Consultants Responsible for the Program
- Head of Pediatric Oncology and Malignant Hematology Department, Shefa Al-Orman Oncology Hospitals
- Assistant Professor of Pediatric Oncology, Malignant Hematology & Stem Cell Transplant, South Egypt Cancer Institute, Assiut University
- Consultant of Pediatric Oncology and Malignant Hematology, Shefa Al-Orman Oncology Hospitals
- Lecturer of Pediatric Oncology, Malignant Hematology, South Egypt Cancer Institute, Assiut University
- Consultant of Pediatric Oncology and Malignant Hematology, Shefa Al-Orman Oncology Hospitals
- Lecturer of Pediatric Oncology, Malignant Hematology, South Egypt Cancer Institute, Assiut University
Prof. Mohamed Mahmoud AbdElhakim
- Professor of Radiation oncology, National Cancer Institute, Cairo University, Cairo, Egypt
- Head of Radiation Oncology Department, Shefa Al Orman Oncology hospitals, Luxor, Egypt
- Head of Radiation Oncology Department, Gharbia cancer society
- Consultant of Rheumatology, Physical medicine
Acute Lymphoblastic Leukemia
o In leukemia, cancer cells grow rapidly in the bone marrow. When this happens, healthy blood cells — white blood cells, red blood cells, and platelets — cannot do their jobs correctly.
Incidence
Symptoms of Acute Lymphoblastic Leukemia
Risk factors for acute lymphoblastic leukemia
Most cases of ALL have no known cause. Certain inherited syndromes are linked to an increased risk of ALL:
Diagnosis of acute lymphoblastic leukemia
Physical exam and health history
During the exam and history, the provider will:
Blood and bone marrow tests
A provider will draw blood to run tests. These tests include: · Complete blood count – This test checks the counts of different types of blood cells. In ALL, the blood may have too many white blood cells. Many of these cells will be cancer cells. · Blood chemistry studies – This test checks the amounts of certain substances in the blood. An unusual level (either higher or lower than normal) can be a sign of disease.
Tests after ALL diagnosis
If leukemia is found, the care team will run more tests.
These include lab tests to identify specific genes, proteins, and other factors involved in the leukemia.
This is important because cancer is caused by mistakes (mutations) in the cell’s genes. Identifying these mistakes may help diagnose the specific subtype of leukemia.
Doctors use these details to choose treatment options tailored to your child’s case.
The care team also will run tests to find out if cancer is in other parts of the body:
Lumbar puncture A lumbar puncture will show if leukemia has spread to the brain and spinal cord. The test is also called an LP or spinal tap.
Patients may get chemotherapy at the same time this is done. This is called prophylactic intrathecal chemotherapy. It is given to prevent ALL from spreading to the cerebrospinal fluid.
Chest x-ray A chest x-ray will show if leukemia cells have formed a mass in the middle of the chest.
Other imaging tests and laboratory tests Other imaging studies and laboratory tests may be used if patients have certain signs and symptoms.
A female patient of childbearing age may have a pregnancy test.
A male patient may have an ultrasound to check for testicle involvement. This is rare in ALL. It happens in 1–2% of males.
Fertility counseling
The care team may discuss fertility with you and/or your child
Phases of treatment
Week 1
Treatment prep
Doctors gather information to help plan treatment. · Blood tests
Next 4–6 weeks (Induction phase)
Doctors will look at several factors to plan next steps:
Next 8–16 weeks
Consolidation/intensification phase
This phase uses a different combination of drugs to destroy any remaining cells. It may require hospital stays.
Next 2–3 years
Maintenance/continuation phase
If the leukemia stays in remission, maintenance therapy can begin. Its goal is to destroy any leukemia cell that might remain after the first 2 phases.
Patients will likely have weekly chemotherapy and blood tests with periods of high-dose chemotherapy known as reinduction.
The first 6–9 months of this phase is usually intense. Often patients can return to school after 6–9 months.
Follow-up schedule
Year 1
The patient will return for follow-up visits once every 1–4 months.
These visits may include:
Year 2
Follow-up visits may change to once every 6 months.
Years 3-5
Follow-up visits may change to once a year.
Stem cell (bone marrow) transplant for acute lymphoblastic leukemia A stem cell transplant may be recommended for children who are at high risk for relapse or whose treatment does not work. Patients must be medically able and have a suitable donor.
Doctors sometimes look at how well induction chemotherapy worked to decide whether a transplant is needed.
Radiation therapy for acute lymphoblastic leukemia
Radiation is rarely used in ALL treatment. It may be given in cases where ALL has spread to the brain, spinal cord, or testicles.
Radiation may also be given to prepare patients to receive a stem cell transplant.
Minimal residual disease and ALL
Minimal residual disease (MRD) is a term used when there are so few leukemia cells in the bone marrow that they cannot be seen under a microscope.
Highly sensitive tests can detect 1 leukemia cell in 10,000–1 million normal cells in the bone marrow.
Children who have positive MRD (more than 1 cell in 10,000) after induction therapy are at the greatest risk of relapse. The timing of MRD measurement varies depending on the center.
Acute Lymphoblastic Leukemia Diagnosis Program
The program includes:
o complete blood count
o biochemical blood test
o inflammation markers (CRP, ESR)
o blood coagulation analysis (aPTT, PT, INR)
o differential blood count
o Hepatitis & HIV markers
o histological study
o immunohistochemical study
o molecular & cytogenetic analysis (karyotyping, t(12;21), t(9:22), MLL gene re-arrangement, t(1;19) )
o cardiologist
o otolaryngologist
o immunologist
Required documents
Type of program : Inpatient
Expected duration of the program: 7 days
High-intensity induction chemotherapy of acute lymphoblastic leukemia with complications
o complete blood count
o general urine analysis
o biochemical analysis of blood
o differential blood count
o indicators of inflammation
o indicators blood coagulation
Required documents
Expected duration of the program: 42 days
Consolidation treatment for acute lymphoblastic leukemia
The program includes:
o complete blood count
o biochemical analysis of blood
o TSH-basal, fT3, fT4
o differential blood count
o inflammation indicators (CRP, ESR)
o indicators blood coagulation
o cardiology
o otolaryngology
o immunology
o ophthalmology
Required documents
Type of program : Inpatient
Expected duration of the program: 60 days
Radiation therapy of brain in acute lymphoblastic leukemia (ALL) with brain damage
The program includes:
o complete blood count
o biochemical analysis of blood
o TSH-basal, fT3, fT4
o differential blood count
o inflammation indicators (CRP, ESR)
o indicators of blood coagulation
o cardiology
o otolaryngology
o immunology
o ophthalmology
How program is carried out
During the first visit, the doctor will conduct a clinical examination and go through the results of previous laboratory tests and instrumental examinations. After that, you will undergo an additional examination, including complete blood count, laboratory assessment of liver and kidney function. Based on the received results, the physician will conduct radiotherapy planning with the help of CT or MRI, make the permanent tattoo marks on the skin and conduct CT simulation in order to assess the accuracy of the rays and the radiation dose. If necessary, related medical specialists will be involved in the elaboration of a treatment regimen (tumor board).
Each radiation therapy session lasts less than half an hour (including preparation). All this time, doctors and nurses are monitoring your condition, you can communicate with them through a loudspeaker. The procedure is completely painless. Depending on the planned course of treatment, you will have from 1 to 3-5 sessions of radiation therapy a week.
After the completion of the radiation therapy course, you will undergo control examinations aimed at assessing your condition and efficacy of treatment. After that you will receive the medical report with detailed recommendations regarding further follow-up and treatment. In the future, you will be able to have a distant consultation with your attending physician and schedule the next course of treatment, if necessary.
Required documents
Type of program : Inpatient
Expected duration of the program: 31 day
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