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:
- paleness (pallor)
- bleeding from the gums
- a fever
- bruises or purpura (bleeding within the skin)
- petechiae (red or purple spots on the body)
- lymphadenopathy (characterized by enlarged lymph nodes in the neck, under the arms, or in the groin region)
- enlarged liver
- enlarged spleen
- bone pain
- joint pain
- shortness of breath
- testicular enlargement
- cranial nerve palsies
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.
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.
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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.
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.
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.
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:
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:
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).
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.
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.
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.
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.