Acute lymphocytic leukemia is the most common leukemia in children. This type of cancer is different in children than it is in adults. Due to improvements in diagnosis and treatment, the outlook for this cancer in children is now quite favorable.

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Acute lymphocytic leukemia (ALL) is a fast-growing leukemia. It affects an early form of cells that develop into a type of white blood cell called lymphocytes.

Both adults and children can develop ALL. This article will cover the details of childhood ALL, including its symptoms, how it’s diagnosed and treated, and its general outlook.

You can learn more about ALL here.

Leukemia is the most common childhood cancer. About 75% of childhood leukemias are ALL.

ALL is also more common in children than in adults. Only 40% of all ALL diagnoses are in adults.

The outlook for ALL is better in children compared with adults. This may be due to several factors, including:

  • Children with ALL typically have fewer underlying health conditions that can affect their outlook.
  • Adults with ALL are more likely to have genetic factors linked with a less favorable outlook.
  • The types of chemotherapy drugs, intensity, and duration of treatment can vary between children and adults with ALL. Children often receive more intensive chemotherapy regimens than adults.
  • ALL is more common in children and is typically treated in specialized pediatric oncology centers with vast experience in treating ALL.

While children typically have a better outlook for ALL, treatment decisions must still be made carefully. This is because some ALL treatments may have long-term side effects that can negatively affect a child who’s still growing and developing.

In ALL, leukemia cells accumulate in the bone marrow and start to crowd out healthy red blood cells, white blood cells, and platelets. This reduces the number of these healthy cells and leads to many of the symptoms associated with ALL.

The signs and symptoms of ALL in children that are related to low blood counts include:

Additional signs and symptoms of ALL in children include:

Your child’s doctor will first take your child’s medical history and do a physical exam. They’ll look for signs of illness and ask about things like your child’s symptoms, past illnesses, and any medications they’re taking.

A blood test called a complete blood count (CBC) is also useful. This gives information on the levels of different blood cells. Children with ALL often have high WBC counts due to the presence of leukemia cells. Levels of RBCs and platelets may be low.

To confirm the diagnosis, a sample of bone marrow cells is collected via bone marrow biopsy and aspiration. The sample is examined under a microscope to look for signs of cancer.

If cancer is present, further tests can be done on the bone marrow samples to characterize the genetics and different markers associated with the cancer. This can help to better inform your child’s treatment and outlook.

Other tests that may be done include:

The main treatment for childhood ALL is chemotherapy (chemo). After diagnosis, doctors will classify your child’s ALL into a risk group. This helps determine the types and doses of chemo drugs they will use. Risk groups are based on factors like:

  • your child’s age
  • their WBC counts
  • the genetics of their ALL
  • whether ALL started in B cells or T cells
  • whether ALL is in the CNS
  • how their ALL responds to initial treatment

The entire treatment process can take about 2–3 years and has three phases:

  • Induction: Induction is a period of treatment that aims to put the ALL into remission and typically lasts 4 weeks.
  • Consolidation: A more intensive treatment period, consolidation aims to further reduce the number of leukemia cells. This phase can last for 4–8 weeks.
  • Maintenance: The longest phase of treatment, maintenance typically uses lower doses of chemo drugs than induction and consolidation. Its goal is to keep ALL in remission.

Other potential treatment options for ALL may include:

  • stem cell transplant if ALL returns after treatment
  • targeted therapy if certain genetic factors are present
  • immunotherapy for ALL that’s hard to treat or comes back after treatment
  • chemo or radiation therapy to treat or prevent ALL at sites outside of the bone marrow, such as the CNS

It’s also possible that your child’s care team will recommend that they participate in a clinical trial. Clinical trials test new or updated treatments before they’re made more widely available. Search for clinical trials for ALL here.

Some of the risk factors for ALL in children include having:

The outlook for children with ALL can vary based on many factors, such as:

  • WBC counts at diagnosis
  • the genetics of the ALL
  • whether ALL started in B cells or T cells
  • whether ALL is in the CNS
  • how ALL responds to treatment
  • age and overall health

According to the American Cancer Society, the outlook for ALL in children has improved greatly over the years. The overall 5-year survival rate is about 90%.

Are there complications after treatment for childhood ALL?

Yes. Some treatments for ALL can have long-term effects. These can include:

Can ALL in children be prevented?

No, there’s no known way to help prevent ALL in children. While you can help prevent many adult cancers through lifestyle changes, most children who develop ALL have no known risk factors.

ALL is the most common childhood leukemia. Children with ALL typically have an improved outlook compared to adults with ALL.

ALL treatment typically involves chemo, although other treatments may also be used. Each child with ALL is different. Be sure to ask your child’s care team about their ALL and how it affects their individual treatment and outlook.