THE COOPER HANDS

ALL is a type of blood cancer that starts from young white blood cells called lymphocytes in the bone marrow. It usually develops quickly over day or weeks.

• Lymphocytes are white blood cells that produce antibodies.
• They are vital parts of the body's immune system.
• There are two main types of lymphocytes : 

B Cells

T Cells

• In ALL there is an accumulation in the bone marrow of immature lymphocyte precursor cells, called blast cells
• Eventually the production of normal blood cells is affected by this, resulting in a reduction in the numbers of red cells, normal white cells and platelets in the blood.

• ALL is the only form of leukaemia that is more common in children than adults.
• It is the single most common form of paediatric cancer, accounting for about one-third of all cases in children.
• About 85% of cases of childhood leukaemia are ALL and it occurs in about 400 children in the UK each year.
• ALL mostly occurs between the ages of about two and four years.
• Males are affected more often than females at all ages.

• Infant ALL
• B Cell ALL
• T Cell ALL
• Philadelphia Positive ALL
• T Cell Lymphoblastic Lymphoma

Many of the symptoms of ALL are due to the leukaemia cells multiplying within the bone marrow thus stopping the production of healthy blood cells.

Common symptoms include.

• Tiredness
• Lethargy
• Pallor
• Bruising
• Recurrent fever and infections
• Swollen glands
• Limb pains

• Blood tests to show if there are any leukaemia cells in the bloodstream and how the other cells are affected.
• Chest X-Ray to show whether any of the lymph glands in the chest are enlarged / mediastinal mass.
• Bone marrow aspirate (BMA) to show what type of ALL.
• Lumbar Puncture (LP) to see whether or not thereare any leukaemia cellspresent within the spinal fluid.

There are six stages of treatment.

• The first stage, or block is called induction. The aim is to get rid of the leukaemia.
• The three consolidation phases (stage 2, 3 and 5)aim to destroy any remaining leukaemia cells. They also stop the cancer from spreading to the brain and spinal cord.
• The fourth stage is delayed intensification. It is a combination of the induction and consolidation stages. you have to destroy any remaining cancer cells that may still be there, but they don't show up in tests.
• The final stage is called maintenance. It reduces the risk of cancer coming back after treatment is finished.

In each stage you have a combination of several chemotherapy drugs and steroids

• Asparaginase - an enzyme (a drug that helps other drugs to work) which is injected in to a large muscle, usually the thigh. (Can also be given IV)
• Cyclophosphamide - a chemotherapy drug given intravenously through central line.
• Cytarabine - a chemotherapy drug given intravenously through central line.
• Daunorubicin - a chemotherapy drug given as an injection or through central line.
• Dexamethasone - a steroid that is taken as a tablet or liquid.
• Doxorubicin - a chemotherapy drug given intravenously through central line.
• Mercaptopurine - a chemotherapy drug taken as a tablet or liquid.
• Methotrexate - a chemotherapy drug that can be injected in to the fluid that flows around the spine and brain (similar to having a lumbar puncture), taken by mouth as a tablet or liquid or given intravenously through a central line.
• Vincristine - a chemotherapy drug given intravenously through central line.
• Imatinib - an inhibitor, which blocks the growth of cancer cells. If the child has a type of ALL called Philadelphia positive ALL, or a mutation of the ABL gene, they may have this drug as part of their treatment. - Taken as a tablet.
• Nelarabine - a chemotherapy drug. - May have this drug if the child has high risk T-cell ALL. They will have it intravenously through central line.
• Bilanatumomab - a monoclonal antibody which targets cancer cells so the immune system can find and attack them. They may have this if they have Down's Syndrome and are in one of the intermediate or high-risk groups. They will have it as a continuous intravenous infusion through the central line.

• RBC - Red Blood Cells carry oxygen around the body.
• Platelets - helps blood to clot and control bleeding
• WCC - White Cell Count. White cells help the body fight infection
• Neutrophils - The most common type of white blood cell. They help fight infection.
• Blasts - Immature lymphocyte precursor cells
• BMA - Bone Marrow Aspirate, a sample of bone marrow fluid.
• LP - Lumbar Puncture. A procedure for removing fluid from around the spinal cord using a fine needle in the lower part of the back.
• MRD - Minimal Residual Disease.  A test/measurement to help Doctors determine the risk of relapse and guide treatment decisions.
• Anaemia - A lower-than-normal number of red blood cells in the blood. It causes tiredness, paleness and sometimes shortness of breath.
• Alopecia - The loss of hair. A temporary side-effect of some forms of chemotherapy or radiotherapy used to treat cancer.
• Neutropenia - A lower-than-normal number of neutrophils in the blood. It increases the risk of infection.
• Pancytopenia - Where there are lower-than-normal numbers of a type of all blood cells and platelets in the blood.
• Thrombocytopenia - A lower-than-normal number of platelets in the blood which causes brusing and bleeding.
• Anti-emetic - A drug to prevent or alleviate nausea and vomiting that can sometimes be a side-effect of chemotherapy.
• Anti-fungal - A drug used to treat fungal infections.
• Anti-viral - A drug used to treat viral infections.
• Bone Marrow Transplant - A procedure which replaces blood stem cells in people whose bone marrow has been destroyed by chemotherapy and/or radiotherapy.