ALL: A LOOK INTO ACUTE

LYMPHOBLASTIC LEUKEMIA
| Erica Lacap | Friday May 22, 2015 | Period 4 | John Choi | Biology | Da Vinci Science |

HISTORY OF THE CELL

Growth for the sake of growth is the ideology of the cancer cell.
Edward Abbey
Acute Lymphoblastic Leukemia is cancer in the
blood and bone marrow where the blood cells are
made (see Fig 1). The reason why this leukemia is
acute is because the cancer rapidly creates immature
white bloods cells versus mature ones. This causes
lymphoblasts to become over produced in the bone
marrow and thus causing damage and death to normal
Fig 1 | Image of Bone Marrow
This is where the cancer starts and then
spreads. The dark purple cells are cancerous
cells.

cells such as: red blood cells, white blood cell, and
platelets. ALL affects white blood cells called

lymphocytes. It is most common in children (2-5 years old) and may also happen in adults, but
they have a lower chance to be cured (Seiter 2014). Cure for of affected children have been
achieved over 80%, while for adults, the numbers are lower at 20-40% (Seiter 2014).

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BACKGROUND OF ALL
Some of the symptoms of this cancer include bleeding,
bruising, fever, infections, constant weakness, fatigue, loss
of appetite, aches in bones and joints, swollen lymph nodes
(oval-shaped organ in charge of acting as filters for forging
Fig 2 | Swollen Lymph Nodes
This is one of the symptoms of ALL.

particles and cancer cells)(see fig 2), weight loss, night

sweats (excess sweating occurring during the night),

swelling in your abdomen, and trouble breathing.

Since Acute Lymphocytic Leukemia does not form tumor masses, the way to see the
cancer spreading is through the bone marrow and possibly many organs like: the liver, spleen,
and lymph nodes (cancer.org). There is no staging for ALL. Instead, treatment is determined by
age and the results of tests. There are many ways to classify and diagnose ALL: Blood tests,
bone marrow tests, chromosome testing, Lumbar puncture (spinal tap), Lymph node biopsy, and
imaging tests (such as x-rays). Blood tests look at the number of red blood cells, white blood
cells, and platelets (colorless blood cells that help blood clot) we
have (see fig 3). Majority of the patients have too many
immature white cells in their blood and not enough red blood
cells or platelets. These immature white blood cells are also
called lymphoblasts, hence the name of the cancer. These
lymphoblasts arent normally found in the bloodstream and will

Fig 3| Leukemia White Blood cells

This is what a patients cells look
like. Over population of immature
white blood cells.

not work like the mature white blood cells. For bone marrow tests, a pathologists looks at the

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bone marrow under a microscope to look at the white blood cells to classify their size, shape, and
other traits (cancer.org).
Immunophenotyping, is used to study the protein in cells. It labels white blood cells with antibodies in them. Because of this, the difference of leukemic cells can be precisely determined (University
of Medicine & Dentistry of New Jersey). When doing these studies, we look at two types of cells, B-cells
and T-cells. B lymphocytes (B Cells) are made and mature in the bone marrow. Their main job is to make
antibodies against antigens and making memory B cells. T lymphocytes (T cells) move to the thymus (an
organ in the immune system that helps the body adapt to foreign invaders) prematurely and then mature
there. T cells are in charge of cell-mediated immunity.

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ENVIORNMENTAL AND GENETIC

CAUSES
One risk for ALL is radiation exposure. An example of this are the Japanese atomic bomb
survivors. But it can also be on the smaller side of the scale (but have not been very common).
For example, exposure as a fetus during the first months of development can increase your risk
to getting ALL. Certain chemicals can also increase your risk of ALL such as benzene. Benzene
is found in oil refineries, chemical plants, shoe manufacturing plants, along in cigarette smoke,
glues, cleaning products, detergents. Art supplies, and paint strippers.
ALL doesnt seem to be an inherited disease because it doesnt
seem to run in families, but certain syndromes with genetic changes
raise the risk of ALL. These include: Down syndrome, Klinefelter
syndrome, Fanconi anemia, Bloom syndrome, Ataxia-telangiectasia,
and Neurofibromatosis.
Fig 4 | Apoptosis
Apoptosis is a form of rapid
cell growth. Here is a diagram
showing the process.

Oncogenes are genes that have the potential to cause cancer.

Tumor cells are mutated at high levels. Normal cells experience apoptosis, which is a form of
rapid cell death (see fig 4). A tumor suppressor gene is also known as an anti-oncogene. There
are three categories: caretaker genes, gatekeeper genes, and landscaper genes. Caretaker genes
are in charge of encoding products that stabilize the genome, the genetic material of an organism
(DNA). Tumor cells are able to grow from two mistakes caused by the caretaker gene: changes
in the nucleotide sequence of DNA and the improper rearrangement of chromosomes.

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An example of an oncogene is BCL-2. It delays apoptosis in lymphohematitopoietic cells.

It influences the survival of B-cell progenitors (a cell that has tendency to differentiate into a
specific cell) and explains why lymphoblasts expand outside of the bone marrow.

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TREATMENT AND NEXT STEPS

We may never understand illnesses such as cancer. In fact, we may never cure it. But an ounce
of prevention is worth more than a million pounds of cure.
David Agus
There are many ways to treat ALL. One of the biggest ones is chemotherapy.
Chemotherapy happens in three phases: remission induction, intensification, and maintenance
therapy. During remission induction, the goal is to kill off the tumor cells quickly to get the
patient into remission. The presence of the leukemic blasts in the bone marrow must be 5%.
Intensification is when they use high doses of multidrug chemotherapy to further reduce the
tumor burden. Some centers deliver it through under the scalp or through lumbar punctures.
Maintenance therapys goal is to kill any cells that were not previous killed off in the first two
stages. Even though the number of cancerous cells may be low, if they are not killed off, the
patient may relapse (Hoffbrand 2006). Radiation (also known as radiotherapy) is applied is on
painfully bony areas or in high disease burdens. It is used to kill malignant cells using ionizing
radiation. It has been used before, during, and after chemotherapy.

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PERSONAL JOURNEY
When I found out we were learning about cancer in class, I was both excited and really
sad at the same time. I believe that caner does obviously hinders your ability to do things, but it
also helps you have a different outlook in life. Being surrounded by people of multiple cancers, I
had the struggle of picking what cancer I wanted to research. Having our fishbowl conversation
about caner was really hard for me to listen to because Ive had so many people I love die from
all sorts of cancers. I thought about it long and hard and realized that I wanted to research ALL
because Mr. McGregors son was recently diagnosed with ALL. Also, my childhood friend,
Kayle, lost the battle last year.
While doing the interview with the cancer, my patient hit a lot of big themes. She stated
that, I didnt want to be a burden to people, so I tried my best to be strong. There were days I
didnt want to get up, but I did anyways. I thought this was so profound. Pretty much what shes
saying is that there are two ways you can view the cancer: you can use it as a motivator to get
better, or you can let it defeat you and just lounge around and do nothing. She chose the first path
and thats why shes still here today. What Ive learned though the cancer survivor is that you
always have to stay positive, no matter what. Staying positive has such and impact on yourself
and the people around you. If you are able to confidently say, Yeah, I have cancer. And yeah, I
may be scared. But, Im not gonna let that keep me from doing things that I love. Its not gonna
stop me from being around the people I love, then youve already made such a difference in
your life. Youll fill yourself and your life with love. And I think thats the most important thing
to keep in mind in general, not just pertaining to cancer patients.

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REFERENCES
I.

Department of Hematology-Oncology, St Jude Children's Research Hospital, Memphis,

TN 38101. http://www.ncbi.nlm.nih.gov/pubmed/8427984

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II.

Seiter, K (5 February 2014). Sarkodee-Adoo, C; Talavera, F; Sacher, RA; Besa, EC, ed.
"Acute Lymphoblastic Leukemia". Medscape Reference. WebMD. Retrieved 17 April
2014. http://emedicine.medscape.com/article/207631-overview#showall

III.

American Cancer Society

http://www.cancer.org/cancer/leukemiaacutelymphocyticallinadults/detailedguide/leukemia-acute-lymphocytic-classified

IV.

American Cancer Society

http://www.cancer.org/cancer/leukemiaacutelymphocyticallinadults/detailedguide/leukemia-acute-lymphocytic-classified

V.

Hoffbrand, Victor; Moss, Paul; Pettit, John (31 October 2006). Essential Haematology. Wiley.
ISBN 978-1-4051-3649-5. Retrieved 14 September 2013.

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