Understanding Acute Lymphoblastic Leukemia: Current Insights and Treatment Advances

Acute lymphoblastic leukemia is a cancer that mostly affects lymphocytes, which are immune cells found in white blood cells. It is widely seen in children, but it also has the potential to affect adults.

The fast growth of immature white blood cells known as lymphoblasts, created in the bone marrow, is the identification marker of the disease. The generation of mature white blood cells, platelets, and red blood cells will eventually decline due to these unusual cells.

Symptoms 

• You may experience easy bruising or bleeding

• Individuals will feel fatigue and weakness

• Development of bleeding from the gums

• You may experience frequent and recurring infections

• Individuals will develop bone pain

• Swelling of lymph nodes occurs, especially in the neck, armpit, abdomen, and groin.

• You may appear pale due to loss of blood cells

• Individuals will feel the loss of weight

Treating acute lymphoblastic leukemia:

There are a variety of treatment options available for acute lymphoblastic leukemia, including the conventional standard treatment options that are currently being used and some others being under clinical investigation or under trials.

Phases of ALL Treatments

• Remission induction therapy: 1st phase of treatment that kills most of the tumor cells in blood and bone marrow.

• Post-remission therapy: It is started after remission, and the goal is to kill the leftover leukemia cells that may pose a threat in developing into tumor cells.

• Maintenance therapy: the drugs are given at a lower dose for a prolonged time to prevent the cancer cells from regrowing.

Current treatment options and advancements: 

Chemotherapy: It is a cancer treatment that employs the use of drugs to either stop the growth or kill the tumor cells and prevent them from multiplying is chemotherapy. Drugs can be administered in many ways, such as systemic chemotherapy, where the drug acts on the cancer cells through an oral or intramuscular/ intravenous route. The intrathecal route involves administering drugs directly via spinal fluid through the spinal cord. Newer advances include using multiple combinations of chemotherapeutic drugs that have now yielded more effective and less toxic regimens. 

Certain drugs like peg l-asparaginase are actively being employed in treating acute lymphoblastic leukemia that essentially blocks the asparagine that is needed for the survival of tumor cells.

Targeted therapy:  Targeted therapy refers to medications that specifically target chemicals or processes involved in the growth and development of cancer cells. Monoclonal antibodies aid the immune system in identifying and getting rid of dangerous cells by targeting the proteins on the surface of tumor cells. Tyrosine kinase inhibitors block the formation of newer lymphoblasts and the activity of tumor cells.

Immunotherapy: It is a treatment approach that uses the patient's immune system to fight effectively against cancer cells. Newer approaches involve the use of CAR T cell therapy. This method uses the patient's T cells that are genetically modified outside the laboratory. By adding special receptors, they become chimeric antigen receptor T cells that are reinfused into the patient's bloodstream by infusion. This method has been known for its increased efficacy and safety, particularly in patients with relapsed acute lymphoblastic leukemia.

Radiation therapy: The employment of high-power energy rays to kill cancer cells. This method is employed when the cancer cells have begun to spread to the brain and spinal cord. It is also used as palliative care to improve the symptoms.

Precision medicine approaches: Various advanced treatments using genomic sequencing techniques and flow cytometry techniques have laid a path in the detailed immunophenotypic profiling of leukemia cells. These techniques contribute to a good understanding of leukemia and enable the physician to provide a precision medical treatment.

Conclusion: 

In a modern medical world where the treatment approaches have developed in a more advanced manner, there are certain times when the increased resistance and genetic factors involved in the development of acute lymphoblastic leukemia facilitate the need for multifaceted approaches, and further clinical trials are needed to reduce the treatment-related side effects and improved quality of life.