acute lymphoblastic leukemia (ALL), a hematologic, malignant disease characterized by large numbers of lymphoblasts in the bone marrow, circulating blood, lymph nodes, spleen, liver, and other organs. The number of normal blood cells is usually reduced. More than three fourths of cases in the United States occur in children, with the greatest number diagnosed between 2 and 5 years of age. The risk of the disease is increased for people with Down syndrome and for siblings of leukemia patients. Also called acute lymphocytic leukemia. ▪ OBSERVATIONS: The disease has a sudden onset and rapid progression marked by fever, pallor, anorexia, fatigue, anemia, hemorrhage, bone pain, splenomegaly, and recurrent infection. Blood and bone marrow studies are used for diagnosis and for determination of the type of proliferating lymphocyte, which may be B cells, T cells (which usually respond poorly to therapy), or null cells that lack T or B cell characteristics. ▪ INTERVENTIONS: Treatment includes intensive combination chemotherapy, therapy for secondary infections and hyperuricemia, and intrathecal methotrexate. ▪ PATIENT CARE CONSIDERATIONS: The diagnosis of leukemia usually causes fear and anxiety. The coordinated support of the health care team is essential. When the patient is a child, it is important to determine the child’s stage of development and relationships with parents, caregivers, or grandparents, in addition to preventing infection and monitoring the impact of medications and the the effect of the disease itself. Establishing a plan that includes age-appropriate activities, as well as including the patient and family in planning, will facilitate adjustment and maintenance of the quality of life for patients of all ages.
