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  Acute lymphocytic leukemia

Acute lymphocytic leukemia (ALL) is a subtype of leukemia that develops from single cell in the bone marrow. This single cell has an acquired genetic injury to its DNA. The leukemic cell that replaces the typical marrow through reproduction is called a lymphoblast. This disease can also be referred to as Lymphoblastic leukemia. The result of this form of leukemia is an unrestrained growth of lymphoblasts, a.k.a. leukemic blasts and the obstructed production of normal marrow cells. The leukemic blasts fail to function as normal blood cells leading to a decrease in red cells, white cells and platelets. The decrease in these cells causes the body to develop anemia; thrombocytopenia and neutropenia.

Acute lymphocytic leukemia
Acute lymphocytic leukemia


Acute lymphocytic leukemia usually develops in children under the age of ten.

Symptoms:

The symptoms of acute lymphocytic leukemia are first noted in a patient’s marked loss of feeling well, or not at their usual health. Patients may tire easily and have a pallor associated with anemia. Unusual bleeding because of low platelet count may also be evident. Unusual bleeding can present as black and blue marks with no obvious cause, pin prick bleeding or red spots under the skin known as petechia and excessive bleeding from minor cuts. Achy bones and joints are also a symptom of acute lymphocytic leukemia. Fever with no apparent cause can occur. When leukemic lymphoblasts build up, the lymph notes may swell. When leukemic cells appear or congregate in the brain lining or spinal cord vomiting and headache similar to brain injury symptoms may be present.

Cause:

Acute lymphocytic leukemia does not have a specific identified cause. Some factors have been associated with a greater risk of developing the disease, as noted in studies of survivors of Hiroshima and Nagasaki atomic bomb sites. It has been observed that different geographic locations have different rates than other locations, such as populations of developed countries and in higher economic, social collections have a higher rate of ALL than their counterparts.

Lifestyles and environmental factors have been examined for possible links to developing acute lymphocytic leukemia, but no absolute determining factor has been discovered. One suggestion from the variety of studies conducted is that complex, multiple factors are involved in the development of acute lymphocytic leukemia.

There is evidence that a portion of acute lymphocytic leukemia is caused by a cellular mutation that occurs during gestation – which is that the leukemia is diagnosed soon after birth. There are cases though, that years can pass before leukemia is diagnosed or present. This case suggests that genetic mutations occur after birth to trigger the onset of this disease.

Diagnosis:

Diagnosis of acute lymphocytic leukemia is diagnosed via a biopsy of bone marrow and a blood test. A biopsy is a procedure in which bone marrow is removed either by aspiration (a smaller needle) or the typical larger needle (to remove a large portion of marrow or a small bone portion) from the hip. Sedation is used to keep patients comfortable during biopsies. Usually, during the biopsy procedure the cells are examined immediately under a microscope. The sample of cells are stained and examined for a low count of red cells and platelets. In the case of a positive diagnosis, leukemic blast cells are also present. Leukemia cells in the bone marrow confirm the diagnosis. Studies of the shape and count of chromosomes may also be required. This is called a cytogenetic examination.

Treatment:

Treatment for acute lymphocytic leukemia almost always includes chemotherapy. The goal of treatment is to eradicate as many leukemia cells to place the patient in remission. Most acute lymphocytic leukemia patients are children under the age of ten. The incidence of this type of leukemia increases in men over the age of forty-five. Treatment is based on the overall health and age of the patient.

The first phase of treatment is known as induction therapy and lasts for about one month. Induction therapy is a cocktail of drugs that are selected based on the age of the patient, the features of the leukemia and the health of the patient. Induction therapy includes drugs taken orally, intramuscularly, via spinal tap and intravenous and possibly radiation treatment. After induction therapy a series of cycles of therapies are given for two years. This post induction therapy may include chemotherapy administered in the methods described above and radiation. Central nervous system prophylaxis is also sometimes incorporated in treatment of acute lymphocytic leukemia. The spine and nervous systems are known as ‘sanctuaries’ for leukemia cells. The CNS prophylaxis targets these areas with radiation and/or drugs injected directly into the spinal cord.

There is a specific population of children with acute lymphocytic leukemia who have a common gene mutation. The mutation is known as BCR-ABL and the leukemia is referred to as Ph-positive ALL (acute lymphocytic leukemia). A drug, imatinib mesylate is used in conjunction with the recommended induction therapy. The drug alone is not a cure.

Stem cell transplants, a relatively new treatment have been successfully used in patients who are between the ages of one and fifty and are in remission.

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