Cancer Health Center

Acute Lymphoblastic Leukemia

Symptoms of Acute Lymphoblastic Leukemia continued...

A shortage of red blood cells may cause symptoms of anemia, including:

• Fatigue or weakness
• Dizziness
• Feeling cold
• Light-headedness
• Shortness of breath

A shortage of normal white blood cells may result in:

• Fevers
• Recurring infections

A shortage of blood platelets may cause symptoms such as:

• Lots of bruising for no obvious reason
• Frequent or severe nosebleeds, bleeding gums, or other unusual bleeding such as from minor cuts

Depending upon where leukemia cells are present, other symptoms may include:

• A full or swollen belly from leukemia cells in the liver or spleen
• Enlarged lymph nodes such as in the neck or groin, under arms, or above the collarbone
• Bone or joint pain
• Headache, trouble with balance, vomiting, seizures, or blurred vision if the cancer has spread to the brain
• Trouble breathing if spread has occurred in the chest area

Treatment for Acute Lymphoblastic Leukemia

ALL is really a group of related diseases, or subtypes. Therefore, your treatment options depend upon your subtype and other factors. You may have more than one type of treatment. These include:

• Chemotherapy, the use of anticancer drugs in combination, generally over a couple of years. Agents used for ALL include:
  • vincristine (Oncovin),
  • cytarabine (Cytosar)
  • daunorubicin (Cerubidine) or doxorubicin (Adriamycin)
  • L-asparaginace (Elspar) or PEG-L-asapraginase (Oncaspar)
  • etoposide (VP-16)
  • teniposide (Vumon)
  • 6-mercaptopurine (6-MP, Purinethol)
  • methotrexate
  • cyclophosphamide (Cytoxan)
  • steroids (prednisone, dexamethasone)

• Targeted therapy, drugs that target specific parts of cancer cells and tend to have fewer or less severe side effects than chemotherapy. Examples include imatinib (Gleevec), dasatinib (Sprycel), ponatinib (Iclusig), and nilotinib (Tasigna), which attack cells with the Philadelphia chromosome.
• Radiation therapy, the use of high-energy radiation to kill cancer cells. This is not used often for ALL but may be used to treat leukemia in the brain or bone, for example, or before a stem cell transplant.
• A bone marrow transplant, which involves use of high doses of chemotherapy and possibly radiation followed by a transplant of bone-forming stem cells. Stem cells usually come from a donor. Or, less likely, they come from your own bone marrow or peripheral blood. If you cannot tolerate high doses of chemotherapy and radiation, lower doses may be used with a "mini-transplant."

Treatment occurs in two parts -- induction therapy and post-induction therapy.

The goal of induction therapy is to achieve remission by:

• Killing as many leukemia cells as possible
• Returning blood counts to normal
• Ridding the body of signs of disease for a long time

About eight or nine out of 10 adults achieve remission after treatments, but many relapse, which lowers the overall cure rate to 30% to 40%. So even with remission, post-induction therapy is needed to prevent relapse. It involves cycles of treatment over two to three years. Usually, the drugs are different than the drugs used in induction therapy. The goal is to completely rid the body of leukemia cells that have not been found by common blood or marrow tests.