What is Acute Lymphocytic Leukemia (ALL)?

Acute lymphocytic leukemia (ALL) is the most common type of blood cancer in infants, children and young adults, but it can also occur in adults. The word “lymphocytic” refers to the kind of white blood cells, called lymphocytes, which ALL affects. Also called acute lymphoblastic leukemia, the disease is considered acute because it progresses quickly, creating immature blood cells rather than full-grown ones.

There are several kinds of leukemia, which starts in your bone marrow (the soft center of your bones). Normally, stem cells there produce healthy red blood cells to carry oxygen throughout your body, white blood cells to fight infection, and platelets to clot your blood. Leukemia develops when the stem cells in your bone marrow change and begin to produce abnormal white blood cells.

Leukemia is categorized according to the type of white blood cell it affects, either myeloid cells or lymphoid cells (lymphocytes) and can be chronic (which gets worse slowly, over months to years) or acute (which develops quickly and progresses over days to weeks).

When diagnosed in children, acute lymphocytic leukemia treatments usually result in a good chance for a cure. In adults, however, the chance of a cure is reduced. ALL accounts for nearly 6,000 new cases of leukemia in the U.S. each year.

What are the signs and symptoms of ALL?

Acute lymphocytic leukemia starts when the DNA in a single bone marrow cell mutates and tells the cell to grow and multiply uncontrollably instead of growing and dying normally at a set rate and time. In addition, the white blood cells that are produced are immature and not able to carry out their function properly. These immature white blood cells are called lymphoblasts.

As these abnormal white blood cells (lymphoblasts) build up, they crowd out and prevent your healthy blood cells from carrying oxygen, fighting infection and clotting your blood.

The causes of DNA mutations in acute lymphocytic leukemia are unknown, but  risk factors for ALL include:

  • Previous cancer treatment with chemotherapy or radiation therapy.
  • Exposure to radiation, such as a survivor of a nuclear reactor accident.
  • Genetic disorders, such as Down syndrome.
  • Age. Children, adolescents or adults over 70 are a greater risk.
  • Gender. Males are more likely to develop ALL than females.
  • Race/ethnicity. ALL is more common among Hispanics and whites.

Many symptoms and signs of ALL mimic signs of the flu that don’t improve. Generally, signs of acute lymphocytic leukemia include:

  • Frequent infections
  • Night sweats
  • Fever
  • Bone pain
  • Enlarged spleen, liver or lymph nodes
  • Unexplained loss of weight or appetite
  • Easy bruising
  • Bleeding gums
  • Fatigue

How is ALL diagnosed?

If your doctor thinks you may have acute lymphocytic leukemia, he or she will order blood tests — CBC with differential, blood chemistry profile, liver function test and coagulation test, among others — to determine if you have too many or too few white cells, not enough red blood cells or platelets. They will also look for the presence of lymphoblasts, or leukemic (leukemia) white blood cells.

Other ALL diagnostic tests include:

  • Bone marrow aspiration or biopsy
  • X-rays
  • Computerized tomography (CT) scan
  • Lumbar puncture (spinal tap)

How is ALL treated?

Because it is extremely aggressive, patients diagnosed with acute lymphocytic leukemia should seek treatment as soon as possible after it is confirmed. Depending on the results of your tests, your doctor will develop an individualized therapy plan that may include one or a combination of the following therapeutic approaches:

  • Chemotherapy
  • Stem cell transplantation
  • Clinical trials – therapy with new drugs, new drug combinations or new approaches to stem cell transplantation

Young adults may respond to a specialized pediatric treatment protocol. Blood and bone marrow tests are done during and after treatment to track your response (efficacy) to therapy.

Why Roswell Park for ALL?

Eunice S. Wang, MD, Chief of the Roswell Park Leukemia Service, plays a national role in setting the standard of care for the treatment of both AML and ALL as a member of the AML and ALL Guidelines panels of the National Comprehensive Cancer Network (NCCN). The NCCN Guidelines specify the best ways of preventing, detecting and treating different types of cancer and are the most widely used standards in the U.S.

Kara Kelly, MD, Chair of Pediatric Oncology, plays a national role in setting the standard of care for the treatment of pediatric ALL as a member of the National Comprehensive Cancer Network (NCCN) guidelines panel for pediatric acute lymphoblastic leukemia.