Acute lymphoblastic leukemia, also referred to as acute lymphocytic leukemia or ALL, is a form of cancer that affects the bone marrow and blood cells.
Early signs of ALL may include symptoms like fever and easy bleeding or bruising. It’s important to familiarize yourself with the symptoms of leukemia and talk with your child’s pediatrician if you have concerns.
This article discusses more about the symptoms to know, how ALL is diagnosed, available treatments, and the outlook for kids with this form of cancer.
As the cancer progresses, the bone marrow produces more immature lymphocytes than mature lymphocytes. Since white blood cells are responsible for fighting infection, this can quickly become a problem.
With ALL, too many immature white blood cells eventually take over the bone marrow and cause various symptoms, like fatigue, bleeding, and difficulty getting over infections.
ALL affects around 30 out of 1 million children in the United States. Of those cases, most are diagnosed in children between ages 3 and 5 years old. The good news is that with proper treatment, most kids can overcome ALL.
The acute part of ALL describes how quickly this cancer can progress. Your child may not have symptoms one day and then symptoms come on the next and progress rapidly.
Symptoms of ALL can include:
- bruising easily
- frequent infections
- swollen lymph nodes, including those near the neck, groin, and under the arms
- abnormal bleeding, such as:
- dizziness or lightheadedness
- shortness of breath
- pale skin
- unexplained weight loss
- abdominal pain or discomfort
- pain in the bones and joints
At the appointment, your child’s pediatrician will consider your child’s symptoms, medical and family history, and then give your child a physical exam. If necessary, the pediatrician may consult with a pediatric oncologist and order tests to get a better picture of your child’s condition. These may include:
- Blood test. Your doctor may order a complete blood count (CBC) test. A CBC is a blood test that measures the number of blood cells in your child’s body, as well as the type (white blood cells, red blood cells, etc.). This is a less invasive test than others but cannot be used alone to diagnose ALL.
- Bone marrow aspiration. In the bone marrow aspiration procedure, a needle is inserted into a bone (usually in the hip) to a sample of bone marrow to assess. After the sample is examined by a pathologist, you may get a formal diagnosis of ALL.
- Spinal tap. Also called lumbar puncture, this test involves inserting a needle into the spinal canal and collecting a sample of cerebrospinal fluid (CSF) to look for leukemia cells.
- X-ray. Your doctor may also order an X-ray (or another imaging test) to get a picture of your child’s bones and organs. Specifically with ALL, an X-ray may help identify a mass in the chest that causes difficulty with breathing.
- Chromosome analysis. Any blood or bone marrow samples that your child’s doctor collects can also be sent to a lab for chromosome analysis. Technicians can look at the size, shape, and origin of certain cells and to decide the best type of treatment.
Treatment for ALL is completed in three main phases:
- Induction. The goal of the induction phase is to get to remission, or a point when no cancer cells are found in the blood or blood marrow. Your child may need to stay in the hospital for the first month or so of treatment as a pediatric oncologist carefully monitors their progress.
- Consolidation. The consolidation phase is often the most intense and may last several months. The goal here is to target any leftover leukemia cells in the body and prevent them from developing a resistance to the medications. Some children may also receive a stem cell transplant during this stage of treatment.
- Maintenance. This type of therapy begins only after a child’s leukemia is in remission after the first two stages. The goal of this stage is to prevent cancer cells from regrowing (relapsing). Medications in this phase are given at lower doses, but it’s important to take them as directed to prevent a relapse.
Specific therapy options may include:
- Chemotherapy. Chemotherapy is the primary course of treatment for kids with ALL. It involves delivering certain cancer-fighting medications through an IV, into the muscle, or into the cerebrospinal fluid. In some cases, chemo may be taken orally. No matter the route, the medications enter the blood to reach the whole body at once.
- Radiation. This treatment uses high-powered X-rays to kill cancer cells and keep them from spreading in the body. In particular, radiation may be used if ALL has spread or has the potential to spread to the brain, spinal cord, or testicles.
- Stem cell transplant. Chemo may be given in combination with a stem cell transplant (bone marrow transplant). Stem cells can help replace damaged blood cells and promote healthy blood cells. This therapy is given via infusion and may be used for an ALL relapse.
- Targeted therapy. There are also drugs that target specific cancer cells and their abnormalities. Targeted therapy kills cancer cells and may be used in combination with other therapies in any phase of treatment.
- New therapies. Beyond these standard treatments, doctors are working with new options, like immunotherapy. CAR T-cell therapy, for example, uses the body’s own immune system to kill off cancer cells. In this treatmenet, T-cells are created in a lab and then infused into the body to attack the ALL.
- Clinical trials. Doctors and researchers are working on creating new treatments for ALL and finding new ways to use current treatments. Your child may be eligible to take part in a clinical trial, but understand that these treatments are experimental. You can discuss both the benefits and risks with your child’s doctor.
The exact course of treatment will depend on whether the cancer cells originated from B or T lymphocytes. Your child’s doctor may prescribe a combination of various chemotherapy drugs as needed.
After each phase of treatment is completed, your child will be given a period of rest before progressing to another phase. In general, treatment with chemo for ALL takes between 2 and 3 years to complete.
Overall, researchers have found that the prognosis for children with ALL is good. According to the Leukemia and Lymphoma Society, survival rates from 2009 to 2015 were 91.9 percent for children younger than 15 years, and 94.1 percent for those younger than age 5.
Around 90 percent of kids with this form of cancer will be cured. “Cured” in this case means that the cancer will not relapse in the 10 years after treatment.
Some children, like those with Down Syndrome, may be more likely to have relapses than other children. And there is a chance that some kids may deal with effects or complications from ALL years after treatment.
Your child’s oncologist can give your more details on their individual prognosis.
Researchers do not definitively know what causes ALL, so prevention is difficult. If you suspect your child may have symptoms of ALL, contact your child’s pediatrician for a checkup and further testing. Since the cancer progresses quickly, early diagnosis is key to getting the care your child needs.
The good news with ALL is that there are many treatments available and a high rate of survival in children.