Acute lymphocytic leukemia

Diagnosis

There are many ways as the following to diagnose acute lymphocytic leukemia:

• Blood tests. Blood tests are used to determine the amount of white blood cells, in order to see if there is an excess or an insufficiency as well as to determine if there are enough red blood cells and platelets. In the blood test we may also see the presence of immature cells (blast cells) which are usually found in the bone marrow.
• Bone marrow test. In this test a sample is obtained through bone marrow aspiration and biopsy where a needle is used to take a sample of the bone marrow and then this sample will be further tested for leukemia cells. These cells will then be divided in to specific types based on their shape, size and genetic components, as well as certain changes in the cancer cells and determine whether the leukemia cells began from B lymphocytes or T lymphocytes.
• Imaging tests. In order to see whether the cancer has spread to the brain and spinal cord or any other organs, an X-ray, a Computerized Tomography (CT) Scan, or an ultrasound will be used.
• Spinal fluid test. The spinal fluid that is around the brain and spinal cord may be used as a sample in order to monitor if there is a spread of cancer cells to the spinal fluid.

In order to determine on which level the condition is, the following factors will be looked at:

• The type of lymphocytes whether they are B cells or T cells
• The genetic changes which are in your leukemia cells
• Your age
• Results from lab tests

Treatment

There are various phases in the treatment for acute lymphocytic leukemia. These phases can reach up to two to three years:

• Induction therapy. The first phase of treatment will be used in order to destroy most of the leukemia cells in the blood and bone marrow and this will then in turn help to restore normal blood cell production.
• Consolidation therapy. This is the post-remission therapy and in this phase the most important part is to focus on the destruction of any leukemia cells that may remain in the body.
• Maintenance therapy. This is the third stage and used for prevention of the cells from regrowth. In this stage the treatment is given at lower doses and therefore takes a long period of time.
• Preventive treatment to the spinal cord.
  Patient with acute lymphocytic leukemia may receive additional treatment to kill leukemia cells located in the central nervous system during each phase of therapy. Chemotherapy drugs are often injected directly into the fluid that covers the spinal cord.

Treatments are as follows:

• Chemotherapy. This way is used as an induction therapy for both adults and children. It is drugs that are used to kill the cancer cells and can be used in consolidation and maintenance phases.
• Targeted therapy. This kind of therapy is treatment with drugs which focuses on specific abnormalities that are found in cancer cells. If these abnormalities are blocked then it will cause the cancer cells to die. However, the cancer cells need to be tested prior in order to see if targeted therapy will help to destroy them. This kind of treatment can be used alone or with other combinations of
• Radiation therapy. This kind of therapy uses high-powered beams to kill cancer cells. It can be used also when the cancer has spread to the central nervous system.
• Bone marrow transplant. Also known as stem cell transplant, is used in order to treat relapse if it occurs. It helps in order to increase the healthy bone marrow by replacing the leukemic bone marrow from a person that is leukemia free. Prior to the bone marrow transplant, there must be high doses of chemotherapy or radiation in order to destroy the bone marrow that is producing leukemia cells firstly.
• Engineering immune cells to fight leukemia. This treatment uses chimeric antigen receptor (CAR)-T cells which are germ-fighting T cells and creates them to fight cancer cells and then after that returns them back into the body. This treatment can be used for treating consolidation therapy or relapse in children and young adults.