What is ALL?
Acute lymphoblastic leukaemia (ALL) is the most common form of
childhood cancer. The cause of the disease is unknown. It presents
with an excessive growth of abnormal, immature white blood cells
called lymphoblasts. This initially occurs in the bone marrow,
which is the site of all normal blood cell production, (red blood
cells, platelets and various types of white blood cells). The acute
prefix means that the disease can progress rapidly, while a chronic
type of disease develops slowly. The uncontrolled growth of
leukaemic lymphoblasts can replace the normal marrow cells in the
bone marrow, and from there they can spread into the blood stream.
Lymphoblasts have the potential to spread to other organs of the
body such as the liver, spleen, lymph glands, and the
cerebro-spinal fluid (CSF).
Signs & Symptoms
Children with leukaemia can present with a variety of symptoms,
most commonly pallor, lethargy, fever, easy bruising, pain in the
bones or joints, swollen glands and/or weight loss.
Diagnosis
A full blood examination suggests the diagnosis of ALL but a
bone marrow aspirate is necessary to confirm the diagnosis. Other
blood tests, a lumbar puncture and a chest X-ray will also be
done.
Treatment
Chemotherapy is the primary mode of treatment for ALL. Almost
all children with ALL are eligible to participate in clinical
research trials. These are either international trials originating
from the Children's Oncology Group (COG) in the USA or
European trials of infant or relapsed leukaemia. If your child is
eligible to participate in a clinical research trial, then you will
be asked to consent for the clinical and laboratory information to
be collected and collated with that of other patients at the trials
centre. Some trials are randomised clinical trials where two or
more different treatments are compared. Treatment allocation is
determined randomly by computer in order to eliminate bias.
Intensity of treatment is determined by prognostic features at
diagnosis, rate of response to treatment and DNA studies during
early treatment.
Treatment is divided into a number of phases. The initial phase
is induction lasting for 28 to 35 days, with the aim to achieve
remission. After the initial hospital stay following the diagnosis,
the child is required to attend the Outpatient clinic, often weekly
for further chemotherapy and monitoring. Chemotherapy is given
orally, intravenously, intramuscularly, subcutaneously and
intrathecally. Further hospital admissions will depend on the
particular treatment required and whether any side effects of
treatment develop. During some phases of therapy your child may
require blood and/or platelet infusions and/or intravenous
antibiotics if a fever or infection develops.
Therapy is most intensive for the first 5-10 months depending on
the protocol. Thereafter continuation (maintenance) therapy is
given with monthly intravenous injections, 8 to12 weekly
intrathecal therapy and daily and weekly oral chemotherapy to be
taken at home. Chemotherapy for ALL continues for just over two
years for girls and three years for boys. Throughout treatment
children are encouraged to participate as much as possible in
normal activities and attend school. ALL is now curable in 75-80%
of children.
Follow up care
Once therapy is completed there is a regular schedule of follow
up care to monitor initially for disease recurrence, and later the
continued growth and development of the child.