All about ALL

Since Jack's diagnosis, friends and family have wanted to know more about the type of leukemia Jack has and what his medical treatment involves. Below is a summary taken from documentation Anneli and Damond received from the hospital.

Jack has acute lymphoblastic leukemia (ALL). ALL is a cancer of the blood cells. It develops in the bone marrow, which is the soft tissue in the center of bones where blood cells are made. ALL is a cancer in which young, abnormal, infection-fighting white blood cells, called 'blasts', crowd out normal bone marrow cells and spread into the blood stream. Blasts can also spread to the brain, spinal cord, testicles, and other organs.

Jack has leukemia that is classified as Standard Risk (SR) because his white blood cell count is less than 50,000/microliters and he is at least one year old and less than ten. Based on his diagnosis of Standard Risk B-precursor ALL, the Bailey's were invited to enroll Jack in a clinical trial research study organized by Children's Oncology Group (COG). COG is an international research group that conducts clinical trials for children with cancer. The overall goal of the study is to see if the doctors can get rid of the cancer for as long as possible with acceptable side effects of therapy.

The family consented to participate in the clinical trial. The first stage of treatment is called Induction. The leukemia treatment in this stage is the same for patients who choose to be in the clinical study and those who do not. During Induction, the doctors try to remove all visible signs of leukemia and allow normal blood cells to be restored (this is called remission). Five chemotherapy drugs are used during this stage of treatment.

The five chemotherapy drugs are:
1. Cytarabine, which is a drug used to treat the brain and spinal cord and is given using a needle inserted into the fluid surrounding the spinal cord.
2. Vincristine, which is a drug given intravenously.
3. PEG Asparaginase, which is a drug given using a needle injected into the muscle.
4. Dexamethasone, which is a liquid steroid drug given orally twice daily.
5. Methotrexate, which is another drug used to treat the brain and spinal cord and is given using a needle inserted into the fluid surrounding the spinal cord.

Common side effects of the cancer treatment include nausea, vomiting hair loss, and fatigue. The most common serious side effect is lowering of the number of blood cells resulting in anemia, increased chance of infection, and bleeding tendency. In addition, risks associated with the drugs used include increased toxicities that can cause infections or make it harder to fight off infections, loss of healthy blood cells, and damage to bones or joints.

Induction lasts 5-7 weeks, and by the end of Induction, Jack's doctor will know the subtype of the ALL. During Induction, tests will be done on Jack's bone marrow samples to find out how well the treatment is working. These measurements will assess Jack's response to treatment and determine if stronger therapy is needed to reach and maintain a remission. (Patients are either classified as rapid early responders (RER) or slow early responders (SER). RER patients respond to treatment more quickly and go into remission faster, resulting in fewer courses of chemotherapy. SER patients respond to treatment more slowly and take longer to go into remission, resulting in more courses of chemotherapy.) Jack's bone marrow will also be tested at the end of Induction. Hopefully, there will be no more leukemia cells in the bone marrow, and the disease will be in remission.

Based on the study, the doctors should know how strong the rest of Jack's treatment needs to be to keep the leukemia in remission. Once the study doctors know the ALL subtype and how much leukemia is left in Jack's bone marrow, he may continue in Part II of the clinical trial for the next phase of therapy, called Consolidation. We'll summarize that phase when we get to it.

For even more information, you can download the COG Family Handbook for Children with Cancer by clicking here. You can also visit the National Cancer Institute website by clicking here.