Chapter 2: Close-up Details of Pediatric Acute Lymphoblastic Leukemia

This video is a brief review of Chapter 1:

2.1: How is Pediatric Acute Lymphoblastic Leukemia diagnosed?  ^(1) (2) 

It can be diagnosed by the following tests, and these tests are aimed to find the cause of the cancer in a molecular level.

1. Physical exam and history of the patients' habits, previous illnesses and treatments.

2. Complete Blood Count: A test that measure the number of red blood cells, platelets, the amount of hemoglobin, and the number and types of white blood cells. 

3. Cytogenetic analysis which view sample of blood and or bone marrow under microscope in laboratory to chick any genetical mutations.

4. Bone marrow aspiration and biopsy.

5. Immunophenotyping. 

6. Blood chemistry studies. 

2.2: How do cancer cells spread in the body?  ⁽²⁾ 

Metastasis happens when cancer cells spread outside of the blood, and there are three ways cancer cells spread in the body:

1. Cancer cells invade solid tissues such as brain and heart through the blood vessel.

2. Cancer cells can also invade lymph system by spreading in the lymph vessel and form solid tumor. 

3. Cancer cells that have invaded solid tissues and formed tumor can also invade neighboring tissues and organs. 

2.3: What are the risk groups that classify the treatments of patients with Pediatric Acute Lymphoblastic Leukemia?  ^(1) (2) 

There are two risk groups that are used to design treatment plans for children with pediatric acute lymphoblastic leukemia.

1. Low risk group: 

- Children from 1- 9 years. 

- White blood cells count < 50,000/µL at diagnosis

2. High risk group:

- Children < 1 year

- White blood cells count equals or are more than  50,000/µL at diagnosis.  

2.4: What are the different types of treatment for Pediatric Acute Lymphoblastic Leukemia?   ⁽²⁾ 

There are four different standard treatments:

1. Chemotherapy.

2. Radiation therapy.

3. Chemotherapy with stem cell transplant. 

4. Targeted therapy. (Using drugs or substances that target cancer cells only)

2.5: What are the new types of treatment for Pediatric Acute Lymphoblastic Leukemia? Are they being used?  ⁽²⁾ 

These new treatments that are in clinical trials are High-dose chemotherapy and Targeted therapy. Patients may choose to be part of these clinical trials, and follow-up tests are needed to check the rate of the recovery and how far these treatments can go. 

2.6: What is a Recurrent or Relapse Pediatric Acute Lymphoblastic Leukemia and what is the treatment for it? ^{(1) (2)} 

Recurrent or Relapse Pediatric Acute Lymphoblastic Leukemia is when the cancer recurred after treatments. When cancer returns, it can be spread to blood, bone marrow, testicles, brain and spinal cord. 

These are the standard treatments:

1. Chemotherapy and radiation therapy. (When cancer spreads in testicles only)

2. Chemotherapy and intrathecal chemotherapy with radiation therapy. (When cancer spreads in brain and or spinal cord only)

Work Cited:

⁽¹⁾  Childhood Acute Lymphoblastic Leukemia Treatment (National Cancer Institute) http://www.cancer.gov/types/leukemia/patient/child-all-treatment-pdq

⁽²⁾ Childhood Acute Lymphoblastic Leukemia: Learn the Symptoms (MedicineNet) http://www.medicinenet.com/childhood_acute_lymphoblastic_leukemia/article.htm

Chapter 1: Introduction to Pediatric Acute Lymphoblastic Leukemia

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1.1: What is Pediatric Acute Lymphoblastic Leukemia (ALL)? ^{(1) (2)}

Pediatric Acute Lymphoblastic Leukemia or Childhood Acute Lymphoblastic Leukemia is a blood cancer and a cancer of the bone marrow.

1.2: What’s going on in normal bone marrow? ⁽²⁾

In the bone marrow, blood stem cells are formed. These cells are immature cells and overtime, they develop and become mature blood cells. They may become either myeloid stem cells or a lymphoid stem cells.

When myeloid stem cells develop, they become one of these cells: Red blood cells (carrying oxygen), Platelets (blood clotting), or Granulocytes (fighting infection and disease). On the other hand, when lymphoid stem cells are developed, they become T lymphocytes (help B lymphocytes), B lymphocytes (produce antibodies)  and Natural killer cells (kills foreign bodies). 

Image Source: http://www.cancer.gov/images/cdr/live/CDR526538-750.jpg

1.3: What is happening in a children’s bone marrow with Pediatric Acute Lymphoblastic Leukemia? ⁽¹⁾

In children’s bone marrow with acute lymphoblastic leukemia, more of their blood stem cells develop into immature lymphoblasts, B lymphocytes, or T lymphocytes. As a consequence of having many of these leukemia cells, white blood cells, red blood cells, and platelets do not have space to flow in the blood stream.  Cancer cells or leukemia cells do not fight infection or disease as the normal lymphocytes cells do. As a result, blood infection, anemia and bleeding occur. 

Image Source: http://www.cancer.gov/images/cdr/live/CDR755927-750.jpg

1.4: What are the factors that lead to Pediatric Acute Lymphoblastic Leukemia? ⁽¹⁾

These are possible factors that cause pediatric acute lymphoblastic leukemia such as being exposed to x-rays or radiation before birth, genetic mutation in the chromosome. Also having genetic condition such as down syndrome, bloom syndrome, shwachman syndrome, Ataxia-telangiectasia or Neurofibromatosis type 1 (NF1) may lead to pediatric acute lymphoblastic leukemia. Another possible factor could be from a result of past treatment with chemotherapy. ⁽¹⁾

1.5: What are the signs and symptoms of a child with pediatric acute lymphoblastic leukemia? ^{(2) (3)}

These are the possible signs and symptoms that appear to a child with pediatric acute lymphoblastic leukemia which are fever, bruising and bleeding easily, dark spot under the skin, loss of appetite and weakness. The child looks pale and is always tired. The child also suffers from bone or joint pain. Lumps appear in the neck, underarm, groin or stomach of the child. These lumps are not painful. ⁽²⁾

1.6: What are the factors that affect of the chance of the recovery and the treatment? ⁽¹⁾

The prognosis depends on several factors such as age, gender, race, the number count of the white blood cells in the blood, the type of lymphocytes where the leukemia cells begin to grow from. Mutation in the chromosomes or the genes of the lymphocytes has a great affect on the prognosis. The rapid growth of the leukemia cells should decrease after the initial treatment also affects the rate of the recovery.   ⁽¹⁾

The treatment options also depend on the factors that affect the prognosis. The age of the child at the diagnosis plays a role on the treatment options. The decrease in the leukemia cells count after the initial treatment and the type of lymphocytes that the leukemia cells begins to divide and grow affect how the treatment options will be designed. ⁽¹⁾

After reading this chapter, to test your general knowledge about Pediatric Acute Lymphoblastic Leukemia, click on "QUIZ" or use the URL. 

http://www.medicinenet.com/leukemia_quiz/quiz.htm

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Work Cited:

⁽¹⁾  Childhood Acute Lymphoblastic Leukemia Treatment (National Cancer Institute) http://www.cancer.gov/types/leukemia/patient/child-all-treatment-pdq

⁽²⁾ Childhood Acute Lymphoblastic Leukemia: Learn the Symptoms (MedicineNet) http://www.medicinenet.com/childhood_acute_lymphoblastic_leukemia/article.htm

⁽³⁾ Pediatric Acute Lymphoblastic Leukemia (: Practice Essentials, Background, Pathophysiology)

http://emedicine.medscape.com/article/990113-overview