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Acute lymphocytic leukemia

Acute lymphoblastic leukemia (ALL), also known as acute lymphocytic leukemia, is a cancer of the white blood cells, characterised by the overproduction and continuous multiplication of malignant and immature white blood cells (referred to as lymphoblasts) in the bone marrow. It is a hematological malignancy. It is fatal if left untreated as ALL spreads into the bloodstream and other vital organs quickly (hence "acute"). It mainly affects young children and adults over 50. more...

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Symptoms

Initial symptoms of ALL are quite aspecific, but worsen to the point that medical help is sought:

  • Generalised weakness and fatigue
  • Anemia
  • Frequent or unexplained fever and infections
  • Weight loss and/or loss of appetite
  • Excessive bruising or bleeding from wounds, nosebleeds, petechiae (red pinpoints on the skin)
  • Bone pain, joint pains (caused by the spread of "blast" cells to the surface of the bone or into the joint from the marrow cavity)
  • Breathlessness
  • Enlarged lymph nodes, liver and/or spleen

The signs and symptoms of ALL result from the lack of normal and healthy blood cells because they are crowded out by malignant and immature white blood cells. Therefore, people with ALL experience symptoms from their red blood cells, white blood cells, and platelets not functioning properly. Laboratory tests which might show abnormalities include blood counts, renal functions, electrolytes and liver enzymes.

Diagnosis

Diagnosing leukemia usually begins with a medical history and physical examination. If there is a suspicion of leukemia, the patient will then proceed to undergo a number of tests to establish the presence of leukemia and its type. Patients with this constellation of symptoms will generally have had blood tests, such as a full blood count.

These tests may include complete blood count (blasts on the blood film generally lead to the suspicion of ALL being raised). Nevertheless, 10% have a normal blood film, and clinical suspicion alone may be the only reason to perform a bone marrow biopsy, which is the next step in the diagnostic process.

Bone marrow is examined for blasts, cell counts and other signs of disease. Pathological examination, cytogenetics (e.g. presence of the Philadelphia chromosome) and immunophenotyping establish whether the "blast" cells began from the B lymphocytes or T lymphocytes.

If ALL has been established as a diagnosis, a lumbar puncture is generally required to determine whether the malignant cells have invaded the central nervous system (CNS).

Lab tests (mentioned above) and clinical information will also determined if any other medical imaging (such as ultrasound or CT scanning) may be required to find invasion of other organs such as the lungs or liver.

Pathophysiology

The etiology of ALL remains uncertain although some doctors believe that ALL develops from a combination of genetic and environmental factors. However, there is no definite way of determining the cause of leukemia.

Scientific research has shown that all malignancies are due to subtle or less subtle changes in DNA that lead to unimpaired cell division and breakdown of inhibitory processes. In leukemias, including ALL, chromosomal translocations occur regularly. It is thought that most translocations occur before birth during fetal development. These translocations may trigger oncogenes to "turn on", causing unregulated mitosis where cells divide too quickly and abnormally, resulting in leukemia. There is little indication that propensity for ALL is passed on from parents to children.

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Low antioxidant intake in childhood acute lymphoblastic leukemia
From Nutrition Research Newsletter, 7/1/04

Unlike adults with cancer, children diagnosed with cancer rarely have overt malnutrition, especially if the diagnosis was made in a timely fashion. Nutritional deficiencies can develop as a result of the treatment itself or of complications that arise from the chemotherapy or radiation. Antioxidant use is not part of the conventional treatment of children with cancer and therefore it is considered complementary or alternative medicine. However, more studies show that children with cancer were using some form of complementary medicine and almost half of those children were taking vitamin supplements.

Acute lymphoblastic leukemia (ALL) is the most common type of childhood cancer, and therefore patients with ALL represent a large homogenous population of children for study. Most children with ALL do not have overt malnutrition, which makes them a reasonable population in which to investigate the effect of antioxidant status. Therefore, some researchers from Columbia University investigated the effect of therapy on antioxidant intakes in children with ALL, the relationship between dietary antioxidant intakes and plasma antioxidant concentration and the relationship between the incidence of side effects due to treatment and antioxidant intake.

A six-month observation study was conducted on 103 children with ALL. Blood was collected at three regularly scheduled visits (before chemotherapy was given, three months after diagnosis and six months after diagnosis) to test for antioxidant status (total ascorbate, vitamins A and E and total carotenoids). A 24-hour food recall and FFQ were administered on the same days as the blood collection. Data on adverse side effects of chemotherapy was also collected at these three time points.

The children ingested vitamin E, total carotenoid, beta-carotene and vitamin A in amounts that were 66%, 30%, 59% and 29%, respectively, of the US recommended dietary allowance or of the amounts specified in the third National Health and Nutrition Examination Survey. Greater vitamin C intakes at six months were associated with fewer therapy delays, less toxicity and fewer days spent in the hospital. Greater vitamin E intakes at three months were associated with a lower incidence of infection, while greater beta-carotene intakes at six months were associated with a decreased risk of toxicity. Antioxidant supplementation was rare, with 4%, 3% and 1% of patients using supplements at time points 1, 2 and 3.

The findings of this study definitely show that antioxidant intakes, except for vitamin C, are inadequate in children and adolescents with ALL. However, despite adequate intakes of vitamin C, almost half of the patients had inadequate plasma concentrations. There have been concerns about potential adverse interactions between antioxidant supplement and chemotherapy, so Kennedy et al. do not support supplementation at this time. The results do suggest that it would be wise for children with ALL to receive nutritional counseling to ensure that they are meeting their needs for antioxidant nutrients.

Deborah D. Kennedy, Katherine L. Tucker, Elena D. Ladas et al., Low antioxidant vitamin intakes are associated with increases in adverse effects of chemotherapy in children with acute lymphoblastic leukemia, Am J Clin Nutr 79:1029-1036 (June 2004) [Address reprint requests to K. M. Kelly, Division of Pediatric Oncology, Columbia University, 161 Fort Washington Avenue, Irving Pavillion 7, New York, NY 10032. E-mail: kk291@columbia.edu]

COPYRIGHT 2004 Frost & Sullivan
COPYRIGHT 2004 Gale Group

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