Acute lymphoblastic leukemia And Chronic lymphoblastic leukemia

By | July 7, 2015

In our previous post we have seen what leukemia is, signs of leukemia, symptoms of leukemia and types of leukemia .In today’s post we will see types of leukemia, that is acute lymphoblastic leukemia and chronic lymphocytic leukemia in details, their symptoms, signs, risks, diagnosis and treatment.

Let’s get started with Acute lymphoblastic leukemia.

Acute lymphoblastic leukemia: Acute lymphoblastic leukemia is also called acute lymphocytic leukemia and acute lymphoid leukemia. It is rare in adults. It is more common in children. It is called childhood cancer and is developed in children between the age of 3 to 5. Acute lymphoblastic leukemia when invades the blood it spreads throughout the body and it effects other organs, like liver, spleen and lymph nodes. It does not normally produce tumors as do many types of cancer. It is acute type of leukemia, means it can progress quickly and rapidly. If not treated at early stage it becomes fatal within few months.

Acute lymphoblastic leukemia

Subtypes of Acute lymphoblastic leukemia: Acute lymphoblastic leukemia is a type of acute leukemia; in turn acute lymphoblastic leukemia has further sub types based on the type of leukocyte being cancerous. Following are its subtypes.

  • Pre (precursor) B cell ALL: It is the most common type of ALL in adults. It occurs when DNA mutation occurs in young B cells.
  • Mature B cell ALL: This type of ALL is identified by particular genetic changes. It occurs when DNA mutation occurs in mature B cells.
  • Pre (precursor) T cell ALL: It is more likely to develop in young adults and is more common in men as compare to women. It occurs when DNA mutation occurs in young T cells.

Acute lymphoblastic leukemia

 

Causes of Acute lymphoblastic leukemia: Acute lymphoblastic leukemia is caused due to mutation in DNA a base sequence of the cell. Mutation affects the normal functioning and normal count of white blood cells, as a result a great number of abnormal white blood cells are produce which hinder the normal functioning of other cells. The exact cause of the DNA mutation is still unknown but it is said that most of the causes of acute lymphoblastic leukemia are not inherent.

Survival rate in Acute lymphoblastic leukemia: 70 % people of all ages survive 5 years after the diagnosis of ALL. Among children with age les than 14 years, 90 % children survive for 5 years after the diagnosis of disease. For the people between the age of 15 and 24, 66 % people survive for 5 years after the diagnosis of disease. For people whose age is between 24 and 64, 40 % people survive 5 years after the diagnosis of ALL. For the people of age greater than 65, 15 % people survive for 5 years.

Rate of success in Acute lymphoblastic leukemia: The rate of success in treatment of acute lymphoblastic leukemia has increased steadily since the 1960s. The five year event free survival rate has nearly reached 80 percent for children with acute lymphoblastic leukemia and approximately 40 percent for adults. Hematopoietic stem-cell transplantation attempts have boosted cure rates further. More improvement can be made by a better understanding of the pathogenesis of acute lymphoblastic leukemia and the basis of resistance to chemotherapy.

 

Symptoms of Acute lymphoblastic leukemia:

Listed below are the symptoms of Acute lymphoblastic leukemia:

  • Pain in bones and joints.
  • Bruising and bleeding like
  • Bleeding gums.
  • Skin bleeding.
  • Abnormal periods.
  • Weakness
  • Fever and chills.
  • Loss of appetite.
  • Abdominal discomfort.
  • Chest pain.
  • Severe nosebleeds.
  • Testicular enlargement.
  • Cranial nerve palsies
  • Weight loss.
  • Pain below the ribs.
  • Red spots on the skin.
  • Swollen glands in neck and arms.
  • Sweating, more specifically at night.

 

Outlook for acute lymphoblastic leukemia:

Outlook for acute lymphoblastic leukemia depends on the factors which are listed below:

  • Age: Younger you are, better outlook you would have.
  • Lab test results: Less the count of white blood cells, better will be the prognosis.
  • Subtype of acute lymphoblastic leukemia (B-cell ALL or T-cell ALL). If you have a chromosome abnormality called the Philadelphia chromosome you will have a poorer prognosis.
  • Response to chemotherapy: If no evidence of leukemia found, you will have better prognosis.

Risk factors for Acute lymphoblastic leukemia: Though the exact cause of acute lymphoblastic leukemia is not known yet, there are certain risk factors which have been identified. Risk factors are listed below.

  • Exposure to high levels of radiations to treat some other type of cancer.
  • Exposure to chemicals such as benzene which is a solvent used in oil refineries and other industries and is present in cigarette smoke, certain cleaning products, detergents, and paint strippers.
  • Infection with human T-cell .
  • Inherited genetic syndrome like Down syndrome.
  • Whether it is developed from B lymphocytes or T lymphocytes.
  • Your being white.
  • Bone marrow transplant.
  • Exposure to electromagnetic field.
  • Exposure to diesel, gasoline and pesticides.
  • Chromosomal problems.
  • Your being male.

 

Diagnosis of Acute lymphoblastic leukemia:

Diagnosis could be done by following tests.

  • Medical history.
  • Physical examination:
  • Blood tests.
  • Complete blood count.
  • Platelets count.
  • Blood flow.
  • Doppler ultrasound exam
  • Non invasive stress test

 

  • Bone marrow aspiration.
  • Chest X-ray.
  • CT scan.
  • Gallium scan and bone scan.
  • Cardiac function.
  • Lumber puncture.

 

Medical history: In medical history, doctor will check if you are suffering or were suffering from some other syndrome especially cancer.

Physical examination: During physical examination, doctor will check your physical condition. It reveals the following facts

  • Bleeding,
  • Swollen or enlarged liver or spleen.
  • Swollen lymph nodes.

He will also measure your weight. He will check your skin Ask you some questions regarding symptoms that you have observed.

Following questions will be asked.

Q: Do you have night sweats?

Q: Have you noticed loss of appetite?

Q: Do you feel some sort of confusion?

Q: Do you feel abdominal discomfort?

And some more questions like these. He will take certain tests if reports of test revealed that these symptoms are not of ordinary infections and disorders then the doctor will refer to hematologist who has specialized in blood disorders.

Blood tests: Following blood tests will be taken to check any disorder or defect in blood and blood cells.

Complete blood count: This test will check for count of blood cells. If count of leukocytes or white blood cells has increased beyond the normal range of 4000 to 11000 per milliliter than it shows that person may be suffering from leukemia. Further evidence for acute lymphoblastic leukemia will be tested by carrying out some other tests.

Platelets count: If count of platelets drop beyond normal level, it may be the indication of your suffering from acute lymphoblastic leukemia.

Blood flow test:

Blood flow test is done by two ways:

Doppler ultrasound exam: Doppler ultrasound exam of arms and legs is also used to check the flow of blood.

Non invasive stress test: This can test whether your blood is flowing at a normal rate.

Bone marrow tests:

Bone marrow aspiration: Our bone marrow contains two types of substances one are solid tissues other is the liquid fluid. In bone marrow aspiration tissues from bone marrow are extracted and examined. Presence of immature cells in the bone marrow which are called as blasts is the indication that leukemia is acute rather than chronic.

Bone marrow biopsy: Having said that bone marrow consists of two types of substances. The solid tissues which are examine in bone marrow aspiration. The other liquid fluid part is examined in bone marrow aspiration.

Chest X-ray: Chest X-ray will examine any disorder in the region of chest.

CT scan: It is a special kind of x ray in which beam is passed through body that gets the inner picture of body. This helps in checking for swollen lymph nodes.

MRI: Magnetic resonance imaging is used to check brain and spinal cord. It is done by radio and magnetic rays instead of x rays.

Gallium scan and bone scan: In these tests, a slightly radioactive element is put into the blood of patient, it gets accumulated in the area where there are cancerous cells in this way it shows where leukemia has been spread.

Cardiac function: Examines the heart.

Biopsy: In biopsy, sample of tissues or any fluid is taken out from body and then examined under the microscope to check whether cancerous cells are present or not. Biopsy also unveils the fact that whether that cancer started at the point where these tissues or fluid was taken from or has spread and reached from some other point of the body.

Lumber puncture: Spinal fluid is extracted from limber region and examined. Cerebrospinal fluid is extracted to check the presence of leukemia cells. Moreover lumber puncture is also used to put in drugs to prevent the spreading of leukemia.

Treatment of Acute lymphoblastic leukemia:

Treatment of Acute lymphoblastic leukemia involves the following.

  • Combination chemotherapy.
  • Intravascular chemotherapy.
  • Intramuscular chemotherapy.
  • Intrathecally chemotherapy.
  • Stem cell transplant.
  • Radio therapy.

Side effects of chemotherapy treatment:

There are certain side effects associated with the treatments which are listed below.

  • Sickness feeling.
  • Hair loss.
  • Mouth ulcer and other mouth problems.
  • Skin problems like dryness, redness, rash or sensitivity to sunlight.
  • Infertility

 

Prevention of Acute lymphoblastic leukemia:

Acute lymphoblastic leukemia can be prevented if risk factors are reduced or minimized for example by reducing the exposure to harmful and toxic chemicals such as benzene.

Statistics of acute lymphocytic leukemia:

Statistics published by the American Cancer Society about acute lymphoblastic leukemia shows that almost 6,050 new cases of acute lymphoblastic leukemia were diagnosed in US in year 2012 among which 3,405 were males and 2,600 were females. Death count of 1,440 deaths among which 820 were males and 620 were females was also reported. Though this disease is common in children but death rate was greater in adults as compare to children. Children you are of less than age of 5 years were at a higher risk of developing. Chances of recovery in children are also greater as compare to adults.

 

Chronic lymphocytic leukemia: It is a blood disorder where a lot of abnormal white blood cells are produced in bone marrow, which not only effect the functioning of red blood cells to transport oxygen and platelets to make blood clots but the abnormal leukemia cells spread throughout other organs through blood flow. In chronic lymphoblastic leukemia, count of white blood cells increases slowly and steadily and symptoms are mild and are revealed at a later stage. It is harder to cure chronic lymphocytic leukemia as compare to acute lymphoblastic leukemia. Adults are at a greater risk of developing CLL as compare to children.

chronic lymphocytic leukemia

Subtypes of chronic lymphocytic leukemia:

Subtypes of chronic lymphoblastic leukemia are as follow:

  • B cell chronic lymphocytic leukemia.

 

  • T cell chronic lymphocytic leukemia.

 

chronic lymphocytic leukemia

Stages of chronic lymphocytic leukemia:

It has 5 stages:

  1. Stage 0
  2. Stage i
  3. Stage ii
  4. Stage iii
  5. Stage iv

 

St High WBC EnlargedLymph Enlarged liver/spleen Anemia Low platelets count
 0 ü                   X                  X           x         X
 i ü    ü  /x                  X           x         X
            ii ü    ü  / x ü  / x           x         X
       iii ü    ü  / x ü  / x ü         X
       iv ü    ü  / x ü  /x ü  / x ü

 

 Causes of chronic lymphocytic leukemia:

Exact causes of chronic lymphocytic leukemia are not known yet but still some facts are revealed regarding developing cause of CLL.

Some facts regarding cause of CLL are listed below:

  • A person in your family suffering from CLL.
  • Increase in white blood cells (leucocytes) count.
  • DNA mutation in the cells.
  • Age may be the cause of developing CLL. If you are elder there is greater chance of developing it.
  • Tour being white.
  • Your being man.
  • Having any Eastern European or Russian Jew relative.

 

 

Symptoms of chronic lymphocytic leukemia:

Following are the signs and symptoms of chronic lymphocytic leukemia:

  • Swollen lymph nodes (neck, armpits, stomach, groin).
  • Shortness of breath.
  • Pain in stomach.
  • Enlargement of spleen.
  • Sweating specially at Night time.
  • Fever and chills.
  • Weight loss.
  • Loss of appetite.

 

Risk factors for chronic lymphocytic leukemia:

There are certain factors that increase the risk of your developing chronic lymphocytic leukemia. These factors are listed below:

  •  Older the age more likely it is that you suffer from this disease.
  • If you are man you are more likely to suffer from CLL as compare to women.
  • White people are more likely to suffer from chronic lymphocytic leukemia (CLL) as compare to other people.
  • Family history: If you have a family history of blood and bone marrow cancers you are more likely to suffer from CLL.
  • Chemical exposure: Exposure to certain chemicals can cause you to suffer from CLL. Some chemicals used in herbicides, pesticides and insecticides may contain some harmful chemicals that may cause CLL.

Outlook for chronic lymphocytic leukemia:

Outlook for chronic lymphocytic leukemia depends on the factors which are listed below:

  • Age: Younger you are, better outlook you would have.
  • White blood cells count: Less the count of white blood cells, better will be the prognosis.
  • Subtype of acute lymphoblastic leukemia (B-cell ALL or T-cell ALL). If you have a chromosome abnormality called the Philadelphia chromosome you will have a poorer prognosis.
  • Response to chemotherapy: If no evidence of leukemia found, you will have better prognosis
  • Stage: Stage of CLL.
  • Health: General health of patient.

Diagnosis of chronic lymphocytic leukemia:

Diagnosis is done via following tests:

  • Blood tests
  • Complete blood count.
  • Flow cytometry.

 

  • Bone marrow tests
  • Bone marrow aspiration.
  • Bone marrow biopsy.
  • Routine microscopic exam.
  • Gene tests
  • Fluorescent in situ hybridization
  • Molecular tests
  • Lymph node biopsy.
  • Lumbar puncture.
  • IgVHgene mutation test.
  • Imaging tests
  • CT scan
  • Magnetic resonance imaging (MRI).
  • Ultrasound

Blood tests

Complete blood count:

In complete blood count (CBC) test, red blood cells, white blood cells and platelets are counted. If count of red blood cell and platelets decreases below the normal level and count of white blood increases 11000 per milliliter, then it shows that the patient is suffering from acute lymphoblastic leukemia.

Flow cytometry:

In flow cytometry which is  a laser-based is used to examine count of blood cells, cell sorting, biomarker detection and protein, by suspending cells in a stream of fluid and passing them by an electronic detection system.

 

Bone marrow tests

Bone marrow aspiration:

Our bone marrow contains two types of substances one are solid tissues other is the liquid fluid. In bone marrow aspiration tissues from bone marrow are extracted and examined. Presence of immature cells in the bone marrow which are called as blasts is the indication that leukemia is acute rather than chronic.

Bone marrow biopsy:

Having said that bone marrow consists of two types of substances. The solid tissues which are examine in bone marrow aspiration. The other liquid fluid part is examined in bone marrow aspiration.

Routine microscopic exam:

In routine microscopic exam, sample of  blood, bone marrow, or CSF are examined under a microscope by a pathologist ( doctor specializing in lab tests) and might be reviewed by the hematologist/oncologist (a doctor specializing in cancer and blood diseases).The doctors will examine the size, shape, and other characteristics of the white blood cells  to classify them into specific types.

 

Gene tests

Cytogenetics:

In Cytogenetics the structure and function of the cell, especially the chromosomes are checked.

Fluorescent in situ hybridization:

Fluorescent in situ hybridization uses fluorescently labeled DNA probes to locate specific sequences of interest and identifies structural and numeric chromosomal changes including balanced rearrangements and micro deletions.

Molecular tests:

Molecular test is used to analyze biological markers in the genome and proteome, the individual’s genetic code and how their cells express their genes as proteins.

 

Lymph node biopsy:

In lymph node biopsy, tissues from lymph nodes (glands that produce white blood cells called leucocytes) are extracted and examined under microscope.

Lumbar puncture:

Spinal fluid is extracted from limber region and examined. Cerebrospinal fluid is extracted to check the presence of leukemia cells. Moreover lumber puncture is also used to put in drugs to prevent the spreading of leukemia.

IgVH gene mutation test:

IgVH is immunoglobulin heavy-chain variable-region gene. It is a gene that encodes for antibodies that function in immune response. This test examine any mutation in this gene

Immunophenotyping:

Immunophenotyping is a test that is used to check the protein expressed by cells. It is done on tissue section (fresh or fixed tissue) or cell suspension.

 

 

Treatment chronic lymphoblastic leukemia:

Treatment of chronic lymphocytic leukemia includes

In chemotherapy drugs are given orally or are inserted through vein.

  • Stem cell replacement.

Stem cells in your bone marrow are replaced by the stem cells from a healthy donor.

 

Survival rate:

5 year survival rate for all people suffering from chronic lymphocytic leukemia is 84 %.10 year survival rate is 34.8 %.

 Prevention of chronic lymphoblastic leukemia:

Though complete cause of all types and sub types of leukemia is still unknown therefore no such prevention is known. But we can prevent developing chronic lymphocytic leukemia by reducing and minimizing risk factors such as reduce exposure to chemicals and stop using benzene contacting products and detergents.

Statistics of chronic lymphocytic leukemia:

Chronic lymphocytic leukemia is the most common type of cancer. Almost 3,200 people are diagnosed with chronic lymphoblastic leukemia in the UK every year. People who are over the age of 60 are contributing to 75 % of all people suffering from chronic lymphoblastic leukemia. Men are more likely to be effected by CLL as compare to women. 40 out of hundred men and 50 out 0f hundred women survive for only 5 years after the diagnosis of disease.

 

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