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Leukemia, Lymphoblastic

Leukemia, Lymphoblastic

Definition

Acute lymphoblastic leukemia (ALL) is a cancer of the white blood cells in the bone marrow. The white blood cells (lymphocytes) grow in the bone marrow, then travel throughout the body to fight infections.

ALL also causes the bone marrow to make too many of these cells. The overgrowth makes it difficult for other blood cells like red blood cells or platelets to develop. Low levels of other blood cells can cause a variety of symptoms such as bleeding problems, fatigue and shortness of breath.

White Blood Cells
White Blood Cells
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Causes

The cause of ALL is unknown. Many cancers are believed to be caused by a combination of genetic and environmental factors.

Risk Factors

ALL is more common in white males. It is also more likely to occur in children and adults over 70 years of age. Other factors that may increase your chance of ALL include:

  • Previous chemo- or radiation therapy treatment
  • Exposure to toxic chemicals such as pesticides or benzene (common in agriculture, dye works, and paint manufacturing and use)
  • Exposure to atomic bomb radiation or nuclear reactor accident
  • Certain genetic disorders, such as Down syndrome , Bloom syndrome, Fanconi’s anemia, ataxia-telangiectasia, neurofibromatosis , Shwachman syndrome, IgA deficiency, and congenital X-linked agammaglobulinemia

Factors that may increase the chance of ALL in children only include:

  • Having a brother or sister with leukemia
  • Exposure to x-rays before birth
  • Exposure to radiation, including X-rays and CT scans
  • Previous chemotherapy or other treatment that weakens the immune system

Symptoms

ALL may cause:

  • Weakness
  • Fatigue
  • Fever
  • Pale skin
  • Night sweats
  • Easy bruising or bleeding
  • Petechiae (flat, pinpoint spots under the skin caused by bleeding)
  • Shortness of breath
  • Weight loss
  • Loss of appetite
  • Bone or joint pain
  • Stomach pain
  • Pain or a feeling of fullness below the ribs
  • Painless lumps in the neck, underarms, stomach, or groin
  • Swelling of the liver and/or spleen

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done, including checking for swelling of the liver, spleen, or lymph nodes. If your doctor suspects leukemia, you will likely be referred to a specialist.

Abnormal cells may be found through:

  • Blood tests—assessing number of different blood cells to look for abnormally high or low levels and tests of other substances in the blood that may indicate organ stress
  • Bone marrow aspiration and biopsy —to remove and test a portion of bone marrow

Further tests may be done to provide detailed information about the leukemia. These tests will help guide treatment. Tests may include:

  • Cytogenetic analysis—a test to look for certain changes of the chromosomes (genetic material) of the lymphocytes; certain genetic abnormalities
  • Immunophenotyping—examination of the proteins on cell surfaces and the antibodies produced by the body; to distinguish lymphoblastic from myeloid leukemia and determine types of therapy
  • Lumbar puncture —to see if leukemia has spread to spinal cord and brain
  • Chest x-ray —look for masses in chest caused by leukemia

Treatment

Talk with your doctor about the best plan for you. Treatment of ALL is done in 2 phases. First, remission induction therapy is used to kill leukemia cells. Then, maintenance therapy is used to kill any remaining leukemia cells. Cells left behind could grow and cause a relapse. Treatment options include:

Prevention

There are no current guidelines for preventing ALL since its cause is unknown.

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