Acute lymphoblastic leukemia (ALL)

  • Definition
    • Acute lymphoblastic leukemia (ALL) is a fast-growing cancer of a type of white blood cell called a lymphoblast.

      ALL occurs when the bone marrow produces a large number of immature lymphoblasts. Bone marrow is the soft tissue in the center of bones that helps form all blood cells. The abnormal lymphoblasts grow quickly and replace normal cells in the bone marrow. ALL prevents healthy blood cells from being made. Life-threatening symptoms can occur as normal blood counts drop.

  • Alternative Names
    • ALL; Acute lymphoblastic leukemia; Acute lymphoid leukemia; Acute childhood leukemia; Cancer - acute childhood leukemia (ALL); Leukemia - acute childhood (ALL); Acute lymphocytic leukemia

  • Causes
    • Most of the time, no clear cause can be found for ALL.

      The following factors may play a role in the development of all types of leukemia:

      • Certain chromosome problems
      • Exposure to radiation, including x-rays before birth
      • Past treatment with chemotherapy drugs
      • Receiving a bone marrow transplant
      • Toxins, such as benzene

      The following factors are known to increase the risk of ALL:

      • Down syndrome or other genetic disorders
      • A brother or sister with leukemia

      This type of leukemia usually affects children ages 3 to 7. ALL is the most common childhood cancer, but it can also occur in adults.

  • Symptoms
    • ALL makes a person more likely to bleed and develop infections. Symptoms include:

      • Bone and joint pain
      • Easy bruising and bleeding (such as bleeding gums, skin bleeding, nosebleeds, abnormal periods)
      • Feeling weak or tired
      • Fever
      • Loss of appetite and weight loss
      • Paleness
      • Pain or feeling of fullness below the ribs
      • Pinpoint red spots on the skin (petechiae)
      • Swollen lymph nodes in the neck, under arms, and groin
      • Night sweats

      These symptoms can occur with other conditions. Talk to a health care provider about the meaning of specific symptoms.

  • Exams and Tests
    • A physical exam may reveal the following:

      Blood tests may include:

      • Complete blood count (CBC), including white blood cell (WBC) count
      • Platelet count
      • Bone marrow biopsy
      • Lumbar puncture (spinal tap) to check for leukemia cells in the spinal fluid

      Tests are also done to look for changes in the DNA inside the abnormal white cells. Certain DNA changes may determine how well a person does (prognosis), and what kind of treatment is recommended.

  • Treatment
    • The first goal of treatment is to get blood counts back to normal. If this occurs and the bone marrow looks healthy under the microscope, the cancer is said to be in remission.

      Chemotherapy is the first treatment tried with the goal of achieving a remission.

      • The person may need to stay in the hospital for chemotherapy. Or it can be given at a clinic and the person goes home afterward.
      • Chemotherapy is given into the veins (by IV) and sometimes into the fluid around the brain (the spinal fluid).

      After a remission is achieved, more treatment is given to achieve a cure. This treatment can include more IV chemotherapy or radiation to the brain. Stem cell or, bone marrow, transplant from another person may also be done. Further treatment depends on:

      • Age and health of the person
      • Genetic changes in the leukemia cells
      • How many courses of chemotherapy it took to achieve remission
      • If abnormal cells are still detected under the microscope
      • Availability of donors for stem cell transplant

      You and your provider may need to manage other concerns during your leukemia treatment, including:

  • Support Groups
    • You can ease the stress of illness by joining a cancer support group. Sharing with others who have common experiences and problems can help you not feel alone.

  • Outlook (Prognosis)
    • Those who respond to treatment right away tend to do better. Most children with ALL can be cured. Children often have a better outcome than adults.

  • Possible Complications
    • Both leukemia itself and the treatment can lead to many problems such as bleeding, weight loss, and infections.

  • When to Contact a Medical Professional
    • Call your health care provider if you or your child develops symptoms of ALL.

  • Prevention
    • The risk of developing ALL may be reduced by avoiding contact with certain toxins, radiation, and chemicals.

  • References
    • Jeha S, Pui CH. Clinical manifestations and treatment of acute lymphoblastic leukemia in children. In: Hoffman R, Benz EJ, Silberstein LE, Heslop HE, Weitz JI, Anastasi J, eds. Hematology: Basic Principles and Practice. 6th ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 64.

      National Cancer Institute: PDQ adult acute lymphoblastic leukemia treatment. Bethesda, MD: National Cancer Institute. Updated January 26, 2016. Accessed March 17, 2016.

      National Cancer Institute: PDQ childhood acute lymphoblastic leukemia treatment. Bethesda, MD: National Cancer Institute. Updated December 10, 2015. Accessed March 17, 2016.

      National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: acute lymphoblastic leukemia. Version 2.2015. Accessed March 17, 2016.