LEUKEMIA, ACUTE LYMPHOCYTIC

Leukemia is a cancer of the blood and bone marrow. The bone marrow is the spongy tissue located in the center of the bone. This is where blood cells form and develop. Once fully matured, the blood cells (red blood cells, white blood cells, and platelets) leave the bone marrow and move into the bloodstream. Red blood cells function to carry oxygen to cells, white blood cells help fight off infection, and platelets aid in the clotting of blood. Leukemia is divided into acute and chronic types. Acute leukemia affects the immature cell in the bone marrow before the cell has fully developed. Chronic leukemia affects the more mature cells. Leukemia is further divided into four different categories called acute lymphocytic leukemia (ALL), acute myelogenous leukemia (AML), chronic lymphocytic leukemia (CLL), and chronic myelogenous leukemia (CML).

Acute lymphocytic leukemia (ALL) results in the abnormal production of immature white blood cells. Approximately 80% of the ALL originates from white blood cells called B cells. The remaining 20% originate from white blood cells called T cells. Approximately 3000 new cases of ALL are diagnosed each year, predominantly affecting young children before the age of 15 years, but ALL can occur in adults as well.

The cause of ALL is not known. ALL is usually detected by examining the blood and by performing a bone marrow biopsy (marrow removed from the bone and examined under a microscope). ALL can be cured.

ALL results in the decreased production of red blood cells (anemia), white blood cells (neutropenia), and platelets (thrombocytopenia). This causes fatigue, easy bleeding, bruising, and frequent infections. As the excess production of the immature white cells continues, the cells invade the lymph nodes, liver, and spleen, causing swollen glands and enlargement of these organs. Meningitis is rare but possible and is caused by the invasion of the white cells into the brain and central nervous system. Headaches, nausea, vomiting, and increased sensitivity to light (photophobia) are symptoms suggesting meningitis.

Treatment for ALL has dramatically improved in the last 40 years. Chemotherapy and the use of special drugs have been the main reasons for the improvement in survival. The goal of treatment is to eliminate all leukemia cells from the bone marrow and blood. This is generally done in four steps: 1) induction, 2) consolidation, 3) central nervous system prophylaxis, and 4) maintenance.

Induction and consolidation refer to intensive chemotherapy using a combination of medicines. This form of treatment eliminates not only the leukemia cells from the bone marrow but also the normal blood cells. This is required to achieve complete remission; however, it can lead to potentially fatal complications of anemia requiring blood transfusions, easy bleeding requiring platelet transfusions, and frequent infections necessitating the use of antibiotics.

Once complete remission is achieved, radiation of the brain, injection of chemotherapy drugs into the spinal cord, or both are recommended to eliminate any potential cells that may be lining the brain.

Maintenance therapy is the use of a combination of drugs to prevent the recurrence of leukemia and can last up to 2 years.

• Understand that treatment protocols can vary and depend on other important factors such as age of the patient, genetic factors, and the availability of bone marrow transplantation. The decision is made between you and your physician.
• Seek treatment in a center where physicians are experienced in treating patients with ALL.
• Realize what bone marrow transplantation is. Another name for bone marrow transplantation is stem cell transplantation. This is a technique that removes stem cells from a donor that matches the patient. Stem cells are the cells responsible for the formation of all blood cells. As stated above, the goal of intensive chemotherapy is to eliminate all the leukemia cells in the blood and bone marrow. Unfortunately, the chemotherapy also eliminates the normal cells of the bone marrow, leaving the bone marrow incapable of producing any blood cells. Stem cells are then transplanted to "rescue" this failing bone marrow. The stem cells start to produce new blood cells without any leukemia cells.

• Don't miss follow-up appointments. The appointments serve to prepare you for what to expect. For example, your physician may recommend a "central line" or catheter be placed into a vein in the chest to allow easy access to draw blood, administer chemotherapy, and administer blood transfusions. Follow-up appointments are extremely important after chemotherapy has been started to monitor if complete remission has been achieved or if the leukemia has returned. This may require repeat bone marrow biopsies.

• If you are bleeding.
• If you have a fever after chemotherapy has started.
• If you need a referral to a treatment center specializing in ALL.

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