Acute lymphoblastic leukemia (ALL)
Acute lymphoblastic leukemia (ALL) is a fast-growing cancer of a type of white blood cells called lymphocytes.
ALL occurs when the bone marrow produces a large number of immature lymphoblasts, a cancerous form of lymphocytes. Bone marrow is the soft, spongy tissue found inside most bones in children and in the front chest bone (sternum) and the pelvis bones in adults 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
- Past treatment with chemotherapy drugs
Chemotherapy
The term chemotherapy is used to describe cancer-killing drugs. Chemotherapy may be used to:Cure the cancerShrink the cancerPrevent the cancer from ...
Read Article Now Book Mark Article - Receiving a bone marrow transplant
- Toxins, such as benzene
Toxins
Toxins are substances created by plants and animals that are poisonous (toxic) to humans. Toxins may also include some medicines that are helpful in...
Read Article Now Book Mark Article
The following factors are known to increase the risk for ALL:
- Down syndrome or other genetic disorders
Down syndrome
Down syndrome is a genetic condition in which a person has 47 chromosomes instead of the usual 46.
Read Article Now Book Mark Article - 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 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
Paleness
Paleness is an abnormal loss of color from normal skin or mucous membranes.
Read Article Now Book Mark Article - Pain or feeling of fullness below the ribs from an enlarged liver or spleen
- Pinpoint red spots on the skin (petechiae)
Pinpoint red spots
Bleeding into the skin can occur from broken blood vessels that form tiny red dots (called petechiae). Blood also can collect under the tissue in la...
Read Article Now Book Mark Article - Swollen lymph nodes in the neck, under arms, and groin
Swollen lymph nodes
Lymph nodes are present throughout your body. They are an important part of your immune system. Lymph nodes help your body recognize and fight germ...
Read Article Now Book Mark Article - Night sweats
These symptoms can occur with other conditions. Talk to your health care provider about the meaning of specific symptoms.
Exams and Tests
Your provider will perform a physical exam and ask about your symptoms.
Blood tests may include:
- Complete blood count (CBC), including white blood cell (WBC) count
White blood cell (WBC) count
A WBC count is a blood test to measure the number of white blood cells (WBCs) in the blood. It is a part of a complete blood count (CBC). WBCs are a...
Read Article Now Book Mark Article - Platelet count
- Bone marrow biopsy
Bone marrow biopsy
A bone marrow biopsy is the removal of marrow from inside bone. Bone marrow is the soft tissue inside bones that helps form blood cells. It is foun...
Read Article Now Book Mark Article - Lumbar puncture (spinal tap) to check for leukemia cells in the spinal fluid
Spinal tap
Cerebrospinal fluid (CSF) collection is a test to look at the fluid that surrounds the brain and spinal cord. CSF acts as a cushion, protecting the b...
Read Article Now Book Mark Article
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). Oral chemotherapy may be given after a remission to maintain it.
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:
Radiation to the brain
When you have radiation treatment for cancer, your body goes through changes. Follow your health care provider's instructions on how to care for you...
Read Article Now Book Mark ArticleStem cell
A bone marrow transplant is a procedure to replace damaged or diseased bone marrow with healthy bone marrow stem cells. Bone marrow is the soft, fatt...
Read Article Now Book Mark Article- Age and health of the person
- Genetic changes in the leukemia cells
- How many courses of chemotherapy it took to achieve remission
- If abnormal cell DNA is detected in the bone marrow after remission
- Availability of donors for stem cell or bone marrow transplant
You and your provider may need to manage other concerns during your leukemia treatment, including:
- Having chemotherapy at home
Having chemotherapy at home
You or your child will be going home from the hospital soon. Your health care provider has prescribed medicines or other treatments that you or your...
Read Article Now Book Mark Article - Managing your pets during chemotherapy
Managing your pets
If you have a weak immune system, having a pet can put you at risk for serious illness from diseases that can spread from animals to humans. Learn w...
Read Article Now Book Mark Article - Bleeding problems
Bleeding problems
Your bone marrow makes cells called platelets. These cells keep you from bleeding too much by helping your blood clot. Chemotherapy, radiation, and...
Read Article Now Book Mark Article - Dry mouth
Dry mouth
Some cancer treatments and medicines can cause dry mouth. Take good care of your mouth during your cancer treatment. Follow the measures outlined b...
Read Article Now Book Mark Article - Eating enough calories
Eating enough calories
If you are sick or undergoing cancer treatment, you may not feel like eating. But it is important to get enough protein and calories so you do not l...
Read Article Now Book Mark Article - Safe eating during cancer treatment
Safe eating
When you have cancer, you need good nutrition to help keep your body strong. To do this, you need to be aware of the foods you eat and how you prepa...
Read Article Now Book Mark Article
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.
Cancer support group
The following organizations are good resources for information on cancer:American Cancer Society. Support and online communities. www. cancer. org/...
Read Article Now Book Mark ArticleOutlook (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
Contact your provider if you or your child develops symptoms of ALL.
Prevention
The risk for developing ALL may be reduced by avoiding contact with certain toxins, radiation, and chemicals.
Reviewed By
Mark Levin, MD, Hematologist and Oncologist, Monsey, NY. Review provided by VeriMed Healthcare Network. Internal review and update on 02/20/2024 by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
National Cancer Institute website. Acute lymphoblastic leukemia treatment (PDQ) - health professional version. www.cancer.gov/types/leukemia/hp/adult-all-treatment-pdq. Updated March 28, 2024. Accessed August 2, 2024.
National Cancer Institute website. Childhood acute lymphoblastic leukemia treatment (PDQ) - health professional version. www.cancer.gov/types/leukemia/hp/child-all-treatment-pdq. Updated June 18, 2024. Accessed August 2, 2024.
Pillai PM, Carroll WL. Acute lymphoblastic leukemia. In: Fish JD, Lipton JM, Lanzkowsky P, eds. Lanzkowsky's Manual of Pediatric Hematology and Oncology. 7th ed. Philadelphia, PA: Elsevier; 2022:chap 18.