Acute lymphocytic leukemia (ALL)

Definition

Acute lymphocytic leukemia (ALL) is a fast-growing cancer in which the body produces a large number of immature white blood cells (lymphocytes). These cells are found in the blood, bone marrow, lymph nodes, spleen, and other organs.

Alternative Names

ALL; Acute childhood leukemia; Cancer - acute childhood leukemia (ALL); Leukemia - acute childhood (ALL)

Causes, incidence, and risk factors

ALL makes up 80% of childhood acute leukemias. Most cases occur in children ages 3 - 7. The disease may also occur in adults.

In acute leukemia, cancerous cells multiply quickly and replace normal cells. Cancerous cells take over normal parts of the bone marrow, causing bone marrow failure. A person with ALL is more likely to bleed and have infections because there are fewer normal blood cells.

Most cases of ALL have no obvious cause. However, the following may play a role in the development of leukemia:

• Chromosome problems
• Radiation
• Some chemotherapy drugs
• Toxins such as benzene

Persons with Down syndrome or who have a brother or sister with leukemia are at increased risk for ALL.

Symptoms

• Bleeding gums
• Bone pain or tenderness
• Easy bruising
• Excessive or prolonged bleeding
• Fatigue
• Fever
• Joint pain
• Infection
• Menstrual irregularities
• Nosebleeds
• Paleness
• Palpitations
• Pinpoint red spots on the skin (petechiae)
• Shortness of breath (made worse by exercise)
• Swollen glands (lymphadenopathy)
• Swollen gums
• Unintentional weight loss

Signs and tests

A physical exam may reveal the following:

• Bruising
• Enlarged liver and spleen
• Signs of bleeding (petechiae, purpura)

Blood tests may show the following:

• Abnormal white blood cell (WBC) count
• Low red blood cell count (anemia)
• Low platelet count (thrombocytopenia)

A bone marrow aspiration will show abnormal levels of certain cells.

ALL may also change the results of the following tests:

• B-cell leukemia/lymphoma panel
• T-lymphocyte count
• WBC differential

If you are diagnosed with ALL, genetic tests will be done to determine the specific type of ALL. Doctors can look for chromosome changes in the cells of some leukemias. Leukemias with certain types of chromosome changes have a poor outlook, while those with other types of genes can have a very good outlook. This may determine what kind of therapy is used to treat the ALL.

Treatment

The goal of treatment is to get the blood counts and the bone marrow back to normal. If this occurs, the cancer is said to be in remission.

If you have ALL, you will need chemotherapy. For the first round of chemotherapy, you may need to go to the hospital for 3 - 6 weeks. Later you may get chemotherapy on an outpatient basis. If you have a low white blood cell count, you may need to be placed in a room by yourself so you do not catch an infection.

Additional treatments depend on other symptoms. They may include:

• Transfusion of blood products, such as platelets or red blood cells, to fight thrombocytopenia and anemia
• Antibiotics to fight infection, especially if a fever occurs

If you go into remission, you may receive additional chemotherapy or radiation therapy to kill any cancer cells that are in the spinal fluid. You may also receive chemotherapy from time to time to prevent relapse. A bone marrow or stem cell transplant may also be recommended, especially if one of your siblings is proven to be a full match.

If your leukemia returns or does not respond to other treatments, a bone marrow or stem cell transplant is usually recommended.

Support Groups

Patients can ease the stress of their illness by joining a support group where members share common experiences and problems.

See also: Cancer - support group

Expectations (prognosis)

Children usually have a better outcome than adults. Most adults go into complete remission. Without treatment, a person with ALL can expect to live for only about 3 months.

Complications

• Bleeding
• Disseminated intravascular coagulation (DIC)
• Relapse of ALL
• Severe infection

Calling your health care provider

Call your health care provider if:

• You develop ALL-like symptoms
• You have ALL and you have a persistent fever or other signs of infection

Prevention

Because the cause is usually unknown, it is not possible to prevent most cases. You may reduce your risk of ALL by avoiding exposure to toxins, radiation, and chemicals.

References

Appelbaum FR. The acute leukemias. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 194.

National Cancer Institute. Acute lymphoblastic leukemia - adult, treatment (PDQ). Accessed February 24, 2009.

National Cancer Institute. Acute lymphoblastic leukemia - childhood, treatment (PDQ). Accessed February 24, 2009.