Acute lymphoblastic leukemia (ALL)

Disease information

Overview
Causes
and Symptoms
Treatment

Overview

Acute Lymphoblastic Leukemia (ALL) is a serious blood disorder that begins in the bone marrow, where a group of white blood cells called lymphocytes multiply too quickly in their immature form. This rapid growth can crowd out the normal blood cell-making process in the marrow. ALL is particularly common among children, making up about 85% of leukemia cases in patients younger than 20 years old. While children with ALL often respond well to treatments and can have favorable outcomes, adults diagnosed with this disease unfortunately tend to have a much poorer prognosis.

Causes and Symptoms

The exact cause of ALL is unknown, but there are several factors that have been associated with an increased risk of developing this disease. These include:

Exposure to large amounts of radiation e.g.) victims of nuclear bombings
In cases of viral infection
In cases of genetic disorders such as Down Syndrome
Long-term exposure to toxic chemicals such as benzene

As for the clinical findings of Acute Lymphoblastic Leukemia (ALL), symptoms related to the suppression of the production of normal erythrocytes, leukocytes, and thrombocytes usually suddenly emerge, even in those who have been living a healthy life.

Decrease in red blood cells(Erythrocytopenia ) : Symptoms of anemia Dizziness, dyspnea, headache, fatigue, etc.
Decrease in white blood cells (Leukocytopenia)(neutrophils) : Symptoms of infection and fever Fever, chills, body aches
Thrombocytopenia : hemorrhage symptoms nasal bleeding, gum bleeding, subcutaneous hemorrhage
Systemic nonspecific symptoms : ostalgia, enlargement of lymph nodes or organs (ex.: liver, spleen)

▲ Symptoms of bleeding due to thrombocytopenia

Treatment

In the treatment of Acute Lymphoblastic Leukemia (ALL) among adults, prognostic outcomes vary. Adults in the favorable prognosis category can achieve long-term survival rates of approximately 60%-70% following a comprehensive treatment approach that includes chemotherapy and hematopoietic stem cell transplantation. However, the outlook is less positive for older adults or those categorized within poor prognosis groups; even with stem cell transplantation, their long-term survival rates typically range from 20%-35%.
A notable treatment aspect of ALL, which sets it apart from Acute Myeloid Leukemia (AML), is the proactive use of intrathecal chemotherapy. This treatment is essential due to the high risk of the disease spreading to the central nervous system (CNS). Intrathecal chemotherapy involves administering cancer-fighting drugs directly into the spinal canal, which helps to prevent or treat CNS infiltration by leukemia cells

Hematopoietic stem cell transplantation Autologous hematopoietic stem cell transplantation, allogeneic hematopoietic stem cell transplantation, targeted therapy, CAR-T therapy
Chemotherapy Induction therapy, consolidation therapy and maintenance therapy, CNS prophylaxis