About Leukemia (ALL)
Acute Lymphoblastic Leukemia (ALL)
Acute lymphoblastic leukemia (ALL) is a fast-growing cancer of the white blood cells. Lymphocytes are a type of white blood cell that the body uses to fight infections. In ALL, the bone marrow makes lots of unformed cells called blasts that normally would develop into lymphocytes. However, the blasts are abnormal. They do not develop and cannot fight infections. The number of abnormal cells (or leukemia cells) grows quickly. They crowd out the normal red blood cells, white blood cells and platelets the body needs. There are about 4,000 new cases of ALL in the United States each year.
Signs and symptoms
The symptoms a person with ALL has depend on how many normal blood cells he or she has. Symptoms also depend on how many leukemia cells there are and where they collect in the body.
- Red blood cells carry oxygen throughout the body. Low numbers of red blood cells can lead to anemia — feeling tired or weak, being short of breath and looking pale.
- White blood cells fight infections. Low numbers of white blood cells can lead to fever and frequent infections that are hard to treat.
- Platelets control bleeding. Low numbers of platelets can lead to cuts that heal slowly, easy bruising or bleeding and tiny red spots under the skin (petechiae).
- High numbers of leukemia cells can cause pain in the bones or joints, lack of appetite, headache or vomiting. These symptoms are less common.
ALL is diagnosed when blood and bone marrow samples show a large number of abnormal lymphocyte blasts. To find out the type of ALL and how well it might respond to treatment, doctors test samples taken from the blood and bone marrow to learn:
- The size and number of leukemia cells.
- The type of lymphocyte affected — the leukemia cells can begin from one of two types of lymphocytes, B cells or T cells.
- What changes appear in the chromosomes of the leukemia cells. This is called cytogenetics.
Doctors also use a test called a lumbar puncture (or spinal tap) to find out whether there are leukemia cells in the fluid around the brain and spinal cord.
Treatment options for acute lymphoblastic leukemia
ALL can get worse quickly, so doctors usually begin treatment right away. To plan the treatment, doctors look at a patient’s risk factors (also called prognostic factors). Risk factors are patient and disease traits that clinical research studies have linked to better or poorer outcomes from treatment. Examples of risk factors are a patient’s age and the type of ALL he or she has. For more details, see Risk Factors for Planning ALL Treatment.
For a patient with ALL, the treatment plan may include:
- Chemotherapy — drugs that destroy cancer cells or stop them from growing (discussed further below). Some form of chemotherapy will be part of the treatment plan for all patients with ALL.
- Radiation therapy — most patients do not receive radiation therapy. However, children who have signs of disease in the central nervous system (brain and spinal cord) or have a high risk of the disease spreading to this area may receive radiation therapy to the brain.
- Bone marrow or cord blood transplant (also called a BMT) — a transplant (discussed further below) offers some patients the best chance for a long-term remission of their disease. Because transplants can have serious risks, this treatment is used for patients who are less likely to reach a long-term remission with chemotherapy alone.