Acute Lymphoblastic Leukemia (ALL.) is a cancer of the white blood cells, the cells in the body that normally fight infections. Leukemia cells are abnormal cells that cannot do what normal blood cells do. The abnormal cells are immature white blood cells that cannot help the body fight infections. For this reason, children with ALL often get infections and have fevers.
Children with ALL frequently have low amounts of health red blood cells and platelets. As a result, there are not enough red blood cells to carry oxygen through the body. The patients may be anemic and may look pale and feel weak and tired. When there are not enough platelets, patients bleed and bruise easily.
Leukemia cells travel through the body. In ALL, the abnormal cells may collect in the brain or spinal cord. In boys, leukemia cells can also collect in the testicles and cause swelling.
Little is known about the causes of and risk factors for childhood ALL. Scientists know that ALL in children occurs slightly more often in boys than in girls and in white children more often than in black children. However, they cannot explain why one person gets leukemia and another does not.
Certain factors affect prognosis and treatment options.
- Age and white blood cell count at diagnosis.
CJ’s age (4 yrs old) and low white cell count are working to his advantage. - How quickly and how low the leukemia cell count drops after initial treatment.
The initial treatment usually takes up to 28 days so we won’t know the answer to this for awhile yet.
- Gender and race.
ALL occurs in boys more often than girls and the treatment program for boys is typically longer than for girls.
The sub-type of ALL that CJ has is pre-B cell. It is my understanding that this is the most common and most treatable sub-type of ALL and ALL is the most common and treatable form of leukemia.
A sample of cells retrieved from CJ’s bone marrow are being tested now. It will be another week or more before we will have the results.
CJ had a spinal tap last Saturday. The doctors were encouraged that the fluid sample they took was clear – not cloudy. Their initial report was good – they found 2 white blasts and 2 red blasts. They expected the lab report to come back negative for any cancer cells in the spinal cord or brain.
- Whether the child has Down syndrome.
CJ does not have Down syndrome.
Treatment Plan
The earlier ALL is detected, the more effective the treatment. The aim is to induce a lasting remission, defined as the absence of detectable cancer cells in the body (usually less than 5% blast cells on the bone marrow).
CJ’s treatment plan will include intensive combined treatments of chemotherapy and steroids. He will receive some of these drugs through his port, some will be injected into a muscle (thigh) or tissue (under the skin) and others will be administered orally – by pill or liquid. Because this disease can invade the central nervous system, CJ will receive periodic doses of chemo directly into his spinal fluid. Each time the doctors draw spinal fluid for testing, the fluid will be replaced with a chemo treatment.
The treatment of ALL usually has 3 phases: - Induction therapy: This is the first phase of treatment. Its purpose is to kill the leukemia cells in the blood and bone marrow. This puts the leukemia into remission.
- Consolidation/intensification therapy: this is the second phase of therapy. It begins once the leukemia is in remission. The purpose of consolidation/intensification therapy is to kill any remaining leukemia cells that may not be active but could begin to re-grow and cause a relapse.
- Maintenance therapy: This is the third phase of treatment. Its purpose is to kill any remaining leukemia cells that may re-grow and cause a relapse. Often the cancer treatments are given in lower doses than those used for induction and consolidation/intensification therapy. The length of maintenance therapy is 3 years for boys, 2 years for girls.
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