We often see in movies that patients with blood cancer are in urgent need of bone marrow transplantation. However, this is not necessarily the case with acute lymphoblastic leukemia (ALL)! In fact, the diagnosis and treatment of ALL are very different from other leukemias. When acute lymphoblastic leukemia occurs, what is the patient’s prognosis and survival rate? This article will give you an in-depth introduction to the diagnosis, treatment and prognosis of acute lymphoblastic leukemia.
Diagnosis of acute lymphoblastic leukemia
Since a large number of cancerous lymphoblasts mainly accumulate in the bone marrow, to accurately diagnose which type of leukemia a patient has, it is usually necessary to obtain it through bone marrow puncture.
In addition to first understanding the patient’s medical history and conducting a physical examination to see if there are any symptoms that may be caused by ALL such as abdominal distension and bleeding, the doctor will then conduct a blood test to confirm the results of the complete blood count (CBC) and blood smear test. If the red blood cells are When the number of platelets is too low, the number of platelets is too low, a large number of immature white blood cells, etc., a bone marrow examination will be considered. A bone marrow puncture needle is used to extract a small amount of bone marrow from the intestinal ridge to check the cell differentiation in the bone marrow.
In addition, because acute lymphoblastic leukemia has a higher risk of invading the central nervous system, doctors may require patients with suspected ALL to undergo a spinal fluid test, that is, lumbar puncture, to extract spinal fluid from the lumbar spine with a special needle to further check for the presence of cancer cells.
Treatment of acute lymphoblastic leukemia
The treatment of acute lymphoblastic leukemia, like other blood cancer types, is mainly chemotherapy. The following is the standard treatment process:
1.Initial chemotherapy: drastically eliminate cancer cells
The first stage is the guided remission period, which lasts for about five weeks. Doctors will use drugs such as Prednisolone, Vincristine, Epirubicin (or Idarubicin), L-asparaginase, etc. to eliminate cancer cells in the patient’s body and check the number of trace remaining leukemia cells in the patient’s body. , based on this and whether there are other extra-marrow invasion conditions, ALL patients are divided into: standard risk group, high risk group, and highest risk group. Patients with higher risk may need increased treatment time or drugs, such as adding VP- 16 and cyclophosphamide and other powerful drugs, or bone marrow transplantation may be necessary.
2.Consolidation treatment: control the number of cancer cells
After the first stage is completed, although most of the cancer cells have been eliminated, consolidation treatment is still required to prevent the recurrence of blood cancer. Doctors will change chemotherapy drugs and use high-dose MTX or 6-mercaptopurine (6-MP), etc. Drugs, high-risk groups will add Cytarabine and Cyclophosphamide, and after the completion of consolidation therapy, high-risk patients may also need to undergo reintroduction therapy, which is basically a course of guided remission treatment, coupled with bone marrow testing, in order to detect cancer. Only when the number of cells drops to an ideal value can subsequent treatments such as central nervous system prevention and bone marrow transplantation be carried out.
3.Central Nervous Treatment: Reduce the Risk of Relapse
As mentioned above, lumbar puncture is required for diagnosis. After guiding and consolidating treatment, in order to treat or prevent ALL from invading the central nervous system, doctors will inject anti-cancer drugs (MTX, Cytarabine, Hydrocortisone) from the lumbar spine and blend into the spinal fluid. to destroy cancer cells that may be hiding in the meninges. In addition to lumbar injection, cobalt hexafluorotherapy to the head also has a similar effect, but it is not usually used in standard risk groups because of the serious sequelae.
4.Regular medication treatment: Continuous observation is required during the maintenance period
The last stage is the maintenance period. Patients need to receive regular injections or oral anti-cancer drugs for two or three years to avoid the recurrence of hidden cancer cells. At this time, the dosage of cancer drugs used will also be reduced, such as Dexamethasone, Vincristine, 6MP, MTX, etc., but if you are in the highest risk group, you still need to add VP-16, Cyclophosphamide, and Cytarabine.
Novel targeted therapies are expected to provide potent antileukemic activity while reducing the toxicity of traditional chemotherapeutic drugs. Given the multiple molecular and genetic alterations that occur in ALL, it is unlikely that a single drug will be effective in all patients with ALL. With the ability to characterize the immunophenotype and genotype of each patient’s leukemia, targeted therapies hold the promise of improving responses and survival as part of a personalized treatment strategy.
Tyrosine kinase inhibitors used to treat CML have been successfully used to treat Ph-positive ALL, and other signaling pathways, such as PI3K/AKT/mTOR, are also promising targets for small molecule inhibition. In addition to targeting intracellular pathways, monoclonal antibodies also recognize cell surface antigens. Immunoconjugates, such as inotuzumab ozogamicin, bind to blood cancer cells, internalize and release cytotoxins that kill the cancer cells.
As for CAR-T immunotherapy, the patient’s own T cells are genetically engineered to recognize leukemia cells to induce an anti-blood cancer immune response.
Prevent complications of Pneumocystis pneumonia
Chemotherapy not only destroys cancer cells but also attacks normal cells. Therefore, leukemia patients’ immunity will also decrease and they are prone to bacterial or viral infections. Particularly dangerous is Pneumocystis pneumonia, so doctors may prescribe Baktar to prevent it.
Does acute lymphoblastic leukemia require bone marrow transplantation?
Most children with leukemia will improve significantly without the need for bone marrow transplantation, but a small number of patients (no more than 5%) do not have complete remission during the induction period, or those with special chromosomal mutations (such as Philadelphia chromosome) may need bone marrow transplantation. . In most cases, bone marrow transplantation is considered for children with leukemia only if the disease relapses.
After achieving complete remission, treatment options include consolidation and maintenance chemotherapy or allogeneic stem cell transplantation (Allo-SCT) in eligible patients. For high-risk patients and those with relapsed/refractory disease, Allo-SCT has long been considered the standard of care and the best chance of achieving a durable response. Although criteria vary from study to study, high-risk disease is generally defined as Ph-positive ALL, elevated WBC count, CNS disease, high-risk gene rearrangements, or hypodiploidy.
The prognosis of adult ALL patients is poor, especially those with Philadelphia chromosome, and induction of remission is often followed by bone marrow transplantation to improve survival rates.
Prognosis of acute lymphoblastic leukemia
Judging from the current treatment status, the cure rate and long-term survival rate of childhood ALL patients can reach more than 70%, which can be said to be very good. Therefore, parents whose children suffer from blood cancer do not need to be too discouraged or desperate, and cooperate well with the treatment. Childhood leukemia is the most curable type of leukemia.