Acute Lymphocytic Leukemia

Acute lymphocytic leukemia is actually an abnormality of the white blood cells where the bone marrow starts overproducing lymphocytes which are not fully developed and appear as immature in an uncoordinated fashion in the circulating blood. It is a true malignant neoplasm where survival is less than 6 months because of its rapidly progressive nature/acute. It occurs in children with an age less than 15 years.

CAUSES:

It happens when the normal hematopoietic process of the bone marrow gets disturbed by replacement of these cells by the early lymphoid precursor's proliferation. Certain risk factors also cause it:

• Radiation exposure
• Chromosomal abnormality
• Smoking
• Genetic 
• Past chemotherapy
• Epstein-Barr virus
• Syndromes such as down syndrome
• Children
• Impaired immunity

 SYMPTOMS:

• Weakness
• Fever
• Petechiae and ecchymosis
• Headache
• Generalized swelling of the lymph nodes
• Lymphadenopathy
• Spleen, kidney becomes enlarged
• Hemorrhages are common due to a decrease in platelets.
• Feeling tired
• Weight loss
• Pain in your bones and joints
• Breathlessness
• Skin looks paler than normal.
• Gingival hyperplasia
• Rapid loosening of the tooth due to the destruction of the alveolar bone.

DIAGNOSIS:  

• Hematological examination
• Chest X-ray
• Lumbar puncture
• Bone marrow test
• CT scan
• MRI scan
• Tissue typing
• Cytochemical stains –PAS positive

TREATMENT:

• MEDICATIONS:

• INDUCTION OF REMISSION – vincristine, L-asparaginase, daunorubicin, oral prednisolone, methotrexate.

• CONSOLIDATION PHASE: Daunorubicin, cytosine arasinoside, etoposide, 6-mercaptopurine, vincristine

• MAINTENANCE PHASE ( 3months cyclic x 6 cycles ): predinosolone,mercaptopurine, L-asparaginase, vincristine, methotrexate , danorubicin.

• CHEMOTHERAPY: to destroy cancer cells by using anti-cancer drugs like doxorubicin, asparaginase, methotrexate, cytarabine

• STEM CELL OR BONE MARROW TRANSPLANTS: it is the best and effective treatment done during the second remission to reconstitute the hematopoietic system by giving high doses of chemotherapy and total body irradiation. It kills the leukemic cells and healthy stem cells in the bone marrow to make space for the donor stem cells.

• CORTICOSTEROIDS: such as prednisolone, dexamethasone can be used.  

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