Acute lymphocytic leukemia (ALL)

Answer 1

Definition

Acute lymphocytic leukemia (ALL) is a fast-growing cancer in which the body produces a large number of immature white blood cells (lymphocytes). These cells are found in the blood, bone marrow, lymph nodes, spleen, and other organs.

Alternative Names

ALL; Acute childhood leukemia; Cancer - acute childhood leukemia (ALL); Leukemia - acute childhood (ALL)

Causes, incidence, and risk factors

ALL makes up 80% of childhood acute leukemias. Most cases occur in children ages 3 - 7. The disease may also occur in adults.

In acute leukemia, cancerous cells multiply quickly and replace normal cells. Cancerous cells take over normal parts of the bone marrow, often causing low blood counts .

Most cases of ALL have no obvious cause. However, the following may play a role in the development of leukemia:

• Certain chromosome problems
• Radiation exposure or being exposed to x-rays before birth
• Past treatment with chemotherapy drugs
• Receiving a bone marrow transplant
• Toxins such as benzene

Persons with Down syndrome or other genetic disorders, or who have a brother or sister with leukemia are at increased risk for ALL.

Symptoms

A person with ALL is more likely to bleed and have infections because there are fewer normal blood cells and platelets. Life-threatening symptoms may develop.

• Bone and joint pain or tenderness
• Easy bruising and bleeding (bleeding gums, skin bleeding, nosebleeds, menstrual irregularities)
• Feeling weak or tired
• Fever
• Loss of appetite and weight loss
• Paleness
• Pain or feeling of fullness below the ribs
• Pinpoint red spots on the skin (petechiae)
• Swollen glands (lymphadenopathy) in the neck, under arms, and groin
• Night sweats

Note: These symptoms can occur with other conditions. Talk to your doctor about the meaning of your specific symptoms.

Signs and tests

A physical exam may reveal the following:

• Bruising
• Enlarged liver, lymph nodes, and spleen
• Signs of bleeding (petechiae, purpura)

Blood tests may show the following:

• Abnormal white blood cell (WBC) count
• Low red blood cell count (anemia)
• Low platelet count (thrombocytopenia)

A bone marrow aspiration will show abnormal levels of certain cells. The bone marrow is usually taken from the back of one of the hip bones, but can be taken from other bones. Tests are done on the bone marrow cells to identify the type of leukemia.

A lumbar puncture or spinal tap is usually done to both detect if leukemia cells are in the spinal fluid and to give chemotherapy to prevent spread to the spinal fluid.

Doctors look for chromosome changes in the cells of some leukemias. This helps aid in diagnosis and prognosis. Leukemias with certain types of chromosome changes have a poor outlook, while those with other types of genes can have a very good outlook. This may determine what kind of therapy is used to treat the ALL.

Treatment

The goal of treatment is to get the blood counts and the bone marrow back to normal. If this occurs and the bone marrow looks healthy under the microscope, the cancer is said to be in remission.

If you have ALL, you will need chemotherapy. For the first round of chemotherapy (called induction), you may need to stay in the hospital for 3 - 6 weeks.

Later you may get chemotherapy on an outpatient basis (living at home and going to a clinic to receive your treatments). If you have a low white blood cell count, you may need to be placed in a room by yourself so you do not catch an infection.

Many chemotherapy drugs given into the veins do not reach the brain and spinal cord tissue. Therefore, many patients will also receive radiation therapy to the brain or chemotherapy drugs injected into the space around the brain and spinal column to prevent later spread to these sites.

If you go into remission, you may receive additional chemotherapy or radiation therapy to kill any cancer cells that are in the spinal fluid. You may also receive chemotherapy from time to time to prevent relapse. A bone marrow or stem cell transplant may also be recommended, especially if one of your siblings is proven to be a full match.

If your leukemia returns or does not respond to other treatments, a bone marrow or stem cell transplant is usually recommended.

Additional treatments depend on other symptoms. They may include:

• Transfusion of blood products, such as platelets or red blood cells, to fight thrombocytopenia and anemia
• Antibiotics to fight infection, especially if a fever occurs

Support Groups

Patients can ease the stress of their illness by joining a support group where members share common experiences and problems.

See also: Cancer - support group

Expectations (prognosis)

Children usually have a better outcome than adults. Almost all children go into complete remission. Without treatment, a person with ALL can expect to live for only about 3 months.

The following patients tend to do better:

• Younger adults (especially those younger than age 50)
• Children between the ages of 1 and 9
• Those who have a WBC count below 50,000 when first diagnosed
• Those who do not have a Philadelphia chromosome-positive ALL (a specific genetic change)
• Those who achieve complete remission (disappearance of signs and symptoms of cancer) within 4 - 5 weeks of starting treatment

Patients whose leukemia spreads to the brain or spinal cord tend to have a worse outcome.

Complications

• Bleeding
• Damage to different organs from chemotherapy
• Disseminated intravascular coagulation (DIC)
• Relapse of ALL
• Severe infection
• Spread of the cancer to other parts of the body

Calling your health care provider

Call your health care provider if:

• You develop ALL-like symptoms
• You have ALL and you have a persistent fever or other signs of infection

Prevention

Because the cause is usually unknown, it is not possible to prevent most cases. You may reduce your risk of ALL by avoiding exposure to toxins, radiation, and chemicals.

References

Appelbaum FR. The acute leukemias. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 194.

Pui CH, Robison LL, Look AT. Acute lymphoblastic leukaemia. Lancet. 2008 Mar 22;371(9617):1030-43.

Answer 2

Definition

Acute myeloid leukemia (AML) is cancer that starts inside bone marrow, the soft tissue inside bones that helps form blood cells. The cancer grows from cells that would normally turn into white blood cells.

Acute means the disease develops quickly.

See also:

• Chronic lymphocytic leukemia (CLL)
• Chronic myelogenous leukemia (CML)
• Leukemia

Alternative Names

Acute myelogenous leukemia; AML; Acute granulocytic leukemia; Acute nonlymphocytic leukemia (ANLL); Leukemia - acute myeloid (AML); Leukemia - acute granulocytic; Leukemia - nonlymphocytic (ANLL)

Causes, incidence, and risk factors

Acute myeloid leukemia (AML) is one of the most common types of leukemia among adults. This type of cancer is rare under age 40. It generally occurs around age 65. (This article focuses on AML in adults.)

AML is more common in men than women.

Persons with this type of cancer have abnormal cells inside their bone marrow. The cells grow very fast, and replace healthy blood cells. The bone marrow, which helps the body fight infections, eventually stops working correctly. Persons with AML become more prone to infections and have an increased risk for bleeding as the numbers of healthy blood cells decrease.

Most of the time, a doctor cannot tell you what caused AML. However, the following things are thought to lead to some types of leukemia, including AML:

• Certain chemicals (for example, benzene)
• Certain chemotherapy drugs, including etoposide and drugs known as alkylating agents
• Radiation

Problems with your genes may also play a role in the development of AML.

You have an increased risk for AML if you have or had any of the following:

• A weakened immune system (immunosuppression) due to an organ transplant
• Blood disorders, including:
  • Polycythemia vera
  • Essential thrombocythemia
  • Myelodysplasia (refractory anemia)
• Exposure to radiation and chemicals

Symptoms

• Abnormal menstrual periods
• Bleeding from the nose
• Bleeding gums
• Bruising
• Bone pain or tenderness
• Fatigue
• Fever
• Paleness
• Shortness of breath (gets worse with exercise)
• Skin rash or lesion
• Swollen gums(rare)
• Weight loss

Signs and tests

The doctor will perform a physical exam. There may be signs of a swollen spleen, liver, or lymph nodes.

A complete blood count (CBC) shows anemia and a low number of platelets. A white blood cell count (WBC) can be high, low, or normal.

Bone marrow aspiration will show if there are any leukemia cells.

If your doctor learns you do have this type of leukemia, further tests will be done to determine the specific type of AML. There are eight subtypes of AML. They range from M0 to M7, based on which blood cells are abnormal.

Treatment

Treatment involves using medicines to kill the cancer cells. This is called chemotherapy. But chemotherapy kills normal cells, too. This may cause side effects such as excessive bleeding and an increased risk for infection. Your doctor may want to keep you away from other people to prevent infection.

Other treatments for AML may include:

• Antibiotics to treat infection
• Bone marrow transplant or stem cell transplant
• Red blood cell transfusions to fight anemia
• Transfusions of platelets to control bleeding

Most types of AML are treated the same way. However, a form of AML called acute promyelocytic leukemia (APL) is treated with a medicine called all-trans retinoic acid (ATRA). This medicine helps leukemia cells grow into normal white blood cells.

The drug arsenic trioxide is approved for use in patients with APL who do not get better with ATRA or chemotherapy.

Support Groups

See:

• Cancer support group
• Leukemia support group

Expectations (prognosis)

When the signs and symptoms of AML go away, you are said to be in remission. Complete remission occurs in many patients.

With treatment, younger patients with AML tend to do better than those who develop the disease at an older age. The 5-year survival rate is much lower in older adults than younger persons. Experts say this is partly due to the fact that the body of a younger person may better tolerate strong chemotherapy medicines.

If the cancer does not come back (relapse) within 5 years of the diagnosis, you are considered permanently cured. Most of the time, the cancer returns within 2 years of diagnosis.

Complications

Complications of AML and cancer treatment include severe infections and life-threatening bleeding. Sometimes, the cancer comes back (relapses) after treatment.

Calling your health care provider

Call for an appointment with your health care provider if you develop symptoms of AML.

Call your health care provider if you have AML and have a fever that will not go away or other signs of infection.

Prevention

If you work around radiation or chemicals linked to leukemia, you should always wear protective gear.

References

American Cancer Society. Cancer Facts and Figures 2007.Atlanta, GA: American Cancer Society; 2007.

Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKena WG. Clinical Oncology. 3rd ed. Orlando, Fl: Churchill Livingstone; 2004.

Goldman L, Ausiello D, eds. Cecil Textbook of Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:pp.1390-7.

Answer 3

Definition

Acute lymphocytic leukemia (ALL) is a fast-growing cancer of a type of white blood cells called lymphocytes. These cells are found in the bone marrow and other parts of the body.

See also: Leukemia

Alternative Names

ALL; Acute childhood leukemia; Cancer - acute childhood leukemia (ALL); Leukemia - acute childhood (ALL)

Causes, incidence, and risk factors

Acute lymphocytic leukemia (ALL) occurs when the the body produces a large number of immature white blood cells, called lymphocytes. The cancer cells quickly grow and replace normal cells in the bone marrow. Bone marrow is the soft tissue in the center of bones that helps form blood cells. ALL prevents healthy blood cells from being made. Life-threatening symptoms can occur.

This type of leukemia usually affects children ages 3 - 7. It is the most common childhood acute leukemia. However, the cancer may also occur in adults.

Most of the time, there is no obvious cause. However, the following may play a role in the development of leukemia in general:

• Certain chromosome problems
• Exposure to radiation, including x-rays before birth
• Past treatment with chemotherapy drugs
• Receiving a bone marrow transplant
• Toxins such as benzene

The following increases your risk for this ALL:

• Down syndrome or other genetic disorders
• A brother or sister with leukemia

Symptoms

Acute lymphocytic leukemia (ALL) makes you more likely to bleed and develop infections. Symptoms include:

• Bone and joint pain
• Easy bruising and bleeding (such as bleeding gums, skin bleeding, nosebleeds, abnormal periods)
• Feeling weak or tired
• Fever
• Loss of appetite and weight loss
• Paleness
• Pain or feeling of fullness below the ribs
• Pinpoint red spots on the skin (petechiae)
• Swollen glands (lymphadenopathy) in the neck, under arms, and groin
• Night sweats

Note: These symptoms can occur with other conditions. Talk to your doctor about the meaning of your specific symptoms.

Signs and tests

A physical exam may reveal the following:

• Bruising
• Swollen liver, lymph nodes, and spleen
• Signs of bleeding (petechiae, purpura)

Blood tests may include:

• Complete blood count (CBC), including white blood cell (WBC) count
• Platelet count
• Bone marrow aspiration and biopsy
• Lumbar puncture (spinal tap) to check for leukemia cells in the spinal fluid

Tests are also done to look for chromosome changes in the cells of some leukemias. Leukemias with certain types of chromosome changes have a poor outlook, while those with other types of genes can have a very good outlook. This may determine what kind of treatment you receive.

Treatment

The goal of treatment is to get the blood counts back to normal. If this occurs and the bone marrow looks healthy under the microscope, the cancer is said to be in remission.

Chemotherapy is used to treat this type of leukemia.

• The first time you receive chemotherapy, you may need to stay in the hospital for several weeks.
• Later you may receive chemotherapy as an outpatient, meaning you come to a clinic to receive the treatment

If you have a low white blood cell count, you may need to be placed in a hospital room by yourself so you do not catch an infection.

ALL may spread to the brain and spinal cord. Chemotherapy drugs givent through a vein cannot reach these areas. Therefore, you may also receive:

• Chemotherapy given directly into the space around your brain or in the spinal column
• Radiation therapy to the brain

You may also receive chemotherapy from time to time to prevent the cancer from coming back.

If your leukemia returns or does not respond to other treatments, a bone marrow or stem cell transplant is usually recommended. A bone marrow or stem cell transplant may also be recommended if you have a brother or sister who is a complete match, or if you have a high-risk type of leukemia.

Additional treatments depend on other symptoms. They may include:

• Transfusion of blood products, such as platelets or red blood cells
• Antibiotics to fight infection, especially if a fever occurs

Support Groups

Joining a support group where members share common experiences and problems may help ease the stress related to illness.

See: Cancer - support group

Expectations (prognosis)

Most children with ALL can be cured. Children usually have a better outcome than adults.

The following patients tend to do better:

• Younger adults (especially those younger than age 50)
• Children between the ages of 1 and 9
• Those who have a white blood cell (WBC) count below 50,000 when first diagnosed
• Those who do not have a specific genetic change called Philadelphia chromosome-positive ALL
• Those whos are in remission within 4 - 5 weeks of starting treatment

Patients whose leukemia spreads to the brain or spinal cord tend to have a worse outcome.

Complications

• Bleeding
• Damage to different organs from chemotherapy
• Disseminated intravascular coagulation (DIC)
• Relapse of ALL
• Severe infection
• Spread of the cancer to other parts of the body

Calling your health care provider

Call your health care provider if:

• You develop ALL-like symptoms
• You have ALL and you have a persistent fever or other signs of infection

Prevention

You may reduce your risk of ALL by avoiding contact to certain toxins, radiation, and chemicals.

References

Pui CH, Robison LL, Look AT. Acute lymphoblastic leukaemia. Lancet. 2008 Mar 22;371(9617):1030-43.

Reviewed By

Review Date: 02/28/2011

David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., and Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital.

Answer 4

Definition

Acute myeloid leukemia (AML) is cancer that starts inside bone marrow, the soft tissue inside bones that helps form blood cells. The cancer grows from cells that would normally turn into white blood cells.

Acute means the disease develops quickly.

See also:

• Chronic lymphocytic leukemia (CLL)
• Chronic myelogenous leukemia (CML)
• Leukemia

Alternative Names

Acute myelogenous leukemia; AML; Acute granulocytic leukemia; Acute nonlymphocytic leukemia (ANLL); Leukemia - acute myeloid (AML); Leukemia - acute granulocytic; Leukemia - nonlymphocytic (ANLL)

Causes, incidence, and risk factors

Acute myeloid leukemia (AML) is one of the most common types of leukemia among adults. This type of cancer is rare under age 40. It generally occurs around age 60. (This article focuses on AML in adults.)

AML is more common in men than women.

Persons with this type of cancer have abnormal cells inside their bone marrow. The cells grow very fast, and replace healthy blood cells. The bone marrow, which helps the body fight infections, eventually stops working correctly. Persons with AML become more prone to infections and have an increased risk for bleeding as the numbers of healthy blood cells decrease.

Most of the time, a doctor cannot tell you what caused AML. However, the following things are thought to lead to some types of leukemia, including AML:

• Certain chemicals (for example, benzene)
• Certain chemotherapy drugs, including etoposide and drugs known as alkylating agents
• Radiation

Problems with your genes may also play a role in the development of AML.

You have an increased risk for AML if you have or had any of the following:

• A weakened immune system (immunosuppression) due to an organ transplant
• Blood disorders, including:
  • Polycythemia vera
  • Essential thrombocythemia
  • Myelodysplasia (refractory anemia)
• Exposure to radiation and chemicals

Symptoms

• Bleeding from the nose
• Bleeding gums
• Bruising
• Bone pain or tenderness
• Fatigue
• Fever
• Heavy menstrual periods
• Pallor
• Shortness of breath (gets worse with exercise)
• Skin rash or lesion
• Swollen gums(rare)
• Weight loss

Signs and tests

The doctor will perform a physical exam. There may be signs of a swollen spleen, liver, or lymph nodes.

A complete blood count (CBC) shows anemia and a low number of platelets. A white blood cell count (WBC) can be high, low, or normal.

Bone marrow aspiration will show if there are any leukemia cells.

If your doctor learns you do have this type of leukemia, further tests will be done to determine the specific type of AML. There are eight subtypes of AML. They range from M0 to M7, based on which blood cells are abnormal.

Treatment

Treatment involves using medicines to kill the cancer cells. This is called chemotherapy. But chemotherapy kills normal cells, too. This may cause side effects such as excessive bleeding and an increased risk for infection. Your doctor may want to keep you away from other people to prevent infection.

Other treatments for AML may include:

• Antibiotics to treat infection
• Bone marrow transplant or stem cell transplant after radiation and chemotherapy
• Red blood cell transfusions to fight anemia
• Transfusions of platelets to control bleeding

Most types of AML are treated the same way. However, a form of AML called acute promyelocytic leukemia (APL) is treated with a medicine called all-trans retinoic acid (ATRA). This medicine helps leukemia cells grow into normal white blood cells.

The drug arsenic trioxide is for use in patients with APL who do not get better with ATRA or chemotherapy.

Support Groups

See:

• Cancer support group
• Leukemia support group

Expectations (prognosis)

When the signs and symptoms of AML go away, you are said to be in remission. Complete remission occurs in most patients.

With treatment, younger patients with AML tend to do better than those who develop the disease at an older age. The 5-year survival rate is much lower in older adults than younger persons. Experts say this is partly due to the fact that the body of a younger person can better tolerate strong chemotherapy medicines.

If the cancer does not come back (relapse) within 5 years of the diagnosis, you are considered permanently cured.

Complications

Complications of AML and cancer treatment include severe infections and life-threatening bleeding. Sometimes, the cancer comes back (relapses) after treatment.

Calling your health care provider

Call for an appointment with your health care provider if you develop symptoms of AML.

Call your health care provider if you have AML and have a fever that will not go away or other signs of infection.

Prevention

If you work around radiation or chemicals linked to leukemia, you should always wear protective gear.

References

Appelbaum FM. The acute leukemias. In Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 194.

Reviewed By

Review Date: 09/06/2010

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; James R. Mason, MD, Oncologist, Director, Blood and Marrow Transplantation Program and Stem Cell Processing Lab, Scripps Clinic, Torrey Pines, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.