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Acute lymphocytic leukemia (ALL)
ALL; Acute childhood leukemia; Cancer - acute childhood leukemia (ALL); Leukemia - acute childhood (ALL)Overview
Acute lymphocytic leukemia (ALL) is a fast-growing cancer in which the body produces a large number of immature white blood cells (lymphocytes). These cells are found in the blood, bone marrow, lymph nodes, spleen, and other organs.
Review Date: 3/2/2010
Reviewed By: David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., and Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital.
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ALL makes up 80% of childhood acute leukemias. Most cases occur in children ages 3 - 7. The disease may also occur in adults.
In acute leukemia, cancerous cells multiply quickly and replace normal cells. Cancerous cells take over normal parts of the bone marrow, often causing low blood counts .
Most cases of ALL have no obvious cause. However, the following may play a role in the development of leukemia:
Persons with Down syndrome or other genetic disorders, or who have a brother or sister with leukemia are at increased risk for ALL.
A person with ALL is more likely to bleed and have infections because there are fewer normal blood cells and platelets. Life-threatening symptoms may develop.
Note: These symptoms can occur with other conditions. Talk to your doctor about the meaning of your specific symptoms.Calling your health care provider
Call your health care provider if:
The goal of treatment is to get the blood counts and the bone marrow back to normal. If this occurs and the bone marrow looks healthy under the microscope, the cancer is said to be in remission.
If you have ALL, you will need chemotherapy. For the first round of chemotherapy (called induction), you may need to stay in the hospital for 3 - 6 weeks.
Later you may get chemotherapy on an outpatient basis (living at home and going to a clinic to receive your treatments). If you have a low white blood cell count, you may need to be placed in a room by yourself so you do not catch an infection.
Many chemotherapy drugs given into the veins do not reach the brain and spinal cord tissue. Therefore, many patients will also receive radiation therapy to the brain or chemotherapy drugs injected into the space around the brain and spinal column to prevent later spread to these sites.
If you go into remission, you may receive additional chemotherapy or
If your leukemia returns or does not respond to other treatments, a bone marrow or stem cell transplant is usually recommended.
Additional treatments depend on other symptoms. They may include:
Because the cause is usually unknown, it is not possible to prevent most cases. You may reduce your risk of ALL by avoiding exposure to toxins, radiation, and chemicals.
Children usually have a better outcome than adults. Almost all children go into complete remission. Without treatment, a person with ALL can expect to live for only about 3 months.
The following patients tend to do better:
Patients whose leukemia spreads to the brain or spinal cord tend to have a worse outcome.
A physical exam may reveal the following:
Blood tests may show the following:
A lumbar puncture or spinal tap is usually done to both detect if leukemia cells are in the spinal fluid and to give chemotherapy to prevent spread to the spinal fluid.
Doctors look for chromosome changes in the cells of some leukemias. This helps aid in diagnosis and prognosis. Leukemias with certain types of chromosome changes have a poor outlook, while those with other types of genes can have a very good outlook. This may determine what kind of therapy is used to treat the ALL.