What is acute lymphocytic leukemia (ALL)?

Acute lymphocytic leukemia (ALL) is a cancer of the blood and bone marrow. In ALL, there’s an increase in a type of white blood cell (WBC) known as a lymphocyte. Because it’s an acute, or aggressive, form of cancer, it moves rapidly.

ALL is the most common childhood cancer. Children younger than age 5 have the highest risk. It can also occur in adults.

There are two main subtypes of ALL, B-cell ALL and T-cell ALL. Most types of ALL can be treated with a good chance of remission in children. Adults with ALL don’t have as high of a remission rate, but it’s steadily improving.

The National Cancer Institute (NCI) estimates 5,960 people in the United States will receive a diagnosis of ALL in 2018.

Having ALL increases your chances of bleeding and developing infections. The symptoms and signs of ALL may also include:

The causes of ALL aren’t yet known.

Although doctors don’t yet know the specific causes of ALL, they have identified a few risk factors of the condition.

Radiation exposure

People who’ve been exposed to high levels of radiation, such as those who’ve survived a nuclear reactor accident, have shown an increased risk for ALL.

According to a study from 1994, Japanese survivors of the atomic bomb in World War II had an increased risk of acute leukemia six to eight years after exposure. A 2013 follow-up study reinforced the connection between atomic bomb exposure and the risk of developing leukemia.

Studies done in the 1950s showed that fetuses exposed to radiation, such as in X-rays, within the first months of development present an increased risk for ALL. However, more recent studies have failed to replicate these outcomes.

Experts also note the risk of not getting a needed X-ray, even when pregnant, can outweigh any risks from radiation. Talk to your doctor about any concerns you have.

Chemical exposures

Prolonged exposure to certain chemicals, such as benzene or chemotherapy drugs, is strongly correlated to the development of ALL.

Some chemotherapy drugs may cause second cancers. If a person has a second cancer, it means they were diagnosed with cancer and, afterward, developed a different and unrelated cancer.

Some chemo drugs may put you at risk for developing ALL as a second cancer. However, acute myeloid leukemia (AML) is more likely to develop as a second cancer than ALL.

If you do develop a second cancer, you and your doctor will work toward a new treatment plan.

Viral infections

A 2010 study reports that various viral infections have been linked to an increased risk for ALL.

T cells are a particular type of WBC. Contracting human T-cell leukemia virus-1 (HTLV-1) can cause a rare type of T-cell ALL.

Epstein-Barr virus (EBV), which is usually responsible for infectious mononucleosis, has been linked to ALL and Burkitt’s lymphoma.

Inherited syndromes

ALL doesn’t appear to be an inherited disease. However, some inherited syndromes exist with genetic changes that raise the risk of ALL. They include:

People who have siblings with ALL are also at a slightly increased risk for the disease.

Race and sex

Some populations have a higher risk for ALL, although these differences in risk aren’t yet well-understood. Hispanics and Caucasians have shown a higher risk for ALL than African-Americans. Males have a higher risk than females.

Other risk factors

Experts have also studied the following as possible links to developing ALL:

Your doctor must complete a full physical exam and conduct blood and bone marrow tests to diagnose ALL. They’ll likely ask about bone pain, since it’s one of the first symptoms of ALL.

Here are some of the possible diagnostic tests you might need:

Blood tests

Your doctor may order a blood count. People who have ALL may have a blood count that shows low hemoglobin and a low platelet count. Their WBC count may or may not be increased.

A blood smear may show immature cells circulating in the blood, which are normally found in bone marrow.

Bone marrow aspiration

Bone marrow aspiration involves taking a sample of bone marrow from your pelvis or breastbone. It provides a way to test for increased growth in marrow tissue and reduced production of red blood cells.

It also allows your doctor to test for dysplasia. Dysplasia is an abnormal development of immature cells in the presence of leukocytosis (increased WBC count).

Imaging tests

A chest X-ray can allow your doctor to see if the mediastinum, or the middle partition of your chest, is widened.

A CT scan helps your doctor determine whether cancer has spread to your brain, spinal cord, or other parts of your body.

Other tests

A spinal tap is used to check if cancer cells have spread to your spinal fluid. An electrocardiogram (EKG) and echocardiogram of your heart may be performed to check left ventricular function.

Tests on serum urea and renal and liver function may also be done.

Treatment of ALL aims to bring your blood count back to normal. If this happens and your bone marrow looks normal under a microscope, your cancer is in remission.

Chemotherapy is used to treat this type of leukemia. For the first treatment, you may have to stay in the hospital for a few weeks. Later, you may be able to continue treatment as an outpatient.

In the event you have a low WBC count, you’ll most likely have to spend time in an isolation room. This ensures you’re protected from contagious diseases and other problems.

A bone marrow or stem cell transplant may be recommended if your leukemia doesn’t respond to chemotherapy. The transplanted marrow may be taken from a sibling who’s a complete match.

Of the nearly 6,000 Americans who receive a diagnosis of ALL in 2018, the American Cancer Society estimates that 3,290 will be male and 2,670 will be female.

The NCI estimates ALL to result in 1,470 deaths in 2018. Around 830 deaths are expected to occur in males, and 640 deaths are expected to occur in females.

Although most cases of ALL appear in children and teens, around 85 percent of deaths will occur in adults, estimates the NCI. Children are typically better than adults at tolerating aggressive treatment.

Per the NCI, the five-year survival rate for Americans of all ages is 68.1 percent. The five-year survival rate for American children is around 85 percent.

A variety of factors determines a person’s outlook. They include age, ALL subtype, WBC count, and whether or not ALL has spread to nearby organs or cerebrospinal fluid.

Survival rates for adults aren’t as high as survival rates for children, but they’re steadily improving.

According to the American Cancer Society, between 80 and 90 percent of adults with ALL go into remission. However, about half of them see their leukemia return. They note the overall cure rate for adults with ALL is 40 percent. An adult is considered “cured” if they’ve been in remission for five years.

Children with ALL stand a very good chance of being cured.

There’s no confirmed cause of ALL. However, you can avoid several risk factors for it, such as:

prolonged exposure to diesel fuel, gasoline, pesticides, and electromagnetic fields