ALL (Acute Lymphocytic Leukemia) - Specialists and Information

There are more than a hundred different types of leukemia. In all types, 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 in excessive numbers: These specific white blood cells are called lymphoid progenitor cells.

As a result, lymphocytes appear in large quantities in the blood. However, they are non-functional and can no longer perform their roles in the immune system. These are referred to as lymphoblastic cells.

As the disease spreads to the bone marrow, the number of lymphocytes in the blood increases. In contrast, the levels of red blood cells (erythrocytes), platelets, and white blood cells decrease.

Overall, ALL is considered a rare form of cancer, with 1.5 new cases per 100,000 inhabitants per year. However, accounting for 80 percent of all cases, 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 exact causes of leukemia have not yet been fully elucidated. It is believed that a combination of various genetic changes is responsible for the development of leukemia. Why these genetic changes occur is also not yet known.

Furthermore, ionizing radiation and toxic substances such as benzene are considered established risk factors.

Cytostatic drugs (substances that inhibit cell growth), which are used to treat cancer, can also, in rare cases, contribute to the development of leukemia.

The symptoms associated with leukemia can vary widely:

• Rapid deterioration of general health: Patients feel tired, have little to no appetite, and lose weight. Children often experience fever as well as bone and joint pain.
• Increased tendency to bleed: A shortage of platelets leads to an increased tendency to bleed. Even without any apparent cause, patients may experience nosebleeds, bruises, or small pinpoint hemorrhages on the skin (petechiae).
• Increased susceptibility to infections: Infections can affect any organ. Patients may suffer from pneumonia or urinary tract infections. In advanced stages of the disease, infections can be life-threatening due to impaired immune function.
• Anemia: Typical symptoms include fatigue, pallor, and a pronounced feeling of weakness.
• Enlarged spleen or liver: When the spleen and liver are affected by leukemia cells, this manifests as abdominal pain.
• Swollen lymph nodes: Another characteristic symptom of ALL is swelling of the lymph nodes in the groin, under the arms, or in the neck.

In rare cases, immature lymphoblasts invade 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
• Sensory disturbances
• Headaches with or without vomiting

Treatment for ALL consists of several components:

• Chemotherapy

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

Chemotherapy is very intensive and spans several treatment cycles, each lasting several weeks. Not all patients respond equally well to conventional cytostatic drugs. 

Since leukemia cells often spread to the brain as well, cytostatic drugs are also injected directly into the cerebrospinal fluid. The cerebrospinal fluid surrounds the brain and spinal cord.

• Radiation Therapy to the Skull

In addition, radiation therapy to the skull may be necessary. Doctors also treat malignant lymph nodes using radiation therapy.

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

• Bone marrow or blood stem cell transplantation

Only a portion of patients can achieve a permanent cure with the aforementioned treatment methods. Recurrences—that is, a return of the disease—are common. For many patients, the chances of a cure can be increased through a bone marrow or blood stem cell transplant. 

To prepare for this, patients first receive high-dose chemotherapy and total-body irradiation. The goal is to destroy the entire bone marrow and, with it, all diseased cells.

This is followed by the transplantation of healthy blood-forming stem cells. There are two methods for this:

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

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

The average duration of treatment for acute lymphoblastic leukemia is between two and three years. In 60 to 80 percent of cases, a complete remission of the disease’s symptoms can be achieved.

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