Acute lymphocytic leukemia (ALL)
Definition
Acute lymphocytic leukemia (ALL) is a fast-growing cancer of a type of white blood cells called lymphocytes. These cells are found in the bone marrow and other parts of the body.
Acute lymphocytic leukemia (ALL) occurs when the body produces a large number of immature lymphocytes. The cancer cells grow quickly and replace normal cells in the bone marrow. Bone marrow is the soft tissue in the center of bones that helps form all blood cells. ALL prevents healthy blood cells from being made. Life-threatening symptoms can occur.
Alternative Names
ALL; Acute lymphoblastic leukemia; Acute lymphoid leukemia; Acute childhood leukemia; Cancer - acute childhood leukemia (ALL); Leukemia - acute childhood (ALL)
Causes
Most of the time, noclear cause can be found for ALL.But the following may play a role in the development of leukemia in general:
- 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 increasethe riskof ALL:
- Down syndrome or other genetic disorders
- A brother or sister with leukemia
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 makesthe personmore 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 glands (lymphadenopathy) in the neck, under arms, and groin
- Night sweats
Note: These symptoms can occur with other conditions. Talk tothe doctor about the meaning of specific symptoms.
Exams and Tests
A physical exam may reveal the following:
- Bruising
- Swollen 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 aspiration and 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 whitecells. CertainDNA changes may determine what kind of treatmentthe personreceives and the outlook.
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 complete remission.
- Theperson may need to stay in the hospital for chemotherapy. Or it can be given at a clinic and the patient goes home afterward.
- Chemotherapy is given into the veins (by IV) and sometimes next to the spine and brain.
After remission, more treatment is needed to be cured. This treatment can include more chemotherapy orradiation to the brain. Stem cell transplant from another person may also be done. Further treatment depends on:
- Age and health of the person
- Type of leukemia cells, including the DNA changes found
- How many courses of chemotherapy it took to achieve remission
- Availability of donors for stem cell transplant
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. Mostchildren with ALL can be cured. Childrenoften 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 develop symptoms ofALL.
Prevention
You may reduce your risk of ALL by avoiding contactwith 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 Jr, Silberstein LE, et al., eds. Hematology: Basic Principles and Practice. 6th ed.Philadelphia, PA: Elsevier Saunders; 2012: chap 64.
National Cancer Institute: PDQ Adult Acute Lymphoblastic Leukemia Treatment. Bethesda, MD: National Cancer Institute. Date last modified 07/10/2012. Available at http://www.cancer.gov/cancertopics/pdq/treatment/adultALL/HealthProfessional. Accessed 01/03/2013.
National Cancer Institute: PDQ Childhood Acute Lymphoblastic Leukemia Treatment. Bethesda, MD: National Cancer Institute. Date last modified 11/01/2012. Available at http://cancer.gov/cancertopics/pdq/treatment/childALL/HealthProfessional. Accessed 01/03/2013.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Acute Lymphoblastic Leukemia. Version 2.2012. Available at http://www.nccn.org/professionals/physician_gls/pdf/all.pdf. Accessed 01/03/2013.
Reviewed By: Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Blackman, Stephanie Slon, and Nissi Wang.
