Acute Lymphoblastic Leukemia - Symptoms, causes and treatment

Acute lymphoblastic leukemia or lacute lymphoblastic leukemia (LLA)is one kind blood cancer. This disease occur when White blood cellimmature (lymphoblast) multiply quickly and aggressively.

This disease occurs due to an error in the production of white blood cells in the bone marrow. White blood cells are formed from the maturation process of stem cells (stem cells). To form a type of white blood cell called a lymphocyte, the stem cell will first turn into a lymphoblast.

In patients with ALL, this maturation process is impaired, in which most of the lymphoblasts do not turn into lymphocytes. As a result, more and more lymphoblasts and fill the bone marrow, until then out of the bone marrow and into the bloodstream.

Acute lymphoblastic leukemia is more common in children, although adults can also get the disease. When it occurs in adults, ALL will be more difficult to cure. Because it is aggressive (fast-growing), acute lymphoblastic leukemia needs to be treated immediately by an oncologist.

Symptoms of Acute Lymphoblastic Leukemia

Patients with acute lymphoblastic leukemia will experience symptoms due to a lack of mature blood cells. Symptoms that appear include:

• Bleeding gums, easy bruising on the skin, or frequent nosebleeds.
• Vulnerable to infection, which is characterized by frequent
• Pale, weak, and short of breath due to anemia.

These symptoms arise due to a decrease in the number of mature blood cells (red blood cells, white blood cells, and platelets), because the bone marrow is only controlled by lymphoblasts. Other symptoms that can be felt by patients with acute lymphoblastic leukemia are:

• Joint and bone pain.
• A lump appears in the neck, armpit, or groin due to swollen lymph nodes.
• Stomach feels bloated due to enlargement of the liver and spleen.
• Testicular enlargement.

In some cases, ALL can also cause neurological disorders due to lymphoblasts that accumulate in the brain and spinal cord. Symptoms of a nervous breakdown can include:

• Headache
• Dizzy
• Throw up
• Blurred vision
• Seizures

Immediately consult a doctor, if you experience symptoms that may indicate acute lymphoblastic leukemia.

Causes of Acute Lymphoblastic Leukemia

Acute lymphoblastic leukemia is caused by changes or genetic mutations of stem cells in the bone marrow, so that the maturation process is disrupted. In addition to interfering with the maturation process of stem cells from lymphoblasts to lymphocytes, these genetic mutations cause lymphoblasts to continue to multiply, thereby interfering with the production of other blood cells.

The cause of the emergence of these gene mutations is not clearly known, but there are several things that are thought to increase the possibility of these changes, including:

• Suffer other genetic disorders. Suffering from certain genetic disorders, for example Down syndrome, is thought to put a person at risk of developing ALL.
• Have a family member who has ALL. A person who has a family member with ALL is at risk for suffering from ALL as well. However, do not misinterpret that ALL is inherited genetically from parents to their children.
• Have you ever lived? cancer treatment. A person who has had other types of cancer and is undergoing treatment, either chemotherapy or radiotherapy, is more at risk
• Exposure to radiation. People exposed to radiation are more at risk of developing ALL. For example workers in nuclear reactors or victims of nuclear disasters.
• Smoke.Exposure to various harmful chemicals from cigarette smoke, such as benzene, makes a smoker more at risk of suffering from ALL.
• Work in an environment exposed to chemicals. Not following standard procedures and not using personal protective equipment when working in a chemical-related environment can increase the risk of exposure
• viral infection. Epstein-Barr virus is one of the viruses that are at risk of causing ALL.
• Weak immune system. A person with a weakened immune system, for example due to AIDS or taking immunosuppressive drugs in the long term, is more at risk of developing ALL than other people.

Diagnosis of Acute Lymphoblastic Leukemia

From the symptoms suffered, the doctor will perform a physical examination to find out the cause of the complaint. If you suspect that acute lymphoblastic leukemia is the cause, your doctor will perform further tests in the form of:

• Tblood ice. Complete blood count examination will show changes in the number of white blood cells (can increase or decrease), as well as abnormalities in the type of white blood cells. In addition, the number of red blood cells and platelets will be low.
• Aspiration Bone marrow. Bone marrow aspiration is performed to take samples of blood and tissue in the patient's bone marrow, namely the bones around the buttocks. This sample will be examined under a microscope to see the shape of the blood cells and changes in bone marrow tissue.
• Lumbar puncture. A lumbar puncture is performed by taking samples of cerebrospinal fluid and spinal cord, from the sidelines of the spine. A sample of cerebrospinal fluid will be examined to see if the cancer cells have spread to the brain and spinal cord
• Genetic testing. A genetic test uses a sample taken during a bone marrow aspiration. The goal is to see the gene mutations that occur.

Other tests, such as scans (X-rays, ultrasound, or CT scans) and lymph node biopsies, are rarely performed. This examination is carried out if the doctor suspects that the patient's complaints are caused by other diseases, such as lymphoma.

Treatment of Acute Lymphoblastic Leukemia

The main treatment for acute lymphoblastic leukemia is chemotherapy, which will be given in several phases, namely:

• Induction phase

  This phase of therapy aims to kill cancer cells in the body, especially in the blood and bone marrow.

• Consolidation phase

  This phase of therapy aims to kill any remaining cancer cells after induction therapy.

• Maintenance phase

  This phase of therapy is done to prevent cancer cells from growing back.

• Adjunct therapy for the central nervous system

  This therapy is specifically given to patients whose cancer cells have spread to the central nervous system.

Other therapies that can be undertaken by patients to treat acute lymphoblastic leukemia are:

• Bone marrow transplant

  Bone marrow transplant is done by replacing the patient's bone marrow with healthy bone marrow from a donor.

• Radiotherapy

  Radiotherapy is done by firing a special beam into the area. The goal is to kill cancer cells that have spread to the brain or spinal cord.

• Targeted therapy

  This therapy is done by giving drugs according to the gene mutation experienced.

The cure rate of this disease is influenced by various factors. ALL in children is generally easier to treat than ALL in adults. In addition to age, other factors that affect the cure rate of ALL patients are the type of ALL, the number of white blood cells, and the spread of cancer cells in the body.

Complications of Acute Lymphoblastic Leukemia

Some of the complications that can arise from acute lymphoblastic leukemia are:

• Bleeding

  ALL patients are more prone to bleeding because of the low number of blood clotting cells (platelets) in the blood. Bleeding can occur in the skin or internal organs.

• Infection

  ALL patients are more susceptible to infection because they have a weak immune system due to a lack of white blood cells. Infection can also occur as a side effect of ALL treatment.

• Kemandulan

  Infertility can also occur as a side effect of ALL treatment.

Prevention of Acute Lymphoblastic Leukemia

Acute lymphoblastic leukemia can be prevented by avoiding the risk factors that cause this disease. Some preventive measures that can be taken are:

• Quit smoking.
• Follow standard procedures and wear personal protective equipment when working in chemically-intensive environments.
• Practicing safe sex, namely by using condoms and not changing partners, to prevent HIV infection which can increase the risk of developing