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What is Acute Lymphoblastic Leukaemia (ALL)?

ALL is the most common type of cancer in children and accounts for 20% of blood cancers in adults. It is a type of blood cancer which leads to the overproduction of abnormal white blood cells called lymphoblasts. These lymphoblasts circulate in the bloodstream and infiltrate the bone marrow, lymph glands and other organs in the body. As a result, the normal function of the bone marrow is affected leading to poor production of red cells, normal white cells and platelets. If left untreated, it is usually fatal within 3 months of diagnosis..
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Causes of Acute Lymphoblastic Leukaemia (ALL)

 

The development of ALL is related to the genetic damage that happens in the blood stem cells within the bone marrow or lymph nodes. The exact cause of the damage is not clear, but there are certain factors that increase your risk of developing ALL:

  1. Sex. Men are slightly more likely to develop ALL than women. 
  2. Exposure to radiation in high doses. High levels of radiation, such as in nuclear reactor accidents, can increase the risk of leukaemia
  3. Exposure to certain chemicals. Some chemicals such as Benzene can increase the chances of developing ALL.  However strict regulations in most countries limit the exposure of such chemicals which means they play a very small part in causing ALL.
  4. Smoking. Smoking is associated with more than 15 types of cancers including leukaemia, as cigarettes contain many substances which are harmful to the body. There are also reports on an increased risk of leukaemia in children of parents who smoke.
  5. Genetics. Certain conditions have an increased risk of Acute Leukaemia eg. Down Syndrome.
  6. Previous cancer treatment. People who have previously received certain types of chemotherapy or radiotherapy have an increased risk of ALL.
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What is Acute Leukaemia?
Video from: Centre for Clinical Haematology
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Acute Lymphoblastic Leukemia (ALL) – Disease Information
Video from: Centre for Clinical Haematology

Acute Lymphoblastic Leukemia (ALL) – Diagnosis
Video from: Centre for Clinical Haematology

Acute Lymphoblastic Leukemia (ALL) Treatment & Outlook?
Video from: Centre for Clinical Haematology

Blood Cancers

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Other Blood Conditions

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Signs & Symptoms of Acute Lymphoblastic Leukaemia (ALL)

Signs & Symptoms of Acute Lymphoblastic Leukaemia (ALL)

  1. Fever.  This can be caused by the disease itself or an underlying infection. 
  2. Fatigue. This is a symptom of anaemia which is due to the lack of red blood cells.
  3. Bleeding symptoms. Such symptoms include easy bruising, prolonged gum bleeding after brushing teeth, recurrent nosebleeds or heavy periods. This is due to low platelets.
  4. Pale Skin. This is another symptom of anaemia. 
  5. Weight Loss. 
  6. Lymph Node Swelling.  Swelling of the lymph nodes is caused by infiltration of leukaemia cells. It may result in swellings over the neck, armpits and groin.
  7. Enlarged Abdomen. This may be caused by an enlargement of the spleen, liver and/or lymph nodes within the abdomen.
  8. Neurological Impairment. This is very rare. Patients may experience double vision, numbness or weakness. This is due to leukaemia cells affecting the nervous system..

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Treatments for Acute Lymphoblastic Leukaemia (ALL)

The management of ALL can be complex and there are often many factors to consider (such as the patient age, physical fitness, and disease status) when deciding the actual treatment pathway required. At CFCH, our experienced team of medical professionals will counsel and assist you in tailoring the optimal treatment plan.

 

Treatment plans for ALL commonly include one or more of the following:.

 

Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells.  Chemotherapy will also damage some normal cells, which means that there are side effects. Chemotherapy drugs are usually given in combination.  Steroid drugs such as dexamethasone or prednisolone have also been found to be effective in treating ALL..

Targeted Therapy
Targeted therapy as the name describes, is a type of treatment where drugs attack specific abnormalities which are known to be found on the cancer cells.  For example, some patients with ALL have a genetic abnormality called the Philadelphia chromosome and for these patients, targeted drugs can effectively be used to attack cells which contain this genetic abnormality..

Immunotherapy
Immunotherapy uses the body’s own immune system to destroy cancer cells.  Such drugs work by targeting and attaching to specific proteins on the surface of cancer cells. They then stimulate the body’s own immune system to destroy these cells..

CNS Treatment
As ALL may affect the Central Nervous System, treatment requires injections of drugs into the CSF by lumbar puncture.  This is called intrathecal (IT) chemotherapy and is a very important component in ALL treatment. Radiation therapy may also be required if disease has spread to the nervous system. 

Bone Marrow Transplantation
This is also known as a stem cell transplant and is offered to suitable patients with high risk ALL. The procedure involves using high dose chemotherapy or radiation to destroy the bone marrow of the patient and replacing it with healthy bone marrow from a compatible donor.

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FAQs on ALL

Often patients initially present to the doctor with non-specific symptoms such as tiredness, bruising, recurrent fevers or swelling over the neck, groin or armpit. On other occasions, patients may be referred for investigations after having an abnormal blood test.

Blood Tests
Your doctor will most likely order a blood test called a Full blood Count (FBC), which will raise the suspicion of leukaemia. The FBC may show a high white blood cell count, a low haemoglobin level and low platelet count. An urgent referral to a Haematologist for further evaluation and treatment is required.

Bone Marrow Test
A bone marrow test is an important investigation to establish the diagnosis of acute leukaemia. Bone marrow is the soft tissue inside your bone which is responsible for making your blood cells.  The bone marrow test involves inserting a small needle into your hip bone and withdrawing a sample of bone marrow.  This is normally done under local anaesthetic. The sample is sent to the laboratory for various tests which help to determine the diagnosis and help the doctor develop the most suitable treatment regime.

Radiology Tests
X-rays, ultrasound or CT scans may be done to determine if other areas of the body are affected.

Lumbar Puncture
As ALL may affect the nervous system, a lumbar puncture may be performed to determine if there are any leukaemia cells in the nervous system.  This is done by passing a fine needle into the spine to withdraw a small amount of the cerebral spinal fluid (CSF) which surrounds the spine and brain.

Results from a routine blood test can indicate to your doctors that you may have Acute Lymphoblastic Leukaemia if you have a raised (or sometimes lowered white cell count) or other abnormal blood tests. In the early stages of ALL, the standard full blood counts may be normal.

If your doctor suspects that you may have ALL, they will likely refer you to a haematologist for further testing and to confirm the diagnosis.

Acute Lymphoblastic Leukaemia is a relatively rare condition amongst adults. However, it is the most common form of cancer in children and teenagers.

Acute Lymphoblastic Leukaemia is not typically hereditary. This means you do not have an increased risk of developing the condition if your family member is diagnosed with it.

However, your risk may increase if you have an identical twin diagnosed with ALL.

Acute Lymphoblastic Leukaemia is an aggressive form of leukaemia. The overproduction of the abnormal white blood cells responsible for Acute Lymphoblastic Leukaemia can occur over several days or weeks.

Patients with ALL usually need to commence some form of treatment soon after initial diagnosis so as to stabilise the disease and prevent the development of adverse effects. Once the diagnosis is firmly established, it is recommended that patients commence proper ALL treatment as soon as possible.

Acute Lymphoblastic Leukaemia typically develops relatively quickly. The overproduction of the abnormal white blood cells responsible for Acute Lymphoblastic Leukaemia can occur over several weeks to months.

ALL is an aggressive form of blood cancer that can progress rapidly without treatment. If left untreated, it is often rapidly fatal over a few months. This is due to the overproduction of abnormal blood cells, which suppress the production of healthy red blood cells, white blood cells, and platelets.

The survival rate for Acute Lymphoblastic Leukaemia is higher in children. However, more recent advances in treatment have extended adult survival rates. The current 5-year survival rate for patients over the age of 20 is 40%. On the other hand, the 5-year survival rate for patients under the age of 20 is 80-90%

While 80-90% of children and young adults will respond to initial ALL treatment, it is estimated that approximately 10-15% will experience disease relapse. For adults, the risk of disease relapse is even higher at 40-50%.

The signs and symptoms of an Acute Lymphoblastic Leukaemia relapse are the same as those experienced when you are first diagnosed. These signs may include swollen lymph nodes, bone and joint pain, anaemia, and difficulty breathing.

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FAQs on ALL Treatments

At CFCH, we offer the following treatments for ALL: 

  • Chemotherapy
  • Targeted therapy 
  • CAR T-cell therapy
  • Stem cell transplant
  • CNS treatment

Patients with ALL usually need to commence some form of treatment soon after initial diagnosis so as to stabilise the disease and prevent the development of adverse effects. Once the diagnosis is firmly established, it is recommended that patients commence proper ALL treatment as soon as possible.

Modern-day treatments mean that 80-90% of children are alive and well at 5 years with current protocols. The 5-year overall survival is approximately 65% for adolescents, 40% for adults, and 15-20% for older patients.

Targeted therapy is able to attack specific abnormalities which are known to be found on the cancer cells.

CAR T-cell therapy is a form of immunotherapy that involves collecting a patient’s immune cells and modifying them in a laboratory to target specific cancer cells. These modified cells are then returned to the patient to strengthen their immune system against the cancer cells. It may be used in the treatment of Acute Lymphoblastic Leukaemia when two prior treatment options have proven unsuccessful

Patients who do not attain remission after induction or consolidation therapy are usually considered for an allogeneic haematopoietic stem cell transplantation. In addition, patients with poor prognostic markers on cytogenetics and molecular analysis are also considered for upfront transplantation.

In recent years with the advancement of cellular therapy and targeted immunotherapy, patients are being considered for treatment with these newer therapies before haematopoietic stem cell transplantation.

ALL can affect the Central Nervous System. If it does, CNS treatment will be needed by injecting drugs into the cerebrospinal fluid by lumbar puncture. This is called intrathecal (IT) chemotherapy.

The primary form of treatment for paediatric Acute Lymphoblastic Leukaemia is a combination of chemotherapy and targeted novel immunotherapy. Chemotherapy is typically administered over three stages – induction, consolidation, and maintenance.

There are several non-chemotherapy based options which are now available for patients with ALL. Targeted drugs like immunochemotherapy have been shown to be effective with less toxicity in older patients. In addition, with improvements in conditioning regimens and supportive care, selected older patients can still benefit from allogeneic haematopoietic stem cell transplantation.

Treatment for Acute Lymphoblastic Leukaemia typically lasts between two to three years. The first 3-6 months of treatment are often the most intense – known as the induction and consolidation phases of treatment which are given with the aim to clear the bone marrow of ALL.

Thereafter, patients are often on the maintenance phases of ALL for several years, intending to continue lower doses of therapy to prevent the relapse of the disease. During maintenance therapy, children and adults often are able to return to school and work.

While the majority of newly diagnosed ALL patients will receive a combination of chemotherapy with targeted therapy, there are now several newer treatment options available for patients with ALL who relapse after initial treatment. These include potent new targeted therapies, including a class of drugs known as bispecific antibodies. CAR-T cell therapy is also a new and exciting form of cellular therapy for patients with ALL.

The cost of ALL varies depending on the age and risk group of the patient. Some patients may only require chemotherapy and targeted therapy, whereas other patients may benefit from an allogeneic haematopoietic stem cell transplantation. For patients with aggressive ALL, there are novel targeted therapies as well as cellular therapy such as CAR-T cell therapy.

Our haematologists at CFCH will carefully assess your medical condition and work with you to determine the appropriate treatment options.

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Disclaimer:
The information on the Centre For Clinical Haematology website is intended for educational use.  It should not be considered or used as a substitute for medical advice, diagnosis or treatment from a qualified health professional.

What is Acute Leukaemia?
Video from: Centre for Clinical Haematology
frfr

Acute Lymphoblastic Leukemia (ALL) – Disease Information
Video from: Centre for Clinical Haematology

Acute Lymphoblastic Leukemia (ALL) – Diagnosis
Video from: Centre for Clinical Haematology

Acute Lymphoblastic Leukemia (ALL) Treatment & Outlook?
Video from: Centre for Clinical Haematology

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    Locations

    Contact

    WhatsApp : +65 6256 8836
    Email : contact@cfch.com.sg
    .

    Consultation Hours

    Monday to Friday : 8.30am – 5.30pm
    Saturday : 8.30am – 12.30pm
    Closed on Sunday & Public Holidays

    Find us on Facebook

    Drop a Line

    If you have any questions about your condition or would like to make an appointment, simply fill up the form and we'll contact you as soon as we can

      © Centre for Clinical Haematology | 2023