Adult Acute Lymphocytic Leukemia
Table of Contents
What is adult acute lymphocytic leukemia?
Stages of adult acute lymphocytic leukemia
How adult acute lymphocytic leukemia is treated
- Treatment by stage
- Untreated Adult Acute Lymphocytic Leukemia
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- Adult Acute Lymphocytic Leukemia in Remission
- Recurrent Adult Acute Lymphocytic Leukemia
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- To Learn More
What is adult acute lymphocytic leukemia?
Adult acute lymphocytic leukemia (also called acute lymphoblastic leukemia or ALL) is a
disease in which too many infection-fighting white blood cells called lymphocytes are
found in the blood and bone marrow. Lymphocytes are made by the bone marrow and by other
organs of the lymph system. The bone marrow is the spongy tissue inside the large bones in
the body. The bone marrow makes red blood cells (which carry oxygen and other materials to
all tissues of the body), white blood cells (which fight infection), and platelets (which
make the blood clot). Normally, the bone marrow makes cells called blasts that develop
(mature) into several different types of blood cells that have specific jobs to do in the
body.
Lymphocytes are found in the lymph which is a colorless, watery fluid present in the
lymph vessels. The lymph vessels are part of the lymph system which is made up of thin
tubes that branch, like blood vessels, into all parts of the body. Along the network of
vessels are groups of small, bean-shaped organs called lymph nodes. Clusters of lymph
nodes are found in the underarm, pelvis, neck, and abdomen. The spleen (an organ in the
upper abdomen that makes lymphocytes and filters old blood cells from the blood), the
thymus (a small organ beneath the breastbone), and the tonsils (an organ in the throat)
are also part of the lymph system.
Lymphocytes fight infection by making substances called antibodies, which attack germs
and other harmful bacteria in the body. In ALL, the developing lymphocytes do not mature
and become too numerous. These immature lymphocytes are then found in the blood and the
bone marrow. They also collect in the lymph tissues and make them swell. Lymphocytes may
crowd out other blood cells in the blood and bone marrow. If the bone marrow cannot make
enough red blood cells to carry oxygen, then anemia may develop. If the bone marrow cannot
make enough platelets to make the blood clot normally, the bleeding or bruising may
develop more easily. The cancerous lymphocytes can also invade other organs, the spinal
cord, and the brain.
Leukemia can be acute (progressing quickly with many immature cancer cells) or chronic
(progressing slowly with more mature looking leukemia cells). ALL progresses quickly and
can occur in adults and children. Treatment is different for adults than it is for
children. (For more information on childhood ALL, refer to the PDQ patient information
statement on childhood acute lymphocytic leukemia. Separate PDQ patient information
statements are also available for chronic lymphocytic leukemia, chronic myelogenous
leukemia, adult or childhood acute myeloid leukemia, and hairy-cell leukemia).
ALL is often difficult to diagnose. The early signs may be similar to the flu or other
common diseases. A doctor should be seen if the following signs or symptoms won't go away:
fever, persistant weakness or tiredness, achiness in the bones or joints, or swollen lymph
nodes.
If there are symptoms, a doctor may order blood tests to count the number of each of
the different kinds of blood cells. If the results of the blood tests are not normal, a
doctor may do a bone marrow biopsy. During this test, a needle is inserted into a bone and
a small amount of bone marrow is taken out and looked at under the microscope. A doctor
may also do a spinal tap in which a needle is inserted through the back to take a sample
of the fluid that surrounds the brain and spine. The fluid is then looked at under a
microscope to see if leukemia cells are present. A doctor can then tell what kind of
leukemia is present and plan the best treatment.
The chance of recovery (prognosis) depends on how the leukemia cells look under a
microscope, how far the leukemia has spread, and the patient's age and general health.
Stages of adult acute lymphocytic leukemia
There is no staging for ALL. Your choice of treatment depends on whether a patient has
been treated before.
Untreated
Untreated ALL means that no treatment has been given except to treat symptoms. There
are too many white blood cells in the blood and bone marrow, and there may be other signs
and symptoms of leukemia.
In remission
Remission means that treatment has been given and that the number of white blood cells
and other blood cells in the blood and bone marrow is normal. There are no signs or
symptoms of leukemia.
Recurrent/refractory
Recurrent disease means that the leukemia has come back after going into remission.
Refractory disease means that the leukemia has failed to go into remission following
treatment.
How adult acute lymphocytic leukemia is treated
There are treatments for all patients with ALL. The primary treatment of ALL is
chemotherapy. Radiation therapy may be used in certain cases. Bone marrow transplantation
is being studied in clinical trials.
Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it
may be put into the body by a needle in a vein or muscle. Chemotherapy is called a
systemic treatment because the drug enters the bloodstream, travels through the body, and
can kill cancer cells throughout the body. Chemotherapy may sometimes be put into the
fluid that surrounds the brain by inserting a needle in the brain or back (intrathecal
chemotherapy).
Radiation therapy uses x-rays or other high-energy rays to kill cancer cells and shrink
tumors. Radiation for ALL usually comes from a machine outside the body (external
radiation therapy).
There are two phases of treatment for ALL. The first stage is called induction therapy.
The purpose of induction therapy is to kill as many of the leukemia cells as possible and
make patients go into remission. Once in remission with no signs of leukemia, patients
enter a second phase of treatment (called continuation therapy), which tries to kill any
remaining leukemia cells. A patient may receive chemotherapy for up to several years to
stay in remission.
Radiation therapy or chemotherapy to the brain may be given to patients if leukemia
cells have spread to the brain. Patients may also receive central nervous system (CNS)
prohylaxis, another type of therapy, to prevent leukemia cells from growing in the brain
during induction therapy and remission.
Bone marrow transplantation is used to replace bone marrow with healthy bone marrow.
First, all of the bone marrow in the body is destroyed with high doses of chemotherapy
with or without radiation therapy. Healthy marrow is then taken from another person (a
donor) whose tissue is the same as or almost the same as the patient's. The donor may be a
twin (the best match), a brother or sister, or a person who is not related. The healthy
marrow from the donor is given to the patient through a needle in the vein, and the marrow
replaces the marrow that was destroyed. A bone marrow transplant using marrow from a
relative or person not related to the patient is called an allogeneic bone marrow
transplant.
Another type of bone marrow transplant, called autologous bone marrow transplant, is
being studied in clinical trials. To do this type of transplant, bone marrow is taken from
the patient and treated with drugs to kill any cancer cells. The marrow is frozen to save
it. Next, high-dose chemotherapy is given with or without radiation therapy to destroy all
of the remaining marrow. The frozen marrow that was saved is then thawed and given to the
patient through a needle in a vein to replace the marrow that was destroyed.
A greater chance for recovery occurs if the doctor chooses a hospital that does more
than five bone marrow transplantations per year.
Treatment by stage
Treatment of adult ALL depends on the type of disease, the patient's age and overall
condition.
Standard treatment may be considered based on its effectiveness in past studies, or
participation in a clinical trial may be considered. Not all patients are cured with
standard therapy, and some standard treatments may have more side effects than are
desired. For these reasons, clinical trials are designed to find better ways to treat
cancer patients and are based on the most up-to-date information. Clinical trials are
ongoing in most parts of the country for most stages of ALL. For more information, call
the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.
Treatment will probably be systemic chemotherapy. This may be intrathecal chemotherapy
alone or combined with either radiation therapy to the brain or high doses of systemic
chemotherapy to treat or prevent leukemia in the brain. Treatment may also include blood
transfusions, antibiotics, and instructions to keep the body and teeth especially clean.
Clinical trials are testing new drugs.
Treatment may be one of the following:
- 1. Clinical trials of short-term, high-dose chemotherapy followed by long-term, low-dose
chemotherapy.
2. Clinical trials of allogeneic bone marrow transplantation.
3. Clinical trials of autologous bone marrow transplantation.
4. Intrathecal chemotherapy alone, or combined with either radiation to the brain or high
doses of systemic chemotherapy, to prevent leukemia cells from growing in the brain (CNS
prophylaxis).
Radiation therapy may be given to reduce symptoms. Patients may also choose to take
part in a clinical trial of bone marrow transplantation.
TO LEARN MORE..... CALL 1-800-4-CANCER
To learn more about adult ALL, call the National Cancer Institute's Cancer Information
Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. By dialing this
toll-free number, trained information specialists can help answer your questions.
The Cancer Information Service also has a variety of booklets about cancer that are
available to the public and can be sent on request.
The following booklets about leukemia may be helpful:
- What You Need To Know About Leukemia
Research Report: Bone Marrow Transplantation
The following general booklets on questions related to cancer may also be helpful:
- Taking Time: Support for People with Cancer and the People Who Care About
- Them
What Are Clinical Trials All About?
Chemotherapy and You: A Guide to Self-Help During Treatment
Radiation Therapy and You: A Guide to Self-Help During Treatment
Eating Hints for Cancer Patients
Advanced Cancer: Living Each Day
When Cancer Recurs: Meeting the Challenge Again
What You Need To Know About Cancer
There are many other places where people can get materials and information about cancer
treatment and services. The social service office at a hospital can be checked for local
and national agencies that help with getting information about finances, getting to and
from treatment, getting care at home, and dealing with problems.
For more information from the National Cancer Institute, please write to this address:
- National Cancer Institute
Office of Cancer Communications
31 Center Drive, MSC 2580
Bethesda, MD 20892-2580
Date Last Modified: 10/97
If you want to know more about cancer and how it is treated, or if you wish to know
about clinical trials for your type of cancer, you can call the NCI's Cancer Information
Service at 1-800-422-6237, toll free. A trained information specialist can talk
with you and answer your questions.
Source: National Cancer Institute
National Institutes of Health
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