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Acute Lymphoblastic Leukemia

(Acute Lymphocytic Leukemia; ALL)

Definition

Acute lymphoblastic leukemia (ALL) is a cancer of the white blood cells. The white blood cells (lymphocytes) grow in the bone marrow. Normally, they help the body fight infections. ALL causes the bone marrow to make too many white blood cells. This makes it hard for other types of blood cells to develop.

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. Other things that raise the risk are:

  • Previous chemotherapy or radiation treatment
  • Certain genetic disorders, such as:
    • Down syndrome and Bloom syndrome
    • Fanconi's anemia, ataxia-telangiectasia, and neurofibromatosis
    • Shwachman syndrome, IgA deficiency, and congenital X-linked agammaglobulinemia
  • Exposure to toxic chemicals
  • High exposure to radiation

Things that raise the risk of ALL in children are:

  • X-rays before birth
  • Radiation exposure, including X-rays and CT scans
  • Having a brother or sister with leukemia
  • Previous chemotherapy

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
  • Bone marrow aspiration and biopsy —to remove and test a sample of bone marrow

The doctor may do more tests to learn about the leukemia. These tests will help guide treatment. Tests may include:

  • Cytogenetic analysis—to look changes in cells and genes
  • Immunophenotyping—to check the type of leukemia
  • Lumbar puncture — to test the fluid around the brain and spinal cord for cancer
  • Chest x-ray —to look for spreading of cancer to the lungs

Treatment

Treatment of ALL is done in 2 phases. The first phase is to kill leukemia cells. The second stage is to kill any remaining leukemia cells. Cells left behind could grow and cause the leukemia to come back. Options are:

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:

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

Provincial Health Services Authority
http://www.bccancer.bc.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.

Last reviewed January 2021 by EBSCO Medical Review Board Mohei Abouzied, MD, FACP  Last Updated: 3/21/2021