Acute Lymphoblastic Leukemia

Acute lymphocytic leukemia (ALL) is cancer of the lymph cells, a type of white blood cell. While ALL is known as the childhood form of leukemia, 20% of the people who develop the disease are adults.

What is going on in the body?

When the body has an infection, the number of lymph cells often rises sharply. These cells play a role in fighting off infection. When a person has ALL, the lymph cells do not mature enough to do their job. The cells become malignant, and their growth is unchecked. The abnormal cells can build up in the bone marrow, blood, and other tissues.

Generally, the abnormal cells crowd out normal blood cells and cause the following problems:

Other white blood cells help in immune monitoring and healing. ALL can compromise or even stop all of these functions. The buildup of abnormal lymph cells can enlarge or infiltrate any organ in the body, including lymph nodes and the brain.

What are the causes and risks of the disease?

ALL is thought to have many causes, including:

It is known that people:

What are the signs and symptoms of the disease?

ALL can cause blood-clotting problems in any part of the body. These problems include:

Other symptoms of ALL include:

People with ALL often get infections due to the breakdown of the immune system. Signs of this are:

How is the disease diagnosed?

Diagnosis of ALL begins with a medical history and physical exam. Samples of blood and bone marrow cells taken during a biopsy are examined for a buildup of immature cells, called lymphoblasts, and abnormal lymph cells.

Afterward, other tests are done to evaluate the extent of the disease, such as:

What can be done to prevent the disease?

In most cases, ALL cannot be prevented. People can avoid exposure to toxins, such as:

Radiation from highly radioactive compounds is clearly dangerous. This does not involve household appliances. A person who has had chemotherapy or radiation is at risk for ALL. He or she should be monitored for life.

Occasionally, family clusters of acute leukemia occur. Genetic counseling may be helpful in this situation. Whether or not nutrition and generally avoiding infections are of benefit in preventing ALL is actively being researched.

What are the long-term effects of the disease?

Some people live an entirely normal, healthy life after ALL has been treated and cured. However, ALL can be lethal even with good treatment. People who survive often have many chronic health problems. Any organ, including the brain, can be damaged before treatment starts. The treatments can have serious permanent side effects, too.

What are the risks to others?

It is not clear if a leukemia virus might spread ALL. It is an uncommon cancer, and any risk of it spreading from one person to another is very low. However, a person with ALL might have an unusual or aggressive infection that could possibly spread to others. This is more likely to happen when AIDS or another disorder weakens a person’s immune system.

What are the treatments for the disease?

Treatment for ALL may include:

People are treated in a hospital at first, then later as outpatients. Treatment can go on for several months to a couple of years depending on the case. The goal of treatment is a cure, or at least remission. Remission is the disappearance of symptoms and signs of ALL. If the cancer returns, a bone marrow transplant or salvage therapy may be done. Salvage therapy is chemotherapy used to try to get a second remission or to extend life.

What are the side effects of the treatments?

Side effects of treatments can include some of the same signs and symptoms as the leukemia, such as:

When treatment involves the brain and nervous system, the following temporary side effects may occur:

Infertility and impaired memory and math and motor skills can be permanent with this type of treatment.

What happens after treatment for the disease?

People often need long-term care for complications from leukemia or its treatments. Children may have more neurological or psychological problems. Developing bones can be affected, too. Adults have fewer of these complications but have a lower rate of remission and cure.

How is the disease monitored?

People who have been treated for ALL are often monitored for several years. The healthcare provider may order regular blood tests and biopsies. Sometimes spinal taps are done. The fluid is tested for signs of cancer. Genetic testing of the bone marrow may be done, too. It may find traces of residual leukemia before other tests do. Any new or worsening symptoms should be reported to the healthcare provider.