Acute Lymphoblastic Leukaemia in paediatric patients (ALL)
Acute Lymphoblastic Leukaemia in children (also called Acute Lymphoid Leukaemia or ALL) is a blood cancer, which for unknown reasons, produces excessive quantities of immature lymphocytes (lymphoblasts). This disease most commonly affects children, but there are occasionally cases in adolescents, and 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 and erratic behavior of the organs (increasing the size of the spleen and the glands). They can also invade other organs, such as the testicles and the nervous system.
ALL is the most common form of leukaemia in children, with between 35 and 40 new cases per million inhabitants each year.
Find out more about Coke, a 4year old ALL patient.
Main symptoms
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).
Study
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.
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Treatment
The treatment of Acute Lymphoblastic Leukaemia in children will depend on the prognosis group to which the child has been assigned. The prognosis group is based on the child's age, the white blood cell count and the characteristics of the leukaemia cells in the moment of the diagnosis.
The first treatment is induction chemotherapy, which consists of the intravenous administration of medication powerful enough to eliminate cancerous cells. The objective of this treatment is to send the disease into complete remission (absence of symptoms and the visible absence of lymphoblasts in the blood and bone marrow when examined through a microscope). This remission is usually reached after the first cycle of chemotherapy. Further cycles of chemo should be applied in order to consolidate the remission. Finally, patients should receive a consolidation treatment which can last up to two years. Throughout this process, lumbar punctures should be carried out at frequent intervals, to confirm that leukaemia cells have been eliminated. Radiation therapy was once used for the same purpose but it is being used less and less each year.
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.
El 75% de los niños con LLA pueden curarse si se usan tratamientos adaptados a cada grupo de riesgo y situación clínica.
For more information, you can consult the following web pages:
• National Cancer Institute
• Fundación Leucemia y Linfoma
• Enciclopedia Médica Medline Plus
• AECC junior
• Cruz Roja Juventud
• "¿Cómo enfrentarse a la leucemia y el linfoma en los niños?", resource of The Leukaemia & Lymphoma Society
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