WHAT IS ACUTE LYMPHOBLASTIC LEUKAEMIA (ALL) 

Acute Lymphoblastic Leukaemia (ALL) is a cancer that affects the blood and bone marrow. It is characterised by an overproduction of immature white blood cells called lymphoblasts or leukaemic blasts. As the bone marrow is unable to make adequate red cells, normal white cells and platelets, people with ALL become more susceptible to anaemia, recurrent infections, and to bruising and bleeding easily. The blast cells have a tendency to spill out of the bone marrow into the bloodstream and accumulate in various organs including the lymph nodes (glands), spleen, liver and central nervous system (brain and spinal cord).

Types of ALL 

The World Health Organisation (WHO) uses a classification system for ALL that includes: 

1. Pre-B-cell ALL : In between 75-80% of adult cases, ALL arises in B-lymphocytes in the early stages of development in the bone marrow. Therefore, is  called precursor B-cell ALL or Pre-B-cell ALL.

2. B-cell ALL: B-cell ALL arises in more mature developing lymphocytes and is less common accounting for around 3-5% of all adult cases.

3.  T-cell ALL: T-cell ALL commonly presents with a high white blood cell count and involvement of the central nervous system at diagnosis.

Causes of ALL?

The exact causes of ALL remain largely unknown but is thought to result from mutations in one or more of the genes that normally control blood cell development that will result in abnormal growth.Certain other factors too have been identified including exposure to very high doses of radiation either accidentally (nuclear accident) or therapeutically (to treat other cancers); Industrial chemicals like benzene, pesticides, and certain types of chemotherapy used to treat other cancer; Certain viral infections and the way in which the immune system reacts may as well play a role in the development of some types of ALL. People with Down’s syndrome,  Fanconi’s Anaemia may also have a higher than average risk of developing ALL.

WHAT ARE THE SYMPTOMS OF ALL 

• Anaemia due to a lack of red cells resulting in persistent tiredness, dizziness, paleness, or shortness of breath 

• Frequent or repeated infections  combined with slow healing 

• Increased or unexplained bleeding or bruising 

• Bone and/or joint pain 

• Swollen lymph nodes (glands), chest pain and abdominal discomfort 

DIAGNOSIS & TREATMENT

Diagnosis: Occasionally ALL is diagnosed during a routine blood tests 

1. Full Blood Count
2. Bone Marrow Biopsy 
3. Immunophenotyping, cytogenetic and molecular tests, etc 
4. Other tests to monitor your general health like  further blood tests and imaging tests (x-rays, scans and ECG) 

Treatment: The type of treatment used will depend on the genetic make-up of the leukaemic cells, age and general well being. But, the treatment needs to begin soon after diagnosis.

• Chemotherapy - Initially, the aim of treatment is to destroy leukaemic cells and induce a remission. Patients may be offered even more Intensive Therapy followed by a stem cell transplant.

Treatment for ALL can be divided into three phases:

• Induction therapy

• Post-remission (consolidation) therapy

• Maintenance therapy

IMPORTANT INFORMATION

Side effects 

• Blood count (the number of white cells, platelets and red cells circulating in the blood) generally falls within a week of treatment. 

• Tendency to bruise and bleed more easily. In many cases, a transfusion of platelets is given to reduce the risk of bleeding until the platelet count recovers.

• Anaemia & Lethargy.

• Nausea and vomiting 

• Both chemo and radiation therapy can cause temporary changes to sense of taste and smell. 

• inflammation of the lining of the mouth, throat or gut is a common 

• Bowel changes, cramping, wind, abdominal swelling and diarrhoea

• Hair loss 

• Infertility

• Early menopause

• Inflammation of the saliva-producing glands in the mouth (Parotitis)