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Acute Lymphoblastic Leukemia

Definition

Acute lymphoblastic leukemia (ALL) is a cancer of the white blood cells in the bone marrow. The white blood cells, called lymphocytes, grow in the bone marrow but then travels through the body in the blood to help fight instructions. When these white blood cells have leukemia they are not able to fight infections.

ALL also causes the bone marrow to make too many of these cells. The overgrowth makes it difficult for other blood cells like red blood cells or platelets to develop. Low levels of other blood cells can cause a variety of symptoms such as bleeding problems, fatigue and shortness of breath.

White Blood Cells
White Blood Cells
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Causes

The cause of ALL is unknown. Many cancers are beleived to be caused by a combination of environmental and genetic factors.

Risk Factors

ALL is more common in white males. It is also more likely to occur in children and adults over 70 years of age. Other factors that have been associated with an increased chance of ALL include:

  • Previous chemotherapy or radiation therapy treatment
  • Exposure to atomic bomb radiation or nuclear reactor accident
  • Exposure to toxic chemicals such as pesticides or benzene (common in agriculture, dye works, and paint manufacturing and use)
  • Certain genetic disorders, such as Down syndrome , Bloom syndrome, Fanconi's anemia, ataxia-telangiectasia, neurofibromatosis , Shwachman syndrome, IgA deficiency, and congenital X-linked agammaglobulinemia

Factors that may increase the chance of ALL in children only include:

  • Having a brother or sister with leukemia
  • Exposure to x-rays before birth
  • Exposure to radiation, including X-rays and CT scans
  • Previous chemotherapy or other treatment that weakens the immune system

Symptoms

These symptoms may be caused by other, less serious health conditions. You should see a doctor if you or your child is experiencing:

  • Weakness
  • Tiredness
  • Fever
  • Pale skin
  • Night sweats
  • Easy bruising or bleeding
  • Petechiae (flat, pinpoint spots under the skin caused by bleeding)
  • Shortness of breath
  • Weight loss
  • Loss of appetite
  • Bone or joint pain
  • Stomach pain
  • Pain or a feeling of fullness below the ribs
  • Painless lumps in the neck, underarms, stomach, or groin
  • Swelling of the liver and/or spleen

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done including check for swelling of the liver, spleen, or lymph nodes. If your doctor suspects leukemia, you will likely be referred to a specialist.

Abnormal cells may be found through:

  • Blood tests—assessing number of different blood cells to look for abnormally high or low levels and tests of other substances in the blood that may indicate organ stress
  • Bone marrow aspiration and biopsy —to remove and test a portion of bone marrow

Further tests may be done to provide detailed information about the leukemia. These tests will help guide treatment. Tests may include:

  • Cytogenetic analysis—a test to look for certain changes of the chromosomes (genetic material) of the lymphocytes; certain genetic abnormalities
  • Immunophenotyping—examination of the proteins on cell surfaces and the antibodies produced by the body; to distinguish lymphoblastic from myeloid leukemia and determine types of therapy
  • Lumbar puncture —to see if leukemia has spread to spinal cord and brain
  • Chest x-ray —look for masses in chest caused by leukemia

Treatment

Talk with your doctor about the best plan for you. Treatment of ALL is done in two phases. First, remission induction therapy is used to kill leukemia cells. Then, maintenance therapy is used to kill any remaining leukemia cells. Cells left behind could grow and cause a relapse. Treatment options include:

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. It may be given by pill, injection, and via a catheter. The drugs enter the bloodstream and travel through the body. It kills mostly cancer cells, but also some healthy cells.

Clinical trials are now underway to test medications that are better are targeting cancer cells. One drug is imatinib (Gleevec). This drug is used to treat chronic myelogenous leukemia (CML) . It helps to prevent the function of genes associated with ALL.

Some ALL may spread to the brain and spinal cord. In this case, chemotherapy may be deliverd directly into the spinal column. This type of chemotherapy is known as intrathecal therapy.

Radiation Therapy

Radiation therapy is the use of radiation to kill cancer cells and shrink tumors. For ALL, external radiation therapy is used. The radiation is directed at the tumor from outside the body. This type of treatment is used for ALL that has or may spread to the brain and spinal cord.

Chemotherapy With Stem Cell Transplant

Stem cells are immature blood cells that are removed from the blood or bone marrow of the patient or donor. The chemotherapy destroys the blood cells. The stem cells are then infused through the blood to restore the blood cells. It is most often used with ALL that was treated but then returned.

Biologic Therapy

This process is still being tested in clinical trials. This is the use of medications or substances made by the body. The substance is used 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

People treated for ALL in their youth may have a risk of cancer later in life. The exact type of new cancer can vary. It is important that people who have had ALL be carefully watched for new cancer development. These screenings should be carried out through their lifetime.

Prevention

There are no guidelines for preventing ALL since its cause is unknown.

Revision Information

  • American Cancer Society

    http://www.cancer.org/

  • The Leukemia and Lymphoma Society

    http://www.lls.org/

  • Canadian Cancer Society

    http://www.cancer.ca/

  • Leukemia & Lymphoma Society of Canada

    http://www.llscanada.org

  • Acute lymphoblastic leukemia (ALL). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed . Updated October 29, 2012. Accessed October 30, 2012.

  • Adult acute lymphoblastic leukemia (PDQ): treatment. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/adultALL/Patient/page1 . Updated July 23, 2012. Accessed October 30, 2012.

  • Childhood acute lymphoblastic leukemia (PDQ): treatment. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/childALL/HealthProfessional . Updated October 5, 2012. Accessed October 30, 2012.

  • Leukemia—Acute lymphocytic (ALL) in adults. American Cancer Society website. Available at: http://www.cancer.org/docroot/CRI/CRI%5F2%5F3x.asp?rnav=cridg&dt=57 . Accessed October 30, 2012.

  • 3/29/2007 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : 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.