Acute lymphocytic leukemia (ALL) is a cancer of the blood and bone marrow. It affects white blood cells, which your body needs to fight infection. It’s the most common type of cancer in children, but can also affect adults. Children have a much better chance of recovering from ALL than adults.
Acute lymphoblastic leukemia (acute lymphocytic leukemia, ALL) is a rare blood cancer that affects a type of white blood cell called lymphocytes. ALL may affect anyone at any age, but children younger than 15 and adults older than 50 are more likely to develop the condition.
While ALL is a serious condition, thanks to newer treatments, including long-term chemotherapy, children with the condition can be cured, and other people are living longer with ALL.
No, it’s not. Acute lymphocytic leukemia accounts for less than half of 1% of all cancers in the U.S. However, ALL is the most common cancer that affects children, teenagers and young adults. Most ALL cases affect children ages 2 to 5.
It starts in your bone marrow, the spongy center of most bones that produces blood cells and platelets. Your bone marrow usually makes a carefully calibrated number of red blood cells, white blood cells and platelets that remain in your bone marrow until they mature and move into your bloodstream.
ALL affects your lymphocytes, a type of white blood cell that helps your body fight viruses and bacteria. Normally, your bone marrow produces immature white blood cells (lymphoblasts) that mature into healthy lymphocytes.
In ALL, leukemic lymphoblasts never mature. Instead, they multiply, crowding out other blood cells and platelets before moving from your bone marrow to your bloodstream and then to other areas of your body. As a result, your platelet levels are low and you’re likely to bruise more easily, bleed more than usual or develop anemia.
The two main types are B-cell ALL and T-cell ALL, named for the blood cells affected by ALL:
A third type, natural killer ALL, is very rare.
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Most ALL symptoms come on suddenly and affect children and adults similarly. Common initial symptoms include:
Many acute lymphoblastic leukemia symptoms mimic other less serious conditions. Having one or more of the symptoms listed above isn’t a sign that you have ALL. In general, you should talk to a healthcare provider about changes in your body that last more than two weeks.
Researchers continue to find genetic mutations (changes) that cause ALL. Young children with ALL may have had genetic changes that happened before they were born. Some people have ALL because they inherited conditions that increase their chance of developing the disease. ALL in adults is linked to some carcinogens, including tobacco.
Risk factors include:
People with the following inherited conditions have a higher risk of ALL than people who don’t have the conditions:
ALL that spreads to your brain and spine may cause the following complications:
Your healthcare provider evaluates your symptoms, reviews your medical history and does a physical exam. If they suspect ALL, they may do the following tests, including tests to look for genetic changes:
Healthcare providers may treat ALL with long-term chemotherapy, targeted therapy, immunotherapy or stem cells (bone marrow) transplantation. Adults and children with ALL may receive different types of cancer drugs and treatments.
Providers use chemotherapy as initial or front-line treatment for ALL. People with ALL receive chemotherapy in four phases. The treatment goal is to put ALL into complete remission. (Complete remission means treatment eliminates your symptoms, and tests show no sign of cancer.)
Chemotherapy for ALL takes place over several months and sometimes years, and typically involves high doses of cancer-killing drugs. People receiving chemotherapy for ALL should consider palliative care to help manage treatment side effects. ALL chemotherapy includes:
Targeted therapy focuses on specific genetic changes. About 25% of adults and some children with ALL have chromosomal mutations. Healthcare providers currently use tyrosine kinase (TKI) therapy to treat ALL in children and adults with a specific mutation called Philadelphia chromosome or t(9;22). TKI therapy blocks an enzyme zyme essential for ALL growth. TKI therapy kills ALL cells so your body gets back to normal blood cell production.
Healthcare providers may recommend radiation therapy to treat recurrent ALL or ALL that doesn’t respond to chemotherapy. Recently, providers have used radiation therapy to treat ALL that’s spread (metastasized) to people’s brains or spinal fluid.
When other treatments haven’t eliminated ALL, a healthcare provider may recommend allogeneic stem cell (bone marrow) transplantation to treat adults with acute lymphoblastic leukemia.
No, it can’t. Children with ALL develop the condition because of genetic changes that happened before they were born. But adults with ALL may be able to lower their risk by avoiding carcinogens, including tobacco and toxic chemicals.
Your prognosis is the outcome you may expect after treatment. ALL often goes into complete remission after chemotherapy that kills cancerous cells. In general, children and young adults have a better prognosis than do people age 20 and older.
Acute lymphoblastic leukemia survival rates vary based on people’s ages. For example, studies show:
When you think about survival rates, it’s important to remember that they’re estimates based on the experiences of people who have the same condition. Survival rates use data from the recent past, not the present. More than that, a survival rate estimate may not reflect your situation or your child’s situation. If you have questions about ALL survival rates, your healthcare provider is your best resource for information.
In some cases, yes, ALL can be cured. Children with ALL who remain in complete remission after five years are considered cured. That’s because ALL rarely recurs (comes back) after five years. Older children and adults with ALL are less likely to be cured because treatment doesn’t always put ALL into long-term remission.
Depending on your situation, living with lymphoblastic leukemia may be like living with a chronic disease:
If you or your child have acute lymphocytic leukemia, you may want to ask your healthcare provider the following questions:
A note from Cleveland Clinic
Acute lymphoblastic leukemia (ALL) is a rare blood cancer. Anyone can develop ALL, but it’s more common in young children than in teenagers and adults. Thanks to newer treatments, people are living longer with ALL. More than that, more children are considered cured of ALL after completing treatment.
But there are ongoing challenges in living with ALL, even ALL that’s cured. For example, most people need several years of chemotherapy before they’re considered cured. People with ALL in remission may worry the condition will come back. Children with ALL often encounter late effects. (Late effects are medical issues that develop years after people complete treatment.) If you or your child have ALL, ask your healthcare providers what you may expect to happen during treatment and beyond. They understand what it’s like to live with ALL.
Last reviewed by a Cleveland Clinic medical professional on 04/25/2023.
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