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showThe global incidence of medical cases related to Acute Lymphoblastic Leukaemia (ALL) has increased by 30.81% to 64.19×103 in 2017 from 49.07×103 in 1990 [1]. It is a type of cancer of the bone and bone marrow characterised by a large number of lymphoid cells. Smoking and high BMI (body mass index) could increase the risk of Acute Lymphoblastic Leukaemia.
A reduction in white blood cells, red blood cells and platelets leads to a compromised immunity, blood coagulation ability, and oxygen-carrying capacity of your blood, among other less prominent effects. It is important to get the necessary treatment as soon as possible to avoid complications.
Here’s a quick glance at the symptoms, causes, complications and treatment of ALL.
Symptoms | Dizziness, fatigue, pale complexion, shortness of breath, bleeding gums, prolonged bleeding, bruises, red spots in the skin, nosebleeds, heavier menstrual periods, fever, frequent infection, loss of appetite and weight, pain in joints, etc. |
Complications | The weakened immune system, internal bleeding like intracranial, pulmonary and gastrointestinal haemorrhage, infertility, psychological complications |
Causes | Previously done chemotherapy, smoking, obesity, genetic disorders like Down syndrome, weak immunity due to diseases like HIV |
Onset | There is no definite applicable onset period for acute lymphoblastic leukaemia |
Diagnosis | Complete blood count (CBC) test, biopsy and bone marrow assessment, cell assessment, immunophenotyping, cytogenetic analysis, fluorescence in situ hybridization, polymerase chain reaction |
Prevention | No proven measures are available that can help prevent acute lymphoblastic leukaemia |
Medication | Vincristine, doxorubicin, anthracyclines, methotrexate, vincristine, cytarabine, cyclophosphamide, imatinib, ponatinib and dasatinib, etc. |
There are three types of blood cells within the human body, all having different functions. Among them, the main functions of each kind of cell are as follows [2]:
Bone marrow, a spongy material within the bone, is responsible for the production of these blood cells. When individuals suffer from acute lymphoblastic leukaemia, the bone marrow fails to produce these at a normal rate. This happens because the leukaemia cells flock around the bone marrow, leading to shortfalls of WBC, RBC and platelets.
Patients encounter the following symptoms of acute lymphoblastic leukaemia due to insufficiency of these blood cells:
1.Symptoms Due to Anaemia
These symptoms occur when there is a low count of red blood cells within your body:
2. Symptoms Due to Thrombocytopenia
In thrombocytopenia, the count of platelet reduces significantly, causing symptoms like:
3. Symptoms Due to Neutropenia
Neutropenia occurs due to the shortages of neutrophils, a type of WBC which helps in fighting pathogens and infections. Following are the signs you can encounter due to neutropenia:
Besides these, you can also notice other general symptoms due to this haematological condition.
4. General Symptoms of Acute Lymphoblastic Leukaemia
Following are some noticeable general symptoms [2] [3]:
In a normal human body, the bone marrow releases completely developed blood cells. However, in acute lymphoblastic leukaemia, the bone marrow lets off stem cells within the blood. These are not developed fully and are known as blast cells. With the increase of these blast cells, counts of other matured blood cells decrease significantly, causing anaemia or other medical conditions of acute lymphoblastic anaemia.
Genetic mutation of stem cells is the reason behind this release of immature blood cells within the bloodstream. However, there is no particular reason that can cause this genetic change. It can be a result of several risk factors as mentioned below [3]:
Weak Immune System: Individuals with low immunity run a higher risk of developing the medical condition of acute lymphoblastic leukaemia. The weakened immune system can be the result of existing diseases like HIV.
Following is the classification and sub-classification of acute lymphoblastic leukaemia [4]:
1. B-Lymphoblastic Leukaemia/Lymphoma
Here are the subtypes of this category of acute lymphoblastic leukaemia:
2.T-Lymphoblastic Leukaemia / Lymphoma
Following are the subtypes of T-lymphoblastic leukaemia/lymphoma:
After your diagnosis of acute lymphoblastic leukaemia, it is essential that you contact your doctor as soon as possible. With early initiation of treatment, you can avoid aggravating the medical condition and cure the disorder without much difficulty [5].
They can suggest the necessary medicines and plan other therapies according to your signs and symptoms. Generally, the overall treatment period takes nearly 2 years. However, a relapse of the disorder can also stretch this duration.
For the timely and effective treatment of acute leukaemia, it is paramount that the diagnosis is accurate. It can help a haematologist oncologist to identify the probable future progression of the disease. They can also devise an adequate treatment plan after that.
Following are some different diagnosis for acute lymphoblastic leukaemia [6]:
Here are the different tests a haematologist oncologist refers to:
The result of this test helps the doctor understand the count of blood cells, including WBC, RBC, platelet and haemoglobin within the bloodstream. Generally, doctors conduct the CBC test that includes a differential as well. It lets the doctor know the count of different types of WBCs.
People with acute lymphoblastic leukaemia usually have an increased number of WBC. However, this higher WBC count does not strengthen their immunity. This is because these WBC are not mature and properly developed.
If doctors find that the concerned individual has leukaemia, they conduct other necessary blood and bone marrow tests to confirm whether they have developed acute lymphoblastic leukaemia.
In this diagnosis, doctors will collect a sample of your bone marrow. Usually, they take the sample from the hip bone after applying local anaesthesia. In case, doctors intend to perform a bone marrow biopsy, they will collect a minuscule amount of bone along with the liquid bone marrow.
A haematologist oncologist also assesses the sample of your blood and bone marrow under a microscope. It helps them understand the shape, size and type of those cells. From their appearance, the haematologist will infer the share of immature or blast cells in your blood.
Through this test, haematologist oncologists try to understand whether there are certain proteins or antigens attached to the cancer-causing cells. It helps them know if the concerned individual has the medical condition of lymphoma or leukaemia.
Most often, healthcare experts collect samples from bone marrow. They can also perform this diagnosis by collecting samples from lymph nodes, blood or other tissues. This immunophenotyping lets haematologists know the type of lymphocytes and understand the maturity of blood cells.
Following are some genetic tests that doctors may suggest to examine your genes and chromosomes:
In cytogenetic analysis, doctors test the sample of blood or bone marrow. They condition the samples in such a way that can promote the growth of leukaemia cells. Before examining those samples, they add markers or stains on them so that the identification of any changes becomes much easier. Through this test, they are able to understand any abnormal changes in leukaemia cells in terms of structure, shape and size or the quantity of chromosomes.
It is a type of laboratory-based cytogenetic test. Oncologists use this method to assess the chromosomes or genes of blood cells. Through this process, they can easily identify any abnormal changes in the genes of leukaemia cells.
PCR is also an efficient laboratory-based methodical process to detect mutations in genes and changes in chromosomes. This process amplifies the DNA of samples so that it becomes much easier for the expert to perform the tests.
After conducting these diagnostic processes, the expert identifies the reason for lymphoblast and the count of blast cells. Thereafter, they start the medication or other treatment procedures according to the extent of the condition.
The prognosis of acute lymphoblastic leukaemia is excellent for children below 15 years old. The rate of curing the disease is more than 85%. Its prognosis declines with the increasing age of patients. The rate of curing acute lymphoblastic leukaemia for adults older than or equal to the age of 40 is around 30% – 40% [7].
Patients can encounter relapse of this medical condition after a certain period of treatment. Relapse is one of the leading causes of fatalities for patients with this type of leukaemia.
There are also some factors that cause poor prognosis of acute lymphoblastic leukaemia, as mentioned below [4]:
You may need to undergo the following treatment procedures to treat acute lymphoblastic leukaemia:
Chemotherapy is one of the effective treatment procedures that can stop the rapid progress of a medical condition. The drugs used in this treatment destroy rapidly-growing cells, including cancer cells as well as healthy cells [8].
There are different stages of chemotherapy as mentioned below:
The main goal of this induction therapy is to kill as many cancer cells as possible. For this, you may need to stay in the hospital for about 4-6 weeks. Through several medications, including Vincristine, doxorubicin, anthracyclines and corticosteroids, doctors try to achieve remission in the patient’s body.
The objective of remission is to ensure that there is less than 5% blast cell in the bone marrow. It also attempts to restore the blood cell count to normal and eliminate signs of the disorder.
There can be some residual cancer cells within your body even after achieving complete remission. This phenomenon is medically referred to as Minimal Residual Disease. You can experience a relapse of acute lymphoblastic leukaemia if there are any residual cells within your body. Through several diagnostics like PCR, cytometry or sequencing, doctors can identify the existence of residual cells. If your diagnostic result is positive, the doctor may suggest you take medicines like blinatumomab.
As the name suggests, you need to undergo this therapy after achieving remission so that you do not have to witness relapse due to residual cells. There are also two sub-phases of this therapy.
The first sub-phase is consolidation therapy, in which the doctors recommend a high dosage of medications for acute lymphoblastic leukaemia. These include methotrexate, vincristine, cytarabine, cyclophosphamide, etc.
On the other hand, the second sub-phase is referred to as maintenance therapy. At this stage, a haematologist oncologist will prescribe medicines to eliminate the chances of disease relapse. Some medicines that doctors can recommend are methotrexate, 6-mercaptopurine and corticosteroids.
The presence of leukaemia cells inside the cerebrospinal fluid is very unlikely. Its prevalence is only 3% – 7%. However, if you develop this medical condition you may need to undergo the required treatment procedures, which may include intrathecal chemotherapy, systemic chemotherapy and cranial irradiation.
In this process, doctors first destroy the cancer cells using high doses of medicines. Following this, they replace affected stem cells with healthy ones that have the ability to generate and release mature blood cells [9]. There are two different types of stem cell transplantation, as mentioned below:
Through this surgical operation, a patient gets stem cells from another person. Doctors need to ensure that the stem cells that are to be infused within a patient fully or partially match with their original stem cells. They collect these cells from family members or other individuals after ensuring the similarity or compatibility factors.
In this process, doctors insert the patient’s own stem cells to treat the medical condition. However, this may not be an effective treatment process. It also comes with a high risk of relapse.
Targeted therapy is applicable for patients with Philadelphia chromosome-positive acute lymphoblastic leukaemia, a subtype of the medical disorder. In this treatment process, you will have to take imatinib, as per the suggestion of your doctor [10].
Imatinib helps in blocking signals received by the cancerous cells. As a result of these restricted signals, those cancerous cells fail to grow and reproduce. Eventually, the medication kills those cells.
There are also two other types of medicines that doctors use according to the medical condition of patients after a relapse of acute lymphoblastic leukaemia. These are ponatinib and dasatinib.
If you encounter a relapse of the disorder, you may need to again undergo chemotherapy, depending on your medical condition. Your healthcare expert may suggest different medicines like Nelarabine, blinatumomab, inotuzumab ozogamicin, etc., along with corticosteroids. If you are physically fit, your haematologist oncologist may also suggest you undergo the allogeneic stem cell transplantation process [11].
There is still no scientific way that can help you prevent the onset of acute lymphoblastic leukaemia. Many patients develop this medical condition from even unknown risk factors.
Furthermore, there are also some risk factors that are beyond your control. For example, you cannot control the genetic disorders that may cause acute lymphoblastic leukaemia or you cannot avoid chemotherapy required for treating some other diseases [12].
What is in your hand is that you can reduce your obesity through exercise or quitting smoking so that these risk factors do not become the cause of acute lymphoblastic leukaemia.
You may have to encounter the following complications when suffering from acute lymphoblastic leukaemia [13]:
One of the major complications that you can experience is reduced immunity due to a lack of mature white blood cells within your body. Owing to this factor, it becomes challenging or sometimes not possible for your body to make an adequate immune response against diseases or subsequent infections. Whatsoever, your immunocompromised condition may also result from the side effects of medicines you take during the treatment process. Doctors also may suggest you avoid crowds so that you do not come in exposure to pathogens.
The vulnerability to bleeding increases after any minor to major bruises. The bleeding may continue for a prolonged time due to shortages of platelets within your bloodstream after this leukaemia.
Some of the high dosages of medications advised in chemotherapy can also react adversely, causing the side effect of infertility. Apart from medicines, other treatment procedures like bone marrow and stem cell transplants and radiotherapy also significantly increase the risk of the patient becoming infertile. If you are concerned about this risk, you can take measures according to your doctor’s guidance to get yourself safeguard against it.
It may become distressing for the patient if they know that they have developed acute lymphoblastic leukaemia. The fact may trigger depression and anxiety. This is why after being diagnosed with the medical condition or during the treatment period, you need to contact a psychologist for periodic counselling. This expert will help you fight against anxiety and depressing thoughts. You may also need to take antidepressants, depending on your mental health condition severity.
The approximate cost of treating acute lymphoblastic leukaemia in India can range from Rs.80,000–Rs.70,00,000. However, it can differ from one patient to another, depending on the stage and progress of acute lymphoblastic leukaemia and the treatment facilities they will require.
For example, if you are cured with chemotherapy only, you may not need to bear much expense. On the flip side, the overall cost of stem cell transplantation is much higher. Apart from these, the charges of doctors and laboratories also can influence the overall cost of treatment.
Acute lymphoblastic leukaemia is a type of cancer in which the bone marrow releases immature stem cells instead of properly developed blood cells. It causes a shortfall of WBC, RBC and platelet count within the blood. In case you witness the symptoms of ALL, you should seek medical guidance from a licensed doctor. With timely diagnosis and treatment, you will be able to get the disease under control easily and avoid the risk of fatalities.
The treatment for ALL could lead to financial stress. Getting comprehensive health insurance can help prevent burning a hole in your life’s savings. For cashless treatments at 10,000+ network hospitals, unlimited online consultations, home hospitalisation, annual check-ups and many other perks, purchase Navi Health Insurance. Premiums start at just Rs.234 per month. Get a quote now!
There are three main stages of treating acute lymphoblastic leukaemia, as mentioned below: Stage 1 or Remission Induction: The main objectives at this stage are to damage cancerous cells available within the bone marrow and to restore the count of healthy blood cells. Stage 2 or Consolidation: At this phase, doctors recommend medications to damage the remaining cancerous cells. Stage 3 or Maintenance: You need to take regular medications to avoid relapse of the disease.
The potential side effects of acute lymphoblastic leukaemia are as follows: Hair loss Feeling sickness Infertility Loss of appetite Diarrhoea Tiredness Mouth ulcers Skin rashes These side effects subside after your treatment is over.
Imatinib is one of the effective medicines that your haematologist oncologist may suggest as a part of targeted therapy for acute lymphoblastic leukaemia. It can cause side effects like diarrhoea, muscle cramps, skin rash and swelling in the legs and/or face.
Following are a few types of cancer in which the symptoms are almost the same as acute lymphoblastic leukaemia: Acute myeloid leukaemia Non-hodgkin lymphoma B cell lymphoma
Exposure to ionising radiation and benzene can act as environmental risk factors for acute lymphoblastic leukaemia.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7746341/
https://www.lls.org/leukaemia/acute-lymphoblastic-leukaemia/signs-and-symptoms
https://www.nhs.uk/conditions/acute-lymphoblastic-leukaemia/
https://www.ncbi.nlm.nih.gov/books/NBK459149/
https://www.cancer.org/cancer/acute-lymphocytic-leukemia/treating.html
https://www.lls.org/leukaemia/acute-lymphoblastic-leukaemia/diagnosis
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6245970/
https://www.lls.org/leukemia/acute-lymphoblastic-leukemia/treatment/chemotherapy
https://www.lls.org/leukemia/acute-lymphoblastic-leukemia/treatment/stem-cell-transplantation
https://www.nhs.uk/conditions/acute-lymphoblastic-leukaemia/treatment/
https://www.lls.org/leukemia/acute-lymphoblastic-leukemia/treatment/relapsed-and-refractory
https://stanfordhealthcare.org/medical-conditions/cancer/acute-lymphoblastic-leukemia-all/about-this-condition/prevention.html
https://www.nhs.uk/conditions/acute-lymphoblastic-leukaemia/complications/
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