(From The Leukemia and Lymphoma Society)
Acute lymphocytic leukemia (ALL) is a type of blood cancer. Other names for ALL are acute
lymphoblastic leukemia and acute lymphoid leukemia. About 5,430 people in the United States are diagnosed each year. It is
the most common type of leukemia in children under age 15. The risk of getting ALL increases in people ages 45 and older.
However, people can get ALL at any age. Most children with ALL are cured of their disease after treatment.
and Risk Factors
ALL starts with a change to a single cell in the bone marrow.
Scientists are studying the exact genetic changes that cause a normal cell to become an ALL cell. ALL is not contagious (catching).
signs or symptoms of ALL are similar to other more common and less severe illnesses. Specific
blood tests and bone marrow tests are needed to make a diagnosis. A person with ALL may have:
- Aches in arms, legs, back
- Black-and-blue marks for no apparent reason
- Enlarged lymph nodes
- Fever without obvious cause
- Pinhead-size red spots under
- Prolonged bleeding from
- Shortness of breath during
Blood and bone marrow tests are done to look for leukemia
cells. A CBC (complete blood count) is used to help diagnose ALL. A bone
marrow aspirate and a bone marrow biopsy are two of the tests that are
done. There are two main cell types of ALL, B-Cell and T-Cell. Most people with
ALL have the B-cell type. Most cases of the B-cell type are called precursor B-cell type.
To decide the best treatment for the patient, the doctor will consider:
- The patient's age
- The number of ALL cells in the blood
- If the ALL has spread to the covering of the brain or spinal cord
- If there are certain chromosomal changes.
Patients with ALL need to start chemotherapy
right away. It is important to get medical care in a center where doctors are experienced in treating patients with ALL.
Patients with ALL often have leukemic cells in the lining of the
spinal cord and brain. The procedure used to check the spinal fluid for leukemic cells is called a spinal tap. The cells cannot
always be found in an exam of the spinal fluid.
prevent leukemia in the central nervous system (CNS) leukemia, all patients have the lining of the spinal cord and brain treated.
More treatment is needed even after
a patient with ALL is in remission. This is called long term maintenance therapy. It is given in cycles for two to three
years. Long term maintenance therapy is given because some ALL cells remain that are not found by common blood or marrow tests.
Effects of Treatment
effects of treatment for ALL include:
number of red cells may decrease (called anemia). Transfusions of red cells (blood cells that are donated and given to the patient) may be needed
to increase red cells.
also may have a drop in the number of platelets. If a patient's platelet count is very low he or she may need a platelet
transfusion to prevent bleeding.
big drop in white cells may lead to an infection. Such infections are usually treated with antibiotics,
until the white cell count goes up and the infection clears up. The doctor may talk about the absolute neutrophil count or ANC, which
is the number of neutrophils, a type of white cell a person has to fight an infection. Fever or chills may be the only
signs of infection.
lower the risk of infection:
patient, the patient's visitors and medical staff need to wash their hands well.
- Patients on chemotherapy should take good care of their teeth and gums.
Chemotherapy affects the parts of the body where new cells form
quickly. This includes the inside of mouth and bowel, and the skin and hair. Some other chemotherapy side effects are:
- Mouth sores
and other therapies can be given to prevent or treat nausea or vomiting.
Patients who have finished all of their therapy still need to go to
their doctors regularly for exams and tests. The doctor may recommend longer periods of time between follow-up visits if a
patient continues to be disease free.
for ALL can cause long-term or late effects. Children should be checked for treatment effects
on growth or learning that may not take place right away. It is important to identify problems early. Talk to the doctor about
when your child's learning skills should be assessed. Some children will need special help with schoolwork during and
or Refractory ALL
have a remission after treatment but then ALL cells return later - this is called a relapse.
Other patients with ALL may still have ALL cells in the marrow even after treatment (refractory
Clinical trials are used to study new drugs, new treatments or new uses
for approved drugs or treatments. These are some of the types of trials under way:
Leukemia-specific therapy, based on a patient's
specific type of leukemia - such as the type of chromosome changes
- is being studied.
ALL cells of some patients are not as easily killed by drugs as those of other patients. This is called drug resistance. Scientists
are trying to understand why some ALL cells are resistant to the effects of chemotherapy.
This will help them develop better treatments.
Scientists are studying ways to boost the body's natural defenses, called immunotherapy.
The goal is to kill or prevent the growth of ALL cells.
Scientists are studying the exact genetic changes that cause a normal cell to become an ALL
cell. This research is leading to the development of new treatments. These treatments could block the effects of cancer-causing
genes called oncogenes.
will be used more in the future to design more specific treatments for the different types of leukemia. New targeted treatments
are being developed for ALL.