Acute Lymphocytic Leukemia (ALL) is a type of cancer that affects the white blood cells, specifically the lymphocytes. It is characterized by the uncontrolled growth of abnormal lymphocytes in the bone marrow, blood, and lymphatic system. ALL is the most common type of cancer in children, but it can also affect adults. In this article, we will discuss the case, pathophysiology, signs, symptoms, investigations, treatment, and advice for patients with ALL.
Mrs. X, a 35-year-old woman, presented with symptoms of fatigue, fever, and frequent infections. Her medical history was unremarkable, and she had no family history of cancer. On examination, she had pallor, mild lymphadenopathy, and splenomegaly. Blood tests showed anemia, low platelet count, and leukocytosis. A bone marrow biopsy was performed, which revealed the presence of blasts (immature white blood cells) consistent with ALL.
ALL occurs when there is a genetic mutation in the lymphoid stem cells, leading to the production of immature lymphocytes that cannot function normally. These abnormal cells rapidly multiply and accumulate in the bone marrow, preventing the production of healthy blood cells. The leukemic cells can also spread to other parts of the body, such as the lymph nodes, spleen, liver, and brain.
Signs and Symptoms:
The signs and symptoms of ALL can vary depending on the age of the patient and the stage of the disease. Some of the common symptoms include:
Fatigue and weakness
Fever and night sweats
Bone pain and joint pain
Pallor and easy bruising
Loss of appetite and weight loss
Enlarged lymph nodes, liver, or spleen
The diagnosis of ALL is made by conducting a complete blood count (CBC) and a bone marrow biopsy. The CBC will show abnormalities in the number and types of blood cells, while the bone marrow biopsy will reveal the presence of immature cells consistent with ALL. Other tests that may be done include flow cytometry, cytogenetic analysis, and molecular testing to determine the specific type of ALL and the prognosis.
The treatment for ALL typically involves chemotherapy, radiation therapy, and bone marrow transplantation. Chemotherapy is used to kill the leukemic cells and restore normal blood cell production. Radiation therapy may be used to treat leukemia that has spread to the brain or spinal cord. Bone marrow transplantation is used for patients who have a high risk of relapse or who have not responded well to chemotherapy. Other supportive measures, such as blood transfusions, antibiotics, and antiemetics, may also be used to manage the symptoms of the disease and the side effects of treatment.
Patients with ALL should follow a healthy lifestyle and avoid exposure to infections. They should also adhere to their treatment plan and attend all scheduled appointments with their healthcare providers. It is important to discuss any concerns or questions about the disease and its treatment with their healthcare team. Family and friends can also provide emotional support during this challenging time.
Hunger SP, Mullighan CG. Acute Lymphoblastic Leukemia in Children. N Engl J Med. 2015 Dec 3;373(23):2297-311.
Rowe JM, Tallman MS. How I treat acute lymphoblastic leukemia in adults. Blood. 2020 Oct 1;136(14):1524-1535.
National Cancer Institute. Adult Acute Lymphoblastic Leukemia Treatment (PDQ®)–Patient Version. https://www.cancer.gov/types/leukemia/patient/adult