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Acute Lymphoblastic Leukemia in Infancy

Acute Lymphoblastic Leukemia (ALL) is a blood cancer that originates in the bone marrow of the body. The word “acute” in ALL refers to the fact that the disease progresses rapidly and creates immature white blood cells, leaving no space for the mature cells that perform normal functions. This type of blood cancer affects the white blood cells called the lymphocytes. It is the most common type of cancer in children, and the chances of cure are higher. In adults, the chances of cures are lesser. 


Like most types of blood cancer, Acute Lymphoblastic Leukemia is also majorly due to a genetic mutation in a person’s body that causes the white blood cells to grow at an abnormally fast rate that, crowds out the healthy white blood cells. These rapidly growing white blood cells are immature and also don’t perform the normal functions of a white blood cell. The root cause and reason for why the genetic mutation that turns normal cells into cancerous cells is still unknown. 


Since the onset of Acute Lymphoblastic Leukemia is relatively rapid, the symptoms are also severe and quick to appear. Symptoms of Acute Lymphoblastic Leukemia are bleeding of the gums and frequent and severe nosebleeds, including lumps and blood clots caused by swollen lymph nodes in and around the neck, abdomen, armpit and also groin area. Moreover, some of the other common symptoms include fever, shortness of breath, bone pain along with weakness, fatigue and a general decrease in tiredness. 

Acute Lymphoblastic Leukaemia in infants

Although ALL is more common in children, it is quite rare among infants. Studies in the USA show that less than 90 infants a year have Acute Lymphoblastic Leukemia, which constitutes 3% of all childhood cases of ALL. Research shows that even the most prominent pediatric centres in the USA only see very few points of ALL in infants less than a year old. 

Diagnosis of Acute Lymphoblastic Leukemia in Infants

ALL in infants are biologically completely different from ALL in older children and usually more aggressive. Diagnosing Acute Lymphoblastic Leukemia in infants involves a series of tests, including physical examination, analysis of the patient’s medical history, bone marrow aspiration and biopsy and lumbar puncture. Bone marrow aspiration and biopsy is the sampling of the bone marrow tissue of the patient. This is so that the cancer cells are in close observation and the patient receives an accurate treatment. 

Treatment for Acute Lymphoblastic Leukaemia in Infants

 The most mainstream treatment for ALL infants involves chemotherapy with various medicines, and in some cases, the patients receive bone marrow transplants or stem cell transplants. The doctors prefer to take an approach that usually analyses the risk of relapse in a patient and adjusts the intensity of treatment according to those factors. 

There are a few factors that are taken into consideration before the patient receives treatment. The response a patient has to the treatment and the time they take to respond to the therapy is considered. The patients that take lesser time to respond to treatment are considered to be low-risk patients and are given treatment that is less intense than that of high-risk patients.

The age of the patient is also taken into account since infants who are closer to the age of 1 respond better to treatment than infants who are younger than six months. The white blood cell count is also taken into consideration since a higher white blood cell count can cause a poorer response to treatment. Another critical factor that is looked at is the MLL rearrangement in the infant’s genes. MLL rearrangement is a genetic alteration in the infant that reduces the response to treatment while increasing the chance of relapse in the patient. MLL rearrangement is in up to 80% of infants who have ALL.

Side effects caused by treatments

While the side effects can vary according to the patients and the type of treatments that they receive, there are a few common factors that infants are more vulnerable to, such as infections, particularly affecting the respiratory system, toxic effects on the liver and kidney of the patient due to chemotherapy and some damage on the central nervous system. While these side effects are typical in infants with ALL, the care team who observes the patient through the treatment will work with the families to reduce the impact as much as possible and also monitor the treatment. 

 Further research on ALL

While the survival rate of infants with ALL is less than 50%, and the risk of relapse is also high in comparison to other types of cancer, there is a lot of groundbreaking research that is happening. This includes integrating various new ways of treatments that are less invasive along with traditional chemotherapy. The standard chemotherapy drugs that are used to treat ALL infants are being combined with newly evaluated drugs and are being used in clinical trials to improve the quality and effectiveness of the medicine. 


Acute Lymphoblastic Leukemia (ALL) in Infants. (2018, December). St. Jude together. https://together.stjude.org

Childhood acute lymphoblastic leukaemia treatment (pdq®)–patient version. (2020, December 10). National Cancer Institute. https://www.cancer.gov/types/leukemia/patient/child-all-treatment-pdq

Firas El Chaer, Karen K Ballen, & Michael Keng. (2020, April). MLL-Rearranged Acute Lymphoblastic Leukemia. PubMed.

Lewis B Silverman. (2007). Acute lymphoblastic leukaemia in infancy. PubMed.

St. Jude Children’s Research Hospital. (2022, April 12). Total therapy for infants with acute lymphoblastic leukaemia (ALL) I. ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT02553460

Susan R. Rheingold. (n.d.). Acute lymphoblastic leukaemia (ALL). Children’s Hospital of Philadelphia. https://www.chop.edu/conditions-diseases/acute-lymphoblastic-leukemia-all


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