Acute lymphocytic leukemia (ALL) is a fast-growing cancer of the blood and bone marrow. It affects a type of white blood cells called lymphocytes. The cancer causes large numbers of abnormal white cells to form, crowding out normal blood cells in the bone marrow.
Another name for this type of leukemia is acute lymphoblastic leukemia.
The cancer starts in the bone marrow. Marrow is the soft, fatty tissue inside the hard, outer supporting part of the bones. The marrow makes blood stem cells, which become the different types of blood cells, including white blood cells, red blood cells, and platelets.
Normally, white blood cells help your body fight infection and other diseases. Acute lymphocytic leukemia happens when the body makes too many abnormal lymphocytes. The abnormal cells crowd out other, normal blood cells needed by the body. The abnormal lymphocytes cannot fight infections like normal white blood cells. In addition, you become anemic because you don’t have enough red blood cells. The number of platelets also decreases. This causes you to have blood clotting problems and to bleed easily.
The cancer can spread to the blood, lymph nodes, spleen, liver, central nervous system, and other organs.
It is not known why the bone marrow becomes cancerous, but there are some known risk factors for developing ALL. You are more likely to get ALL if:
Often the first signs or symptoms of ALL are subtle and nonspecific. Symptoms may include:
Your healthcare provider will ask about your medical history, including symptoms and possible risk factors, and you will have a physical exam.
Diagnostic tests include:
When the blood and bone marrow tests confirm a diagnosis of ALL, more tests may be done before you start treatment to see if the cancer has spread beyond the blood and bone marrow. This is called staging and phasing. Tests that may be done include:
The treatment depends on the stage of the leukemia. The goal is to make the signs and symptoms decrease or go away. In general there are 2 phases of treatment:
Possible treatments include chemotherapy (anticancer drugs), radiation therapy, and stem cell therapy.
Newer therapies are available and continue to be studied. Examples of new treatments you may want to ask your healthcare provider about are tyrosine kinase inhibitors and immunotherapy (which is also called biotherapy or biologic therapy).
Your treatment will also be focussed on:
You may want to think about participating in a clinical trial. Clinical trials are research studies to find the most effective cancer treatments. They usually compare existing treatments with new, experimental treatments. This is a way you may be able to have treatment with the latest drugs. Ask your healthcare provider about clinical trials that might be available to you. It’s always your choice whether you consider them or not.
Many people with leukemia live normal lives for many years. Treatment for newly diagnosed ALL results in a remission 80 to 85% of the time. When the cancer is in remission, you will need to have regular follow-up visits with your healthcare provider to keep checking your blood counts and overall health. In some cases you may have treatment during remission to try to keep the cancer in remission. The cancer may return in weeks, months, or years. When the cancer comes back, it is called a recurrence. Recurrences can be treated. The overall cure rate is 30 to 40%.
Because we don’t know what causes ALL, there’s no way to prevent it.