Acute lymphoblastic leukemia: Difference between revisions

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{{short description|Blood cancer characterised by overproduction of lymphoblasts}}
{{Infobox medical condition
{{Infobox medical condition (new)
| name         = Acute Lymphoblastic Leukemia
| name           = Acute lymphoblastic leukemia
| image        =
| synonyms       = Acute lymphocytic leukemia, acute lymphoid leukemia
| caption      =
| image          = Acute leukemia-ALL.jpg
| synonyms     = Acute lymphocytic leukemia, acute lymphoid leukemia
| caption        = Bone marrow aspirate smear from a person with precursor B-cell ALL. <br>The large purple cells are lymphoblasts.
| specialty    = [[Oncology]], [[Hematology]]
| field          = [[Hematology]], [[oncology]]
| symptoms     = Fever, bleeding, bone pain, fatigue
| symptoms       = Feeling tired, pale color, fever, easy bleeding or bruising, bone pain, <br>[[lymphadenopathy|enlarged lymph nodes]]<ref name=NCI2017Pt/>
| complications = [[Infection]], [[Anemia]], bleeding
| complications   = [[Infection]], [[tumor lysis syndrome]]
| onset         =  
| onset           = 2–5 years old
| duration     =  
| duration       =
| types         =  
| types           = [[Precursor B-cell lymphoblastic leukemia|B-cell ALL]], <br>[[T-lymphoblastic leukemia/lymphoma|T-cell ALL]]
| causes       = Genetic mutations, environmental factors
| causes         = Usually unknown<ref name=MDAnd2016/>
| risks         = Radiation exposure, genetic disorders
| risks           = [[Identical twin]] with ALL, [[Down syndrome]], [[Fanconi anemia]],<br> [[ataxia telangiectasia]], [[Klinefelter syndrome]], [[high birth weight]], significant [[radiation]] exposure
| diagnosis     = Blood tests, bone marrow biopsy
| diagnosis       = [[Blood tests]] and [[bone marrow examination]]
| differential =  
| differential   = [[Infectious mononucleosis]], [[acute myeloid leukemia]], <br>[[lymphoblastic lymphoma]], [[aplastic anemia]]
| prevention   =  
| prevention     =
| treatment     = Chemotherapy, radiation therapy, stem cell transplant
| treatment       = [[Chemotherapy]], [[stem cell transplantation]],
| medication   =  
[[radiation therapy]], [[targeted therapy]]
| prognosis     = Varies by age and genetic factors
| medication     =  
| frequency     =  
| prognosis       = '''Children''': 90% [[five-year survival rate]]><br />'''Adults''': 35% five-year survival
| deaths       =  
| frequency       = 1 in 1,750 children
| deaths         = 111,000 (2015)
}}
}}
[[File:Diagram showing the cell that ALL starts in CRUK 295.svg|thumb|right|In ALL, lymphoid cell development stops at the lymphoblast (arrow), which are also overproduced]]


'''Acute Lymphoblastic Leukemia''' (ALL) is a type of [[cancer]] that primarily affects the [[white blood cell|white blood cells]] known as [[lymphocyte]]s. It is characterized by the rapid development of immature lymphocytes, which crowd out other healthy cells in the [[bone marrow]].
'''Acute lymphoblastic leukemia''' (ALL) is a type of [[cancer]] that affects the [[white blood cells]]. It is characterized by the overproduction of immature white blood cells, known as lymphoblasts or leukemic blasts. ALL is most commonly diagnosed in children, making it the most prevalent type of cancer in this age group, but it can also affect adults.


== Overview and Etiology == <!--T:2-->
==Etiology==
The exact cause of ALL is not well understood, but it is believed to involve a combination of genetic and environmental factors. Genetic mutations in the DNA of bone marrow cells can lead to the development of ALL. These mutations cause the cells to grow uncontrollably and accumulate, leading to leukemia. Environmental factors, such as exposure to radiation or toxic chemicals, may also play a role in the development of ALL.


ALL is most prevalent in children, with a peak incidence between the ages of two and five years. However, it can also occur in adults, where it generally carries a poorer prognosis. The exact cause of ALL is unknown, although it is thought to be a combination of genetic and environmental factors.<ref>{{cite journal|last=Belver|first=L.|title=The genetics and treatment of acute lymphoblastic leukaemia|journal=Nature Reviews Cancer|year=2020|volume=20|pages=227–246|doi=10.1038/s41568-019-0232-4}}</ref>
==Pathophysiology==
In ALL, the genetic mutations affect the lymphoid line of blood cells, leading to the production of abnormal lymphoblasts. These cells are unable to function properly as immune cells and rapidly divide, crowding out normal blood cells in the bone marrow. This disruption in blood cell production leads to the symptoms associated with ALL, such as anemia, infection, and bleeding disorders.


== Signs and Symptoms == <!--T:3-->
==Symptoms==
Common symptoms of ALL include:
* Fever
* Frequent infections
* Fatigue
* Bleeding and bruising easily
* Bone and joint pain
* Swollen lymph nodes
* Abdominal discomfort due to an enlarged spleen or liver


Symptoms of ALL can vary but often include fatigue, fever, bleeding or bruising easily, frequent infections, bone or joint pain, and swollen lymph nodes.
==Diagnosis==
Diagnosis of ALL typically involves blood tests, which may show an abnormal number of white blood cells and a presence of blast cells. A bone marrow biopsy is often performed to confirm the diagnosis and to determine the specific type of leukemia.


== Diagnosis == <!--T:4-->
==Treatment==
Treatment for ALL usually involves a combination of therapies including:
* [[Chemotherapy]]: the main treatment for ALL, which uses drugs to kill cancer cells.
* [[Radiation therapy]]: sometimes used to kill cancer cells or to prepare for a stem cell transplant.
* [[Stem cell transplant]]: replaces diseased bone marrow with healthy bone marrow from a donor.


Diagnosis is typically made via blood tests and bone marrow examination. The presence of immature lymphocytes, or lymphoblasts, in the blood or bone marrow is characteristic of ALL. Molecular and genetic tests may also be used to further characterize the disease and guide treatment decisions.<ref>{{cite journal|last=Campana|first=D.|title=Minimal residual disease in acute lymphoblastic leukemia|journal=Hematology|year=2010|volume=2010|pages=7–12|doi=10.1182/asheducation-2010.1.7}}</ref>
Treatment may vary depending on the patient's age, overall health, and specific characteristics of the leukemia.


== Treatment == <!--T:5-->
==Prognosis==
The prognosis for patients with ALL varies. Children often have a better prognosis than adults, with higher rates of remission and cure. The prognosis in adults is influenced by the specific subtype of ALL and the presence of certain genetic abnormalities.


Treatment for ALL generally involves chemotherapy, which can be divided into several phases including induction, consolidation, and maintenance. Other treatments, such as radiation therapy or stem cell transplantation, may be utilized in certain cases. The specific treatment plan depends on various factors such as patient age, disease subtype, and genetic profile.<ref>{{cite journal|last=Pui|first=C.H.|title=Acute lymphoblastic leukemia: Diagnosis and treatment|journal=Mayo Clinic Proceedings|year=2016|volume=91|pages=1645–1666|doi=10.1016/j.mayocp.2016.09.010}}</ref>
==Epidemiology==
ALL is the most common type of cancer in children and represents a significant percentage of cancer diagnoses in this group. It is less common in adults, but the incidence increases with age.


== Prognosis == <!--T:6-->
==See also==
* [[Leukemia]]
* [[Cancer]]
* [[Chemotherapy]]
* [[Radiation therapy]]
* [[Stem cell transplant]]


The prognosis for ALL varies and depends on a multitude of factors. However, the survival rate in children is generally favorable, with about 90% achieving a long-term cure. In adults, the prognosis is less favorable but has improved significantly with advancements in treatment.
[[Category:Leukemia]]
[[Category:Cancer]]
[[Category:Pediatric cancers]]
[[Category:Hematology]]
[[Category:Oncology]]


<gallery>
{{medicine-stub}}
File:ALL - Peripherial Blood - Diagnosis - 01.jpg|acute lymphoblastic leukemia (ALL), peripheral blood of a child, Pappenheim stain, magnification x100
File:ALL-KM-2.jpg|bone marrow smear (large magnification) from a person with acute lymphoblastic leukemia
File:ALL-KM-3.jpg|bone marrow smear from a person with acute lymphoblastic leukemia
</gallery>
== References == <!--T:7-->
<references />
{{stub}}
{{Arthritis in children}}
{{Chromosomal abnormalities}}
{{Hematological malignancy histology}}
[[Category:Acute lymphocytic leukemia]]
[[Category:Articles containing video clips]]
[[Category:Pediatric cancers]]
[[Category:RTT]]

Revision as of 14:31, 13 August 2024

Acute Lymphoblastic Leukemia
Synonyms Acute lymphocytic leukemia, acute lymphoid leukemia
Pronounce N/A
Specialty Oncology, Hematology
Symptoms Fever, bleeding, bone pain, fatigue
Complications Infection, Anemia, bleeding
Onset
Duration
Types
Causes Genetic mutations, environmental factors
Risks Radiation exposure, genetic disorders
Diagnosis Blood tests, bone marrow biopsy
Differential diagnosis
Prevention
Treatment Chemotherapy, radiation therapy, stem cell transplant
Medication
Prognosis Varies by age and genetic factors
Frequency
Deaths


Acute lymphoblastic leukemia (ALL) is a type of cancer that affects the white blood cells. It is characterized by the overproduction of immature white blood cells, known as lymphoblasts or leukemic blasts. ALL is most commonly diagnosed in children, making it the most prevalent type of cancer in this age group, but it can also affect adults.

Etiology

The exact cause of ALL is not well understood, but it is believed to involve a combination of genetic and environmental factors. Genetic mutations in the DNA of bone marrow cells can lead to the development of ALL. These mutations cause the cells to grow uncontrollably and accumulate, leading to leukemia. Environmental factors, such as exposure to radiation or toxic chemicals, may also play a role in the development of ALL.

Pathophysiology

In ALL, the genetic mutations affect the lymphoid line of blood cells, leading to the production of abnormal lymphoblasts. These cells are unable to function properly as immune cells and rapidly divide, crowding out normal blood cells in the bone marrow. This disruption in blood cell production leads to the symptoms associated with ALL, such as anemia, infection, and bleeding disorders.

Symptoms

Common symptoms of ALL include:

  • Fever
  • Frequent infections
  • Fatigue
  • Bleeding and bruising easily
  • Bone and joint pain
  • Swollen lymph nodes
  • Abdominal discomfort due to an enlarged spleen or liver

Diagnosis

Diagnosis of ALL typically involves blood tests, which may show an abnormal number of white blood cells and a presence of blast cells. A bone marrow biopsy is often performed to confirm the diagnosis and to determine the specific type of leukemia.

Treatment

Treatment for ALL usually involves a combination of therapies including:

  • Chemotherapy: the main treatment for ALL, which uses drugs to kill cancer cells.
  • Radiation therapy: sometimes used to kill cancer cells or to prepare for a stem cell transplant.
  • Stem cell transplant: replaces diseased bone marrow with healthy bone marrow from a donor.

Treatment may vary depending on the patient's age, overall health, and specific characteristics of the leukemia.

Prognosis

The prognosis for patients with ALL varies. Children often have a better prognosis than adults, with higher rates of remission and cure. The prognosis in adults is influenced by the specific subtype of ALL and the presence of certain genetic abnormalities.

Epidemiology

ALL is the most common type of cancer in children and represents a significant percentage of cancer diagnoses in this group. It is less common in adults, but the incidence increases with age.

See also


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