Acute lymphoblastic leukemia (ALL) is a cancer of the white blood cells in the bone marrow. The white blood cells, called lymphocytes, grow in the bone marrow but then travels through the body in the blood to help fight instructions. When these white blood cells have leukemia they are not able to fight infections.
ALL also causes the bone marrow to make too many of these cells. The overgrowth makes it difficult for other blood cells like red blood cells or platelets to develop. Low levels of other blood cells can cause a variety of symptoms such as bleeding problems, fatigue and shortness of breath.
The cause of ALL is unknown. Many cancers are beleived to be caused by a combination of environmental and genetic factors.
ALL is more common in white males. It is also more likely to occur in children and adults over 70 years of age. Other factors that have been associated with an increased chance of ALL include:
Factors that may increase the chance of ALL in children only include:
These symptoms may be caused by other, less serious health conditions. You should see a doctor if you or your child is experiencing:
Your doctor will ask about your symptoms and medical history. A physical exam will be done including check for swelling of the liver, spleen, or lymph nodes. If your doctor suspects leukemia, you will likely be referred to a specialist.
Abnormal cells may be found through:
Further tests may be done to provide detailed information about the leukemia. These tests will help guide treatment. Tests may include:
Talk with your doctor about the best plan for you. Treatment of ALL is done in two phases. First, remission induction therapy is used to kill leukemia cells. Then, maintenance therapy is used to kill any remaining leukemia cells. Cells left behind could grow and cause a relapse. Treatment options include:
Chemotherapy 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.
Clinical trials are now underway to test medications that are better are targeting cancer cells. One drug is imatinib (Gleevec). This drug is used to treat chronic myelogenous leukemia (CML). It helps to prevent the function of genes associated with ALL.
Some ALL may spread to the brain and spinal cord. In this case, chemotherapy may be deliverd directly into the spinal column. This type of chemotherapy is known as intrathecal therapy.
Radiation therapy 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.
Stem cells are immature blood cells that are removed from the blood or bone marrow of the patient or donor. The chemotherapy destroys the blood cells. The stem cells are then infused through the blood to restore the blood cells. It is most often used with ALL that was treated but then returned.
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.
People treated for ALL in their youth may have a risk of cancer later in life. The exact type of new cancer can vary. It is important that people who have had ALL be carefully watched for new cancer development. These screenings should be carried out through their lifetime.
American Cancer Society
The Leukemia and Lymphoma Society
Canadian Cancer Society
Leukemia & Lymphoma Society of Canada
Acute lymphoblastic leukemia (ALL). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated October 29, 2012. Accessed October 30, 2012.
Adult acute lymphoblastic leukemia (PDQ): treatment. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/adultALL/Patient/page1. Updated July 23, 2012. Accessed October 30, 2012.
Childhood acute lymphoblastic leukemia (PDQ): treatment. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/childALL/patient. Updated October 5, 2012. Accessed October 30, 2012.
Leukemia—Acute lymphocytic (ALL) in adults. American Cancer Society website. Available at: http://www.cancer.org/docroot/CRI/CRI_2_3x.asp?rnav=cridg&dt=57. Accessed October 30, 2012.
3/29/2007 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Hijiya N, Hudsdon MM, Lensing S, et al. Cumulative incidence of secondary neoplasms as a first event after childhood acute lymphoblastic leukemia. JAMA. 2007;297:1207-1215.
Last reviewed December 2013 by Mohei Abouzied, MD
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 medical condition.