Acute lymphoblastic leukemia(ALL): Symptoms, Diagnosis, Prognosis factors & Treatments
Symptoms
Leukemia is the most common cancer among childhood cancers. Among them, Acute lymphoblastic leukemia (ALL) is the most common cause, and ALL is the most common cancer among childhood cancers. Clinical symptoms of ALL are very nonspecific. Fever, hemorrhagic tendency, bone pain, enlargement of the lymph nodes, and splenomegaly. If these nonspecific symptoms persist without resolution, ALL should always be suspected in children.
Diagnosis
ALL can be classified as morphological, CD marker, or cytogenetic. The morphological classification follows the FAB classification and is classified into L1, L2, and L3 according to the shape through the Bone marrow biopsy. CD markers can be used to determine whether this ALL is a T cell lineage or B cell lineage. Most of ALL is B cell lineage, and the T cell lineage has a poor prognosis. The cytogenetic classification is based on chromosomal studies to classify ALL based on chromosomal anomalies or presence or absence of genes. Philadelphia chromosome t (9; 22) is known to have poor prognosis when it has chromosomal abnormalities. Morphologic, CD marker and cytogenetic classification are very important in predicting the outcome after treatment of ALL.
In addition to the above ALL classification, the prognosis of ALL is also bad. If the patient is younger than 1 year of age, 10 years of age or older, has a slow response to initial treatment, severe hepatomegaly or spleen enlargement, or involvement of the central nervous system. Because it is very important to perform treatment with prognosis prediction, CSF study and CD marker evaluation can be performed in the above patients.
ALL can be strongly suspected if it is seen as a BM failure on a peripheral blood test. ALL patients are predominantly anemia and thrombocytopenia, and leukemic cells may not show peripheral blood tests. In case of suspected ALL, BM biopsy should be performed for diagnosis. With biopsy, flow cytometry, cytogenetics, and molecular studies can be used to diagnose and classify ALL. ALL should show lymphoblast over 25% on BM biopsy, and CSF examination is also required for accurate staging. If lymphoblasts are seen on CSF, treatment for CNS is needed and systemic therapy is needed.
Prognosis factors & Treatments
The most important factor in the prognosis of ALL is cure. The treatment of ALL is based on the patient's risk. The most important factor is the patient's age at the time of diagnosis, the initial white blood cell count, and the rate of response to treatment. The initial goal of treatment is to remove leukemic cells in the bone marrow, which is called induction. During induction, vincristine, corticosteroid, and L-asparaginase were given for 4 weeks. Intrathecal cytarabine and methotrexate were also given. This means that 98% of patients are treated, and a remission of less than 5% blast is observed in the bone marrow, and the hemocyte count is recovered and the symptoms disappear. After initial treatment, CNS therapy is performed to prevent recurrence of ALL in the CNS. After remission induction and CNS therapy, repeat therapy can be administered through multi-agent therapy for 14 to 28 weeks to prevent recurrence of ALL. Strengthening therapy after 5 to 7 months after induction therapy is called late reinforcement therapy. Also, even if remission is induced, 6-mercaptopurine every day, MTX every week, is called maintenance therapy, assuming there are unresponsive cancer cells, and it is maintained for 2 ~ 3 years.
Because ALL have different risk factors for ALL, the response is different. Therefore, even if you are diagnosed with ALL, you do not have to be treated with the same regimen. If your patients have any risk factors, if they are complex, And selecting chemotherapy regimen is very important to determine the prognosis of ALL.
Leukemia is the most common cancer among childhood cancers. Among them, Acute lymphoblastic leukemia (ALL) is the most common cause, and ALL is the most common cancer among childhood cancers. Clinical symptoms of ALL are very nonspecific. Fever, hemorrhagic tendency, bone pain, enlargement of the lymph nodes, and splenomegaly. If these nonspecific symptoms persist without resolution, ALL should always be suspected in children.
Diagnosis
ALL can be classified as morphological, CD marker, or cytogenetic. The morphological classification follows the FAB classification and is classified into L1, L2, and L3 according to the shape through the Bone marrow biopsy. CD markers can be used to determine whether this ALL is a T cell lineage or B cell lineage. Most of ALL is B cell lineage, and the T cell lineage has a poor prognosis. The cytogenetic classification is based on chromosomal studies to classify ALL based on chromosomal anomalies or presence or absence of genes. Philadelphia chromosome t (9; 22) is known to have poor prognosis when it has chromosomal abnormalities. Morphologic, CD marker and cytogenetic classification are very important in predicting the outcome after treatment of ALL.
In addition to the above ALL classification, the prognosis of ALL is also bad. If the patient is younger than 1 year of age, 10 years of age or older, has a slow response to initial treatment, severe hepatomegaly or spleen enlargement, or involvement of the central nervous system. Because it is very important to perform treatment with prognosis prediction, CSF study and CD marker evaluation can be performed in the above patients.
ALL can be strongly suspected if it is seen as a BM failure on a peripheral blood test. ALL patients are predominantly anemia and thrombocytopenia, and leukemic cells may not show peripheral blood tests. In case of suspected ALL, BM biopsy should be performed for diagnosis. With biopsy, flow cytometry, cytogenetics, and molecular studies can be used to diagnose and classify ALL. ALL should show lymphoblast over 25% on BM biopsy, and CSF examination is also required for accurate staging. If lymphoblasts are seen on CSF, treatment for CNS is needed and systemic therapy is needed.
Prognosis factors & Treatments
The most important factor in the prognosis of ALL is cure. The treatment of ALL is based on the patient's risk. The most important factor is the patient's age at the time of diagnosis, the initial white blood cell count, and the rate of response to treatment. The initial goal of treatment is to remove leukemic cells in the bone marrow, which is called induction. During induction, vincristine, corticosteroid, and L-asparaginase were given for 4 weeks. Intrathecal cytarabine and methotrexate were also given. This means that 98% of patients are treated, and a remission of less than 5% blast is observed in the bone marrow, and the hemocyte count is recovered and the symptoms disappear. After initial treatment, CNS therapy is performed to prevent recurrence of ALL in the CNS. After remission induction and CNS therapy, repeat therapy can be administered through multi-agent therapy for 14 to 28 weeks to prevent recurrence of ALL. Strengthening therapy after 5 to 7 months after induction therapy is called late reinforcement therapy. Also, even if remission is induced, 6-mercaptopurine every day, MTX every week, is called maintenance therapy, assuming there are unresponsive cancer cells, and it is maintained for 2 ~ 3 years.
Because ALL have different risk factors for ALL, the response is different. Therefore, even if you are diagnosed with ALL, you do not have to be treated with the same regimen. If your patients have any risk factors, if they are complex, And selecting chemotherapy regimen is very important to determine the prognosis of ALL.
