Acute lymphocytic leukemia
- Chronic leukemias develop slowly, during the early stages of disease, and progress slowly over weeks or months. Chronic leukemias generally involve an accumulation of more mature but abnormal white cells.
- Radiation: People exposed to large doses of radiation are more likely to develop acute lymphocytic leukemia. People who have received large doses of radiation therapy for the treatment of cancers also have an increased risk of developing acute lymphocytic leukemia.
- Chemicals: Exposures to high level of benzene over a long period of time may increases the risk of some blood disorder like acute lymphocytic leukemia.
- Certain viral infections: Infection with the human T-cell lymphoma/leukemia virus-1 (HTLV-1) can cause a rare type of T-cell acute lymphocytic leukemia. Most cases occur in Japan and the Caribbean area. This disease is not common in the United States. Epstein-Barr virus (EBV) most often causes infectious mononucleosis ("mono") in the United States. In Africa, the virus has been linked to Burkitt lymphoma, as well as to a form of acute lymphocytic leukemia.
- Certain disease or conditions: Down syndrome, Klinefelter syndrome, Fanconi anemia, Bloom syndrome, ataxia-telangiectasia, neurofibromatosis.
- Other factors that have been studied for a possible link to acute lymphocytic leukemia include: Exposure to electromagnetic fields (such as living near power lines), Workplace exposure to diesel, gasoline, pesticides, and certain other chemicals, smoking, exposure to hair dyes.
- Easy bruising and bleeding (such as bleeding gums, skin bleeding, nosebleeds, abnormal periods).
- Feeling weak or tired.
- Loss of appetite and weight loss.
- Pain or feeling of fullness below the ribs.
- Pinpoint red spots on the skin (petechiae).
- Swollen glands (lymphadenopathy) in the neck, under arms, and groin.
- Night sweats.
- A microscopic exploration of the blood will usually show that leukemic blast cells are present. However, the diagnosis has to be confirmed by more specific tests.
- The doctor may also perform a bone marrow aspiration and biopsy to confirm the diagnosis of ALL. Aspiration involves the withdrawal of a liquid sample of marrow. During the biopsy, a cylindrical piece of bone and marrow is removed. The tissue is generally taken out of the hipbone. These samples are sent to the laboratory for examination.
- Lumbar puncture (spinal tap) to check for leukemia cells in the spinal fluid.
- Cytogenetic studies, which examine the number and shape of the chromosomes in the DNA (deoxyribonucleic acid) of individual blast cells, should be conducted in addition to the immunophenotyping of cells of the bone marrow. This procedure involves applying various stains to the marrow cells. These stains help doctors identify some of the proteins lying on the surface of the cells.
- Fluorescent in situ hybridization (FISH): This is another type of chromosome test. It uses special fluorescent dyes that only attach to specific parts of particular chromosomes. FISH can find most chromosome changes (such as translocations) that are visible under a microscope in standard cytogenetic tests, as well as some changes too small to be seen with usual cytogenetic testing. FISH can be used to look for specific changes in chromosomes. It can be used on regular blood or bone marrow samples. It is very accurate and can usually provide results within a couple of days.
- Polymerase chain reaction (PCR): This is a very sensitive DNA test that can also find some chromosome changes too small to be seen with a microscope, even if very few leukemia cells are present in a sample. These tests may also be used after treatment to try to find small numbers of leukemia cells that may not be visible with a microscope.
- Second phase — Consolidation chemotherapy.
- Third phase — Maintenance chemotherapy.
- Fourth phase — Central nervous system (CNS) prophylaxis.
- Allogeneic transplant: An allogeneic transplant replaces the abnormal cells in a patient's bone marrow with healthy blood-forming cells from a family member or unrelated donor or cord blood unit. An allogeneic transplant has a higher risk of serious side effects than consolidation chemotherapy or an autologous transplant. However, the risk of relapse is lower after an allogeneic transplant.
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