Acute Lymphoblastic Leukemia (ALL)

A team of Cleveland Clinic Children’s healthcare providers are here for you and your child during their experience with acute lymphoblastic leukemia. This care team could include:

• Pediatric hematologists/oncologists
• Radiologists (imaging specialists)
• Radiation oncologists
• Surgeons
• Genetics counselors
• Child psychologists
• Child life specialists
• Advanced practice providers (certified nurse practitioners, physician assistants)

During your child’s first visit, their healthcare providers will begin by checking them out with a physical exam and talking with you about their medical history. The providers might also do blood work since ALL involves white blood cells and others tests to get more information.

Bone marrow biopsy

This test lets us look for abnormal blood cells or check for cancer cells in your child’s blood and bone marrow. During a bone marrow biopsy, we’ll first give them general anesthesia so they will be asleep and not feel any pain. 

Your provider will use a special needle to remove liquid from spongy bone marrow in the back of your child’s hip (the most common spot). They’ll also get a small piece of bone marrow to test. A bone marrow biopsy lasts about 30 minutes, and once your child wakes up, they should be able to go home.

Spinal tap (lumbar puncture)

Everyone has clear fluid surrounding their spine and brain called cerebrospinal fluid. Your providers can learn a lot from a sample of it, including what kind of white blood cells are there and if there is any ALL in the spinal fluid. 

During a spinal tap, your child will likely have a sedative delivered intravenously (IV) or general anesthesia. They’ll be relaxed or asleep. Their provider will insert a thin needle between the bones in their spine (vertebrae) to remove spinal fluid for testing. Your child should be able to go home after they wake up.

Genetic testing

Sometimes, acute lymphoblastic leukemia starts from a genetic mutation or other issues. If appropriate, your family can meet with one of our genetic counselors to discuss options for genetic testing and counseling.

Once we confirm an ALL diagnosis, we’ll work with you to craft a personalized treatment plan for your child based on their age, health and other factors. 

Usually, ALL is treated with chemotherapy and consists of a few general phases:

• Induction: We use chemo to destroy cancer cells in your child’s blood and bone marrow to put them in complete remission (no signs of cancer). 
• Consolidation: Once your child is in remission, they undergo chemotherapy for several months to make sure we’ve destroyed all cancer cells.
• Maintenance: In this last phase, your child takes oral chemotherapy medications for up to two years as maintenance. Many children return to school and other activities during this phase. 

It’s important to understand treatment isn’t the same for every child. Most children need multiple rounds of intensive chemotherapy over several months, but some may need chemotherapy for a year or longer. 

When we design your child’s personalized care plan, we’ll use information from diagnostic tests and their physical exam and medical history to decide what drugs and dosage to use and how many rounds of treatment they’ll need in each treatment phase.

Other acute lymphoblastic leukemia treatments

In addition to chemotherapy, we might also recommend using other options, including: 

• Radiation therapy to their spine and brain, especially if we find potential cancer cells in their spinal fluid. Radiation treatment destroys cancer cells in their spinal fluid that chemotherapy drugs might miss. 
• Bone marrow transplant is a treatment where your provider replaces unhealthy cells with healthy ones.  
• Targeted therapy targets specific genetic mutations (changes) that turn healthy cells into cancer cells.
• Immunotherapy (including CAR T-cell therapy) is a rapidly advancing field in ALL.

During treatment, your child will have regular testing so their providers can see how well they’re responding to chemotherapy. This could include a bone marrow biopsy after the first cycle of chemotherapy and lumbar punctures at regular intervals throughout treatment. 

Relapsed acute lymphoblastic leukemia 

Outcomes for children diagnosed with childhood ALL are good. Overall, the five-year survival rate for acute lymphoblastic leukemia is about 90%. Most children will go into deep remission and live an active, healthy life. 

But, if your child’s ALL relapses, they’ll need additional treatment. We offer options that aren’t available at all hospitals, including: 

• Bone marrow transplant
• CAR T-cell therapy
• Targeted therapy

Long-Term Care and Support

After cancer treatment, children with ALL need ongoing appointments and testing. They might also need treatment for conditions that could develop later. We provide care over the long haul — even into adulthood — and will help your child live a long, healthy life.

Taking the Next Step

The words, “cancer diagnosis,” can upend the lives of your child and family. But at Cleveland Clinic Children’s, we’ll surround your child with the highest level of care and support they (and your family) need from day one. From innovative treatments and clinical trials to a warm, compassionate care team, we’re here for your child and you throughout their entire cancer journey.