Leukemia is a cancer of the white blood cells (leukocytes). Most types of diseases cause abnormal synthesis of leukocytes in bone marrow. They can get into the bloodstream and spread throughout the body. Since these cells do not work fully, it is not able to defend the body against infections and bacteria.
Leukemia is divided into two main groups - acute (rapidly developing disease) and chronic (marked slow pace, over several months or years, mostly without symptoms).
Acute lymphoblastic leukemia (lymphocytic, limfoleyoz, ALL) affects immature lymphoid cells, is progressing rapidly. In the absence of the necessary therapy is completed fatal.
Symptoms of acute lymphoblastic leukemia
The main objective of leukocytes - to fight infections. As the abnormal cells are not able to work effectively, the risk of infection increases, which is difficult to treat.
Excessive amounts of lymphocytes fills the bone marrow, there is no place for other types of blood cells. There is a lack of red blood cells and platelets. Deficiency of red blood cells provokes anemia, platelets - blood coagulation problems.
Due to the increasing number of white blood cells begin to accumulate in the spleen, bone marrow, lymph nodes, causing swelling. Sometimes it occurs in the liver, spinal cord or brain, men - in the testicles.
The difference between acute lymphoblastic leukemia and lymphoma
Acute lymphocytic leukemia develops in the bone marrow, and then penetrate into other parts of the body; lymphoma - in the lymph nodes and other organs, and may then hit the bone marrow.
If abnormal cells exist in the bone marrow and the lymphatic system, it is sometimes difficult to say, leukemia or lymphoma is.
Many of the symptoms of acute lymphoblastic leukemia in adults are vague. Condition resembles the flu. Possible symptoms:
- General weakness.
- Weight loss.
- Private infection.
- Easy bruising occur, without any apparent reason.
- Bleeding from the gums and nose.
- Blood in the urine and stool.
- Pain in the bones and joints.
- Swollen lymph nodes.
- Fullness and abdominal discomfort due swollen spleen or liver.
These symptoms are caused by an excess of abnormal white blood cells and the lack of normal white blood cells, red blood cells and platelets.
There have been difficulties in the human body with ALL, to cope with the infection, because there are not enough white blood cells to fight off bacteria or viruses.
The accumulation of leukemia cells occurs in the lymph nodes, bones and joints, causing pain and swelling.
platelet deficiency leads to problems of blood clotting, a lack of red blood cells - anemia.
Symptoms T-cell leukemia
This type of leukemia can cause swelling of the lymph nodes in the center of the chest and the thymus gland. They are putting pressure on the trachea, causing shortness of breath and cough. In addition, possible pressure on the veins that carry blood away from the head passes. This causes the pressure in the blood vessels; face, neck and hands swell up and become red. Such a state is called the superior vena cava obstruction.
Causes of acute lymphoblastic leukemia (ALL)
The disease rarely occurs in adults, but it is the most common type of leukemia in children. The most common disease diagnosed in men than in women.
Studies indicate the following risk factors:
- Radiation exposure. It has long been known that high doses of radiation increase the risk of acute lymphocytic leukemia. There is some evidence that the holding of an X-ray during pregnancy increases the likelihood of leukemia in the child as a child.
- Exposure to benzene. Interaction with this chemical may in industries such as chemical, pharmaceutical, printing; for the production of rubber, shoes, gasoline. The higher the level of exposure for many years, the greater the risk. Benzene is also found in cigarette smoke.
- Smoking and consumption of coffee. A review of studies (meta-analysis) in 2009 showed that parental smoking in the home increases the risk of ALL in children. This includes the father's smoking before conception. These French study (ESCALE) in 2013 showed that the consumption of more than 2 cups of coffee a day during pregnancy significantly increases the risk of ALL in the child's childhood. However, more research is needed.
- Genetics. Some rare hereditary diseases increase the risk of acute lymphoblastic leukemia: Down syndrome, Fanconi anemia, ataxia telangiectasia. Also, as a possible cause is called lymphocytic leukemia chemotherapy. Treatment with chemotherapy, as etoposide, mitoxantrone, amsacrine and idarubicin - increases the likelihood of ALL after many years.
- Viruses. Human T-lymphotropic virus increases the risk of a rare type of leukemia T cells.
- Electromagnetic fields. Some studies suggest that exposure to very high power levels increases the likelihood of leukemia in children, but the results are not clear.
- Overweight. Some studies say that obese people there is an increased risk of leukemia.
- The impact of the paint as a possible risk factor noted one of the studies. However, further study of this issue is required.
- A weakened immune system. The increase in the likelihood of developing lymphocytic leukemia twice or thrice observed in people with HIV (AIDS) and those who have had organ transplants.
Factors that reduce the risk of leukemia:
- Exposure to infections during childhood. Reduced likelihood of ALL observed in children who went to nursery or at an early age were under the care of a nanny.
Types of acute lymphoblastic leukemia
Doctors divide acute myeloid leukemia and lymphoblastic on. But myeloid and lymphocytic also shared into smaller groups (subtypes). Identification of leukemia helps the doctor to plan treatment at Assuta .
Israeli doctors use the WHO classification system. It is based on the type of lymphocyte that has become cancerous. There are three subtypes:
- Pre-B-cell - the most common type of leukemia in adults.
- Mature B-cell - is identified in connection with specific genetic disorders. Also called Burkitt's type, because it is similar to another type of cancer - Burkitt's lymphoma.
- Pre-T cell - most often develops in young adults, in most cases - in men.
More rarely used French-American-British classification, which is divided ALL into three types:
- L1 - lymphocytes appear as mature.
- L3 - cells are immature and look abnormal.
- L2 - average between L1 and L3, the most common type among adults.
Leukemia cells examined under a microscope to identify and correlate with any subtype. Furthermore, research conducted proteins (antibodies markers) in abnormal cells, malignant changes in the chromosomes of the cells (cytogenetics).
Sometimes leukemia is a combination of ALL and acute myeloid leukemia (AML). Abnormal cells exhibit protein (markers) of both types. It biphenotypical acute leukemia. Biphenotypic means both.
Diagnosis of acute lymphoblastic leukemia in adults in the clinic Assuta
With the patient runs a hematologist, may hold the following types of tests.
They can be performed:
- complete blood count (FBC), in which the process examines various types of cells;
- blood tests to determine how well the liver or kidneys;
- if there is an infection, tests are carried out for the purpose of its determination and the type of antibiotic.
Bone marrow examination
Bone marrow synthesizes blood cells. The doctor may take a sample of the body to check for signs of leukemia and other diseases. There are two types of diagnosis of acute lymphoblastic leukemia - bone marrow aspiration and biopsy, or biopsy.
Aspiration doctor takes a sample of bone marrow fluid from the hip bone. The patient was previously injected with a local anesthetic.
During the biopsy the doctor uses a needle larger to remove a small amount of bone and bone marrow. Usually these two procedures are performed simultaneously.
In addition hematologist can check whether there is a change in the chromosomes of the leukemic cells. Such tests are called cytogenetic. The analysis for the presence of specific proteins that produce certain types of leukemic cells. This test is called immunophenotyping.
In a number of cases of the disease in people with acute lymphocytic leukemia in leukemia cells have a mutation called the Philadelphia chromosome. It is formed when ABL gene on chromosome 9 breaks off and joins the BCR gene on chromosome 22, which leads to the creation of a new gene - BCR-ABL. This provokes an excessive amount of protein synthesis - tyrosine stimulating the growth and division of leukemic cells.
This test helps to identify mutations in the genes of the cell and choose the right treatment.
Puncture is needed to find out whether there are abnormal cells in the cerebrospinal fluid (around the brain and spinal fluid). With a needle inserted into the spine, a physician collects a small amount of cerebrospinal fluid.
This test is done to check the overall health. In acute lymphoblastic tumor sometimes arise from leukemic cells in the center of the chest, in the area around the heart (mediastinum zone).
CT is performed to identify the specific features of lymphocytic leukemia or examine your overall health.
Throughout the course of treatment in Israel and the follow-up will be carried out bone marrow diagnosis. This can help:
- In the first place, to determine the right type of leukemia.
- Learn how leukemia responds to treatment.
- Check leukemia cells after treatment. Evaluate minimal residual disease.
The following types of surveys can be performed:
- CT scan is conducted to visualize enlarged lymph nodes or other abnormalities in the body's organs.
- MRI shows a detailed picture of the body, more clearly than CT visualises soft tissue.
- Ultrasound is done to check whether there is acute lymphocytic leukemia in the spleen or in the testes (in men).
- Tissue typing is carried out, if the physician considers stem cell transplantation as a suitable treatment. This is a special blood test that will show how much of the bone marrow tissue is possible donor matches the patient's tissue. Leukocytes have on their surface proteins - HLA markers. If the patient's bone marrow and donor cells have very similar HLA markers, more likely that the patient's immune system will not reject the donor organ.
Detection of leukemic cells after treatment
Often after chemotherapy appears that the patient is cured. In the blood and bone marrow samples do not find the abnormal cells, such a state is remission. But the leukemia cells can be preserved. The test for minimal residual disease will help to make sure whether the disease is present.
There are two ways. One - polymerase chain reaction (PCR) - searching for the genetic changes in cells. It can help you find one leukemic cell among millions of healthy people. Another test - Immunophenotyping - checks proteins by abnormal cells. Thus, these tests will determine the effectiveness of chemotherapy and the likelihood of relapse.
Survival in acute lymphoblastic leukemia
Your doctor may give the most complete information about the forecast for a particular patient. Statistics contained herein is provided for general information. The terms 5-year and 10-year survival rate for acute lymphoblastic leukemia is a number of people that participated in the trials that were alive after 5 or 10 years after diagnosis and the therapy.
Successful treatment of cancer is caused by a number of factors:
- The type of leukemia.
- Development of the disease.
- Response to treatment with cytotoxic drugs.
More than 8 out of 10 people achieve remission. If relapses, it is sometimes possible to achieve a second remission with cytostatic treatment.
Perspectives in acute lymphoblastic leukemia
Age greatly influences the outcome. This is partly due to the fact that young people are better able to cope with very intensive therapy.
On average, for every age group to 70% of people say the survival of 5 years or more after diagnosis. Further, the survival rate of 5 years or more indicate:
- For 90% of patients aged 14 years or younger.
- For 66% of people aged 15-24 years.
- To 40% - in the age of 25-64 years.
- To 15% - at the age of 65 years and older.
- Gender (women have a better prognosis than men).
- White blood cell count (if high, the worse the prognosis).
- The specific type of white blood cells.
- Genetic mutations in the chromosomes.
The prognosis of acute lymphoblastic worse if abnormal cells are found in the brain or cerebrospinal fluid in the diagnosis. Some of the specific genetic mutations in leukemia cells impede successful treatment of cancer. If abnormal cells remain after induction chemotherapy, leukemia can be difficult to therapy.