Acute Lymphoblastic Leukemia (A

Acute Lymphoblastic Leukemia (A.L.L.)
The Facts

ALL is a form of cancer that affects the lymphoid cells of the blood and bone marrow.

In leukemia, the bone marrow produces an overabundance of underdeveloped white blood cells (leukemia cells) that cannot perform their usual function of fighting infection.

When the leukemic cells fill the marrow, production of healthy red cells, platelets and white cells decreases causing anemia, bleeding and infection.

The exact cause of childhood leukemia is unknown, but it is thought that certain genetic factors, along with environmental, immunologic and possibly viral factors predispose individuals to leukemia.

Leukemia is the most common form of childhood cancer and ALL comprises about 70% to 75% of acute leukemias in this age group.

Approximately 3000 children are diagnosed with ALL each year.

ALL is diagnosed most frequently in children 3-5 years of age.

Almost all children with ALL can be treated effectively with chemotherapy and probably more that 75% can be cured.

Symptoms

The most common signs and symptoms seen with ALL reflect the abnormal blood cell production in the bone marrow.

Excessive fatigue and weakness caused by lack of healthy red cells
Pain in bones and joints of the arms and legs caused by the bone marrow filling with leukemia cells
Excessive bruising, bleeding and petechiae caused by lack of platelets
Persistent infections and fever caused by lack of healthy white cells

Diagnosis

A physician may suspect the diagnosis of leukemia by their history and physical exam, but it can only be confirmed by laboratory tests.

Complete Blood Count (CBC) to measure the different kinds of blood cells and hemoglobin level

Blood smear to visualize the appearance of the cells under a microscope

Bone Marrow Aspirate to distinguish what type of leukemia is present

Chromosome Analysis to predict a likely response to certain treatments

Treatment

Chemotherapy – the use of various drugs to destroy the abnormal leukemic cells

Radiotherapy – Radiation may be used on the brain and spinal cord to treat or prevent the spread of leukemic cells to the central nervous system. Only a small percentage of children require radiation.

Bone marrow transplantation – currently being studied in clinical trials for children who fail to enter remission or who relapse

Common Chemotherapy Agents

Vincristine

Dexamethasone

Daunorubicin

L-aspariginase

Ara-C

Methotrexate

Mercaptopurine

Thioguanine

Cyclophosphamide

ALL Clinical trials open at Children’s Mercy Hospital

CCG 1961

– Treatment of ALL with unfavorable features

CCG 1991

– Escalating dose Methotrexate without Leucovorin rescue vs. oral Methotrexate and singe vs. double delayed intensification for children with standard risk ALL

P9423

– A Phase I Cooperative Agreement Pediatric Trial of Mitoxantrone, Etoposide and PSC-833 Therapy in Patients with Relapsed and Refractory Acute Leukemia

P9973

– A Phase I Study of STI571 in Ph+ Leukemia

B945

– The Molecular Epidemiology of de novo and Treatment Related to 11q23 Leukemia in Children

B951

– Pharmacological Studies of L-Asparaginase in Pediatric Patients with ALL or Lymphoma

B957

– Genetic Etiology in Acute Leukemia in Down Syndrome

B9804

– Clinical and Biological Predictors of Therapy Related Leukemia

E23

– Epidemiology of Down Syndrome-Leukemia and Down Syndrome