Acute lymphoblastic leukaemia

About

Acute lymphoblastic leukaemia (ALL) is a type of cancer of the blood and bone marrow. It is an aggressive type of leukaemia that is mostly seen in children. It is caused when the body produces too many immature lymphocytes, a type of white blood cell, which crowd out and suppress the production of the other blood cells. This makes it difficult for the body to fight infections and can cause anaemia. Symptoms of ALL include fatigue, fever, weight loss, bruising and bleeding, bone pain and paleness. Treatment for ALL includes chemotherapy, radiation, stem cell transplant and targeted therapy.

Symptoms

The symptoms of Acute lymphoblastic leukaemia (ALL) can vary from person to person and can include the following:

Unexplained fatigue or tiredness
Loss of appetite
Unexplained fever
Pain in the bones or joints
Shortness of breath
Unexplained weight loss
Pale skin
Easy bleeding or bruising
Swollen lymph nodes
Night sweats
Repeated infections

Causes

The exact cause of acute lymphoblastic leukaemia (ALL) is unknown. However, there are several factors that may increase an individual’s risk of developing the condition, including genetic predisposition, radiation exposure, and certain diseases. Additionally, environmental exposure to certain chemicals, such as benzene or pesticides, has been linked to a higher risk of developing ALL.

Risk factors

The risk factors for acute lymphoblastic leukaemia (ALL) include:

Family history: having a first-degree relative with the disease increases the risk.
Genetic conditions: having certain genetic conditions, such as Down syndrome and ataxia-telangiectasia, is associated with an increased risk of developing ALL.
Chemicals: exposure to benzene and radiation can increase risk.
Race: Certain racial and ethnic groups, such as Native American, Hispanic and non-Hispanic white, are more likely to develop ALL than other groups.
Age: ALL is most common in children, but it can also affect adults.
Gender: ALL is more common in boys than girls.
Viral infections: Having a weakened immune system due to a viral infection may increase the risk.

Diagnosis

Acute lymphoblastic leukaemia (ALL) is usually diagnosed through a number of tests, including a complete blood count (CBC) and other blood tests, a bone marrow biopsy, and a lumbar puncture (spinal tap). A CBC measures the number of white and red blood cells, including their size and shape. Other blood tests help to measure the number of different types of cells in the blood, such as the presence of lymphoblasts, a type of immature white blood cell that indicates ALL. A bone marrow biopsy tests a sample of the patient’s bone marrow to identify the presence of abnormal cancer cells. A lumbar puncture is a procedure where a needle is inserted into the lower back to collect a sample of cerebrospinal fluid (CSF) from around the spinal cord. This fluid can be tested for abnormal lymphoblasts.

Sub-types

Acute lymphoblastic leukemia (ALL) is the most common childhood cancer, and is classified into two main subtypes: B-cell ALL and T-cell ALL.

B-cell ALL is the more common of the two subtypes and is characterized by the overproduction of B-lymphocytes—a type of white blood cell. This form of ALL is typically divided into three categories: Common, Pre-B-cell, and Pro-B-cell. Common B-cell ALL is the most common subtype of B-cell ALL and affects mostly children between the ages of 2 and 5. Pre-B-cell ALL is a less common subtype of B-cell ALL and affects mostly children between the ages of 7 and 10. Finally, Pro-B-cell ALL is a rare subtype of B-cell ALL and affects mostly teenagers.

T-cell ALL is the less common of the two subtypes and is characterized by the overproduction of T-lymphocytes—another type of white blood cell. It is further divided into three categories: Early-Thymic, Late-Thymic, and Not-Thymic. Early-Thymic T-cell ALL affects mostly children between the ages of 3 and 5. Late-Thymic T-cell ALL is the most common subtype of T-cell ALL and affects mostly children between the ages of 6 and 12. Finally, Not-Thymic T-cell ALL is a rare subtype of T-cell ALL and affects mostly teenagers.

Treatments

The treatment options for acute lymphoblastic leukaemia (ALL) depend on the type and stage of the cancer. The most common treatment options include chemotherapy, targeted therapy, stem cell transplant, radiation therapy, and immunotherapy.

Chemotherapy is the main treatment for ALL. Depending on the type of ALL, chemo drugs that may be used include vincristine, doxorubicin, cyclophosphamide, methotrexate, mercaptopurine, and others.

Targeted therapy is used to specifically target cancer cells, while leaving healthy cells unharmed. Targeted therapies for ALL may include BCR-ABL inhibitors, which are drugs that target cells with a genetic abnormality that tells them to keep dividing, as well as tyrosine kinase inhibitors, which are drugs that block signals inside cancer cells that tell them to keep growing and dividing.

Stem cell transplants may be used in some cases to replace diseased blood cells with healthy ones from a donor. This procedure is done with the help of high-dose chemotherapy.

Radiation therapy involves using high-energy beams to destroy cancer cells. This is typically used for localized cases of ALL.

Immunotherapy is a type of treatment that boosts the body’s natural defenses to fight cancer. This type of therapy is used to treat both localized and advanced ALL.

Overall, the treatment plan for ALL should be tailored to the individual. It is important to have an informed discussion with the healthcare team to determine the best treatment plan for you.

Prevention

The primary prevention of acute lymphoblastic leukaemia (ALL) requires reducing avoidable risk factors as much as possible. This may include:

Limiting exposure to radiation— radiation is a known risk factor for ALL. Limiting unnecessary exposure to x-rays, CT scans, and other types of radiation is important for reducing risk of ALL.
Reducing exposure to pollutants— air pollution has been linked with an increased risk of ALL. Limiting exposure to pollutants, such as car exhaust and cigarette smoke, is important for reducing risk.
Eating a healthy diet— eating a balanced diet rich in fruits, vegetables and whole grains can help reduce the risk of ALL.
Avoiding smoking— research has found that smoking cigarettes increases the risk of ALL. Quitting smoking and avoiding exposure to secondhand smoke is important for reducing risk of ALL.
Limiting alcohol intake— excessive alcohol consumption has been linked with an increased risk of ALL. Limiting intake of alcohol and avoiding binge drinking are important for reducing risk.
Getting regular exercise— regular physical activity has been linked with a decreased risk of ALL in adults.
Getting adequate sleep— research suggests that poor sleep quality or not getting enough sleep is associated with an increased risk of ALL. Adults should aim to get 7-9 hours of quality sleep each night.

Gender differences?

Yes, there are gender-specific differences in the presentation and management of Acute lymphoblastic leukaemia (ALL). Boys generally have higher rates of ALL than girls, particularly in the early years of life. Girls tend to have a higher rate of relapse following initial treatment and tend to have a poorer prognosis overall. Boys are also more likely to have a higher white blood cell count than girls and higher rates of the Philadelphia chromosome mutation. Boys are more likely to require more aggressive treatment with higher doses of chemotherapy and longer treatment periods. Girls tend to respond better to treatment, often requiring less aggressive or shorter treatment courses. Additionally, girls may benefit more from supportive care, such as nutritional support, to manage the side effects of ALL treatment.

Nutrition

Nutrition plays an important role in the management of Acute lymphoblastic leukaemia. Good nutrition is essential to maintain energy and immune function, which can be compromised due to the cancer itself and treatments such as chemotherapy. Eating a balanced diet full of fresh fruits and vegetables, lean proteins, and whole grains can help support the body’s ability to fight off the cancer and its treatments. Additionally, good nutrition can help reduce side effects from chemotherapy. Nutrients that may be beneficial for Acute lymphoblastic leukaemia include omega-3 fatty acids, zinc, and selenium. Consuming a diet rich in these nutrients can help support the body’s immune system, which is essential for overcoming the cancer. Consuming adequate calories is also essential for providing the body with the energy it needs to fight off the cancer. Finally, ensuring adequate hydration is important to support the organs, fight fatigue, and reduce the risk of infection.

Physical Activity

Physical activity has been found to have a beneficial effect on Acute lymphoblastic leukaemia (ALL). According to a study published in the journal Cancer, physical activity in children with ALL was associated with improved outcome in terms of the time to the start of treatment and overall survival rate. Higher levels of physical activity were linked to better outcomes and a lower risk of relapse or mortality. The study also suggested that physical activity may reduce the risk of infection, improve physical functioning and quality of life, reduce treatment and hospitalization costs, and reduce risk of chemotherapy-related adverse effects. Therefore, physical activity should be encouraged as part of the treatment regimen for ALL to improve patient outcomes.