Acute lymphoblastic leukemia (ALL), sometimes called acute lymphocytic leukemia, is the most common form of leukemia found in children, accounting for about 30 percent of all pediatric cancer. There are about 3,000 cases of ALL in children and youth up to age 21 each year in the United States. ALL has one of the highest cure rates of all childhood cancers. Acute lymphoblastic leukemia affects the immature forms of white blood cells, called lymphocytes. There are two basic types of lymphocytes, B-lymphocytes and T-lymphocytes, and their immature forms are the source of the two corresponding subsets of ALL, T-ALL and B- or pre-B ALL. The job of lymphocytes is to identify and destroy foreign proteins in the body, such as bacteria and viruses. In ALL, the bone marrow makes too many immature lymphocytes (called lymphoblasts) that do not mature correctly. Immature blood cells (blasts) do not have the ability to fight infection. The lymphoblasts overproduce and crowd out normal blood-forming cells in the bone marrow.
The most common signs and symptoms of acute lymphoblastic leukemia in children are:
The diagnosis of acute lymphoblastic leukemia in children is based on a complete medical history and physical examination and on the following diagnostic tests:
Treatment for acute lymphoblastic leukemia usually begins by addressing the signs and symptoms your child has such as anemia, bleeding and/or infection. In addition, treatment for leukemia will include most of the following:
Treatment stagesTreatment of acute lymphoblastic leukemia takes months or years and takes place in three or more stages. InductionInduction refers to the first month or so of treatment in which a combination of chemotherapeutic drugs is given to reduce the numbers of leukemia cells from visible to not visible under the microscope. The goal in this stage of treatment is to reduce the number of leukemia cells in the marrow to a minimum and to make room for the return of the normal red blood cells, white blood cells and platelets. When this happens, the leukemia is said to be in "remission." ConsolidationIn ALL, consolidation involves one or two months of drug treatment. During this phase, the rare remaining leukemia cells are targeted. The patient receives weekly spinal taps to prevent leukemia from going to the brain/spinal fluid. Interim maintenancePatients receive methotrexate in combination with other chemotherapy agents. In some protocols the methotrexate has to be given as an inpatient. IntensificationIn ALL, intensification involves repeating chemotherapy combinations similar to those used in induction and consolidation several months later. This stage is slightly more intensive and about half of patients get admitted to the hospital for fever, infection or other side effects. MaintenanceThis treatment stage involves repeated courses of less intense chemotherapy every 28 days for an additional 2 to 3 years. Monthly outpatient visits are required to determine response to treatment, detect any recurrent disease and manage any side effects of the treatment.
Some children treated for acute lymphoblastic leukemia may develop complications years later. Our Cancer Survivorship Program provides information about the potential long-term effects of the specific treatment your child received, including ways of monitoring and treating these effects. Reviewed by Susan R. Rheingold, MD
a. Transposition of great arteries b. Ventricular-septal defect c. Coarctation of the aorta d. Patent-ductus arteriosus Answer a. Transposition of great arteries CORRECT. An infant who has transposition of great arteries will have severe cyanosis because reversal of the anatomic position of the aorta and pulmonary artery allows venous blood to enter the systemic circulation without oxygenation. b. Ventricular-septal defect An infant who has a ventricular-septal defect, a hole in the septal wall between the ventricles, can have increased pulmonary vascular resistance but is unlikely to have cyanosis, because oxygenation of the blood remains adequate for the systemic circulation. c. Coarctation of the aorta An infant who has coarctation of the aorta, a constricted segment of the aorta that obstructs blood flow to the body, is unlikely to have cyanosis, because even though the left ventricle must generate higher than normal pressures for adequate stroke volume, oxygenation of the blood remains adequate for the systemic circulation. d. Patent-ductus arteriosus An infant who has a patent-ductus arteriosus will have a blood vessel connecting the pulmonary artery to the aorta. The infant can have increased pulmonary vascular resistance, but oxygenation of the blood remains adequate for the systemic circulation. |