What is Acute Lymphoblastic Leukaemia (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 and 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. Intensity of treatment is determined by prognostic features at diagnosis, DNA studies looking at the specific genetic changes that drive the leukaemia cells, as well as most importantly, the child’s response to 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 Oncology Outpatient clinic regularly for further chemotherapy and monitoring. Chemotherapy can be given by various routes, namely 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.
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.