Back لوكيميا الأرومة اللمفاوية الحادة Arabic Остра лимфобластна левкемия Bulgarian Leucèmia limfoide aguda Catalan Lewcemia lymffoblastig aciwt Welsh Akute lymphatische Leukämie German Leucemia linfoide aguda Spanish لوسمی حاد لنفوئیدی Persian Akuutti lymfaattinen leukemia Finnish Leucémie aiguë lymphoblastique French Leucemia linfoblástica aguda Galician

Acute lymphoblastic leukemia

Acute lymphoblastic leukemia
Other namesAcute lymphocytic leukemia, acute lymphoid leukemia
Left to right: L1, L2, L3 morphological types of acute lymphoblastic leukemias
SpecialtyHematology, oncology
SymptomsFeeling tired, pale color, fever, easy bleeding or bruising, bone pain, enlarged lymph nodes[1]
ComplicationsInfection, tumor lysis syndrome[2][3]
Usual onset2–5 years old[4]
TypesB-cell ALL, T-cell ALL[2]
CausesUsually unknown[5]
Risk factorsIdentical twin with ALL, Down syndrome, Fanconi anemia, ataxia telangiectasia, Klinefelter syndrome, high birth weight, significant radiation exposure[6][5][1]
Diagnostic methodBlood tests and bone marrow examination[3]
Differential diagnosisInfectious mononucleosis, acute myeloid leukemia, lymphoblastic lymphoma, aplastic anemia[3]
TreatmentChemotherapy, stem cell transplantation, radiation therapy, targeted therapy[7][1]
PrognosisChildren: 90% five-year survival rate[2]
Adults: 35% five-year survival[8]
Frequency1 in 1,750 children[4][9]
Deaths111,000 (2015)[10]

Acute lymphoblastic leukemia (ALL) is a cancer of the lymphoid line of blood cells characterized by the development of large numbers of immature lymphocytes.[1] Symptoms may include feeling tired, pale skin color, fever, easy bleeding or bruising, enlarged lymph nodes, or bone pain.[1] As an acute leukemia, ALL progresses rapidly and is typically fatal within weeks or months if left untreated.[11]

In most cases, the cause is unknown.[2] Genetic risk factors may include Down syndrome, Li–Fraumeni syndrome, or neurofibromatosis type 1.[1] Environmental risk factors may include significant radiation exposure or prior chemotherapy.[1] Evidence regarding electromagnetic fields or pesticides is unclear.[4][6] Some hypothesize that an abnormal immune response to a common infection may be a trigger.[4] The underlying mechanism involves multiple genetic mutations that results in rapid cell division.[2] The excessive immature lymphocytes in the bone marrow interfere with the production of new red blood cells, white blood cells, and platelets.[1] Diagnosis is typically Acute lymphoblastic leukemia based on blood tests and bone marrow examination.[3]

Acute lymphoblastic leukemia is typically treated initially with chemotherapy aimed at bringing about remission.[2] This is then followed by further chemotherapy typically over a number of years.[2] Treatment usually also includes intrathecal chemotherapy since systemic chemotherapy can have limited penetration into the central nervous system and the central nervous system is a common site for relapse of acute lymphoblastic leukemia.[12][13]

Treatment can also include radiation therapy if spread to the brain has occurred.[2] Stem cell transplantation may be used if the disease recurs following standard treatment.[2] Additional treatments such as Chimeric antigen receptor T cell immunotherapy are being used and further studied.[2]

Acute lymphoblastic leukemia affected about 876,000 people globally in 2015 and resulted in about 111,000 deaths.[14][10] It occurs most commonly in children, particularly those between the ages of two and five.[15][4] In the United States it is the most common cause of cancer and death from cancer among children.[2] Acute lymphoblastic leukemia is notable for being the first disseminated cancer to be cured.[16] Survival for children increased from under 10% in the 1960s to 90% in 2015.[2] Survival rates remain lower for babies (50%)[17] and adults (35%).[8]

  1. ^ a b c d e f g h "Childhood Acute Lymphoblastic Leukemia Treatment". National Cancer Institute. 8 December 2017. Retrieved 20 December 2017.
  2. ^ a b c d e f g h i j k l Hunger SP, Mullighan CG (October 2015). "Acute Lymphoblastic Leukemia in Children". The New England Journal of Medicine. 373 (16): 1541–52. doi:10.1056/nejmra1400972. PMID 26465987. S2CID 609394.
  3. ^ a b c d Ferri FF (2017). Ferri's Clinical Advisor 2018 E-Book: 5 Books in 1. Elsevier Health Sciences. p. 743. ISBN 9780323529570.
  4. ^ a b c d e Inaba H, Greaves M, Mullighan CG (June 2013). "Acute lymphoblastic leukaemia". Lancet. 381 (9881): 1943–55. doi:10.1016/S0140-6736(12)62187-4. PMC 3816716. PMID 23523389.
  5. ^ a b Cite error: The named reference MDAnd2016 was invoked but never defined (see the help page).
  6. ^ a b Childhood acute lymphoblastic leukemia. Vora, Ajay (editor). Cham, Switzerland: Springer International Publishing. 2017. pp. 1–44, 61–86. ISBN 9783319397078. OCLC 984342596.{{cite book}}: CS1 maint: others (link)
  7. ^ Cite error: The named reference BCDtargetedTherapy was invoked but never defined (see the help page).
  8. ^ a b Paul S, Kantarjian H, Jabbour EJ (November 2016). "Adult Acute Lymphoblastic Leukemia". Mayo Clinic Proceedings. 91 (11): 1645–1666. doi:10.1016/j.mayocp.2016.09.010. PMID 27814839.
  9. ^ Cite error: The named reference Boer2017 was invoked but never defined (see the help page).
  10. ^ a b Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A, et al. (October 2016). "Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1459–1544. doi:10.1016/s0140-6736(16)31012-1. PMC 5388903. PMID 27733281.
  11. ^ Marino BS, Fine KS (2013). Blueprints Pediatrics. Lippincott Williams & Wilkins. p. 205. ISBN 9781451116045.
  12. ^ Pui CH, Evans WE (12 January 2006). "Treatment of Acute Lymphoblastic Leukemia". New England Journal of Medicine. 354 (2): 166–178. doi:10.1056/NEJMra052603. ISSN 0028-4793. PMID 16407512.
  13. ^ Larson RA (2 January 2018). "Managing CNS disease in adults with acute lymphoblastic leukemia". Leukemia & Lymphoma. 59 (1): 3–13. doi:10.1080/10428194.2017.1326597. ISSN 1042-8194. PMID 28535095. S2CID 24564241.
  14. ^ Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, et al. (October 2016). "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1545–1602. doi:10.1016/S0140-6736(16)31678-6. PMC 5055577. PMID 27733282.
  15. ^ "Acute Lymphocytic Leukemia – Cancer Stat Facts". SEER. Retrieved 20 December 2017.
  16. ^ Tubergen DG, Bleyer A, Ritchey AK (2011). "Acute Lymphoblastic Leukemia". In Kliegman RM, Stanton BM, Geme J, Schor NF, Behrman RE (eds.). Nelson Textbook of Pediatrics (19th ed.). Philadelphia, PA: Elsevier/Saunders. pp. 1732–1737. ISBN 978-1437707557. OCLC 706780860.
  17. ^ Brown P (6 December 2013). "Treatment of infant leukemias: challenge and promise". Hematology. American Society of Hematology. Education Program. 2013 (1): 596–600. doi:10.1182/asheducation-2013.1.596. PMC 4729208. PMID 24319237.
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