those affected that they organize their times appropriately at all. Depending on what is currently physically possible, you should neither overload nor not challenge it at all. It is good for body and soul if it is supported by a little movement to become active. Phases of fatigue can also be minimized in this way.

As a supplement to conventional therapy, food supplements that support the metabolism are suitable (these are particularly recommended if food intake is restricted during treatment due to nausea or loss of appetite ) and stabilize the immune system. In some cases, however, drugs are also administered in therapy that are supposed to activate the immune system. Which food supplements are ultimately useful can be discussed with the oncologist very well.

Psychosocial contact in everyday life is also very important for the patient. It is not uncommon for those affected to find themselves in isolation due to the effects of the disease, for example because certain hygiene regulations have to be observed and they do not want to burden anyone with it. This should be avoided at all costs through regular contact with friends and family, as emotional balance and joy in life can support the path of recovery and have a positive effect.