Acute lymphoblastic leukemia (ALL) is a cancer of the blood and bone marrow. Lymphocytes are a type of white blood cell. With ALL, the bone marrow makes too many of these cells. ALL begins in immature lymphocytes. It progresses very quickly. It may occur at any age, but is most common in children. It is also common as the end stage of a chronic leukemia of adults called
chronic lymphocytic leukemia
. Childhood ALL was one of the first cancers for which effective
was developed. ALL remains highly curable today.
Cancer occurs when cells in the body become abnormal. They divide without control or order. Leukemia is cancer of the white blood cells and their parent cells. Leukemia cells do not function normally. They cannot do what normal blood cells do. In this case they can not fight infections. This means that the person is more likely to become infected with viruses or bacteria. The cancerous cells also overgrow the bone marrow. This forces other normal components, like platelets out. Platelets are needed to help the blood clot. As a result, people with leukemia may bleed more easily.
Exposure to atomic bomb radiation or nuclear reactor accident
Exposure to toxic chemicals such as benzene (common in agriculture, dye works, and paint manufacturing and use)
Certain genetic disorders, such as
, Bloom syndrome, Fanconi's anemia, ataxia-telangiectasia,
, Schwachman syndrome, IgA deficiency, and congenital X-linked agammaglobulinemia
The following risk factors are specific to childhood ALL:
Petechiae (flat, pinpoint spots under the skin caused by bleeding)
Shortness of breath
Loss of appetite
Bone or joint pain
Pain or a feeling of fullness below the ribs
Painless lumps in the neck, underarms, stomach, or groin
Swelling of the liver and/or spleen
Your doctor will ask about your symptoms and medical history. A physical exam will be done. The doctor may also check for swelling of the liver, spleen, or lymph nodes. You will likely be referred to an oncologist. This is a doctor who specializes in treating cancer.
Tests may include the following:
Blood tests—to check for changes in the number or appearance of different types of blood cells
Bone marrow aspiration—removal of a sample of liquid bone marrow to test for cancer cells
—removal of a sample of liquid bone marrow and a small piece of bone to test for cancer cells
—removal of a small amount of cerebrospinal fluid to check for cancer cells
Routine microscopic exam—examination of a sample of blood, bone marrow, lymph node tissue, or cerebrospinal fluid
Bone, blood marrow, lymph node tissue, or cerebrospinal fluid tests—to distinguish among types of leukemia
Cytogenetic analysis—a test to look for certain changes of the chromosomes (genetic material) of the lymphocytes; certain genetic abnormalities include:
Relocation of genetic material from one chromosome to another
Presence of a particular gene (Ikaros)
Presence of a variant gene, which controls an enzyme that influences folate metabolism
Immunophenotyping—examination of the proteins on cell surfaces and the antibodies produced by the body; to distinguish lymphoblastic from
and determine types of therapy
—x-rays of the chest that may detect signs of lung infection or enlarged lymph nodes in the chest
—a type of x-ray that uses a computer to make pictures of structures inside the body
—a test that uses magnetic waves to make pictures of structures inside the body
Gallium Scan and
—injection of a radioactive chemical into the bloodstream to detect areas of cancer or infection
—a test that uses sound waves to examine masses and organs inside the body
Talk with your doctor about the best plan for you. Treatment of ALL is done is two phases. First remission induction therapy to kill leukemia cells. Then maintenance therapy to kill any remaining leukemia cells. Cells left behind could grow and cause a relapse. Treatment options include:
is the use of drugs to kill cancer cells. It may be given by pill, injection, and via a catheter. The drugs enter the bloodstream and travel through the body. It kills mostly cancer cells, but also some healthy cells.
Some ALL may spread to the brain and spinal cord. In this case,
intrathecal chemotherapy may be used. Chemotherapy drugs are placed directly into the spinal column.
is the use of radiation to kill cancer cells and shrink tumors. For ALL, external radiation therapy is used. The radiation is directed at the tumor from outside the body. This type of treatment is used for ALL that has or may spread to the brain and spinal cord.
Chemotherapy With Stem Cell Transplant
Chemotherapy is followed by a transplantation of stem cells (immature blood cells). These will replace blood-forming cells destroyed by cancer treatment. Stem cells are removed from the blood or bone marrow of the patient or donor. They are then infused into the patient.
This process is still being tested in clinical trials. This is the use of medications or substances made by the body. The substance is used to increase or restore the body's natural defenses against cancer. This type of therapy is also called biological response modifier therapy. Sometimes, very specific (monoclonal) antibodies are developed to target the leukemia cells specifically. Currently, monoclonal antibody therapy is restricted to clinical trails and not generally available.
Possible Development of New Cancers
People treated for ALL in their youth may have a risk of cancer later in life. A recent study found that they are more likely than the general population to develop a secondary cancer. The exact type of cancer can vary. It is important that people that have had ALL are carefully watched for new cancer development. These screenings should be carried out through their lifetime.
There are no guidelines for preventing ALL since its cause is unknown.
*Updated Treatment section on 3/29/2007 according to the following study, as cited by
DynaMed's Systematic Literature Surveillance
DynaMed's Systematic Literature Surveillance
: Hijiya N, Hudsdon MM, Lensing S, et al. Cumulative incidence of secondary neoplasms as a first event after childhood acute lymphoblastic leukemia.
Please be aware that this information is provided to supplement the care
provided by your physician. It is neither intended nor implied to be a
substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER
IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the
advice of your physician or other qualified health provider prior to
starting any new treatment or with any questions you may have regarding a