Acute Lymphoblastic Leukaemia (ALL) in adults
Acute Lymphoblastic Leukaemia (also known as acute lymphoid leukaemia or ALL) is a blood cancer that, for unknown reasons, produces excessive quantities of immature lymphocytes (lymphoblasts). Although ALL predominantly affects children, it is not infrequent to see cases in teenagers or young adults.
Under normal conditions the lymphoblasts are produced in the bone marrow and in other organs of the lymphatic system (thymus, glands, spleen) and once they are mature (lymphocytes), they are charged with the defence of the organism. They are ready attack, directly or through the production of antibodies, any strange substance that enters our organism.
ALL causes the lymphoblasts to develop immaturely and in excessive numbers. These immature lymphocytes invade the blood, the bone marrow, and the lymphatic tissues, causing inflammation. They can also invade other organs, such as the testicles and the nervous system.
This type of leukaemia predominantly affects young adult males (the average age is between 25 and 30 years old; only 10/15 % of patients are over 50 years of age). The number of new cases each year stands at 30 in a million.
Meet Olga, an Acute Lymphoblastic Leukaemia patient.
Some of the main symptoms are: loss of appetite, weakness, fatigue, fever, pain in the bones, muscles and joints, and bruising on the arms and legs. Occasionally there could be spontaneous bleeding (nose, gums) or excessive bleeding from small wounds. Some patients experience a fever or infection (abscess, sinusitis, pneumonia, etc) as an initial symptom. In some patients the growth of their glands is notable and abdominal pains can be caused by the inflation of liver and spleen. A small percentage of patients suffer from certain manifestations as a result of the inflammation of the glands and the compression of neighbouring organs (such as the mediastinum). Other symptoms can manifest from the invasion of the nervous system (headache, vomiting, drowsiness, etc) of the testicles (pain and swelling) or the bones (bone pains).
The differing cellular origin and the grade of immaturity of the cells that cause the disease lead to varying subtypes of ALL. Given that all the different subtypes of the disease have distinct treatments it is necessary to analyze the blood and the bone marrow in detail. This analysis should be carried out with several extractions of blood and bone marrow (the latter obtained by a puncture of the sternum or the hip bone) and with radiographs to evaluate the level of inflammation of the mediastinum glands. The extent to which the disease has spread to the nervous system can also be analysed, by conducting a lumbar puncture and examining the liquid that circulates the system. If it is suspected that the testicles have been infiltrated then a biopsy will need to be carried out.
The treatment will be determined case by case, taking into account age and general state of health of the patient and the characteristics of the leukaemia cells.
The treatment is always based on intensive chemotherapy (the intravenous administration of medication) with the objective of eliminating symptoms and leukaemia blasts from the blood and the bone marrow, thus permitting the normal production of the other blood cells. When this situation is reached it is called complete remission, and it is usually achieved after the first cycle of chemo. This is followed by consolidation treatment and in order to maintain the remission, new cycles of chemo will be applied.
Throughout this process, lumbar punctures should be carried out at frequent intervals, to confirm that leukaemia cells have been eliminated.
In patients who are considered a high risk (with an elevated risk of relapsing) the option of a bone marrow transplant should be contemplated. This could be realized using a compatible donor (allogeneic transplant) or using the patient themselves (autologous transplant). The transplant can be introduced as a part of the initial treatment if the patient is a high risk or as a part of the treatment for patients who suffer a relapse after conventional chemotherapy.
The prognosis of the disease varies depending on the subtype of leukaemia and the response to the treatment.
For more information, you can consult the following webpages:
• National Cancer Institute
• Fundación Leucemia y Linfoma
• Médica Medline Plus Encyclopedia
• The Leukaemia & Lymphoma Society
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