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Acute lymphoblastic leukemia (ALL)

ALL; Acute lymphoblastic leukemia; Acute lymphoid leukemia; Acute childhood leukemia; Cancer - acute childhood leukemia (ALL); Leukemia - acute childhood (ALL); Acute lymphocytic leukemia

Acute lymphoblastic leukemia (ALL) is a fast-growing cancer of a type of white blood cell called a lymphoblast.

ALL occurs when the bone marrow produces a large number of immature lymphoblasts. Bone marrow is the soft tissue in the center of bones that helps form all blood cells. The abnormal lymphoblasts grow quickly and replace normal cells in the bone marrow. ALL prevents healthy blood cells from being made. Life-threatening symptoms can occur as normal blood counts drop.

Causes

Most of the time, no clear cause can be found for ALL.

The following factors may play a role in the development of all types of leukemia:

  • 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 factors are known to increase the risk of ALL:

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.

Symptoms

ALL makes a 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
  • Fever
  • Loss of appetite and weight loss
  • Paleness
  • Pain or feeling of fullness below the ribs
  • Pinpoint red spots on the skin (petechiae)
  • Swollen lymph nodes in the neck, under arms, and groin
  • Night sweats

These symptoms can occur with other conditions. Talk to a health care provider about the meaning of specific symptoms.

Exams and Tests

A physical exam may reveal the following:

  • Bruising
  • Enlarged liver, lymph nodes, and spleen
  • Signs of bleeding (petechiae, purpura)

Blood tests may include:

  • Complete blood count (CBC), including white blood cell (WBC) count
  • Platelet count
  • Bone marrow 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 person does (prognosis), and what kind of treatment is recommended.

Treatment

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 remission.

Chemotherapy is the first treatment tried with the goal of achieving a remission.

  • The person may need to stay in the hospital for chemotherapy. Or it can be given at a clinic and the person goes home afterward.
  • Chemotherapy is given into the veins (by IV) and sometimes into the fluid around the brain (the spinal fluid).

After a remission is achieved, more treatment is given to achieve a cure. This treatment can include more IV 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 and your provider may need to manage other concerns during your leukemia treatment, including:

Support Groups

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.

Outlook (Prognosis)

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.

Possible Complications

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.

Prevention

The risk of developing ALL may be reduced by avoiding contact with certain toxins, radiation, and chemicals.

References

Jeha S, Pui CH. Clinical manifestations and treatment of acute lymphoblastic leukemia in children. In: Hoffman R, Benz EJ, Silberstein LE, Heslop HE, Weitz JI, Anastasi J, eds. Hematology: Basic Principles and Practice. 6th ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 64.

National Cancer Institute: PDQ adult acute lymphoblastic leukemia treatment. Bethesda, MD: National Cancer Institute. Updated January 26, 2016. www.cancer.gov/types/leukemia/hp/adult-all-treatment-pdq. Accessed March 17, 2016.

National Cancer Institute: PDQ childhood acute lymphoblastic leukemia treatment. Bethesda, MD: National Cancer Institute. Updated December 10, 2015. www.cancer.gov/types/leukemia/hp/child-all-treatment-pdq. Accessed March 17, 2016.

National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: acute lymphoblastic leukemia. Version 2.2015. www.nccn.org/professionals/physician_gls/pdf/all.pdf. Accessed March 17, 2016.

    • Bone marrow aspiration

      Bone marrow aspiration - illustration

      A small amount of bone marrow is removed during a bone marrow aspiration. The procedure is uncomfortable, but can be tolerated by both children and adults. The marrow can be studied to determine the cause of anemia, the presence of leukemia or other malignancy, or the presence of some storage diseases, in which abnormal metabolic products are stored in certain bone marrow cells.

      Bone marrow aspiration

      illustration

    • Acute lymphocytic leukemia - photomicrograph

      Acute lymphocytic leukemia - photomicrograph - illustration

      This picture shows the darkly-stained lymph cells (lymphoblasts) seen in acute lymphocytic leukemia (ALL), the most common type of childhood leukemia.

      Acute lymphocytic leukemia - photomicrograph

      illustration

    • Auer rods

      Auer rods - illustration

      Note multiple Auer rods which are found only in acute myeloid leukemias, either myeloblastic or monoblastic. These rods consist of clumps of azurophilic granule material.

      Auer rods

      illustration

    • Bone marrow from hip

      Bone marrow from hip - illustration

      Bone marrow may be harvested from the hip (iliac bone) to serve as bone grafts elsewhere in the body.

      Bone marrow from hip

      illustration

    • Immune system structures

      Immune system structures - illustration

      The immune system protects the body from potentially harmful substances. The inflammatory response (inflammation) is part of innate immunity. It occurs when tissues are injured by bacteria, trauma, toxins, heat or any other cause.

      Immune system structures

      illustration

      • Bone marrow aspiration

        Bone marrow aspiration - illustration

        A small amount of bone marrow is removed during a bone marrow aspiration. The procedure is uncomfortable, but can be tolerated by both children and adults. The marrow can be studied to determine the cause of anemia, the presence of leukemia or other malignancy, or the presence of some storage diseases, in which abnormal metabolic products are stored in certain bone marrow cells.

        Bone marrow aspiration

        illustration

      • Acute lymphocytic leukemia - photomicrograph

        Acute lymphocytic leukemia - photomicrograph - illustration

        This picture shows the darkly-stained lymph cells (lymphoblasts) seen in acute lymphocytic leukemia (ALL), the most common type of childhood leukemia.

        Acute lymphocytic leukemia - photomicrograph

        illustration

      • Auer rods

        Auer rods - illustration

        Note multiple Auer rods which are found only in acute myeloid leukemias, either myeloblastic or monoblastic. These rods consist of clumps of azurophilic granule material.

        Auer rods

        illustration

      • Bone marrow from hip

        Bone marrow from hip - illustration

        Bone marrow may be harvested from the hip (iliac bone) to serve as bone grafts elsewhere in the body.

        Bone marrow from hip

        illustration

      • Immune system structures

        Immune system structures - illustration

        The immune system protects the body from potentially harmful substances. The inflammatory response (inflammation) is part of innate immunity. It occurs when tissues are injured by bacteria, trauma, toxins, heat or any other cause.

        Immune system structures

        illustration

      A Closer Look

       

      Tests for Acute lymphoblastic leukemia (ALL)

       

      Review Date: 2/1/2016

      Reviewed By: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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