Understanding B-cell Acute Lymphoblastic Leukemia: Key Points to Remember
B-Cell Acute Lymphoblastic Leukemia (ALL) is a type of cancer that affects white blood cells known as B-cell lymphoblasts, accounting for approximately 75% of adult leukemia cases. This article aims to provide an overview of the causes, symptoms, diagnosis, and treatment of B-cell ALL.
Causes
The exact cause of B-cell ALL is unknown, but it involves mutations or changes in the DNA that cause the cells to replicate and divide more rapidly. Common genetic factors associated with the development of B-cell ALL in adults include specific chromosomal abnormalities and gene fusions. Notable genetic alterations involve the BCR::ABL1 fusion transcript, which is linked to aggressive B-ALL and can be detected by molecular methods.
Other frequent genetic abnormalities include hyperdiploidy and the ETV6::RUNX1 fusion. Certain inherited genetic disorders such as Down syndrome, Li-Fraumeni syndrome, and neurofibromatosis also confer an increased risk for developing ALL. Presence of somatic mutations in proto-oncogenes or tumor suppressor genes also plays a significant role, especially in adults.
Regarding environmental factors, increased risk has been associated with exposure to high doses of radiation (either environmental or therapeutic), as well as prior treatment with chemotherapy or radiation for other cancers. Male gender and ethnicity also show some association, with males and people of white ethnicity having slightly higher incidence.
Symptoms
Symptoms of ALL include weight loss, fever, reduced appetite, night sweats, pale skin, fatigue, bruising, shortness of breath, dizziness, infections, bleeding gums or nosebleeds, enlarged lymph nodes, a swollen abdomen, and pain in the bones or joints. As leukemia cells increase, there are fewer healthy, mature white blood cells, red blood cells, and platelets.
Diagnosis
Doctors diagnose ALL by using various tests such as a complete blood count (CBC), bone marrow aspiration and biopsy, cell assessments, immunophenotyping, genetic tests, and other specialized tests to inspect the bone marrow or blood for signs of abnormal cells and to identify specific cells.
Treatment
Treatment for ALL has three phases: induction, consolidation, and maintenance, which span around 2 years. Induction therapy aims to stabilize and reduce the number of lymphoblasts and regulate the individual's blood cell production. Children with ALL receive a similar three-phase chemotherapy regime but also receive chemotherapy in the cerebrospinal fluid to kill any cancer cells in the brain and spinal cord.
The treatment for adults with B-cell ALL typically involves long-term chemotherapy. Stem cell transplants are an option for some individuals to replace bone marrow affected by lymphoblasts with healthier, new bone marrow.
Support and Resources
People who have concerns about ALL should contact their doctor or healthcare practitioner for advice. Cancer facilities often have support staff who can direct people to resources and support. In the United States, the Leukemia and Lymphoma Society and American Cancer Society offer support and information for people living with ALL and other types of leukemia.
Prognosis
The prognosis for individuals with B-cell ALL depends on various factors such as age at diagnosis, white blood cell count at the point of diagnosis, and response to chemotherapy. Children and young people are significantly more likely to undergo successful treatment and enter remission compared to adults.
Pfizer's PF-06463922, a BCR-ABL1 inhibitor, has shown promise in preventing relapses in patients with BCR::ABL1-positive B-cell ALL who are naïve to targeted therapy. This medication has the potential to improve health-and-wellness outcomes for these individuals.
While chemotherapy remains the standard treatment for B-cell ALL, it can have severe side effects, particularly in adults. Science is continually working to find alternative treatments that are less toxic, yet effective, to block these side effects and improve the overall treatment experience.
Individuals undergoing treatment for B-cell ALL should be aware that following a healthy lifestyle, including a balanced diet and regular exercise, can support their health-and-wellness during and after treatment. Additionally, maintaining open communication with healthcare providers and being informed about one's medical-conditions and treatment options is essential for making informed decisions about managing one's health.
