Acute lymphoblastic leukemia (ALL)

Acute lymphoblastic leukemia (ALL)
International Classification (ICD) C91.00

Basics

The blood can be considered one of the most important organs of our body. If the system no longer functions, no substances can be transported, no oxygen can reach the tissues, no germs and pathogens can be fought, the whole organism collapses.

The individual blood components

However, not only the blood as such, but each individual blood component is of great importance. We need the erythrocytes (red blood cells) above all for the transport of oxygen and carbon dioxide, while the thrombocytes (blood platelets) take care of the blood clotting.

Leukocytes (white blood cells) are of particular importance for the body's defence. However, these are further subdivided into different groups, which also include the lymphocytes, which in turn are divided into T-lymphocytes and B-lymphocytes. In acute lymphocytic leukemia, one of these groups is degenerated in some way. As a result, immature and non-functional precursors of the cells (also called blasts) are washed out into the blood.

Children in particular are affected

Acute lymphatic leukaemia mainly affects children between one and five years of age. 80% of affected children suffer from the subtype of B-ALL, in which the B lymphocytes are affected.

Causes

An exact cause for acute lymphatic leukaemia can only be given in very few cases. Most of the time, one is in the dark in the search for the trigger, especially since one naturally puts most of one's energies into fighting the disease. However, there are some factors that at least contribute to the development of leukaemia.

Genetic factors

It is striking that acute lymphatic leukaemia occurs more frequently in children who already have a genetic disease such as trisomy 21 or Fanconi syndrome. But even in otherwise completely healthy children, a familial predisposition, i.e. an inherited tendency to leukaemia, can lead to the development of the disease.

Apart from this, there are also numerous spontaneous mutations, i.e. small changes in the genetic material of the precursor cells of the lymphocytes, which trigger acute lymphatic leukaemia. These mutations happen thousands of times a day in every organism, only they are usually not significant, or are immediately repaired.

Ionizing radiation

Everyone knows that radiation in too high a dose is not good. Especially ionizing radiation can damage the cells to such an extent that they degenerate. That is why you should always make sure that you avoid this dangerous radiation as much as possible. This includes, for example, avoiding unnecessary X-rays or CT scans.

Other triggers of leukaemia

In addition to the triggers mentioned above, viruses, chemical substances, cytostatic drugs and pre-existing haematological diseases can also be considered as triggering factors.

Symptoms

Acute lymphoblastic leukemia is a disease of the blood, which is why the symptoms can be very diverse and distributed throughout the organism.

Symptoms of anaemia

Due to the increased formation of immature lymphocytes, other blood cells may be displaced. This is why signs of anaemia are often visible, such as a general feeling of weakness, paleness or shortness of breath.

A lack of platelets can also lead to the increased formation of haematomas (bruises) or even spontaneous bleeding. Sometimes small punctiform bleedings in the skin (petechiae) can be seen.

Symptoms due to increased cell formation

If cells are formed more quickly and in greater numbers, this naturally requires more space. In addition, all the lymphocytes still have to be imprinted in other organs, which can become overloaded if too many immature lymphocytes are formed and flushed out.

The increased production of lymphocytes can therefore lead to bone pain, abdominal pain, enlargement of the spleen or liver and a disturbance in the filling of the heart due to an overly large thymus. Often the lymph nodes swell as well.

B-symptomatics as a general indication

As with many other serious diseases, the so-called B-symptomatics are usually developed. This includes not only weight loss and weakness, but also night sweats as a typical symptom.

Further symptoms

Due to the loss of function of the lymphocytes, germs in the form of viruses or bacteria can of course no longer be fought by the body. There is an increased susceptibility to infections of all kinds.

In addition, neurological deficits often occur, which must be diagnosed precisely.

Diagnosis

In addition to the exact anamnesis, a physical examination is of course important. In this, for example, a swollen liver and or spleen and also enlarged lymph nodes may be noticeable.

Laboratory values confirm the diagnosis

To confirm the diagnosis, a number of blood tests must be carried out. For example, the presence of blasts, i.e. precursors of white blood cells, in the peripheral blood is considered proof of the presence of leukemia. However, some other examination methods have to define more precisely which cells are degenerated in order to be able to start the right therapy.

Bone marrow puncture to confirm the diagnosis

The exact diagnosis of the degenerated cells can only come from the examination of the bone marrow. For this purpose, the hip bone, sometimes also the shoulder blade, is usually punctured with a thick needle and some material is taken from the bone. This is then examined in specialised laboratories.

Further examinations

Because acute lymphoblastic leukemia is a serious disease, a number of other tests need to be done. These include not only X-rays of the chest and ultrasound of the abdomen, but other imaging techniques such as computer tomography or magnetic resonance imaging or skeletal scintigraphy can also be of great relevance.

Therapy

The therapy of acute lymphatic leukemia must be carried out in a specialized center, so that it can be really effective. It is also important to take additional measures to protect the body and support it in healing.

Supportive measures

Supportive measures include, for example, making sure that the environment is low in germs. For children, this means that they must be taken out of kindergarten and school and often admitted to hospital. Special hygiene measures must be taken both at home and in hospital.

If, despite this, an infection with any disease occurs, it is essential to support the immune system with broad-spectrum antibiotics.

Improving the quality of life

To improve the quality of life, so-called concentrates of blood components can be given. For example, red blood cells (erythrocytes) are given if there are signs of anemia, and platelets (thrombocytes) are given if there is a tendency to bleed.

Chemotherapy as a central treatment

A real improvement of the disease can only be achieved by chemotherapy. This takes place in several phases, between which there are recovery phases in which the body can recover from the aggressive drugs.

Often, the chemotherapy is first prepared in a preliminary phase so that the actual therapy can be more effective later. In an induction therapy, which usually lasts eight weeks, an attempt is then made to achieve remission, i.e. to reduce the leukaemia cells by 95%. This is done by administering drugs that destroy cells that divide quickly. Of course, this has many unpleasant side effects, as healthy body cells are also attacked.

This is followed by the so-called consolidation therapy, in which strong drugs are given for another eight weeks. This is followed by a six-week reinduction therapy, which is basically the same as the induction therapy.

Once these difficult weeks have been survived, maintenance therapy is initiated, in which oral medications are given over two years, which should help to keep you in remission, to stop the tumor cells from spreading any further.

Alternative or extended therapies

If chemotherapy does not have the desired effect, frequent relapses occur or particularly severe forms of ALL are present, then radiation therapy may also be considered.

Alternatively, stem cell transplantation or bone marrow transplantation can be performed. Although it is often possible to keep the body in remission, it is important to realise that this does not amount to a cure. It only means that the disease is kept in check. A cure is only achieved when all the degenerated cells have been destroyed.

Forecast

The prognosis for children with ALL has improved dramatically in recent years. Thanks to better diagnostics and new drugs, more than 80% of children can now be treated to the point where they can survive free of relapses. This means that the leukemia never recurs.

Several factors in the success of treatment

However, even though many children can be cured, the chances of a relapse-free life depend on several factors. These include, for example, the age of the child, the response to chemotherapy, the presence of a donor within the family and any changes in the genetic material.

However, even though acute lymphatic leukaemia can be treated very well today, it is by no means a disease to be taken lightly. One thing must be clearly stated: if treatment is not given, leukaemia leads to death within a few weeks or months. But fortunately, this can usually be prevented today!

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