Acute lymphoblastic leukemia (ALL), or acute lymphocytic leukemia, is a blood cancer.
Leukemias are classified depending on the type of blood cells affected and how rapidly the disease progresses. “Acute” means it develops rapidly and “lymphoblastic” means it affects lymphocytes.
Lymphocytes are cells that become three types of white blood cells:
People with ALL produce too many immature lymphocytes and not enough healthy white blood cells.
ALL is the most common childhood cancer. About
In this article, we look at how ALL is treated, its outlook, and how much treatment usually costs.
Many different types of treatment are used for ALL, but chemotherapy is used in most regimens. Chemotherapy is usually broken into three phases.
The goal of induction chemotherapy is induce remission. Remission is when doctors are no longer able to find signs of your cancer. The induction phase can take up to 4 weeks, during which time you’ll stay in the hospital.
The following drugs are often used:
Corticosteroids are also commonly added to ALL treatments to help treat the cancer and reduce side effects.
Intensification and consolidation
The intensification and consolidation phase consists of additional chemotherapy to destroy lingering cancer cells that may be in your body, but aren’t detectable. You may also receive a bone marrow transplant at this time. This stage may last several months.
The maintenance phase involves taking a lower dose of chemotherapy drugs for typically about 2 years to prevent relapse. Medications may include:
The best treatment for ALL depends on factors such as your age and overall health. Potential treatments include:
- targeted therapy
- splenectomy, or spleen removal
- radiation therapy
- bone marrow transplants
The standard treatment for adults is chemotherapy and bone marrow transplant. The exact treatment depends on factors such as which subtype of ALL you have, the extent of your leukemia, and the presence of any genetic mutations.
You may have chemotherapy drugs administered through a spinal tap or radiation therapy if there’s evidence of the disease in your central nervous system.
Bone marrow transplant
Chemotherapy damages healthy cells in your body that divide quickly like the cells in your bone marrow that produce blood cells. A bone marrow transplant helps replace these damaged bone marrow cells.
Two types of bone marrow transplants are routinely performed:
- Autologous transplant. Your own bone marrow cells are taken before receiving a high dose of chemotherapy and are returned after treatment. It can only be done if you have healthy bone marrow.
- Allogeneic transplant. You receive cells from either a close family member or a donor who’s a close genetic match. There’s a risk you’ll develop graft-versus-host disease, where your body attacks the new cells.
CAR T cell therapy
A type of immunotherapy called CAR T-cell therapy is a new treatment available for adults up to age 25. It’s sometimes used when ALL doesn’t respond to other treatments.
During this therapy, immune cells are filtered out of your blood. These cells are infused with proteins that help defend against the cancer. They’re then re-infused back into your body.
This helps address the side effects of treatment, especially when cancer is aggressive or not responding to treatments. This can include antibiotics, as well as red blood cell and platelet transfusions.
Treatment for childhood leukemia usually takes 2 to 3 years. Children typical go through three rounds of chemotherapy:
- intensification and consolidation
Chemotherapy drugs often include anthracycline, vincristine, and 1-asparaginase in combination with a corticosteroid.
Additional treatment options depend on whether your child is at low risk or a high risk of the cancer returning.
For low-risk children, an allogeneic bone marrow transplant may be performed after remission if there’s a poor response to chemotherapy.
If your child doesn’t reach remission, they may be given the same treatments as high-risk treatment.
Children at a high risk are given a higher dose of chemotherapy drugs, especially during intensification and consolidation. Radiation therapy or chemotherapy administered directly into the spinal cord are recommended when there’s evidence the disease has spread to the central nervous system.
Clinical trials are investigating the potential benefits of combining chemotherapy with targeted therapy or stem cell transplants. The use of CAR T-cell therapy is also continuing to be investigated.
Chemotherapy is an important part of ALL treatment but can cause side effects such as:
- low blood count
- increased infections
- hand or feet numbness or tingling
- loss of appetite and weight loss
- nausea and vomiting
- hair loss
- mouth sores
Chemotherapy can induce a condition called tumor lysis syndrome that can cause:
Allogeneic bone marrow transplants come with a risk of graft-versus-host disease, where your body attacks the new bone marrow cells. There are other immediate and long-term side effects that can occur including:
Immediate side effects include:
- mouth and throat pain
- nausea and vomiting
- lung issues
Long-term effects can include:
- organ damage
- cancer relapse
- hormone changes
- abnormal tissue growth
Corticosteroids can cause high blood sugar and stomach ulcers.
Looking at the 5-year relative survival rate can give you a rough idea of the outlook of your cancer. The 5-year relative survival rate is a measurement of how many people diagnosed with the disease are alive 5 years later. However, many factors can affect your outlook. The best way to understand your chances of survival is to talk to your medical team.
The National Cancer Institute’s Surveillance, Epidemiology, and End Results Program (SEER) lists the 5-year relative survival rates by age group from 2011 to 2017.
ALL treatment can be expensive, but insurance often helps cover at least some of the cost. For example, Medicare Part A covers hospital stays and cancer treatment you receive at the hospital. Part B covers cancer-related treatments deemed medically necessary such as chemotherapy, doctor visits, and radiation.
A 2018 report commissioned by the Leukemia & Lymphoma Society found that that the average cost of treating acute leukemia in the first year was $463,414 — almost three times higher than the average for all blood cancers. The average out-of-pocket expense for ALL was $5,147.
The average overall cost for all blood cancers was $156,845, and average out-of-pocket cost was $3,877.
This cost for acute leukemia is more for several reasons, particularly the number of transplants that are done, the amount of hospital stays, and the intensity of the treatment regimen.
In general, cost varies by type of cancer, and typically decreases over time. Your out-of-pocket costs will depend on your insurance and how quickly you reach your deductible during the first months of each fiscal year.
The Leukemia & Lymphoma Society has a helpline to offer guidance about health insurance and financial assistance programs. You can call them at 1-800-955-4572.
Getting diagnosed with cancer is difficult, especially if your doctor tells you that your chances of survival are low. Watching your child, friend, or family member go through cancer treatment can also be incredibly difficult.
The outlook for children with ALL is good and the vast majority of children survive. Researchers are constantly discovering new potential treatment options that may increase the survival rate for children and adults in the future.
Many cancers that once had dismal outlooks are now very curable. For example, acute promyelocytic leukemic used to be one of the deadliest forms of leukemia, but one 2013 study found the 2-year, event-free survival rate to be 97 percent.
The Leukemia & Lymphoma Society offers many resources to help you through this difficult time including links to financial support programs, peer-to-peer support, and support groups.
ALL is a type of blood cancer that causes your body to produce too many immature white blood cells and not enough healthy white blood cells. Treatment generally consists of chemotherapy combined with other treatments such as bone marrow transplants, radiation therapy, immunotherapy, or targeted therapies.
The vast majority of children with ALL survive. The survival rate drops with age but is still over 60 percent for adults up to the age of 39.