MANDY'S ILLNESS

                        Acute Lymphocytic Leukemia (A.L.L)

                                    

From the Leukemia-Lymphoma Society:

Causes and Risk Factors

The current causes of acute lymphoblastic leukemia in children or adults are not known. Scientists
continue to explore possible relationships with life-style or environmental factors but no firm
conclusions have yet been reached... It is extremely disconcerting to patients and their families to
wonder what they may have done differently to avoid the disease. Unfortunately, at the present time
there is no known way to prevent the disease.

Acute lymphocytic leukemia occurs most often in the first decade of life but increases in frequency
again in older individuals.

SYMPTOMS and SIGNS:

Most patients feel a loss of well-being. They tire more easily and may feel short of breath when
physically active. They may have a pale complexion from anemia. Signs of bleeding because of a
very low platelet count may be noticed. These include black-and-blue marks occurring for no reason
or because of a minor injury, the appearance of pinhead-sized, red spots under the skin, called
petechiae, or prolonged bleeding from minor cuts. Discomfort in the bones and joints may occur.
Fever in the absence of an obvious cause is common. Leukemic lymphoblasts may accumulate in the
lymphatic system, and the lymph nodes can become enlarged. The leukemia cells can also collect on
the lining of the brain and spinal cord and lead to headache or vomiting.

Mandy's first symptoms were pain in her hips. It spread to her back and her joints. Also, she was
extremely tired. We did not know but she was also losing blood - when testing was finally done on
her, she was down to just 1 or 2 pints of blood left in her body. By that time, she was hallucinating.

From the American Cancer Society:

PREVENTION:

While some people with acute leukemia have one or more known risk factors, most do not. The cause
of their cancer remains unknown at this time. Even when a patient has one or more risk factors, there
is no way to tell whether it actually caused the cancer. And, many people with one or more cancer
risk factors never develop this disease.

Some people with certain types of cancer have inherited DNA mutations from a parent. These
changes increase their risk for the disease. Acute leukemia is very rarely caused by one of these
inherited mutations.

HOW IS A.L.L TREATED?

Adult acute leukemia (which includes A.L.L.) is not a single disease. It is really a group of diseases,
and people with different subtypes vary in how they respond to treatment.

Treatment options are based on the subtype as well as on certain features of the disease called
prognostic features. These features include the patient's age, white blood cell count, certain test results,
response to chemotherapy, and whether or not the person has been treated earlier for another cancer.

CHEMOTHERAPY

Chemotherapy refers to the use of drugs to kill cancer cells. Usually the drugs are given into a vein
or by mouth. Once the drugs enter the bloodstream, they spread throughout the body. Chemotherapy
is the main treatment for acute leukemia.

For A.L.L, chemotherapy treatments are given in the following phases:

Induction: In general, the purpose of the first phase, called induction, is to destroy as many cancer
cells as quickly as possible and bring about a remission.

Consolidation: The goal of this phase is to get rid of leukemia cells from places where they can "hide."

Maintenance: Once the number of leukemia cells has been reduced by the first two phases of
treatment, this last phase can begin. Maintenance, which usually consists of lower doses of
chemotherapy drugs, lasts about two years.

Central Nervous System treatment: Because A.L.L. often spreads to the coverings of the brain and
spinal cord, patients often receive chemotherapy in the spinal fluid or radiation therapy of the head as
a method of prevention.

Mandy was given several rounds of chemotherapy. She also had multiple blood transfusions.
Ultimately, though, nothing worked. According to the doctors, Mandy's cancer was especially
vicious. Each time she would head towards remission, she would take another turn for the worse.