What Is B-Cell Acute Lymphoblastic Leukemia?
B lymphocytes are supposed to grow into cells that help you fight infections. But in this disease, they turn into "leukemia" cells that live longer than normal cells and reproduce quickly. They build up in your bone marrow and move into your bloodstream. From there they can spread to other organs in your body.
Although in most cases it can't be cured, treatment can help you live longer and better. And researchers are looking for new treatments to fight the disease.
Remember, you have control over the decisions you make about your treatment and your life. Make sure you reach out to family and friends so you can talk to them about your plans, your fears, and your feelings. Ask your doctor about support groups, where you can meet people who understand what you're going through.
In most cases, doctors don't know what causes B-cell acute lymphoblastic leukemia (B-cell ALL). It doesn't appear to run in families.
Some things may increase your chances of getting it: for instance, if you've had chemotherapy or radiation treatment for cancer in the past. Also, getting chemotherapy and radiation together can raise your risk even more.
Your symptoms depend on the number of leukemia cells you have. Treatments that kill your leukemia cells also get rid of the symptoms.
When you first get B-cell ALL, you may feel tired and get a fever. You also might lose your appetite and get night sweats.
If the leukemia cells in your bone marrow crowd out cells that are in charge of making blood, you won't have enough normal blood cells. When this happens, you may start feeling weak, dizzy, or light-headed.
You may also get symptoms such as:
- Shortness of breath
- Repeated infections
- Bruise easily
- Frequent bleeding, such as nosebleeds or from your gums
Some symptoms depend on where in your body the leukemia cells move. For instance, if they travel to your liver and spleen, they may cause these organs to get bigger. Your belly may swell. You might feel full after you eat only a little bit of food.
You may feel pain in your joints or bones if the leukemia cells have spread there. If the cancer cells have moved into the lymph nodes of your neck, underarms, or groin, you may see swelling in those areas.
Getting a Diagnosis
Your doctor will do a physical exam and ask you questions about your medical history. They may ask you:
- Do you feel extremely tired?
- Have you ever felt dizzy or weak?
- Do you have bruises?
- Have you been sick a lot recently?
- Do you get a lot of nosebleeds or do your gums bleed?
Your doctor may also want you to take some blood tests that can give clues about whether you have B-cell ALL:
Complete blood count (CBC). It checks the number of blood cells in your body, including white blood cells.
Peripheral blood smear. It looks for changes in the number of blood cells and how they look.
The results of these tests can reveal signs that you may have B-cell ALL, such as too many young white blood cells or too few of the two other types of blood cells -- red blood cells and platelets.
You may also need to get a bone marrow test. Your doctor will take samples of your bone marrow, usually from the back of your hip bone. For this test, you lie down on a table and get a shot that will numb the area. Then your doctor uses a needle to remove a small amount of liquid bone marrow.
Your doctor will look at the sample under a microscope. They will check the size and shape of the white blood cells. Cells that look like they haven't developed fully could be signs that you have B-cell ALL.
Once B-cell ALL has been diagnosed, your doctor may want to do tests to see if it has spread to other parts of your body. These might include an X-ray or a CT scan. An X-ray uses radiation in low doses to make images of your body's structures. A CT scan is a series of X-rays from different angles that makes detailed images of what is inside your body.
You may also get a test called a spinal tap (lumbar puncture). It checks to see if cancer cells have spread to the brain and spinal cord. For this test, your doctor gives you a shot to numb your lower back. Then they put a needle in the area around your spinal cord to remove some fluid called CSF (cerebrospinal fluid).
Questions for Your Doctor
There's a lot to take in when your doctor gives you a diagnosis of B-cell ALL. Some questions you can ask your doctor include:
- What kind of treatment do you recommend?
- Are there side effects?
- How will you check on my progress?
- Are there clinical trials of new treatments that I should consider joining?
The word "acute" in B-cell acute lymphoblastic leukemia means the disease spreads quickly, so it's important to get early treatment.
You have different choices for treatment. In general, your treatment will have three phases. The goal of the first phase is "total remission" -- to kill the leukemia cells and get rid of all your symptoms. Your doctor may call it the induction phase.
If you go into remission, the next stage is to kill any leftover leukemia cells that aren't active but could grow later, causing the disease to return. Your doctor may call this phase of treatment the consolidation phase or "post-remission therapy."
The third phase is generally called maintenance therapy and the goal is to prevent the cancer cells from coming back.
Talk with your doctor about the best type of treatment for you. And remember, you don't have to face things alone. Talk to family and friends who can give you emotional support.
Your treatment options include:
Chemotherapy. In this treatment, you take drugs that move through your bloodstream and kill cancer cells throughout your body. You might get these drugs in three phases over about 2 years. While you're getting chemo, you may feel nauseous, but certain medicines can reduce vomiting.
Chemotherapy with stem cell transplant. Some people with B-cell ALL may need large doses of chemotherapy. But doctors hesitate to give large amounts, because it can damage your bone marrow. That's where a stem cell transplant can help. After your high-dose chemo, you'll get a transplant of stem cells that can help get your bone marrow working right again.
The stem cells in a transplant live in your bone marrow and help make new blood cells.
When you get this transplant, a donor will supply the new stem cells. You'll need to get on a waiting list to find a donor who is the right match for you, so your body doesn't "reject" the new cells. Close relatives, such as a brother or sister, are the best chance for a good match. If that doesn't work out, you need to get on a list of potential donors from strangers. Sometimes the best chance for the right stem cells for you will be from someone who is the same race or ethnicity as you.
Before the transplant, you'll likely need to get treated with high doses of chemo for about a week or two. This can be a tough process, because you may get side effects like nausea and mouth sores.
When the high-dose chemo is done, you'll start the transplant. The new stem cells are given to you through an IV. You won't feel any pain from this, and you're awake while it’s happening.
After your transplant, it could take 2 to 6 weeks for the stem cells to multiply and start making new blood cells. During this time you may be in the hospital, or at the very least, will need to make visits every day to get checked by your transplant team. It can take 6 months to a year until the number of normal blood cells in your body gets back to what it should be.
Targeted therapy. This treatment uses drugs that go after specific parts of cancer cells. You often get the drugs in this type of therapy every day in pill form. They usually have fewer severe side effects than chemotherapy. This treatment doesn't work for everyone, but it puts a lot of people into remission and may help keep the cancer from coming back.
CAR T-cell therapy. It's a type of gene therapy that the FDA has approved for children and adults whose B-cell ALL doesn't get better with other treatments.
CAR T-cell therapy uses some of your own immune cells, known as T cells, to treat your cancer. Doctors take the cells out of your blood and change them by adding new genes. The new T-cells can work better to find and kill cancer cells.
Taking Care of Yourself
While you're getting treatment, you can do a lot of things to manage side effects and stay healthy.
Since chemotherapy can sometimes upset your stomach, you can try changing some of your eating habits. For instance, stay away from fried or spicy foods. You can also try eating five or six small meals a day rather than the traditional three meals.
If your treatment makes you tired, try to take short naps. You also might find that short walks can help boost your energy.
If you're stressed about your treatment, sometimes deep breathing or meditation can help you relax.
Reach out to family and friends who can give you emotional support when you need it.
What to Expect
It's likely that your treatment for B-cell ALL will take a number of years. After your treatment is over, you'll have regular visits to your doctor so they can check to make sure your cancer hasn't returned. Your doctor will also check for any lingering side effects of your therapy.
For some people, treatment makes the cancer go away. For others, the cancer may not go away completely, or it may return. If that's the case, you may need regular treatment with chemotherapy or other drugs to keep it in check for as long as possible.
It's possible that treatment to fight B-cell ALL may stop working. If that happens, you may want to focus on making sure you're as comfortable as possible, known as palliative care. You may not be able to control your cancer, but you can control choices about how you'll live your life.
You don't have to face things alone. Consider joining a support group, where you can share your feelings with others who understand what it's like.
You can get more information about B-cell acute lymphoblastic leukemia, and learn how to join support groups, on the web site of the American Cancer Society.