Acute Lymphoblastic Leukemia (ALL)

What Is Acute Lymphoblastic Leukemia?

Acute lymphoblastic leukemia (ALL) is a type of blood cancer that starts in white blood cells in your bone marrow, the soft inner part of your bones. It develops from immature lymphocytes, a kind of white blood cell that’s key to your immune system.

ALL is also known as acute lymphocytic leukemia or acute lymphoid leukemia. ”Acute” means it gets worse quickly. It’s a rare type of leukemia, or blood cancer, in adults but the most common type in children.

Acute lymphoblastic leukemia invades your blood and can spread to other organs, such as your liver, spleen, and lymph nodes. But it usually doesn’t make tumors like other types of cancer.

Acute Lymphoblastic Leukemia Causes and Risk Factors

Doctors don’t know what causes most cases of ALL. But research has found that certain things might raise your risk, including:

  • Contact with high levels of radiation to treat other types of cancer
  • Contact with chemicals such as benzene, a solvent used in oil refineries and other industries and found in cigarette smoke; and some cleaning products, detergents, and paint strippers
  • Infection with the human T-cell lymphoma/leukemia virus-1 (HTLV-1) or the Epstein-Barr virus (EBV), mostly outside the U.S.
  • Having a medical condition that’s tied to your genes, such as Down syndrome
  • Being white
  • Being male

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Acute Lymphoblastic Leukemia Symptoms

Some symptoms of ALL can be vague. They include:

Many of the symptoms happen because your body is reacting to a lack of healthy blood cells. Leukemia cells can crowd them out in your bone marrow.

A lack of red blood cells may cause symptoms of anemia, including:

  • Fatigue or weakness
  • Dizziness or light-headedness
  • Feeling cold
  • Shortness of breath

Without enough healthy white blood cells, you may have:

  • Fevers
  • More infections than usual

A lack of platelets, tiny cells that help your blood clot, may cause:

  • Lots of bruising for no clear reason
  • Frequent or severe nosebleeds, bleeding gums, or other unusual bleeding, such as from minor cuts

Depending on where the leukemia cells are, you might also have:

Acute Lymphoblastic Leukemia Diagnosis

Your doctor will ask about your symptoms and medical history. They’ll do a physical exam to look for swollen lymph nodes, bleeding and bruising, or signs of infection.

If your doctor suspects leukemia, they may do tests, including:

  • Blood tests. A complete blood count (CBC) shows how many of each type of blood cell you have. A peripheral blood smear checks for changes in how your blood cells look.
  • Bone marrow tests. Your doctor will put a needle into a bone in your chest or hip and take out a sample of bone marrow. A specialist will look at it under a microscope for signs of leukemia.
  • Imaging tests. X-rays, CT scans, or ultrasounds can tell your doctor whether the cancer has spread.
  • Spinal tap. This is also known as a lumbar puncture. Your doctor will use a needle to take a sample of fluid from around your spinal cord. A specialist can look at it to see if the cancer has reached your brain or spinal cord.

Your doctor might also test your blood or bone marrow for changes in your chromosomes or look for markers on cancer cells. The results will tell them more about the type of leukemia you have and help them plan your treatment.

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Acute Lymphoblastic Leukemia Treatment Stages

Most cancers are divided into stages, based on how far they’ve spread. But with ALL, doctors describe it according to treatment.

  • Untreated. This is a new diagnosis. You might have been treated for symptoms but not for the cancer itself.
  • Remission. You’ve had treatment to kill as many leukemia cells as possible. Your CBC is normal, and no more than 5% of cells in your bone marrow are leukemia cells.
  • Recurrent. This is cancer that’s come back after treatment and remission.

Acute Lymphoblastic Leukemia Treatment

Treatment happens in two parts: induction therapy, to put you in remission, and post-remission therapy.

You may have more than one type of treatment. These include:

  • Chemotherapy. You might take a mix of drugs that kill or slow cancer cells, usually over a couple of years.
  • Targeted therapy. Some drugs target specific parts of cancer cells and tend to have fewer or milder side effects than chemotherapy. They include dasatinib (Sprycel), imatinib (Gleevec), nilotinib (Tasigna), and ponatinib (Iclusig).
  • Radiation therapy. Your doctor might use high-energy radiation to kill cancer cells if they’ve reached your brain or bone or before you have a stem cell transplant.
  • Immunotherapy. These drugs boost your immune system to kill or slow the growth of cancer cells. They include blinatumomab (Blincyto) and inotuzumab ozogamicin (Besponsa).
  • A stem cell transplant. After high doses of chemotherapy and possibly radiation, you get stem cells that will grow into healthy blood cells. They might be your own or come from a donor. If you can’t handle high doses of chemotherapy and radiation, you might get lower doses with a "mini-transplant."

About 80% to 90% of adults reach remission after treatment. For about 30% to 40%, the cancer doesn’t return. But many relapse, meaning the disease returns.

You’ll need post-remission therapy to keep the cancer from coming back. This involves cycles of treatment over 2 to 3 years. It aims to rid your body of leukemia cells.

The FDA has also approved a form of treatment called CAR T-cell therapy. It uses some of your own immune cells, called T cells, to treat your cancer. Doctors take the cells out of your blood and add genes to them. The new T cells are better able to find and kill cancer cells.

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The drug, tisagenlecleucel (Kymriah), is approved only for children and young adults up to age 25 who have a certain type of ALL and haven’t gotten better with other treatments. But scientists are working on a version of CAR T-cell therapy for adults and for other kinds of cancer.

You might also consider joining a clinical trial to test new treatments that aren’t widely available. Talk to your doctor about which one would be the best fit for you and about what to expect.

Acute Lymphoblastic Leukemia Prognosis

The outlook for acute lymphoblastic leukemia depends on several things, including:

  • Your age. Younger patients tend to do better.
  • Your lab test results. The prognosis is better if you have a lower white blood count when you're diagnosed.
  • Your chromosomes. People who don’t have a problem in their genes called the Philadelphia chromosome usually do better.
  • Your response to chemotherapy. The prognosis is better if you have no evidence of leukemia 4 to 5 weeks after starting treatment.

You’ll need follow-up tests for several years after treatment to check your overall health and be sure the cancer doesn’t come back.

It’s natural to feel worried when you’ve been diagnosed with cancer. Reach out to loved ones, religious groups, counselors, or support groups for help and support.

WebMD Medical Reference Reviewed by Laura J. Martin, MD on February 15, 2020

Sources

SOURCES: 

American Cancer Society: "What is acute lymphocytic leukemia?"  "How is acute lymphocytic leukemia classified?"  "What are the risk factors for acute lymphocytic leukemia?" "How is acute lymphocytic leukemia diagnosed?"  "Treating Leukemia -- Acute Lymphocytic (ALL) in Adults;" and "Response rates to treatment," “Tests for Acute Lymphocytic Leukemia (ALL),” “Living as an Acute Lymphocytic Leukemia (ALL) Survivor,” “Immunotherapy for Acute Lymphocytic Leukemia (ALL),” “Typical Treatment of Acute Lymphocytic Leukemia (ALL).”

The Leukemia & Lymphoma Society: "Acute Lymphocytic Leukemia" and "Leukemia Facts & Statistics."

ARIAD Pharmaceuticals, Inc.

FDA: “FDA approval brings first gene therapy to the United States.”

National Cancer Institute: “Adult Acute Lymphoblastic Leukemia Treatment (PDQ) -- Patient Version.”

Mayo Clinic: “Acute lymphocytic leukemia.”

 

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