Acute Lymphocytic

Leukemia

What is Leukemia?

• The word Leukemia comes from the Greek leukos which means "white" and aima which means "blood".

• It’s the cancer of the blood or bone marrow• A person who has leukemia suffers from an abnormal

production of blood cells, generally leukocytes (white blood cells).

Types Of Leukemia

• Chronic lymphocytic Leukemia(CLL): CLL affects lymphoid cells and usually grows slowly.

• Chronic myeloid leukemia (CML): CML affects myeloid cells and usually grows slowly at first.

• Acute lymphocytic (lymphoblastic) leukemia(ALL): ALL affects lymphoid cells and grows quickly.

• Acute myeloid leukemia (AML): AML affects myeloid cells and grows quickly.

Acute lymphocytic leukemia Background Info

• type of cancer in which the bone marrow makes too many lymphocytes (a type of white blood cell)

• 1400 deaths per year• About 3 out of 4 cases of leukemia among children

and teens are acute lymphocytic leukemia (ALL).• Symptoms of ALL will usually start slowly, and then

escalate in severity as the number of blast cells in the blood rises.

What’s Bone Marrow?

• Bone marrow is the soft, spongy material that fills the centre of most bones (where blood cells are made).

2 Types Of Bone Marrow

1. Red marrow, made up mainly of myeloid tissue, produces blood cells and is found in flat bones and at the end of long bones

2. Yellow marrow, made up mostly of fat cells is found in the middle of flat bones. It can convert yellow marrow to red marrow to raise blood cell production

Types of bone marrow in cross section of a bone

Causes

• No single known cause for any types of leukemia exists

• Results from mutations in the DNA. • Certain mutations can trigger leukemia by activating

oncogenes or deactivating tumor suppressor genes may occur spontaneously or as a result of exposure to radiation or carcinogenic substances

• Main causes of ALL is exposure to high levels of radiation or benzene. Smokers are three times as likely to develop ALL

Possible Risk Factors

• Being male—slight increase in risk • Being Caucasian—slight increase in risk • Exposure to high levels of radiation• Having certain genetic disorders such as Down

syndrome(Involved in about 1/20 cases)• Having a sibling with leukemia• Having had certain types of chemotherapy such as

alkylating agents

Prevention

• Some scientists wonder if early exposure to germs might protect children from developing ALL.

• A significantly lower percentage of children who went to playgroups at an early age develop ALL compared to those who didn't.

*Note, as of 2012, there are still no known preventions

Treatments• The treatment of ALL varies according to age, general

condition at diagnosis, and the results of the cytogenetic testing.

• A complete remission is achieved when the blood and bone marrow show no evidence of persistent leukemia and blood counts have returned to normal.

Treatment can be divided into four phases:• First phase — induction chemotherapy • Second phase — consolidation chemotherapy • Third phase — maintenance chemotherapy • Fourth phase — central nervous system (CNS) prophylaxis

Stage 1 treatment

Induction Chemotherapy• The most common drugs used for induction treatment of ALL

are daunorubicin, vincristine, prednisone and asparaginase• Intensive supportive care accompanies the chemotherapy

(ex transfusion of red blood cells and platelets)• Antibiotics are needed as treatment for bacterial and fungal

infections. The agent G-CSF (Neupogen) can be useful in rapidly re-establishing a normal white blood count.

• Once blood counts have returned to normal, a repeat bone marrow biopsy is performed to determine whether the patient has entered complete remission.

Stage 2

Consolidation Chemotherapy• multiple cycles of intensive chemotherapy given over a

six- to nine-month period. • Frequent hospitalizations are required, intensive

supportive care is still needed• Stem cell transplantation isn’t used unless abnormal

cytogenetics are present.• Chemotherapy agents used during consolidation include

the same agents used during induction, as well as Ara-C, etoposide, methotrexate and 6-mercaptopurine

Stage 3

Maintenance Chemotherapy• Once patient’s intensive chemotherapy has been

completed, oral chemotherapy pills are needed for an additional 18 to 24 months.

• The pills — typically methotrexate and 6-mercaptopurine — are usually well-tolerated with minimal side effects

• Patients need to have their blood tests checked once a month while taking chemotherapy pills.

• Most patients can return to work during maintenance therapy.

Stage 4

Central Nervous System (CNS) Prophylaxis• ALL can reoccur in the fluid that bathes the spinal column and

brain(spinal fluid). • To prevent relapse at this location, chemotherapy must be

injected directly into the fluid that bathes the spinal column. (intrathecal chemotherapy).

• Patients are given six or more injections of intrathecal chemotherapy to prevent recurrence of ALL. More may be necessary if leukemia cells are detected in the spinal fluid.

• Most people complete intrathecal therapy within 2-4 months of starting their treatment. Headaches and nausea are occasional side effects.

What about abnormal cytogenetics?

• Cytogenetics is the most important component of deciding whether or not a person should have a bone marrow transplant for ALL.

• Stem cell transplantation, also called blood or marrow transplantation (BMT), is performed only in patients who have abnormal cytogenetics, chromosome testing or other high-risk ALL features.

Who gets ALL the most

• ALL is the most common childhood cancer(3/4 cases of leukemia in children/teens are ALL)

• Usually affects children ages 3 - 7. It is the most common childhood acute leukemia.

• People living in America have a higher chance of getting ALL because of radiation, pollution, and being exposed to x-rays before work

Prominence in society

• It is estimated that 3,450 men and 2,600 women will be diagnosed with ALL

• 1,440 people will die of ALL in 2012

rates are based on cases diagnosed in 2005-2009 from 18 SEER geographic areas.

Lifetime Risk

• Based on rates from 2007-2009, 0.13% of people (1 in 798 ) born today will be diagnosed with ALL at some time during their lifetime.

• The 5-year survival rate for children with ALL has greatly increased over time and is now more than 85%

• 45%-60% of adults have long-term disease-free survival

• Cure rates tend to be higher in younger patients and lower in older patients