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(ALL) Acute lymphocytic leukemia : Causes, Types, Symptoms, Diagnosis ,Treatment , Risk factors , Complications , Prevention

What is(ALL) Acute lymphocytic leukemia?

Acute leukemia (ALL) may be a variety of cancer of the blood and bone marrow the spongy tissue inside bones wherever blood cells are made.  The word "acute" in acute leukocyte leukemia comes from the fact that the sickness progresses through space and creates immature blood cells, instead of mature ones. The word "lymphocytic" in acute lymphocytic leukemia refers to the white blood cells known as lymphocytes, that ALL affects. Acute lymphocytic leukemia is additionally called acute lymphoblastic leukemia.  Acute lymphocytic leukemia is that the most typical type of cancer in children, and coverings result in a good chance for a cure. Acute leukemia may also occur in adults, although the prospect of a cure is greatly reduced. 

  • Acute lymphocytic leukemia (ALL) is a type of cancer that affects the white blood cells and bone marrow. It is the most common type of leukemia in children, but can also occur in adults. In ALL, the bone marrow produces a large number of abnormal, immature white blood cells, termed lymphoblasts. These cells crowd out healthy blood cells and prevent them from functioning properly.

  • Acute lymphocytic leukemia (ALL) is a form of cancer that affects the body’s white blood cells. These white blood cells are called lymphocytes and are responsible for fighting infections. The cancer starts in the bone marrow and quickly spreads to other parts of the body. With ALL, the bone marrow produces too many abnormal lymphocytes which can’t fight off infections.


(ALL) Acute lymphocytic leukemia


Medical term

Cancer begins once cells within the body begin to grow out of control. There are several types of cancer. Cells in nearly any part of the body can become cancerous. To be told additional regarding cancer and the way it starts and spreads, see What's Cancer?  Leukemias are cancers that start in cells that might unremarkably grow to be differing types of blood cells. Most often, leukemia starts in early forms of white somatic cells, but some leukemias begin in different blood cell types.  There are many styles of leukemia, that are divided based mostly chiefly on whether or not the leukemia is acute (fast growing) or chronic (slower growing), and whether it starts in myeloid cells or liquid body substance cells. Knowing the particular variety of leukemia helps doctors better predict every person’s prognosis (outlook) and choose the simplest treatment.  Acute leukemia (ALL) is additionally known as acute lymphoblastic leukemia. “Acute” means the leukemia will progress quickly, and if not treated, would most likely be fatal inside a few months. "Lymphocytic" means it develops from early (immature) forms of bodily fluidocytes, a kind of white blood cell. ALL begins within the bone marrow (the soft inner part of sure bones, wherever new blood cells are made). Most often, the malignant neoplastic disease cells invade the blood fairly quickly. They will also typically unfold to different components of the body, as well as the lymph nodes, liver, spleen, central system (brain and spinal cord), and testicles (in males). Some cancers may also start in these organs so spread to the bone marrow, however these cancers don't seem to be leukemia.  Other varieties of cancer that begin in bodily fluid oocytes are called {lymphoma|cancer|malignant neoplastic sickness}s (either non-Hodgkin lymphoma or Hodgkin lymphoma). whereas malignant neoplastic diseases like ALL chiefly have an effect on the bone marrow and also the blood, lymphomas mainly affect the lymph nodes or different organs (but may involve the bone marrow). Typically it may be exhausting to inform if a cancer of lymphocytes may be a leukemia or a lymphoma. Usually, if a minimum of 20% of the bone marrow is created from cancerous lymphocytes (called lymphoblasts, or simply blasts), the disease is taken into account leukemia.

  1. What is Blood?
  2. What Is a Circulatory System?

Types of leukemia

There are four main types of leukemia, which are determined by the type of white blood cell that is affected and how quickly the leukemia develops. The four main types of leukemia are:  acute lymphocytic leukemia (ALL), chronic lymphocytic leukemia (CLL), acute myeloid leukemia (AML), and chronic myeloid leukemia (CML).

 

The primary kinds of leukemia are:

  • Acute lymphocytic leukemia (ALL). This is the maximum not unusual type of leukemia in young kids. ALL can also arise in adults.

  • Acute myelogenous leukemia (AML). AML is a not unusual form of leukemia. It occurs in children and adults. AML is the most common type of acute leukemia in adults.

  • Hairy cell leukemia (HCL). Hairy cell leukemia (HCL) is a rare, chronic leukemia characterized by the presence of atypical circulating B lymphocytes, called hairy cells, in the peripheral blood.

  • Chronic myelogenous leukemia (CML). This type of leukemia in particular impacts adults. An individual with CML may have few or no signs for months or years earlier than getting into a segment wherein the leukemia cells develop greater quickly.

  • Other kinds. Other, rarer kinds of leukemia exist, including hairy cell leukemia, myelodysplastic syndromes and myeloproliferative problems.

Symptoms  (ALL)

Acute lymphoblastic leukemia (ALL) is a type of cancer that affects the white blood cells. It is one of the most common types of leukemia in children, although adults may be affected as well. Symptoms of ALL can vary depending on the severity and progression of the disease, but can include fever, fatigue, paleness, loss of appetite, and frequent infections. Additionally, those with ALL may experience weight loss, difficulty breathing, bone or joint pain, swollen lymph nodes, and an enlarged spleen or liver.

Many of the symptoms happen as a result of your body reacting to a lack of healthy blood cells. leukemia cells will crowd them into your bone marrow.

Signs and symptoms of acute lymphocytic leukemia may include:

  • Bleeding from the gums

  • Bone pain

  • Fever

  • Pale skin

  • Frequent infections

  • Frequent or severe nosebleeds

  • Lumps caused by swollen lymph nodes in and around the neck, armpits, abdomen or groin

  • Shortness of breath

  • Weakness, fatigue or a general decrease in energy

When to see a doctor

Make a briefing along with your doctor or your child' doctor if you notice persistent signs and symptoms that concern you.  several signs and symptoms of acute cancer of the blood mimic those of the contagious disease. However, flu signs and symptoms eventually improve. If signs and symptoms don't improve as expected, build an appointment with your doctor.

Causes  (ALL)

Doctors don’t know what causes most cases of ALL. however analysis has found that bound things may raise your risk, including: 

 Contact with high levels of radiation to treat different sorts of cancer Contact chemically akin to benzene, a solvent employed in oil refineries and other industries and located in smoke smoke; and a few improvement products, detergents, and paint strippers Infection with the human T-cell lymphoma/leukemia virus-1 (HTLV-1) or the herpes (EBV), largely outside the U.S. Having a medical condition that’s tied to your genes, such as Down syndrome Being white Being male  Acute WBC leukemia happens once a bone marrow cell develops changes (mutations) in its genetic material or DNA. A cell' DNA contains the directions that tell a cell what to do. Normally, the DNA tells the cell to grow at a collection rate and to die at a set time. In acute lymphocytic leukemia, the mutations tell the bone marrow cell to continue growing and dividing.  Once this happens, somatic cell production becomes out of control. The bone marrow produces immature cells that turn into leukemia white blood cells known as lymphoblasts. These abnormal cells are unable to operate properly, and they can build up and force out healthy cells.  It's not clear what causes the DNA mutations that may result in acute WBC leukemia.

is an important part of your body's immune system which works hard to keep you healthy It fights off infections foreign substances and other invaders The lymph nodes make up a network of organs throughout the body that are responsible for filtering lymph fluid which contains white blood cells that fight infection If a particular area of your body is infected or has been injured the lymph nodes closest to that area will swell as they work overtime to fight off infection or to repair damaged tissue Lymph nodes can develop lumps in them when there is a problem with an immune system cell If this happens you will feel pain and experience tenderness around the lump A biopsy in which a sample.

What is the survival rate for acute lymphocytic leukemia?

Acute lymphocytic leukemia (ALL) is the most common form of childhood cancer It accounts for about 20% of all cancers in children and about 75% of all cancers diagnosed in children under 15 years of age Fortunately the prognosis for ALL is good According to research from the National Cancer Institute about 90% of children with ALL are cured after chemotherapy treatment.

Is acute lymphocytic leukemia curable?

Acute lymphocytic leukemia is curable The five-year survival rate for children with ALL is now 93 percent Thanks to research children are living longer and better lives than ever before The overall cure rate for adult patients is 83 percent.

Which is worse, acute or chronic leukemia?

Acute leukemia is a fast-growing cancer of the blood and bone marrow The white blood cells are affected by this type of cancer; because it is a fast-moving disease acute leukemia requires immediate treatment Chronic leukemia develops more slowly than acute leukemia and can take years to develop Chronic leukemia is categorized as either lymphocytic or myelogenous depending on where in the body the malignant cells are located.

(ALL) Acute lymphocytic leukemia (also called acute lymphoblastic leukemia or acute lymphoid leukemia) abbreviated ALL is a type of cancer of the white blood cells characterized by overproduction and accumulation of immature lymphocytes It belongs to a group of diseases termed the leukemias Although over 90% of ALL cases occur in children and adolescents under 20 years old about 3% occur in adults Acute lymphocytic leukemia accounts for 25–40% of all childhood leukemias making it the most common form of childhood cancer.

How serious is acute lymphocytic leukemia?

Acute lymphocytic leukemia is a cancer in which the body produces abnormal white blood cells The disease is serious but most cases can be treated successfully with chemotherapy and radiation Chronic symptoms may include pain infections weakness and fatigue Diagnosis of this form of leukemia often involves bone marrow tests and blood work Other possible signs include chest pain or changes in cognition Treatment usually lasts from six to nine months with some types being more resistant to treatment than others Afterward survivors are monitored closely for problems related to emerging cancers that have developed resistance as a result of the initial treatment regimen.

What happens if acute lymphoblastic leukemia is left untreated?

If the leukemia is not treated symptoms will worsen until they are life threatening Without treatment the person may go into a coma and die Acute lymphoblastic leukemia can spread to other parts of the body and create new tumors that compete with healthy cells for survival and nutrients As the cancerous tumors continue to grow within certain tissues or organs they can eventually impair normal functioning of those tissues or organs This impairment can lead to other serious complications For example: * Infections- Leukemia cells are weakened by chemotherapy and radiation therapy which allows infections that were present before treatment to gain a foothold Infection is.

Who is most affected by acute lymphocytic leukemia?

Acute lymphocytic leukemia is most commonly found in people aged 65 or older Most cases are seen in adults between the ages of 60 and 70. The disease is much less common in children but adolescents can develop it as well. This form of leukemia is most often diagnosed in Caucasian males over the age of 55 who have a history of smoking Smoking and exposure to chemicals pollutants and other toxins are known risk factors for developing this type of cancer.

What age do people usually get leukemia?

Most people who develop leukemia are between the ages of 20 and 60 with a peak onset around age 40. The disease rarely affects children under age 10 and most adults older than 65 have not developed the condition. People over 80 are considered too old to be diagnosed with any type of leukemia Some experts believe that certain types of cancer may disappear as natural aging progresses.

How is acute lymphocytic leukemia diagnosed?

Acute lymphocytic leukemia (ALL) is a type of cancer that starts in the bone marrow and can spread to other organs The most common symptom of ALL is enlarged lymph nodes which are found in the neck armpits groin or chest Other symptoms include anemia frequent infections and bleeding or bruising more easily than normal In some cases ALL does not cause any symptoms until it has already spread to another area of the body An experienced physician will perform a physical exam and may order blood tests or imaging scans such as computerized tomography (CT) or magnetic resonance imaging (MRI) to verify if you.

Risk factors  (ALL)

The primary risk factor for developing acute lymphocytic leukemia is a family history of the disease Other factors that may increase your risk of acute lymphocytic leukemia include exposure to large amounts of ionizing radiation especially in childhood and certain inherited genetic disorders including Down syndrome and Fanconi anemia.

Factors that may increase the risk of acute lymphocytic leukemia include:

  • Previous cancer treatment. Children and adults who've had certain types of chemotherapy and radiation therapy for other kinds of cancer may have an increased risk of developing acute lymphocytic leukemia.

  • Exposure to radiation. People exposed to very high levels of radiation, such as survivors of a nuclear reactor accident, have an increased risk of developing acute lymphocytic leukemia.

  • Genetic disorders. Certain genetic disorders, such as Down syndrome, are associated with an increased risk of acute lymphocytic leukemia.


Diagnosis (ALL)

Your doctor can raise your symptoms and medical history. They’ll do a physical examination to look for swollen body fluid nodes, hemorrhage and bruising, or signs of infection. If your doctor suspects leukemia, they'll do tests, including: 

 Blood tests. a whole blood count (CBC) shows what number of every style of vegetative cell you have. A peripheral blood smear checks for changes in how your blood cells look. Bone marrow tests. Your doctor will place a needle into a bone in your chest or hip and do away with a sample of bone marrow. A specialist can explore it below a magnifier for signs of leukemia. Imagining taking a look at. X-rays, CT scans, or ultrasounds will tell your doctor whether or not the cancer has spread. Spinal tap. This can be also called a body part puncture. Your doctor will use a needle to require a sample of fluid from around your spinal cord. A specialist can look at it to visualize if the cancer has reached your brain or spinal cord. Your doctor may also test your blood or bone marrow for changes in your chromosomes or seek for markers on cancer cells. The results will tell them a lot regarding the kind of malignant neoplastic disease you've got and facilitate them setting up your treatment.

Tests and procedures used to diagnose acute lymphocytic leukemia include:

  • Blood tests. Blood tests may reveal too many or too few white blood cells, not enough red blood cells, and not enough platelets. A blood test may also show the presence of blast cells — immature cells normally found in the bone marrow.

  • Bone marrow test. During bone marrow aspiration and biopsy, a needle is used to remove a sample of bone marrow from the hip bone or breastbone. The sample is sent to a lab for testing to look for leukemia cells.
    Doctors in the lab will classify blood cells into specific types based on their size, shape, and other genetic or molecular features. They also look for certain changes in the cancer cells and determine whether the leukemia cells began from B lymphocytes or T lymphocytes. This information helps your doctor develop a treatment plan.

  • Imaging tests. Imaging tests such as an X-ray, a computerized tomography (CT) scan or an ultrasound scan may help determine whether cancer has spread to the brain and spinal cord or other parts of the body.

  • Spinal fluid test. A lumbar puncture test, also called a spinal tap, may be used to collect a sample of spinal fluid — the fluid that surrounds the brain and spinal cord. The sample is tested to see whether cancer cells have spread to the spinal fluid.

  1. Stages of disease diagnosis

What is bone marrow?

Bone marrow is the soft, spongy tissue located in the center of all bones. It is a small space where different kinds of blood cells are created and where vital resources are supplied to help these cells grow. Blood cells keep our body healthy and running smoothly. There are many different types of blood cells that are produced in the bone marrow. These include: red blood cells, white blood cells, and platelets.

  • Red blood cells carry oxygen and other materials to all parts of the body.

  • White blood cells are responsible for fighting infection.

  • Platelets are important because they help the blood to clot.

Your body produces billions of new blood cells each day in your bone marrow. This keeps you constantly supplied with fresh, healthy cells.

Determining your prognosis

Your doctor uses information gathered from these tests and procedures to determine your prognosis and decide on your treatment options. Other types of cancer use numerical stages to indicate how far the cancer has spread, but there are no stages of acute lymphocytic leukemia.

Instead, the seriousness of your condition is determined by:

  • Your age

  • The type of lymphocytes involved — B cells or T cells

  • The specific genetic changes present in your leukemia cells

  • Results from lab tests, such as the number of white blood cells detected in a blood sample

Treatment (ALL)

Treatment happens in two components: induction therapy, to place you in remission, and post-remission therapy. you'll have over one style of treatment. These embody: 

 Chemotherapy. you would possibly take a mixture of medication that kill or slow cancer cells, typically over a handful of years. Targeted therapy. Some drugs target specific parts of cancer cells and have a tendency to possess fewer or milder aspect effects than chemotherapy. They include bosutinib (Bosulif), dasatinib (Sprycel), imatinib (Gleevec), nilotinib (Tasigna), and ponatinib (Iclusig). Radiation therapy. Your doctor might use high-energy radiation to kill cancer cells if they’ve reached your brain or bone or before you have a vegetative cell transplant. Immunotherapy. These drugs boost your system to kill or slow the expansion of cancer cells. They embody blinatumomab (Blincyto) and inotuzumab ozogamicin (Besponsa). The government agency has additionally approved a kind of treatment referred to as automotive T-cell therapy. It uses a number of your own immune cells, called T cells, to treat your cancer. Doctors take the cells out of your blood and add genes to them. The new T cells are higher ready to notice and kill cancer cells. A stem cell transplant. When high doses of therapy and possibly radiation, you get stem cells that can grow into healthy blood cells. they may be your own or return from a donor. If you can’t handle high doses of chemotherapy and radiation, you could possibly get lower doses with a "mini-transplant."

In general, treatment for acute lymphocytic leukemia falls into separate phases:

  • Induction therapy. The purpose of the first phase of treatment is to kill most of the leukemia cells in the blood and bone marrow and to restore normal blood cell production.

  • Consolidation therapy. Also called post-remission therapy, this phase of treatment is aimed at destroying any remaining leukemia in the body.

  • Maintenance therapy. The third phase of treatment prevents leukemia cells from regrowing. The treatments used in this stage are usually given at much lower doses over a long period of time, often years.

  • Preventive treatment to the spinal cord. During each phase of therapy, people with acute lymphocytic leukemia may receive additional treatment to kill leukemia cells located in the central nervous system. In this type of treatment, chemotherapy drugs are often injected directly into the fluid that covers the spinal cord.

Depending on your situation, the phases of treatment for acute lymphocytic leukemia can span two to three years.

Treatments may include:

  • Chemotherapy. Chemotherapy, which uses drugs to kill cancer cells, is typically used as an induction therapy for children and adults with acute lymphocytic leukemia. Chemotherapy drugs can also be used in the consolidation and maintenance phases.

  • Targeted therapy. Targeted drug treatments focus on specific abnormalities present within cancer cells. By blocking these abnormalities, targeted drug treatments can cause cancer cells to die. Your leukemia cells will be tested to see if targeted therapy may be helpful for you. Targeted therapy can be used alone or in combination with chemotherapy for induction therapy, consolidation therapy or maintenance therapy.

  • Radiation therapy. Radiation therapy uses high-powered beams, such as X-rays or protons, to kill cancer cells. If the cancer cells have spread to the central nervous system, your doctor may recommend radiation therapy.

  • Bone marrow transplant. A bone marrow transplant, also known as a stem cell transplant, may be used as consolidation therapy or for treating relapse if it occurs. 

  • This procedure allows someone with leukemia to reestablish healthy bone marrow by replacing leukemia bone marrow with leukemia-free marrow from a healthy person.
    A bone marrow transplant begins with high doses of chemotherapy or radiation to destroy any leukemia-producing bone marrow. The marrow is then replaced by bone marrow from a compatible donor (allogeneic transplant).

  • Engineering immune cells to fight leukemia. A specialized treatment called chimeric antigen receptor (CAR)-T cell therapy takes your body's germ-fighting T cells, engineers them to fight cancer and infuses them back into your body.
    CAR-T cell therapy might be an option for children and young adults. It might be used for consolidation therapy or for treating relapse.

  • Clinical trials. Clinical trials are experiments to test new cancer treatments and new ways of using existing treatments. While clinical trials give you or your child a chance to try the latest cancer treatment, the benefits and risks of the treatment may be uncertain. Discuss the benefits and risks of clinical trials with your doctor.

Treatment for older adults

Older adults, such as those older than 65, tend to experience a lot of complications from treatments. And older adults usually have a worse prognosis than youngsters who are treated for acute white blood corpuscle leukemia.  Discuss your choices along with your doctor. supported your overall health and your goals and preferences, you will commit to bear treatment for your leukemia.  Some folks may prefer to forgo treatment for the cancer, instead specializing in treatments that improve their symptoms and facilitate them creating the foremost of the time they need remaining. 

Alternative medicine

No different treatments have been tried to cure acute white blood corpuscle leukemia. However, some alternative therapies might ease the facet effects of cancer treatment and cause you to or your kid additional comfort. Discuss your choices along with your doctor, as some alternative treatments might interfere with cancer treatments, reminiscent of chemotherapy.

Alternative treatments that may ease symptoms include:

  • Acupuncture

  • Exercise

  • Massage

  • Meditation

  • Relaxation activities, including yoga and tai chi

Coping and support

Treatment for acute lymphocytic leukemia can be a long road. Treatment often lasts two to three years, although the first months are the most intense.

During maintenance phases, children can usually live a relatively normal life and go back to school. And adults may be able to continue working. To help you cope, try to:

  • Learn enough about leukemia to feel comfortable making treatment decisions. Ask your doctor to write down as much information about your specific disease 

  • as possible. Then narrow your search for info accordingly. Write down queries you would like to raise your doctor before every appointment, and appear for information in your native library and on the internet. sensible sources embrace the National Cancer Institute, the yankee Cancer Society, and therefore the malignant neoplastic disease & malignant neoplastic disease Society.

  • Lean on your whole health care team. At major medical centers and pediatric cancer centers, your health care team may include psychologists, psychiatrists, recreation therapists, child-life workers, teachers, dietitians, chaplains and social workers. These professionals can help with a whole host of issues, including explaining procedures to children, finding financial assistance and arranging for housing during treatment. Don't hesitate to rely on their expertise.

  • Explore programs for children with cancer. Major medical centers and nonprofit groups offer numerous activities and services specifically for children with cancer and their families. Examples include summer camps, support groups for siblings and wish-granting programs. Ask your health care team about programs in your area.

  • Help family and friends understand your situation. Set up a free, personalized webpage at the nonprofit website CaringBridge. This allows you to tell the whole family about appointments, treatments, setbacks and reasons to celebrate — without the stress of calling everyone every time there's something new to report.

Preparing for your appointment

Make an associate appointment along with your general practitioner if you or your kid has signs and symptoms that worry you. If your doctor suspects acute white blood corpuscle leukemia, you'll probably be noticed by a doctor who specializes in treating diseases and conditions of the blood and bone marrow (hematologist). -- as a result, appointments are brief, and since there's often heaps of knowledge to discuss, it's a decent plan to be prepared. Here's some information to assist you get ready, and what to expect from the doctor.

What you can do

  • Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.

  • Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.

  • Write down key personal information, including any major stresses or recent life changes.

  • Make a list of all medications, vitamins or supplements that you're taking.

  • Consider taking a family member or friend along. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.

  • Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out. For acute lymphocytic leukemia, some basic questions to ask the doctor include:

  • Is this condition likely temporary or chronic?

  • What is the best course of action?

  • What is likely causing these symptoms?

  • What are other possible causes for these symptoms?

  • What kinds of tests are necessary?

  • What are the alternatives to the primary approach that you're suggesting?

  • How can other existing health conditions be best managed with ALL?

  • Are there any restrictions that need to be followed?

  • Is it necessary to see a specialist? What will that cost, and will my insurance cover it?

  • Is there a generic alternative to the medicine you're prescribing me?

  • Are there brochures or other printed material that I can take with me? What websites do you recommend?

  • What will determine whether I should plan for a follow-up visit?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask other questions.

What to expect from the doctor

The doctor is likely to ask you a number of questions. Being ready to answer them may allow time to cover other points you want to address. Your doctor may ask:

  • When did symptoms begin?

  • Have these symptoms been continuous or occasional?

  • What, if anything, seems to improve these symptoms?

  • What, if anything, appears to worsen these symptoms?

  • How severe are these symptoms?

What you can do in the meantime

Avoid activity that seems to worsen any signs and symptoms. For instance, if you or your child is feeling fatigued, allow for more rest. Determine which of the day's activities are most important, and focus on accomplishing those tasks.

General summary

Acute lymphocytic leukemia (ALL) is a type of cancer that starts in the bone marrow the spongy material inside our bones where blood cells are made In ALL too many immature white blood cells are produced crowding out the normal blood-cell production and resulting in anemia (low red blood cell count) infection and other problems People with ALL also have high numbers of immature white blood cells circulating in the blood and may experience fever chills weight loss and night sweats.

Current treatment for leukemia depends on the type of leukemia that is diagnosed. Acute lymphocytic leukemia (ALL) is a cancer of the white blood cells and can be treated with chemotherapy or radiation therapy The doctor will select the appropriate treatment based on several factors including the patient's age and health.

(ALL) Acute lymphocytic leukemia : Causes, Types, Symptoms, Diagnosis ,Treatment , Risk factors  , Complications , Prevention

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