Acute lymphocytic leukemia (ALL) is one of the four main types of leukemia.
“Acute” means progressing quickly without treatment. “Lymphocytic” refers to lymphocytes, immature white blood cells. About 4,000 people in the United States are diagnosed with ALL
Philadelphia chromosome (Ph+) ALL is a specific type of ALL characterized by a genetic mutation called the Philadelphia chromosome.
Despite ALL being the
This rare condition goes by several other names, including Ph+ or PH+ acute lymphoblastic leukemia.
Keep reading to learn more about Ph+, including how it differs from other ALL types, risk factors, and treatment options.
Ph+ is a subtype of ALL where leukemia cells contain a genetic mutation called the Philadelphia chromosome, named after its place of discovery. People with other types of ALL don’t have this chromosome.
Human cells usually have 23 pairs of chromosomes that contain genetic information. The Philadelphia chromosome is a shortened version of
BCR-ABL makes a protein called tyrosine kinase. This protein causes leukemia cells to grow uncontrollably and crowd out healthy white blood cells.
Along with people with Ph+,
Several genetic mutations have been identified in people with either type of ALL, such as:
- a missing chromosome 7
- an extra chromosome 8
- abnormal changes in genes on chromosomes 4 and 11
- a less than usual number of chromosomes
- a more than usual number of chromosomes
- abnormal changes in genes on chromosomes 10 and 14
If Philadelphia chromosomes aren’t present, the disease is known as Ph-negative (Ph-) ALL. Determining which type of ALL you have can help a doctor determine your prognosis and the best treatment options.
Having Ph+ was traditionally associated with a less positive outlook. But the recent development of a targeted therapy called tyrosine kinase inhibitors (TKIs) has improved the outlook. Treatment is typically less effective in adults over 60 years old.
Another subtype called Ph-like ALL is three times more common than Ph+.
People with this subtype lack the BCR-ABL gene mutation, but the cancer behaves similarly.
Once you’re diagnosed with ALL, a healthcare professional can perform specialized tests to see which subtype you have.
A small blood sample is analyzed in a lab. A bone marrow aspiration and a biopsy will likely be performed. This is done by extracting a small sample of bone marrow, usually from your hip.
One of several types of laboratory tests may then be used to analyze your samples:
- Cytogenetics. In conventional cytogenetics, DNA is analyzed under a microscope to examine cells as they’re dividing.
- Fluorescent in situ hybridization (FISH) test. This test uses special fluorescent dyes to identify the BCR-ABL gene. These dyes attach to certain genes but not others.
- Polymerase chain reaction (PCR) test. A PCR test can detect even small amounts of Philadelphia chromosomes not identifiable with other tests.
Children are more likely to be diagnosed with ALL — and only 25% of ALL cases in adults are diagnosed as Ph+.
- males than females
- whites than African Americans
- exposure to benzene in substances like sunscreen
- ionizing radiation
- previous chemotherapy and radiotherapy
ALL is more common among children with conditions such as:
- Down syndrome
- Bloom syndrome
Treatment for Ph+ generally consists of a targeted therapy called TKI combined with a mixed chemotherapy regime. Then it’s followed by an allogeneic bone marrow transplant.
This type of transplant is done by taking bone marrow cells from a donor who’s a close genetic match to you and transplanting the cells into your bone marrow to replace your damaged cells. The
TKIs block the ability of the protein BCR-ABL to send signals that lead to the formation of leukemia cells. Imatinib is the most commonly used TKI. Dasatinib and ponatinib are also used. One clinical trial is looking at the effectiveness of ponatinib alongside imatinib.
The outlook of Ph+ has improved since TKIs have been used. Before TKIs were available, the 3-year overall survival rate in adults with Ph+ who received chemotherapy was less than
A 2015 study in the American Journal of Cancer Research found that chemotherapy combined with the TKI imatinib raised the remission rate — meaning that the cancer was gone completely — in adults to more than 90 percent and the 5-year overall survival rate to 43 percent.
Chemotherapy for ALL usually lasts about
Dealing with a Ph+ diagnosis can be difficult, but the use of TKIs has significantly improved its outlook.
Children usually have a higher chance of survival, but survival rates for everyone are rising. Being younger than 30 and having a white blood cell count of less than
Most children with Ph+ are treated successfully
|Overall survival rate||74.1%|
|Survival rate with no complications after five years||54.2%|
|Overall risk of death after five years||25.9%|
|Overall risk of relapse (symptoms worsen again after treatment)||30%|
Ask a healthcare professional about clinical trials that you may qualify for. Some clinical trials give you access to state-of-the-art treatments that otherwise wouldn’t be available.