What is it?
- 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 affects immature blood cells, rather than mature ones. The "lymphocytic" in acute lymphocytic leukemia refers to the white blood cells called lymphocytes, which ALL affects.
Signs and symptoms of acute lymphocytic leukemia may include:
- Bleeding from the gums
- Frequent infections
- Frequent or severe nosebleeds
- Loss of appetite
- Lumps caused by swollen lymph nodes in and around the neck, underarm, stomach or groin
- Pale skin
- Shortness of breath
- Weight loss
- Weakness, fatigue or a general decrease in energy
- Acute lymphocytic leukemia occurs when a bone marrow cell develops errors in its DNA. The errors tell the cell to continue growing and dividing, when a healthy cell would normally die. When this happens, blood cell production goes awry. 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. But doctors have found that most cases of acute lymphocytic leukemia aren't inherited.
Factors that may increase the risk of acute lymphocytic leukemia include:
- Cancer therapy. Children and adults who've had certain types of chemotherapy and radiation therapy or treatment for other kinds of cancer may have a small, but greater, risk of developing acute lymphocytic leukemia than does the general population.
- Exposure to radiation. People exposed to very high levels of radiation, such as survivors of an atomic bomb blast or a nuclear reactor accident, have an increased risk of developing acute lymphocytic leukemia. This includes children who were exposed to significant radiation during the first months of prenatal development.
- Genetic disorders. Certain genetic disorders, such as Down syndrome, are associated with some increased risk of acute lymphocytic leukemia.
- Having a brother or sister with ALL. People who have a sibling, including a twin, with acute lymphocytic leukemia are slightly more likely to develop ALL.
How is ALL Diagnosed?
- Blood tests. A blood test may reveal too many white blood cells, not enough red blood cells and not enough platelets. A blood test may also show the presence of blast cells — immature cells normally found in the bone marrow but not circulating in the blood.
- Bone marrow test. During bone marrow aspiration, a needle is used to remove a sample of bone marrow from the hipbone to look for leukemia cells. The sample is sent to a lab for testing. Doctors in the lab will classify blood cells into specific types based on their size, shape and other features. They also look for certain changes in the cancer cells and find out whether the leukemia cells began from the B lymphocytes or T lymphocytes. This information helps your doctor develop a treatment plan.
- Imaging tests. Imaging tests such as a chest X-ray, computerized tomography (CT) scan or an ultrasound examination may help determine whether cancer has spread to the brain and spinal cord or other parts of the body.
- Spinal fluid test. A lumbar puncture test, also called a spinal tap, may be used to collect a sample of spinal fluid. The sample is tested to see whether cancer cells have spread to the spinal fluid.
In general, treatment for acute lymphocytic leukemia falls into separate phases:
- Induction therapy. The purpose of the first phase of treatment is to kill most of the leukemia cells in the blood and bone marrow.
- Consolidation therapy. Also called post-remission therapy, this phase of treatment is aimed at destroying the leukemia cells remaining in the brain or spinal cord.
- Maintenance therapy. The third phase of treatment prevents leukemia cells from regrowing. The treatments used in this stage are often given at much lower doses.
- Preventive treatment to the spinal cord. People with acute lymphocytic leukemia may also receive treatment to kill leukemia cells located in the central nervous system during each phase of therapy. In this type of treatment, chemotherapy drugs are injected directly into the fluid that covers the spinal cord. This kills cancer cells that can't be reached by chemotherapy drugs given by mouth or through an intravenous line.
Depending on your situation, the phases of treatment for acute lymphocytic leukemia can span 2 1/2 to 3 1/2 years.
Treatments may include:
- Chemotherapy. Chemotherapy, which uses drugs to kill cancer cells, is typically used as an induction therapy for children and adults with acute lymphocytic leukemia. Chemotherapy drugs can also be used in the consolidation and maintenance phases.
- Targeted drug therapy. Targeted drugs attack specific abnormalities present in cancer cells that help them grow and thrive. One targeted drug, imatinib (Gleevec), specifically attacks cancer cells that have a certain abnormality called the Philadelphia chromosome. The drug dasatinib (Sprycel) works in a similar way. These drugs are approved only for people with the Philadelphia chromosome-positive form of ALL.
- Radiation therapy. Radiation therapy uses high-powered beams, such as X-rays, to kill cancer cells. If the cancer cells have spread to the central nervous system, your doctor may recommend radiation therapy.
- Stem cell transplant. A stem cell transplant may be used as consolidation therapy in people at high risk of relapse or for treating relapse when it occurs. This procedure allows someone with leukemia to re-establish healthy stem cells by replacing leukemic bone marrow with leukemia-free marrow. A stem cell 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). In some cases, adults with ALL are able to use their own bone marrow for transplantation (autologous transplant). This may be possible if you go into remission and healthy bone marrow is then harvested for a future transplant.
- Clinical trials. Clinical trials are experiments to test new cancer treatments and new ways of using existing treatments. While clinical trials give you or your child a chance to try the latest cancer treatment, treatment benefits are still being evaluated. Discuss the benefits and risks of clinical trials with your doctor.
ALL in older adults
Older adults, such as those older than 65, tend to experience more complications from ALL treatments. And older adults generally have a worse prognosis than children who are treated for ALL. Discuss your options with your doctor. Based on your overall health and your goals and preferences, you may decide to undergo treatment for your ALL. Some people may choose to forego 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 complimentary treatments have been found 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.
Complimentary treatments that may ease signs and symptoms include:
Talk to your doctor if you're interested in trying complimentary treatments. Some complimentary therapies are safe, while others can interfere with your cancer treatments.
Coping and support
Although treatment for acute lymphocytic leukemia is typically very successful, it can be a long road. Treatment often lasts 2 1/2 to 3 1/2 years, although the first three to six 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.
- Lean on your whole health care team. At major medical centers and pediatric cancer centers, your health care team may include psychologists, psychiatrists, recreation therapists, child-life workers, teachers, dietitians, chaplains and social workers. These professionals can help with a whole host of issues, including explaining procedures to children, finding financial assistance and arranging for housing during treatment. Don't hesitate to rely on their expertise.
- Explore programs for children with cancer. Major medical centers and nonprofit groups offer numerous activities and services specifically for children with cancer and their families. Examples include summer camps, support groups for siblings and wish-granting programs. Ask your health care team about programs in your area.