Adult Acute Lymphocytic Leukemia

What is adult acute lymphocytic leukemia?

Acute lymphocytic leukemia (ALL) is a fast-growing cancer of the blood and bone marrow. It affects a type of white blood cells called lymphocytes. The cancer causes large numbers of abnormal white cells to form, crowding out normal blood cells in the bone marrow.

Another name for this type of leukemia is acute lymphoblastic leukemia.

How does it occur?

The cancer starts in the bone marrow. Marrow is the soft, fatty tissue inside the hard, outer supporting part of the bones. The marrow makes blood stem cells, which become the different types of blood cells, including white blood cells, red blood cells, and platelets.

Normally, white blood cells help your body fight infection and other diseases. Acute lymphocytic leukemia happens when the body makes too many abnormal lymphocytes. The abnormal cells crowd out other, normal blood cells needed by the body. The abnormal lymphocytes cannot fight infections like normal white blood cells. In addition, you become anemic because you don’t have enough red blood cells. The number of platelets also decreases. This causes you to have blood clotting problems and to bleed easily.

The cancer can spread to the blood, lymph nodes, spleen, liver, central nervous system, and other organs.

It is not known why the bone marrow becomes cancerous, but there are some known risk factors for developing ALL. You are more likely to get ALL if:

• You are male.
• You are Caucasian.
• You are 65 years old or older.
• You have had cancer chemotherapy or radiation therapy or been exposed to the chemical benzene.
• You have been exposed to atomic radiation.
• You have a genetic condition that increases your risk.

What are the symptoms?

Often the first signs or symptoms of ALL are subtle and nonspecific. Symptoms may include:

• tiredness
• weakness
• fever
• infections
• easy bruising or bleeding
• full feeling below the ribs, especially on the left
• swollen lymph nodes in the neck, underarms, and groin.

How is it diagnosed?

Your healthcare provider will ask about your medical history, including symptoms and possible risk factors, and you will have a physical exam.

Diagnostic tests include:

• A CBC blood test (complete blood count) to count the cells in your blood and to see if they are normal.
• A bone marrow biopsy, which uses a needle to get a sample of bone marrow from the breast bone or the hip bone (after local anesthesia). The sample is examined in the lab for abnormal cells.
• A blood test to see what type of ALL you have. Treatment and prognosis vary some according to which type you have.

When the blood and bone marrow tests confirm a diagnosis of ALL, more tests may be done before you start treatment to see if the cancer has spread beyond the blood and bone marrow. This is called staging and phasing. Tests that may be done include:

• chest X-ray to look at the lung and chest cavity because there could be a large tumor in the middle of your chest
• lumbar puncture (also called a spinal tap) to check for spread of the cancer to the brain, spinal cord, and their coverings (meninges)
• CT (computed tomography) scan of the belly to look for spread to the organs or lymph nodes in the abdomen.

How is it treated?

The treatment depends on the stage of the leukemia. The goal is to make the signs and symptoms decrease or go away. In general there are 2 phases of treatment:

• Phase 1: Kill tumor cells in the blood and bone marrow and put the cancer in remission, which means that the cancer becomes inactive. This is called remission induction.
• Phase 2: Prevent new tumor cells from becoming active. This is called intensification followed by maintenance.

Possible treatments include chemotherapy (anticancer drugs), radiation therapy, and stem cell therapy.

• Chemotherapy uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. Chemotherapy is usually given by vein, but because the cancer sometimes spreads to the brain and spinal cord, chemotherapy medicines may be injected into the area around the spinal cord.
• Radiation therapy may be used when there is spread of the cancer to the brain and spinal cord.
• Stem cell therapy or bone marrow transplant may be used, especially if the first treatments are not working as well as hoped. This involves taking your own bone marrow, or marrow from a donor, and freezing and storing it. You are then given chemotherapy to kill the cancerous cells in the marrow and blood. The chemotherapy usually causes the blood counts to become very low—low enough to be life-threatening. Then the marrow is given back to you so that new, healthy cells can begin to replace the cells that were killed by the chemotherapy.

Newer therapies are available and continue to be studied. Examples of new treatments you may want to ask your healthcare provider about are tyrosine kinase inhibitors and immunotherapy (which is also called biotherapy or biologic therapy).

Your treatment will also be focussed on:

• preventing infections
• controlling pain or other symptoms you may be having
• controlling the side effects from treatments
• helping you manage your life with cancer

You may want to think about participating in a clinical trial. Clinical trials are research studies to find the most effective cancer treatments. They usually compare existing treatments with new, experimental treatments. This is a way you may be able to have treatment with the latest drugs. Ask your healthcare provider about clinical trials that might be available to you. It’s always your choice whether you consider them or not.

How long will the effects last?

Many people with leukemia live normal lives for many years. Treatment for newly diagnosed ALL results in a remission 80 to 85% of the time. When the cancer is in remission, you will need to have regular follow-up visits with your healthcare provider to keep checking your blood counts and overall health. In some cases you may have treatment during remission to try to keep the cancer in remission. The cancer may return in weeks, months, or years. When the cancer comes back, it is called a recurrence. Recurrences can be treated. The overall cure rate is 30 to 40%.

How can I take care of myself?

• It is very important to have a good relationship with your cancer doctor, so that you feel comfortable asking questions and getting answers. Take a family member or friend with you to your appointments to help you remember what you were going to ask and what was said.
• Follow your provider’s treatment recommendations carefully.
• Read all of the information you are given about your medicines, radiation therapy, and any other treatments. Feel free to ask questions at any time.
• Eat a healthy diet and be as active as is comfortable and recommended. Ask your provider if you need to avoid some activities or be careful about what you eat. Get plenty of rest.
• Take precautions during your treatment to avoid infections. Try to stay away from crowds and people who may be sick. Avoid small children, especially children who attend day care (they often have colds and other infections). When you are around people, including family, wash your hands often. Do not share towels. Ask your provider if you should wear a surgical mask when you are out in public so that you are less likely to breathe in germs.
• If you lose your appetite and begin to lose weight, ask your provider about medicine that can help you have a better appetite.
• Do not smoke.
• Ask your provider if you need to avoid drinking alcohol. It may interfere with medicines you are taking. Alcohol can also make it harder for white blood cells to fight infections.
• Learn about your illness. Join a support group to learn from other cancer survivors and to share what has helped you.
• Tell your healthcare provider if you have new or worsening:
  • tiredness
  • weakness
  • sore throat
  • fever
  • easy bruising or bleeding
  • loss of appetite
  • weight loss
  • bone pain
  • feeling of fullness below the ribs, especially on the left
  • swollen lymph nodes in the neck, underarms, and groin
  • sweating at night
  • infections
• For more information, contact the Leukemia and Lymphoma Society at 800-955-4572 or visit their Web site at http://www.leukemia.org.

How can I help prevent acute lymphocytic leukemia?

Because we don’t know what causes ALL, there’s no way to prevent it.