Acute lymphocytic leukemia (ALL) occurs when the the body produces a large number of immature white blood cells, called lymphocytes. The cancer cells quickly grow and replace normal cells in the bone marrow. Bone marrow is the soft tissue in the center of bones that helps form blood cells. ALL prevents healthy blood cells from being made. Life-threatening symptoms can occur.
This type of leukemia usually affects children ages 3 - 7. It is the most common childhood acute leukemia. However, the cancer may also occur in adults.
Most of the time, there is no obvious cause. However, the following may play a role in the development of leukemia in general:
Certain chromosome problems
Exposure to radiation, including x-rays before birth
Lumbar puncture (spinal tap) to check for leukemia cells in the spinal fluid
Tests are also done to look for chromosome changes in the cells of some leukemias. Leukemias with certain types of chromosome changes have a poor outlook, while those with other types of genes can have a very good outlook. Having certain chromosome changes may determine what kind of treatment you receive.
The first goal of treatment is to get your blood counts back to normal. If this occurs and the bone marrow looks healthy under the microscope, the cancer is said to be in remission. After remission, you will need more treatment to be cured. This treatment can include more chemotherapy or a stem cell transplant from a donor.
Chemotherapy is the first treatment used to try and put you into remission.
The first time you receive chemotherapy, you may need to stay in the hospital for several weeks.
Later you may receive chemotherapy as an outpatient, meaning you come to a clinic to receive the treatment
If you have a low white blood cell count, you may need to be placed in a hospital room by yourself so you do not catch an infection from other people.
ALL may spread to the brain and spinal cord. Many chemotherapy drugs given through a vein cannot reach these areas. Therefore, you may also receive:
Chemotherapy given directly into the space around your brain or into the spinal column
Radiation therapy to the brain
Your health care provider will decide which treatment you receive after you've gone into remission. The treatment will depend on several factors, including:
Other health problems you have
Type of lymphocyte (B-cell versus T-cell) and chromosome changes you have
Availability of donors
If you have more chemotherapy and your ALL relapses, then you will need a stem cell transplant.
Additional treatments depend on other symptoms. They may include:
Transfusion of blood products, such as platelets or red blood cells
Antibiotics to fight infection, especially if a fever occurs
Joining a support group where members share common experiences and problems may help ease the stress related to illness.
Pidala J, Djulbegovic B, Anasetti C, Kharfan-Dabaja M, Kumar A. Allogeneic hematopoietic cell transplantation for adult acute lymphoblastic leukemia (ALL) in first complete remission. Cochrane Database Syst Rev. 2011 Oct. 5:(10):CD008818.
Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix Inc.