Acute lymphoblastic leukemia (ALL) is the form of cancer that affects white blood cells. White blood cells are manufactured in bone marrow, which is the body tissue inside bones. They are also referred to as lymphocytes, and their function is hampered when an individual develops acute lymphoblastic leukemia. For the most part, ALL affects children aged two to five years, but adults can also be at risk. Symptoms of this cancer, like others, do vary among individuals.
Symptoms In Bone Marrow
Acute lymphoblastic leukemia leads to a reduction in the number of normal blood cells, which can lead to symptoms such as feeling tired, weak, and dizzy. Some patients also experience shortness of breath and bruise more easily. This happens because the red blood cells are responsible for carrying oxygen and nutrients to other cells in the body, and too few red blood cells equals low energy.
Since acute lymphoblastic leukemia is a cancer of the white blood cells, fewer of them function normally. This is exhibited in symptoms such as fever, chronic infections, and enlarged lymph nodes. Without the full function of the white blood cells and the other parts of the immune system, the body is at a higher risk for other illnesses from influenza to sepsis.
Symptoms In Other Parts Of The Body
Many other symptoms such as bone and joint pain, abdominal swelling, and coughing can be observed in acute lymphoblastic leukemia patients. It largely depends on where in the body the cancer spreads to in each patient. Sometimes cancer cells can spread to locations near the bones causing bone or joint pain. If acute lymphoblastic leukemia cells accumulate in the liver or spleen, they can cause these organs to become enlarged, which leads to abdominal swelling. Accumulation of ALL cells can also occur at the thymus (a small organ near the trachea in the throat). Swelling of thymus leads to breathing-related symptoms like coughing or trouble breathing.
The cancer treatment team determines solutions, also termed treatments, for acute lymphoblastic leukemia. They are based on the type of ALL present and the affected parts of the body. Chemotherapy is using chemicals (a.k.a. medication) for treatment. Chemotherapy involves taking medications intravenously, by injection, or by mouth, in cycles. The length of each cycle depends on the patient, the progression of their condition, and on their response to chemotherapy. The cycles provide rest periods in which no treatment is provided, which allows the body to recuperate. This provides some insight into the effect of these medications on healthy and cancer cells.
Stem Cell Transplant
Stem cell transplants are used when very high doses of chemotherapy are needed, and the cancer team is worried about the long-term negative effects of these high doses on bone marrow, which is the source of all blood cells. If it is permanently damaged, other complications can follow, such as anemia and increased risk of infection. Doctors transplant stem cells into bone marrow to avoid this. These stem cells help the bone marrow recover from the high doses of chemotherapy.
Targeted therapy involves using medications that work differently from chemotherapy. Chemotherapy has widespread effects, meaning it often kills healthy cells near the cancer cells, but not the medications in targeted therapy. Targeted therapy medications specifically target certain cancer cells. This means less damage to healthy cells and fewer side effects. Targeted therapy medications are consumed orally in the form of pills and are sometimes continued after remission to keep the cancer from returning.
Patients with acute lymphoblastic leukemia do not usually undergo treatment with radiation therapy. However, there are several situations in which it can be useful for affected individuals. Radiation therapy is the use of high-energy particles or beams of radiation to kill off malignant cells in a localized area. Radiation therapy can be useful in treating a patient's leukemia if it has spread to the brain, spinal fluid, or the testicles. Whole body radiation is sometimes used in ALL treatment before the patient undergoes a peripheral blood stem cell transplant or bone marrow transplant.
When a tumor is pressing on a patient's trachea that has formed as a result of acute lymphoblastic leukemia, radiation may be used to shrink it and resolve any breathing problems it is causing. In addition, radiation can be used in a patient who is feeling bone pain in a certain area that has been invaded by ALL when chemotherapy has not provided pain relief. Treatment with radiation therapy is similar to getting an x-ray done, but with much stronger energy. Each radiation treatment is only a duration of a few minutes and the procedure itself is not painful.
Some acute lymphoblastic leukemia patients may elect to undergo the alternative treatment method called acupuncture. This is a type of therapy that is said to help relieve pain and or nausea in cancer patients. Acupuncture is a procedure involving the insertion of very thin needles into certain points on the individual's body at various angles and depths. Every point is deduced to control the sensations of pain in another corresponding part of the individual's body. Some patients may feel a slight ache, tingling, electrical sensation, or dull pain for a few seconds when the needle is inserted, though the needles should not hurt once they are in their respective places.
The needles will stay in place from anywhere between fifteen and thirty minutes. The needles are then carefully removed in a way that should be painless. Any patient who seeks acupuncture to help alleviate pain or nausea due to their ALL should ensure they have it performed by a certified, licensed acupuncturist. Often times the patient's attending oncologist or cancer care team can recommend where to get acupuncture.
Immunotherapy may be used as a form of treatment for a patient's ALL. The use of drugs to assist an affected individual's own immune system with recognizing and destroying malignant cells more effectively is called immunotherapy. Man-made versions of antibodies or proteins that help fight off infections are called monoclonal antibodies, such as blinatumomab. One part of blinatumomab attaches to protein CD19, while the other part attaches to the CD3 protein. The CD19 protein is commonly found on the surface of acute lymphoblastic leukemia malignant cells, while the CD3 protein is found on the immune T cells that help kill malignant cells.
The binding of the malignant cells and the immune cells are thought to help the patient's immune system kill the ALL cells. Another drug called inotuzumab ozogamicin contains anti-CD22 antibodies that bind to the CD22 protein on the cancerous cells. This allows the corresponding chemotherapy drug to target and kill those cells. CAR T-cell therapy is another form of immunotherapy where a patient's own T cells are engineered in a laboratory to attach to and kill malignant cells.
Role Of Surgery
Surgical intervention has a limited contribution to the treatment of a patient's acute lymphoblastic leukemia. Leukemia cells are cancerous cells that circulate in the blood throughout the entire body, so it is not possible to remove the malignancy using surgery. Surgical procedures are sometimes used to perform a biopsy on the patient's lymph nodes to confirm whether leukemia has invaded their lymphatic system. The primary role for surgical procedures in ALL is to place a central venous catheter or tube into the patient's body to administer chemotherapy in a safer and easier way. This type of catheter can also be referred to as a central line, a venous access device.
Another surgical procedure that can be used in the treatment of acute lymphoblastic leukemia is the placement of an Ommaya reservoir for the administration of intrathecal chemotherapy or chemo given directly into the fluid that surrounds the patient's spinal cord and brain. An Ommaya reservoir is a dome-like device that sits just under the patient's scalp that holds a catheter in place. This catheter inserts into the dome device, through a hole in the skull, and then empties into one of the ventricles.
Supportive Care Options
Some patients with advanced acute lymphoblastic leukemia or ALL that is not responding to treatment may choose to pursue supportive care or palliative care options. Supportive or palliative care is care that centers around the relief of symptoms caused by cancer that negatively impact an affected individual's life. Palliative or supportive care focuses on improving the quality of an acute lymphoblastic leukemia patient's life, but it is not intended to cure their condition. Supportive care can be provided with or without curative treatment or treatment intended to cure ALL.
This type of care helps with relief of uncomfortable and bothersome symptoms such as pain, breathlessness, nausea, and fatigue. It also aims to assist with a patient's spiritual and or emotional issues. This type of care may involve the use of drugs to control symptoms, and it may even include treatment that is the same as what is used in curative treatment for acute lymphoblastic leukemia. However, the use of chemotherapy or radiation to relieve symptoms is different than the use of it to actually cure cancer.