ALL in general:
Acute lymphoblastic leukemia is a "liquid" cancer of the blood. ALL is the most common children's cancer. Almost 3,000 cases of childhood and adolescent ALL are diagnosed in the US each year.
Leukemia starts in the bone marrow, the spongy internal part of bones where new blood is made. Leukemia starts when a single, young, white blood cell (a "blast") develops a series of mistakes that allow it to multiply uncontrollably. Eventually, blasts take over the bone marrow and crowd out normal blood cells. One blast soon generates billions of other blasts, with a total of about a trillion leukemia cells typically present in the body at the time of diagnosis.
Blood is made up of three parts. Red blood cells carry oxygen through the body; white blood cells prevent and fight infection, and platelets aid in proper clotting of the blood. Leukemia cells crowd out normal blood cells. This decrease in normal cells produces some or several of the many symptoms of ALL:
--fatigue and paleness from a decrease of red blood cells (anemia)
--fever and infections from a decrease of healthy white blood cells (neutropenia)
--bruising and excessive bleeding from a decrease of platelets (thrombocytopenia)
These symptoms can be the same as those of more common children's illnesses, and many children are treated for those other illnesses before leukemia is diagnosed. Most children with ALL have symptoms for a few weeks to several months before a diagnosis of cancer is made. Diagnosis is made by a blood test and a following bone marrow aspirate.
Current research cannot determine the cause(s) of ALL. All that has been determined is that certain factors can increase one's likelihood of contracting ALL. Children born with genetic syndromes, children born in wealthier countries, the Hispanic and Caucasian races, and males have a slightly higher incidence of ALL.
Treatment of leukemia cannot include surgery as is the case in other cancers. Leukemia must be treated systemically, meaning it affects the entire body. The treatment plan for each patient is determined by many factors at diagnosis--age, prevalence of cancer cells, type of leukemia, chromosomal mutations, and spread of cancer into spine or brain.
Chemotherapy is the mainstay of treatment. Typically three phases of treatment are designed with groups of drugs given orally, intravenously, and/or into the spine over the course of two to three years. Bone marrow aspirates are performed at points along the treatment to determine whether the cancer is in remission and treatment may continue as planned. "Remission" does not mean a cure, because without continued treatment, the cancer will return. In some children's ALL cases, a complete bone marrow transplant is the preferable or necessary treatment to help the patient achieve a cure.
Michael's ALL:
Michael was initially diganosed with ALL. His age (Typically children are two-five when they are diagnosed.) and his gender meant that his treatment would need to be a little more aggressive. Additional testing was done which revealed that his form of ALL had the Philadelphia Chromosome (Ph+ ALL). His leukemia was a result of a recent switching of the the ninth and twenty-second chromosome in his DNA. This mutation causes a creation of a protein which must be inhibited. This Ph+ form of ALL is extremely rare in children (2 to 5% of all cases) and requires a much more aggressive approach. In addition to the traditional chemotherapy to treat the ALL, Michael must take a drug regimen to inhibit this mutation. As recently as three years ago, there were no successful inhibitors available; drugs today have shown the ability to help sixty percent of children achieve long-term remission.
Michael tolerated the first phase of chemotherapy and the inhibitor with great success. At the first bone marrow aspirate, it was determined that he was in remission. The second phase of treatment was much more intense, but it was successful in keeping him in remission. During those weeks, it was discovered that his brother Timothy was a perfect match for bone marrow donation. The decision was made to suspend the remainder of the chemotherapy and inhibitor treatments and rush Michael into a bone marrow transplant while he was still strong and in remission. The first post-transplant tests have shown that the new marrow has engrafted well and that Michael remains in remission; to date, he does not suffer from any of the potentially life-threatening side effects of a transplant. Close monitoring and frequent bone marrow aspirates will continue to mark his progress and determine further treatment.
