Acute lymphocytic leukemia (ALL) is a type of cancer of the blood and bone marrow — the spongy tissue inside bones where blood cells are made.
The word "acute" in acute lymphocytic leukemia comes from the fact that the disease progresses rapidly and creates immature blood cells, rather than mature ones. The word "lymphocytic" in acute lymphocytic leukemia refers to the white blood cells called lymphocytes, which ALL affects. Acute lymphocytic leukemia is also known as acute lymphoblastic leukemia.
Acute lymphocytic leukemia is the most common type of cancer in children, and treatments result in a good chance for a cure. Acute lymphocytic leukemia can also occur in adults, though the chance of a cure is greatly reduced.
Signs and symptoms of acute lymphocytic leukemia may include:
Make an appointment with your doctor or your child's doctor if you notice any persistent signs and symptoms that concern you.
Many signs and symptoms of acute lymphocytic leukemia mimic those of the flu. However, flu signs and symptoms eventually improve. If signs and symptoms don't improve as expected, make an appointment with your doctor.
Acute lymphocytic leukemia occurs when a bone marrow cell develops changes (mutations) in its genetic material or DNA. A cell's DNA contains the instructions that tell a cell what to do. Normally, the DNA tells the cell to grow at a set rate and to die at a set time. In acute lymphocytic leukemia, the mutations tell the bone marrow cell to continue growing and dividing.
When this happens, blood cell production becomes out of control. The bone marrow produces immature cells that develop into leukemic white blood cells called lymphoblasts. These abnormal cells are unable to function properly, and they can build up and crowd out healthy cells.
It's not clear what causes the DNA mutations that can lead to acute lymphocytic leukemia.
Factors that may increase the risk of acute lymphocytic leukemia include:
Tests and procedures used to diagnose acute lymphocytic leukemia include:
Bone marrow test. During bone marrow aspiration and biopsy, a needle is used to remove a sample of bone marrow from the hipbone or breastbone. The sample is sent to a lab for testing to look for leukemia cells.
Doctors in the lab will classify blood cells into specific types based on their size, shape, and other genetic or molecular features. They also look for certain changes in the cancer cells and determine whether the leukemia cells began from B lymphocytes or T lymphocytes. This information helps your doctor develop a treatment plan.
Your doctor uses information gathered from these tests and procedures to determine your prognosis and decide on your treatment options. Other types of cancer use numerical stages to indicate how far the cancer has spread, but there are no stages of acute lymphocytic leukemia.
Instead, the seriousness of your condition is determined by:
In a bone marrow aspiration, a doctor or nurse uses a thin needle to remove a small amount of liquid bone marrow, usually from a spot in the back of your hipbone (pelvis). A bone marrow biopsy is often done at the same time. This second procedure removes a small piece of bone tissue and the enclosed marrow.
During a spinal tap (lumbar puncture) procedure, you typically lie on your side with your knees drawn up to your chest. Then a needle is inserted into your spinal canal — in your lower back — to collect cerebrospinal fluid for testing.
In general, treatment for acute lymphocytic leukemia falls into separate phases:
Depending on your situation, the phases of treatment for acute lymphocytic leukemia can span two to three years.
Treatments may include:
Bone marrow transplant. A bone marrow transplant, also known as a stem cell transplant, may be used as consolidation therapy or for treating relapse if it occurs. This procedure allows someone with leukemia to reestablish healthy bone marrow by replacing leukemic bone marrow with leukemia-free marrow from a healthy person.
A bone marrow transplant begins with high doses of chemotherapy or radiation to destroy any leukemia-producing bone marrow. The marrow is then replaced by bone marrow from a compatible donor (allogeneic transplant).
Engineering immune cells to fight leukemia. A specialized treatment called chimeric antigen receptor (CAR)-T cell therapy takes your body's germ-fighting T cells, engineers them to fight cancer and infuses them back into your body.
CAR-T cell therapy might be an option for children and young adults. It might be used for consolidation therapy or for treating relapse.
Older adults, such as those older than 65, tend to experience more complications from treatments. And older adults generally have a worse prognosis than children who are treated for acute lymphocytic leukemia.
Discuss your options with your doctor. Based on your overall health and your goals and preferences, you may decide to undergo treatment for your leukemia.
Some people may choose to forgo treatment for the cancer, instead focusing on treatments that improve their symptoms and help them make the most of the time they have remaining.
No alternative treatments have been proved to cure acute lymphocytic leukemia. But some alternative therapies may help ease the side effects of cancer treatment and make you or your child more comfortable. Discuss your options with your doctor, as some alternative treatments could interfere with cancer treatments, such as chemotherapy.
Alternative treatments that may ease symptoms include:
Treatment for acute lymphocytic leukemia can be a long road. Treatment often lasts two to three years, although the first months are the most intense.
During maintenance phases, children can usually live a relatively normal life and go back to school. And adults may be able to continue working. To help you cope, try to:
Learn enough about leukemia to feel comfortable making treatment decisions. Ask your doctor to write down as much information about your specific disease as possible. Then narrow your search for information accordingly.
Write down questions you want to ask your doctor before each appointment, and look for information in your local library and on the internet. Good sources include the National Cancer Institute, the American Cancer Society, and the Leukemia & Lymphoma Society.
Make an appointment with your family doctor if you or your child has signs and symptoms that worry you. If your doctor suspects acute lymphocytic leukemia, you'll likely be referred to a doctor who specializes in treating diseases and conditions of the blood and bone marrow (hematologist).
Because appointments can be brief, and because there's often a lot of information to discuss, it's a good idea to be prepared. Here's some information to help you get ready, and what to expect from the doctor.
Your time with your doctor is limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out. For acute lymphocytic leukemia, some basic questions to ask the doctor include:
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask other questions.
The doctor is likely to ask you a number of questions. Being ready to answer them may allow time to cover other points you want to address. Your doctor may ask:
Avoid activity that seems to worsen any signs and symptoms. For instance, if you or your child is feeling fatigued, allow for more rest. Determine which of the day's activities are most important, and focus on accomplishing those tasks.