Acute Lymphoblastic Leukemia (ALL)

Acute lymphoblastic leukemia (ALL) is a rare blood cancer that affects your lymphocytes (a type of white blood cell). It starts in your bone marrow, but it can spread (metastasize) throughout your body.

Acute lymphocytic leukemia makes up less than 1% of all cancers in the U.S. It’s most common in children, but anyone can get it. Most ALL cases affect children ages 2 to 5.

Acute lymphoblastic leukemia is a serious condition. But treatment can help. In many cases, it can cure it.

Types of acute lymphoblastic leukemia

The two main types of acute lymphoblastic leukemia are:

• B-cell acute lymphoblastic leukemia. This is the most common type, affecting B cells that make antibodies and fight infection. It accounts for about 85% of childhood cases and 75% to 80% of all adult cases.
• T-cell acute lymphoblastic leukemia. This type affects T cells, which kill germs and support other immune cells. It makes up around 25% of adult cases, and 12% to 15% of childhood cases.

A third type, natural killer ALL, is very rare.

Symptoms of acute lymphoblastic leukemia

Acute lymphoblastic leukemia symptoms may include:

• Bleeding (like frequent nosebleeds or heavy menstrual periods)
• Bruising
• Fatigue
• Frequent infections
• Joint pain
• Loss of appetite
• Night sweats
• Paleness
• Red, pinhead-sized bleeding spots on your skin (petechiae)
• Shortness of breath
• Swollen lymph nodes
• Unexplained weight loss

Having these symptoms doesn’t necessarily mean you have ALL. But you should always talk to a healthcare provider about changes in your body that last longer than two weeks.

Acute lymphoblastic leukemia causes

Genetic mutations (changes) cause acute lymphoblastic leukemia. Young children with ALL may have had gene changes that happened before they were born. Or you might inherit conditions that make you more likely to develop ALL. In adults, acute lymphoblastic leukemia is linked to some carcinogens, including tobacco.

Risk factors

Certain factors can increase your chances of developing acute lymphoblastic leukemia (ALL):

• Age. The highest risk is in children under 15 and adults over 50.
• Genetic disorders. Conditions like Down syndrome or Fanconi anemia can raise your risk.
• Race. People who are white have a slightly higher risk.
• Radiation exposure. Risk increases with exposure during fetal development or from past radiation therapy.
• Sex. Girls under age 1 are at higher risk than boys. After age 1, the risk is higher for males.
• Viruses. Infections like Epstein-Barr virus and human T-cell leukemia virus may raise your risk.

Complications of this condition

If ALL spreads to your brain or spine, it may cause the following complications:

• Balance problems
• Blurred vision or double vision
• Enlarged liver
• Enlarged spleen
• Facial muscle weakness or numbness
• Headaches
• Nausea and vomiting
• Seizures
• Superior vena cava (SVC) syndrome

How doctors diagnose acute lymphoblastic leukemia

A healthcare provider will start with a physical exam and ask about your symptoms. They’ll want to know how long they’ve lasted and how they interfere with your everyday life.

To confirm a diagnosis, you may need:

• Blood tests
• Bone marrow biopsy
• Imaging tests, like CT scans, PET scans or an MRI
• Lymph node biopsy
• Spinal tap

How is acute lymphoblastic leukemia treated?

Doctors can treat ALL with chemotherapy, targeted therapy, immunotherapy, a bone marrow transplant or a mix of these treatments. The treatment depends on certain markers found on the cancer cells. Kids and adults may get different types of medicine and care.

Chemotherapy

Chemotherapy is the main treatment for acute lymphoblastic leukemia. It happens in four phases, with the goal of reaching complete remission — when you have no symptoms and no signs of cancer in your body.

Treatment can last several months to a few years and often involves high doses of cancer-fighting drugs. Palliative care specialists may help manage side effects.

The four phases of chemotherapy include:

• Remission induction therapy (four to six weeks). This phase aims to kill as many leukemia cells as possible. Most people stay in the hospital during this time.
• Central nervous system-directed therapy. Often given during remission induction, this phase targets or prevents cancer in your brain, spinal cord or spinal fluid.
• Consolidation therapy. This begins once you’re in remission. You’ll likely be hospitalized for about a week every few weeks over several months to get IV chemotherapy.
• Maintenance therapy. This final phase lasts two to three years and usually involves oral anticancer drugs and outpatient IV treatments. Hospital stays aren’t usually needed.

Targeted therapy

Targeted therapy works by focusing on gene changes that turn healthy cells into cancer.

Healthcare providers use a type of targeted treatment called tyrosine kinase (TKI) therapy for people with a specific mutation known as the Philadelphia chromosome — also called t(9;22) or BCR/ABL.

TKI therapy blocks an enzyme that cancer cells need to grow. This helps kill the cancer and allows your body to start making healthy blood cells again.

Immunotherapy

Immunotherapy helps your body’s own immune system attack cancer cells. For acute lymphoblastic leukemia, it may involve monoclonal antibodies or CAR-T cell therapy.

Radiation therapy

Healthcare providers may use radiation therapy to treat acute lymphoblastic leukemia that returns or resists chemotherapy.

Bone marrow transplant

If other treatments don’t stop symptoms, your provider may recommend a donor bone marrow transplant.

What can I expect if I have acute lymphoblastic leukemia?

The outlook for acute lymphoblastic leukemia is generally positive, even with aggressive treatment. Studies show 98% of children go into remission when treated at a center of excellence. Recurrence — when cancer returns — is rare, affecting less than 1% of cases. In adults, treatment is less successful and recurrence is more common than in children.

ALL survival rate

The overall five-year survival rate for ALL is 72%. That means that 72% of children and adults diagnosed with acute lymphoblastic leukemia will still be alive five years later.

Young children have the highest survival rate, around 90%. The five-year survival rate for adults with ALL is around 30% to 40%.

It’s important to know that survival rates are just estimates. They can’t tell you how long you’ll live or how you’ll respond to treatment. To learn more about survival rates and what they mean for you, talk to your healthcare provider.