Acute Lymphocytic Leukemia or ALL is estimated to effect 6000 new people this year. The demographics for this disease is highest among children > 5 years of age and adults < 60 years of age. The odds of developing this disease between the ages of 5-60 is greatly reduced. From 5 years of age until the age of 20 the odds of developing ALL is very small with less than 1% of the population being effected. From the age of 20-60 the odds of developing this type of Leukemia is even smaller. The odds of developing ALL through out the lifetime overall is about 1 in 750 with the most deaths from the disease found in older adults where the rate of death from ALL is 1 in 4. Children respond much better to treatment than adults do and it is thought that the reason for the improved response is largely due to the difference in the Leukemia in children and older adults. The overall cure rate (without recurrence) is 40% in adults. In children the overall cure rate (without recurrence) is 80%.
What Is It?
ALL is a blood cancer that effects the lymphocites (young white cells that are present in bone marrow). This type of cancer spreads rather quickly and can be deadly if it is not discovered early on. In ALL the cancer can easily spread to other organs because it is in the blood which is used by the other organs.
It can be hard to diagnose this type of Leukemia because it can present like a Lymphoma typically as part of the diagnosis criteria at least 25% of the bone marrow cells are replaced by cancerous lymphocytes.
Bone marrow is the soft inner part of some of the bones of the body like the hip bone, the skull and other parts that is responsible for blood production. Within the bone marrow there are fat cells, infection fighting white blood cells, red blood cells that carry oxygen, platelets (cell fragments) and lymphocytes.
In cases of ALL all the cells of the bone marrow are compromised. The ability to create new blood supply is compromised. The ability to fight infection is compromised. This is a very serious illness that can wreak havoc on the body and be fatal if not treated.
Treatments for ALL
There is usually three phases of treatment (which is almost always chemotherapy) which usually takes up to 2 years. The first stage is Induction. Induction or induction remission is the most intense stage. In this stage chemotherapy drugs are introduced with the hopes of “killing” off the leukematic cells. The goal of induction is to return the body to a normal state.
Remission is not a cure but it is a goal that is obtainable through the right chemotherapy treatments. This short phase of the treatment plan (usually a month or so long) will treat with a variety of drugs in various combinations that will be determined by the type and phase of the Leukemia.
The Consolidation or Intesification stage is next. If the Leukemia responds to the Induction stage and remission is achieved than the Consolidation stage begins. This stage is longer than the induction stage and many of the same chemicals in the chemotherapy is used but at higher dosage. The Consolidation stage lasts about two months. At the Consolidation stage the doctors may recommended a transplant. At this point while the remission is relatively new the chance for relapse can be quite high up to 70% so continuing with treatment is important.
The Maintenance stage is the final and longest stage of the treatment plan. The Maintenance stage can last up to two years. Chemotherapy drugs will be taken but in smaller doses and usually orally although in some cases IV maintenance may be required.
The overall long term survival rate for ALL is very high when the disease is treated in its earliest stages. When diagnosis is made after it has spread to the spinal cord or brain the survival rate is cut by 65%.
In some cases 10%-20% the Leukemia is considered refractory even at the earliest stages which means it does not respond to the first round of chemotherapy than a stem cell transplant would be recommended. In a small percentage of cases treatments may have to be halted because the expected response is not present.
In those small percentage of cases 10% or less the focus of treatment will turn to pallative care. As part of that care the goal may be to reduce the growth of the Leukemia instead of stopping it and treating the symptoms of ALL may become the focus when it is clear that the Leukemia is not responding to treatments.
ALL is a sudden onset illness that effects thousands of people each year with early intervention and aggressive treatment the odds of survival are very good in absence of other disease or illness. The long term survival rate (10 years or more) can be as high as 80% across all demographics.