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Definition
Acute lymphoblastic leukemia (ALL) is a cancer of the blood and bone marrow, in which the bone marrow makes too many lymphocytes (a type of white blood cell). ALL begins in immature lymphocytes and progresses very quickly. It may occur at any age, but is most common in children, or as the end stage of a chronic leukemia of adults called chronic lymphocytic leukemia . Childhood ALL was one of the first cancers for which effective chemotherapy was developed and remains highly curable today.
Cancer occurs when cells in the body (in this case, lymphocytes) become abnormal, and divide without control or order. Leukemia is cancer of the white blood cells and their parent cells. Leukemia cells do not function normally and cannot do what normal blood cells do, such as fight infections. This means that a person with leukemia is more likely to become infected with viruses or bacteria. Because the cancerous cells also overgrow the bone marrow, they can force out other normal components, such as the cells that make platelets. Platelets are necessary for proper blood clotting. So people with untreated leukemia may also have unexpected bleeding or may bruise easily.
White Blood Cells 2008 Nucleus Medical Art, Inc. CausesThe cause of ALL is unknown, but research shows that certain risk factors are associated with the disease. Risk FactorsA risk factor is something that increases your chance of getting a disease or condition. The following factors increase your chance of developing ALL: Sex: maleRace: whiteAge: children and elderly (adults older than 70) Previous chemotherapy or radiation therapy treatment Exposure to atomic bomb radiation or nuclear reactor accidentExposure to toxic chemicals such as benzene (common in agriculture, dye works, and paint manufacturing and use) Certain genetic disorders, such as Downs syndrome , Bloom syndrome, Fanconi's anemia, ataxia-telangiectasia, neurofibromatosis , Schwachman syndrome, IgA deficiency, and congenital X-linked agammaglobulinemia The following risk factors are specific to childhood ALL: Having a brother or sister with leukemiaRace: white or HispanicLiving in the United States Exposure to x-rays before birth Exposure to radiationPrevious chemotherapy or other treatment that weakens the immune systemCertain genetic disorders (see above) SymptomsSymptoms include:
WeaknessTirednessFever Paleness (a sign of anemia ) Easy bruising or bleedingPetechiae (flat, pinpoint spots under the skin caused by bleeding)Shortness of breathWeight lossLoss of appetiteBone or joint painStomach painPain or a feeling of fullness below the ribsPainless lumps in the neck, underarms, stomach, or groinSwelling of the liver and/or spleenThese symptoms may also be caused by other, less serious health conditions. Anyone experiencing these symptoms should see a doctor. DiagnosisYour doctor will ask about your symptoms and medical history, and perform a physical exam. He or she may also check for swelling of the liver; spleen; or lymph nodes in the armpits, groin, or neck. You will likely be referred to an oncologist, a doctor who specializes in treating cancer. Tests may include the following: Blood teststo check for changes in the number or appearance of different types of blood cellsBone marrow aspirationremoval of a sample of liquid bone marrow to test for cancer cellsBone marrow biopsy removal of a sample of liquid bone marrow and a small piece of bone to test for cancer cells Spinal tap removal of a small amount of cerebrospinal fluid to check for cancer cells Routine microscopic examexamination of a sample of blood, bone marrow, lymph node tissue, or cerebrospinal fluidBone, blood marrow, lymph node tissue, or cerebrospinal fluid teststo distinguish among types of leukemia Cytogenetic analysisa test to look for certain changes of the chromosomes (genetic material) of the lymphocytes; certain genetic abnormalities include: Relocation of genetic material from one chromosome to anotherPresence of a particular gene (Ikaros)Presence of a variant gene, which controls an enzyme that influences folate metabolism Immunophenotypinga process by which researchers examine the proteins on cell surfaces and the antibodies produced by the body. This helps distinguish lymphoblastic from myeloid leukemia and may also be used to determine what types of therapy are most likely to be effective. Chest x-ray x-rays of the chest that may detect signs of lung infection or enlarged lymph nodes in the chest CT scan a type of x-ray that uses a computer to make pictures of structures inside the body MRI scan a test that uses magnetic waves to make pictures of structures inside the body Gallium Scan and Bone scan injection of a radioactive chemical into the bloodstream to detect areas of cancer or infection Ultrasound a test that uses sound waves to examine masses and organs inside the body TreatmentTalk with your doctor about the best treatment plan for you. Treatment of ALL is done is two phases: remission induction therapy (to kill leukemia cells) and maintenance therapy (to kill any remaining leukemia cells that could grow and cause a relapse). Treatment options include:
ChemotherapyChemotherapy is the use of drugs to kill cancer cells. It may be given in many forms including: pill, injection, and via a catheter. The drugs enter the bloodstream and travel through the body killing mostly cancer cells, but also some healthy cells. Clinical trials are now underway to test drugs, such as imatinib (Gleevec), which is used to treat chronic myelogenous leukemia (CML) , in helping to prevent the function of genes associated with ALL. For ALL that has spreador may spreadto the brain and spinal cord, your doctor may use intrathecal chemotherapy, in which chemotherapy drugs are placed directly into the spinal column. Radiation TherapyRadiation therapy involves the use of radiation to kill cancer cells and shrink tumors. The type of radiation therapy usually performed to treat ALL is external radiation therapy. In external radiation therapy, the radiation is directed at the tumor from a source outside the body. This treatment is used for ALL that has spreador may spreadto the brain and spinal cord. Chemotherapy With Stem Cell TransplantChemotherapy is followed by a transplantation of stem cells (immature blood cells) to replace blood-forming cells destroyed by cancer treatment. Stem cells are removed from the blood or bone marrow of the patient or donor, and infused into the patient.
Biologic Therapy Biologic therapy, which is still being tested in clinical trials, is the use of medications or substances made by the body to increase or restore the body's natural defenses against cancer. This type of therapy is also called biological response modifier therapy . Sometimes, very specific (monoclonal) antibodies are developed to target the leukemia cells specifically. Currently, monoclonal antibody therapy is restricted to clinical trails and not generally available. Possible Development of New Cancers One complication associated with ALL treatment is the development of new cancers later in the life (as opposed to a recurrence of the original ALL). In a recent study, researchers followed 2,169 children and adolescents who had achieved complete remission after treatment for ALL. They found that almost 11% of these patients developed secondary cancers of various types over a period of 30 years. This is substantially higher than the rate of similar cancers in the general population. It is critical, therefore, that young patients successfully treated for ALL are closely monitored throughout their adult lives for an increased risk of cancer. * PreventionThere are no guidelines for preventing ALL since its cause is unknown.
RESOURCES: American Cancer Societyhttp://www.cancer.org The Leukemia and Lymphoma Societyhttp://www.leukemia-lymphoma.org/hm_lls National Cancer Institutehttp://www.cancer.gov CANADIAN RESOURCES BC Cancer Agencyhttp://www.bccancer.bc.ca/default.htm Cancer Care Ontariohttp://www.cancercare.on.ca/ Childhood Cancer Foundationhttp://www.candlelighters.ca/index.html References: Adult acute lymphoblastic leukemia (PDQ): treatment. National Cancer Institute website. Available at: http://www.cancer.gov/cancerinfo/pdq/treatment/adultALL/patient . Accessed November 23, 2005. Childhood acute lymphoblastic leukemia (PDQ): treatment. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/childALL/patient . Accessed November 26, 2005. Detailed guide: leukemiaacute lymphocytic (ALL). American Cancer Society website. Available at: http://www.cancer.org/docroot/CRI/CRI_2_3x.asp?rnav=cridg&dt=57 . Accessed November 23, 2005. *Updated Treatment section on 3/29/2007 according to the following study, as cited by DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Hijiya N, Hudsdon MM, Lensing S, et al. Cumulative incidence of secondary neoplasms as a first event after childhood acute lymphoblastic leukemia. JAMA. 2007;297:1207-1215.
Last reviewed January 2008 by Igor Puzanov, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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