ALL (Acute lymphoblastic leukemia) - Specialists and information

Acute lymphoblastic leukemia, also known as ALL for short, is a malignant disease of the hematopoietic system. In colloquial language, the disease is therefore also known as blood cancer.

Further information and selected specialists for acute lymphoblastic leukemia can be found below.

What is acute lymphoblastic leukemia (ALL)?

There are more than one hundred different types of leukemia. In all types, the white blood cells multiply and spread exceptionally quickly and unchecked.

Acute lymphoblastic leukemia is a disease in which certain white blood cells multiply too quickly and too much: These special white blood cells are called lymphocyte precursor cells.

As a result, the lymphocytes appear in large quantities in the blood. However, they are not functional and can no longer perform any tasks in the immune system. This is referred to as lymphoid blasts.

The spread to the bone marrow increases the number of lymphocytes in the blood. The red blood cells (erythrocytes), the thrombocytes (blood platelets) and the white blood cells, on the other hand, decrease.

Overall, ALL is a rare cancer with 1.5 new cases per 100,000 inhabitants per year. However, at 80 percent, it is the most common form of leukemia in children and adolescents. Children under the age of four are particularly affected by this malignant disease.

In acute lymphoblastic leukemia (ALL) , immature white blood cells multiply in the bone marrow @ LASZLO /AdobeStock

The causes of acute lymphoblastic leukemia (ALL)

The exact causes of leukemia are not yet fully understood. It is assumed that a combination of different genetic changes is responsible for the development of leukemia, and it is not yet known why these genetic changes occur.

Ionizing radiation and toxic substances such as benzene are also considered to be proven risk factors.

Cytostatic drugs (cell growth-inhibiting substances), which are used to treat cancer, can also promote leukemia in rare cases.

Symptoms of acute lymphoblastic leukemia (ALL)

The symptoms that occur in the context of leukemia can vary greatly:

• Rapid deterioration in general condition: patients are tired, have little to no appetite and lose weight. Children often have a fever as well as bone and joint pain.
• Increased tendency to bleed: The lack of platelets leads to an increased tendency to bleed. Nosebleeds, bruises or small punctiform bleedings (petechiae) can occur even for no apparent reason.
• Increased susceptibility to infections: Infections can affect any organ. Patients suffer from pneumonia or inflammation of the urinary tract. In advanced stages of the disease, infections can be life-threatening due to the lack of immune function.
• Anemia: Typical symptoms are tiredness, paleness and a pronounced feeling of weakness.
• Enlarged spleen or liver: If the spleen and liver are affected by leukemia cells, this is manifested by abdominal pain.
• Swelling of the lymph nodes: Another characteristic symptom of ALL is swelling of the lymph nodes in the groin, under the armpits or on the neck.

In rare cases, the immature lymphoblasts affect parts of the nervous system such as the spinal cord, the meninges or the brain.

This can lead to the following symptoms:

• Paralysis of the cranial nerves with double vision or drooping corners of the mouth
• Sensitivity disorders
• Headaches with or without vomiting

The treatment of acute lymphoblastic leukemia (ALL)

The treatment of ALL consists of several components:

• Chemotherapy

The most important component of treatment is chemotherapy. Patients receive cytostatic drugs as an infusion or in the form of tablets. These are intended to inhibit the proliferation of lymphocytes. As the various cytostatic drugs interfere with cell division at different points, a combination of several active substances has proven effective.

Chemotherapy is very intensive and extends over several treatment cycles, each lasting several weeks. Not all patients respond equally well to the classic cytostatic drugs.

As the leukemia cells often also affect the brain, cytostatic drugs are also injected directly into the cerebrospinal fluid. The cerebrospinal fluid surrounds the brain and spinal cord.

• Radiotherapy of the skull

Irradiation of the skull may also be necessary. Doctors also use radiotherapy to treat malignant lymph nodes.

Tyrosine kinase inhibitors such as imatinib or monoclonal antibodies such as rituximab and alemtuzumab are among the newer, specific therapeutic approaches for leukemia.

• Bone marrow or blood stem cell transplantation

A permanent cure can only be achieved in some patients with the aforementioned treatment methods. Recurrences of the disease are common. For many patients, the chances of recovery can be increased by a bone marrow or blood stem cell transplant.

For this, they first receive high-dose chemotherapy and whole-body radiotherapy. The aim is to destroy the entire bone marrow and thus all the diseased cells.

Healthy hematopoietic stem cells are then transferred. There are two methods for this:

1. Autologous stem cell transplantation: If doctors have taken these from the patient before chemotherapy, this is referred to as an autologous stem cell transplant.
2. Allogeneic stem cell transplantation: In an allogeneic stem cell transplant, the patient receives bone marrow or blood stem cells from a suitable donor.

In a bone marrow transplant, the patient receives liquid (healthy) bone marrow via a central venous catheter @ Elroi /AdobeStock

Prognosis for acute lymphoblastic leukemia (ALL)

The average duration of treatment for acute lymphoblastic leukemia is between two and three years. In 60 to 80 percent of cases, the symptoms of the disease subside completely.

However, the relapse rate is 50 to 60 percent. The first relapses usually occur within the first one to two years after treatment.