What is the full form of ALL ?

What is Acute Lymphoblastic leukaemia?

Acute Lymphocytic Leukaemia or ALL is a very progressive disorder and intensifies rapidly thereby creating immature blood cells in the body, rather than forming matured ones. Acute lymphocytic leukaemia is very much prevalent amongst children and correct treatments might increase the chance of survival to a greater extent. Acute lymphocytic leukaemia is also prevalent amongst adults but the chance of getting cured is very less.

Symptoms

There can be multiple symptoms of acute lymphocytic leukaemia which may include −

• Bleeding from the gums

• Severe Bone pain

• High Fever

• Frequent infections in different body parts

• Severe nose bleeding

• Lump formation by swollen lymph nodes around the neck, armpits and in abdomen.

• Paleness in skin

• Breathing problems

• Fatigueness.

Diagnosis

The Diagnosis procedure of ALL involves an in depth medical history followed by different physical examinations, complete blood count profile and smear study. But most of the symptoms of Acute lymphoblastic leukaemia are common illnesses but prolonged persistence of any symptoms might be alarming for any sort of malignancy.

• A biopsy in bone marrow confirms the presence of ALL if >20-25% of the cells are leukemic lymphoblasts. A minute puncture on the lumbar spine determines whether the spinal cord and brain have been taken over.The Brain and spinal cord infection is diagnosed either through the presence of leukemic cells in the lumbar region or via any clinical symptoms of Central nervous system leukaemia.

• Pathological examination are conducted in the presence of Philadelphia chromosome.Immunophenotyping also confirms whether the leukemic cells are myeloblastic in nature in the form of neutrophils, eosinophils, or basophils or lymphoblastic in nature-B lymphocytes or T lymphocytes. Bone marrow samples undergo specific cytogenetic testing that help in detecting the disease and its aggressiveness as well.

• Medical imaging like ultrasound or CT scanning helps to detect whether the other organs like-lung, liver, spleen, brain, kidneys, and reproductive organs have become malignant.

Treatment

ALL treatment aims is to introduce a long lasting remission without any predominant cancer detection.Over the past few years a lot of research is going over the treatment strategies and medications for fast recovery. Following are some of them:-

Chemotherapy

Chemotherapy is the first preferred treatment alternative for ALL diagnosed individuals and they go through a couple of medications. The patient cannot undergo any surgery due to the massive spread of the malignant cells in the entire body. The cytotoxic chemotherapy for ALL patients is done with multiple antileukemic medicines specific for each patient.

Radiation therapy

Radiation therapy is performed mostly on the painful regions of the body,thereby making those areas suitable for a successful bone marrow transplant.Earlier physicians commonly used radiation by applying a technique called whole-brain radiation and applied it in the central nervous system to prevent the recurrence of leukaemia in the same regions. According to the recent advancements Central nervous system chemotherapy proved to be a successful one with minimalistic side effects.

Biological therapy

In Biological therapy specialised targets are selected based on their collaborative effects on the leukemic lymphoblasts which can pave a new way for clinical trials and novel treatment strategies.Tyrosine-kinase inhibitors also known as TKIs, are incorporated into the treatment strategies for patients with a variant of Bcr-Abl1+ (Ph+) lymphoblastic leukaemia.

Immunotherapy

The revolutionary discovery in the field of immunotherapy is the development of Chimeric antigen receptors or CARS for treating ALL patients. The technology involves a single chain variable fragment (scFv) which helps to recognize the surface marker CD19.CD19 is surface marker molecule present on all the B-cells or bone marrow cells and is used to detect the malignant B-cell populations. The clinical trials were first conducted on mice by immunising CD19 antigen and resulted in producing anti-CD19 antibodies.

Relapsed ALL

People who have experienced the relapsed ALL are exposed to the poorer prognosis in comparison to those who have recovered after their induction therapy.Patients with recurring leukaemia will give a better respond to the standard chemotherapy procedure but still for a better result patients should be kept on continuous clinical trial on reinduction chemotherapy and an allogeneic bone marrow transplantation. The tumours can also be revived with palliative radiation on a very low dose outside the central nervous system to get rid of further spreading of infection.Tyrosine kinase inhibitor has also been in great use as a part of relapsed ALL.

Risk Factors

Various factors that enhance the risk of Acute lymphoblastic leukaemia −

• Foregoing cancer treatment − Children and adults who get exposure to different types of chemotherapy and radiation therapy due to their previous history of cancer might be at greater risk of developing the disease.

• Radiation exposure − Individuals exposed to very high amounts of radiation like survivors of a nuclear radiation accident, are also at a greater risk of developing acute lymphocytic leukaemia.

• History of genetic disorders − People with Down syndrome are associated with a greater risk of acute lymphocytic leukaemia.

Conclusion

Acute lymphoblastic leukaemia affected about 8,86,000 individuals and led to 1,21,000 mortality worldwide in 2015.The disease prevalent amongst both children and adults but affects children between the age group of 3-7 years. Almost 75-80% of the cases can be observed before 6 years with a secondary rise post the 40 years.Statistics say ALL affect 1 in 1500 children.According to the present statistics the disease affects about 1.7 per 100,000 people every year.ALL exhibit the most childhood leukemias and the most common childhood cancer.

FAQs

Q1.Who is the doctor who treats ALL?

Ans. Acute lymphoblastic leukaemia is considered a very special disorder and categorised as a type of cancer.Hence this disorder can be best treated by a haematologist or an oncologist. For children paediatric oncologists mostly treat the cases.

Q2.Is there any specific diet recommended for ALL patients?

Ans. There is not much restriction over the diet but all foods must be cooked properly. Anything raw like fresh fruits and vegetables should be avoided,as they must be boiled or cooked.

Q3. What precautions should be taken to avoid this disease?

Ans. The major line of treatment for ALL is avoiding crowds. The more they remain in isolated places,it is good for the sake of their protection.They must be least exposed to people having contaminated diseases like common cold, flu, measles or Chickenpox. Refraining themselves from any kind of stressful activities is mandatory.