Q. My 2-year-old niece has been diagnosed with ALL. I would appreciate any information you can provide on the topic, including when she will need a bone marrow transplant and how much time she has before she starts treatment.
A. My heart goes out to your niece and all her family. The treatment of cancer is a difficult process for adults, let alone a young girl.
Acute lymphoblastic leukemia (ALL) is a life-threatening disease affecting the bone marrow. In ALL, cells that would normally develop into lymphocytes become cancerous, accumulate in the bone marrow and replace normal bone marrow cells that produce healthy red cells, white cells and platelets. These cancerous cells also can invade other organs, including the liver, spleen, lymphatics, kidneys, brain and reproductive organs.
ALL is the most common cancer of childhood. It constitutes about 25 percent of all cancers diagnosed in children under age 15. About 85 percent of people diagnosed with ALL are between the ages of 2 and 10. It also accounts for 20 percent of the leukemia that occurs in adults.
This form of leukemia is diagnosed by doing a complete blood count that includes a differential count, which is counting the various kinds of white cells. This is followed by testing the bone marrow. Almost all people with ALL show a decrease in at least one type of blood cells, and most show a decrease in at least two. The bone marrow is filled with a large number of abnormal-looking white cells.
Many symptoms occur because the bone marrow is not producing enough healthy cells. Signs of anemia occur because too few red blood cells are produced. Bleeding is seen because too few platelets are produced. Infections and fever occur because too few healthy white cells are produced.
In almost all cases, intensive chemotherapy with multiple drugs should be started immediately. This is immediately followed by chemotherapy for the brain and the central nervous system. Treatment for this potentially serious condition includes injection of the right combination of drugs directly into the spinal fluid and radiation of the brain. Maintenance chemotherapy then takes place for two to three years.
Thankfully, more than 70 percent of children receiving combination chemotherapy are cured of ALL. Younger children, those with lower numbers of white cells in the blood and those with certain genetic markers on the cells, have a more favorable outcome.
Although current treatment is much more successful than in the past, there is more than a 10 percent chance that the cancer will return. In relapse, the leukemic cells begin to appear again, often in the bone marrow, brain and, in the case of boys, the testes.
Bone marrow transplants aren't often used as the initial treatment for ALL, because the chemotherapy works well. However, bone marrow transplants are virtually the only chance for someone who relapses during or after treatment with chemotherapy.
Treatment of ALL is much more than simply trying to eradicate the cancerous white blood cells. Treatment also may require red blood cell transfusions for anemia, platelet transfusions to control bleeding and/or antibiotics to treat infection.
Above all, treatment must include a lot of love, support and caring for the person with the disease and everyone else involved. Many people have found that being involved in a support group is a tremendous benefit.
Write to Dr. Douma in care of the Chicago Tribune, Room 400, 435 N. Michigan Ave., Chicago, IL 60611.