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Lymphoblastic Leukemia

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Researchers Robert Peter Gale and Anna Butterini (1988) remark that "There is substantial progress in understanding and treating acute lymphoblastic leukemia (ALL)" (p. 299). Nevertheless, many interesting and controversial issues remain, including: (1) What accounts for the special age distribution in ALL? (2) In what cells does transformation occurs? (3) Does a pre-leukemia phase precede ALL? (4) Are there ALL stem cells? (5) Why is the cure rate in ALL so much higher than most other cancers? (6) Is it necessary to eradicate all ALL cells to cure ALL? (7) Are children with standard-risk ALL currently undertreated? (8) Will more intensive chemotherapy cure more high-risk children and adults with ALL? (9) What are the roles of allogeneic and autotransplantation in ALL? (10) How are persons 16-22 years of age best treated? (11) What are the new therapeutic approaches? There are many more unknowns to be solved before medicine can eradicate the scourge of leukemia.

Just as important and perhaps even as nebulous are the expectancies of long-term pathological effects from current therapies. Green et al. note that: "Many patients who have been treated successfully for childhood cancer with regimens that contain one or more mutagenic chemotherapeutic agents are concerned that their own treatment during childhood or adolescence may adversely affect their children" (141). A number of studies have been carried out with a view to obtaining information about

. . .
earning disabilities, difficulty in keeping up with school work and completing classroom assignments. Children with cancer appeared underactive, socially isolated, self-conscious, and less expressive of their emotions than the control children. These are, of course, ratings by teachers, i.e. subjective observations usually quantified by the academic grading system (p.89). Cognitive and Neurological Effects Perhaps the most common observation regarding the long-term effects of ALL treatment in children has been in the area of cognition. Treatment-related cognitive impairments have been reported for suvivors of childhood leukemia following central nervous system treatment. Significant declines have been found at the four to five year follow-up period on intelligence scores. Children less than seven years at diagnosis and treatment have exhibited greater declines on tasks measuring quantitative abilities than children older at diagnosis. Children with lower Verbal scores at diagnosis have exhibited greater declines on their Verbal scores at the follow-up period. Overall, declines observed after one year related to declines following the four to five year period. These observations suggest that survivors of childhood leukemi
. . .

Some common words found in the essay are:
Carey Burnish, Robison Nesbit, HCL CLL, Anna Butterini, Initial CNS, Oliff Levine, Children IQs, Pless Pinkerton, Smith Grobstein, York City, et al, nervous system, central nervous, central nervous system, acute lymphoblastic leukemia, lymphoblastic leukemia, acute lymphoblastic, bone marrow, childhood leukemia, system treatment, nervous system treatment, late effects, children cancer, acute myeloid leukemia, nervous system therapy,
Approximate Word count = 8235
Approximate Pages = 33 (250 words per page)

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