Acute Lymphoblastic Leukemia

Comprehensive care for ALL, including intensive chemotherapy, targeted therapy, and stem cell transplantation.

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Acute Lymphoblastic Leukemia

Acute Lymphoblastic Leukemia

Hematologic Malignancies

Overview

ALL is an aggressive leukemia requiring intensive, multi-phase treatment. Modern protocols achieve high cure rates, especially in children. Treatment includes induction, consolidation, maintenance, and central nervous system prophylaxis.

When to Consult

Upon diagnosis of ALL, abnormal blood counts, fatigue, bruising, bleeding, infections, bone pain, or suspicious blood test results.

What to Bring

CBC, peripheral smear, bone marrow biopsy, cytogenetic studies, FISH testing, molecular testing (BCR-ABL, Ph-like), flow cytometry, and lumbar puncture results.

Risk Factors

Age (peak in children 2-5 years, second peak in adults over 50)
Previous cancer treatment (chemotherapy, radiation)
Genetic syndromes (Down syndrome, Li-Fraumeni)
Ionizing radiation exposure
Chemical exposure (benzene)
Certain viral infections
Family history (rare)
Male gender (slightly higher risk)

Causes

Genetic mutations in lymphoid precursor cells
Chromosomal abnormalities (Philadelphia chromosome, others)
Environmental carcinogens
DNA damage from radiation or chemicals
Inherited genetic predisposition
Epigenetic changes
Abnormal lymphoid cell development
Immune system dysfunction

Treatment Options

Induction Chemotherapy

Intensive initial phase to achieve complete remission. Multi-drug regimens including vincristine, prednisone, asparaginase, daunorubicin. Typically 4-6 weeks. Goal is <5% blasts in bone marrow.

Consolidation/Intensification

High-dose chemotherapy to eliminate remaining leukemia cells. Multiple cycles with different drug combinations. Prevents relapse.

Maintenance Therapy

Lower-dose, long-term chemotherapy (typically 2-3 years) to prevent recurrence. Oral medications (6-mercaptopurine, methotrexate) with periodic IV treatments.

Central Nervous System Prophylaxis

Intrathecal chemotherapy (methotrexate, cytarabine) and/or cranial radiation to prevent CNS relapse. Critical component of ALL treatment.

Allogeneic Stem Cell Transplantation

For high-risk or relapsed ALL. Donor stem cell transplant offers best chance for cure in high-risk patients. Requires HLA-matched donor.

Targeted Therapy

Imatinib, dasatinib, or ponatinib for Philadelphia chromosome-positive ALL. CAR-T cell therapy (tisagenlecleucel) for relapsed B-cell ALL. Blinatumomab (BiTE) for relapsed disease.

Immunotherapy

Inotuzumab ozogamicin (antibody-drug conjugate) for relapsed ALL. Monoclonal antibodies targeting CD22. Effective for relapsed disease.

Supportive Care

Blood transfusions, platelet transfusions, growth factors, antibiotics, antifungal prophylaxis, and management of treatment complications.

Need Treatment?

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