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by Scholten A
(Acute Lymphocytic Leukemia; ALL)

Definition

Acute lymphoblastic leukemia (ALL) is a cancer of a type of white blood cells called lymphocytes. These cells grow in the bone marrow and help the body fight infections. ALL happens when the bone marrow makes too many of these cells. This makes it hard for the cells to work as they should. It also makes it hard for other types of blood cells to develop.

White Blood Cells
White Blood Cells
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Causes

It is not clear what causes ALL. It is likely a combination of genes and environment.

Risk Factors

ALL is more common in children 2 to 5 years old and adults over 70 years of age.

Things that may raise the risk of ALL are:

Symptoms

ALL may cause:

  • Fever and night sweats
  • Tiredness, weakness, and pale skin
  • Bone or joint pain
  • Easy bruising or bleeding
  • Painless lumps in the neck, underarms, stomach, or groin
  • Problems breathing
  • Loss of hunger, weight loss
  • Stomach pain or feeling of fullness below the ribs

Diagnosis

The doctor will ask about your symptoms and health history. A physical exam will be done. The doctor will check for swelling of the liver, spleen, or lymph nodes. You may be referred to a specialist.

Tests will be done to look for abnormal cells. They include:

  • Blood tests—to look at cells and genes
  • Bone marrow aspiration and biopsy —to remove and test a sample of bone marrow

If cancer cells are found, other tests may be done to see if the cancer has spread. Tests may include:

Treatment

The goal of treatment is to kill cancer cells and return blood and bone marrow back to normal. You will be monitored closely during and after treatment. One of more of these methods may be used:

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. It is given by pill, injection, or IV. The drugs enter the bloodstream and travel through the body. It kills mostly cancer cells, but also some healthy cells.

Drugs may also be injected into the fluid in the spinal column to kill cancer cells that spread to the brain and spinal column. This is called intrathecal therapy.

Radiation Therapy

Radiation therapy is the use of radiation to kill cancer cells and shrink tumors. External radiation therapy is used to direct radiation at the tumor from outside the body. It is used for ALL that may or has spread to the brain and spinal cord.

Stem Cell Transplant

Stem cells are immature blood cells. They are removed from a person's blood or bone marrow before treatment is done. They may also be taken from a healthy donor. A stem cell transplant puts the cells in the body after treatment. These cells can develop new, healthy cells.

Targeted Therapy and Immunotherapy

Targeted therapy uses drugs to attack parts of cancer cells. Some ALL cells have an abnormal chromosome that specific drugs can target and attack. These drugs are called tyrosine kinase inhibitors. They are used with chemotherapy.

Immunotherapy is the use of medicine to help the body’s immune system fight cancer. Monoclonal antibodies made in a lab may be used to attack a specific target, such as a protein on the surface of a cancer cell. Another type of therapy removes immune cells from a person's body, makes changes to them in a lab, and puts them back in the blood so they can better fight cancer.

Prevention

There are no current guidelines for preventing ALL.

RESOURCES

American Cancer Society  https://www.cancer.org 

National Cancer Institute  https://www.cancer.gov 

CANADIAN RESOURCES

BC Cancer  http://www.bccancer.bc.ca 

Canadian Cancer Society  https://www.cancer.ca 

References

Acute lymphoblastic leukemia/lymphoma (ALL). EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/acute-lymphoblastic-leukemia-lymphoma-all. Updated Accessed March 21, 2021.

Acute lymphocytic leukemia (ALL) in adults. American Cancer Society website. Available at: https://www.cancer.org/cancer/acute-lymphocytic-leukemia.html. Accessed March 21, 2021.

Aldoss I, Stein AS. Advances in adult acute lymphoblastic leukemia therapy. Leuk Lymphoma. 2018;59(5):1033-1050.

General information about adult acute lymphoblastic leukemia. National Cancer Institute website. Available at: https://www.cancer.gov/types/leukemia/patient/adult-all-treatment-pdq. Accessed March 21, 2021.

General information about childhood acute lymphoblastic leukemia. National Cancer Institute website. Available at: https://www.cancer.gov/types/leukemia/patient/child-all-treatment-pdq. Accessed March 21, 2021.

Leukemia in children. American Cancer Society website. Available at: https://www.cancer.org/cancer/leukemia-in-children.html. Accessed March 21, 2021.

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