Acute lymphoblastic leukemia (ALL)
Acute lymphoblastic leukemia (ALL) is a fast-growing cancer of a type of white blood cells called lymphoblasts. These cells are usually found in the bone marrow.
ALL occurs when the body produces a large number of immature lymphoblasts. The cancer cells grow quickly and replace normal cells in the bone marrow. Bone marrow is the soft tissue in the center of bones that helps form all blood cells. ALL prevents healthy blood cells from being made. Life-threatening symptoms can occur as normal blood counts drop.
ALL; Acute lymphoblastic leukemia; Acute lymphoid leukemia; Acute childhood leukemia; Cancer - acute childhood leukemia (ALL); Leukemia - acute childhood (ALL)
Most of the time, no clear cause can be found for ALL. But the following may play a role in the development of leukemia in general:
- 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 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.
ALL makes the 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
- Loss of appetite and weight loss
- Pain or feeling of fullness below the ribs
- Pinpoint red spots on the skin (petechiae)
- Swollen glands (lymphadenopathy) in the neck, under arms, and groin
- Night sweats
These symptoms can occur with other conditions. Talk to the doctor 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 aspiration and 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 patient does (prognosis), and what kind of treatment is recommended.
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 complete remission.
Chemotherapy is the first treatment tried with the goal of achieving complete remission.
- The person may need to stay in the hospital for chemotherapy. Or it can be given at a clinic and the patient goes home afterward.
- Chemotherapy is given into the veins (by IV) and sometimes next to the spine and brain.
After achievement of initial complete remission, more treatment is needed to be cured. This treatment can include more 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 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.
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.
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.
The risk of developing ALL may be reduced by avoiding contact with certain toxins, radiation, and chemicals.
Jeha S, Pui CH. Clinical manifestations and treatment of acute lymphoblastic leukemia in children. In: Hoffman R, Benz EJ Jr, Silberstein LE, et al., eds. Hematology: Basic Principles and Practice. 6th ed.Philadelphia, Pa: Elsevier Saunders; 2012: chap 64.
National Cancer Institute: PDQ Adult Acute Lymphoblastic Leukemia Treatment. Bethesda, Md: National Cancer Institute. Date last modified 02/21/2014. Available at http://www.cancer.gov/cancertopics/pdq/treatment/adultALL/HealthProfessional. Accessed: March 23, 2014.
National Cancer Institute: PDQ Childhood Acute Lymphoblastic Leukemia Treatment. Bethesda, Md: National Cancer Institute. Date last modified 12/03/2013. Available at http://cancer.gov/cancertopics/pdq/treatment/childALL/HealthProfessional. Accessed: March 23, 2014.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Acute Lymphoblastic Leukemia. Version 3.2013. Available at http://www.nccn.org/professionals/physician_gls/pdf/all.pdf. Accessed: March 23, 2014.
Reviewed By: Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.