Introduction and early treatment most can be cured.

Introduction

            One of the most common types of leukemia
in children is a heterogenous disease of the bone marrow. Acute lymphoblastic
leukemia (known as ALL) occurs most predominantly from ages 2-5, however, it
can appear in children from 0-14. From genetic mutations and certain risk
factors this disease can develop quickly and without treatment, it can be
fatal. The outlook for cases of childhood ALL are on the up rise and with
special care and early treatment most can be cured.

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Pathophysiology

            In ALL, due to some genetic
alteration of DNA there is an overproduction of immature lymphocytes in the
bone marrow. The body has blood stem cells that can form either myeloid stem
cells or lymphoid stem cells. These stem cells then make a lymphoblast cell and
can differentiate into three types of lymphocytes. For this type of cancer only
two of the three are affected: B-lymphocytes and T-lymphocytes. Both are used
to help fight off infection and when they are mutated they no longer function
properly and crowd out the cells that the body needs such as red blood cells,
healthy white blood cells and platelets. This creates the risk of infection, anemia,
and hemorrhage.  

Etiology

            It is not clear what causes the genetic
mutations in ALL, however there are some health risk factors that could
influence the development of this in children. If a child was exposed to
radiation before birth there have been some evidence that this could lead to
complications in the child’s genetic processes. Previous cancer treatments or
genetic disorders such as Down syndrome, Bloom’s syndrome, ataxia-telangiectasia
and can lead to acute lymphoblastic leukemia.

Diagnosis

            If a child has the following
symptoms they could be diagnosed with acute lymphoblastic leukemia: frequent
infections, pyrexia, ecchymosis from thrombocytopenia, asthenia, fatigue, petechiae,
arthralgia, osteodynia, hemorrhage, and anemia. They would be seen under the
care of pediatrician who would work with other specialists to diagnosis and
treat the child. Hematologists, oncologists, pathologists and radiologists are
just a few that those with ALL would go through. The pediatrician would perform
some diagnostic tests such as a physical exam, medical history, complete blood
count (CBC), blood chemistry studies, and bone marrow aspiration and biopsy. When
blood or bone marrow is removed further tests can be done look for malignant lymphocytes
via immunophenotyping and chromosomal changes via cytogenetic analysis.
Depending on the results and those diagnosed with ALL are put into risk groups
that include the child’s age and their white blood cell count.

Prognosis

            Patients’ chances of remission or
being cured depend many factors and risks, some at the time of diagnosis. These
factors include the patient’s age, weight, sex, race and ethnic background; the
rate of leukemia cell count drops after the first month of treatment; changes
in chromosomes or genes; what type of leukemia cells are at time of diagnosis
(B-Cell or T-Cell); and the location of the leukemia cells (major organs
affected of CNS). Treatment for patients with ALL are dependent upon circumstances
such as where the leukemia cells originate, the level of risk they fall under,
age, and certain chromosomal changes. Late or toxic effects are changes in
health and condition after the patient has completed treatment. Physical
problems such as issues with the heart, blood vessels or osteonecrosis, mood
and behavior changes, and second cancers or other conditions like acute myeloid
leukemia or myelodysplastic syndrome Approximately 1-2% of children with ALL
die before attaining remission and 1-2% die from the toxic effects during
remission. The death rate has significantly dropped since 1950 and ALL patients
have a 90% chance of being cured today. This is largely a result from research
and clinical trials pertaining to this cancer.

Treatment

            Patients with ALL undergo three
phases of treatment: induction, consolidation/intensification, and maintenance.
Induction kills leukemia cells in the blood and bone marrow which results in
returning the white blood cell count to normal (remission). This phase usually
lasts 4-6 weeks and includes medications such as glucocorticoids and
anthracycline drugs. In the second phase, its goal is to rid the body of cells
that could begin to divide and cause leukemia to return (relapse). Patient’s
usually enter remission and this phase can last about 6-8 months of intensive
combination therapy. Lastly, in the maintenance phase, treatments are used to
destroy any cells that have survived from the first two phases. ALL has a
variety of treatments, some of which can be used in combination of therapy and
medications or surgical procedures to removed diseased cells. Chemotherapy is
the most common form of treatment for this type of leukemia. Other treatments
can include stem cell transplant, radiation therapy and targeted therapy.

Conclusion  

            Research and clinical trials are
working towards continually improving the rates of cure for childhood acute lymphoblastic
leukemia. Although chemotherapy is still the most effective method of
treatment, in combination with others a child’s risks of developing dangerous
late effects is decreasing. While being the most common leukemia in children
the outlook and future for this form of cancer is still positive and can give
hope to families and the patients with ALL.