Medicines for Acute lymphoblastic leukaemia

What it is

Acute lymphoblastic leukaemia (ALL) is a type of blood cancer that affects the white blood cells and develops quickly, so it needs prompt treatment. It arises in the bone marrow (where blood cells are made), when immature white blood cells (lymphoblasts) multiply in an uncontrolled way and crowd out the normal, healthy blood cells. ALL is the most common type of leukaemia in children, though it can also affect adults. Because the abnormal cells crowd out healthy blood cells, the symptoms often reflect a shortage of normal blood cells and can include: looking pale and feeling tired or breathless (from a lack of red blood cells, anaemia); getting frequent or persistent infections (from a lack of healthy white cells); bruising or bleeding easily, such as nosebleeds or bleeding gums (from a lack of platelets); and other symptoms such as a high temperature, night sweats, bone or joint pain, swollen glands, and feeling generally unwell. Because these symptoms can be caused by many other, far more common and less serious conditions, they usually do not mean leukaemia — but because ALL develops quickly and needs prompt treatment, symptoms that are persistent, unexplained, or worrying should be checked, and a blood test can quickly point towards a diagnosis. ALL is treated by specialist teams, and treatment is intensive, usually based around chemotherapy over a period, with other treatments in some cases. Outcomes have improved greatly, and many people — especially children — are successfully treated. The key messages are awareness of the symptoms and prompt assessment, as early diagnosis allows treatment to start quickly.

How it is treated

Acute lymphoblastic leukaemia is diagnosed and treated by specialist haematology/oncology teams, and because it develops quickly, treatment usually begins promptly after diagnosis. Diagnosis involves blood tests (which often show abnormal numbers of blood cells), and examination of the bone marrow (a bone marrow test) and specialised tests on the cells, which confirm the type of leukaemia and its features and guide treatment. Treatment is intensive and is given over a period of time; it is usually based around chemotherapy, given in phases (to bring the leukaemia under control, then to consolidate and maintain remission), and may also include other treatments — such as steroids, targeted therapies for certain features of the leukaemia, treatment directed at the brain and spinal cord to prevent or treat spread there, and, in some cases, a stem cell (bone marrow) transplant. Supportive care is an important part of treatment — for example preventing and treating infections, and supporting the blood counts. Treatment is tailored to the individual, including their age and the specific features of the leukaemia. Outcomes have improved considerably over the years, and many people are successfully treated, with particularly good outcomes in children, though treatment is demanding and recovery takes time, with follow-up afterwards. Because ALL develops quickly, the key messages are awareness and prompt assessment: symptoms such as persistent tiredness and paleness, frequent infections, easy bruising or bleeding, unexplained fevers or night sweats, or bone pain — particularly if unexplained or persistent — should be checked, as a simple blood test can point towards the diagnosis and allow treatment to start quickly. It is important to keep perspective, as these symptoms are far more often due to common, benign causes than to leukaemia — but persistent or unexplained symptoms should not be ignored.