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Information about ALL
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Information About ALL

(From The Leukemia and Lymphoma Society)

Acute lymphocytic leukemia (ALL) is a type of blood cancer. Other names for ALL are acute lymphoblastic leukemia and acute lymphoid leukemia. About 5,430 people in the United States are diagnosed each year. It is the most common type of leukemia in children under age 15. The risk of getting ALL increases in people ages 45 and older. However, people can get ALL at any age. Most children with ALL are cured of their disease after treatment.

Causes and Risk Factors

ALL starts with a change to a single cell in the bone marrow. Scientists are studying the exact genetic changes that cause a normal cell to become an ALL cell.  ALL is not contagious (catching).

Signs and Symptoms

Some signs or symptoms of ALL are similar to other more common and less severe illnesses. Specific blood tests and bone marrow tests are needed to make a diagnosis. A person with ALL may have:

  • Aches in arms, legs, back
  • Black-and-blue marks for no apparent reason
  • Enlarged lymph nodes
  • Fever without obvious cause
  • Headaches
  • Pale-looking skin
  • Pinhead-size red spots under the skin
  • Prolonged bleeding from minor cuts
  • Shortness of breath during physical activity
  • Tiredness
  • Vomiting.

Diagnosis

Blood and bone marrow tests are done to look for leukemia cells. A CBC (complete blood count) is used to help diagnose ALL. A bone marrow aspirate and a bone marrow biopsy are two of the tests that are done.  There are two main cell types of ALL, B-Cell and T-Cell. Most people with ALL have the B-cell type. Most cases of the B-cell type are called precursor B-cell type.

To decide the best treatment for the patient, the doctor will consider:

  • The patient's age
  • The number of ALL cells in the blood
  • If the ALL has spread to the covering of the brain or spinal cord
  • If there are certain chromosomal changes.

Treatment

Patients with ALL need to start chemotherapy right away. It is important to get medical care in a center where doctors are experienced in treating patients with ALL.

Patients with ALL often have leukemic cells in the lining of the spinal cord and brain. The procedure used to check the spinal fluid for leukemic cells is called a spinal tap. The cells cannot always be found in an exam of the spinal fluid.

To prevent leukemia in the central nervous system (CNS) leukemia, all patients have the lining of the spinal cord and brain treated.

More treatment is needed even after a patient with ALL is in remission. This is called long term maintenance therapy. It is given in cycles for two to three years. Long term maintenance therapy is given because some ALL cells remain that are not found by common blood or marrow tests.

Side Effects of Treatment

Possible side effects of treatment for ALL include:

  • The number of red cells may decrease (called anemia). Transfusions of red cells (blood cells that are donated and given to the patient) may be needed to increase red cells.
  • Patients also may have a drop in the number of platelets. If a patient's platelet count is very low he or she may need a platelet transfusion to prevent bleeding.
  • A big drop in white cells may lead to an infection. Such infections are usually treated with antibiotics, until the white cell count goes up and the infection clears up. The doctor may talk about the absolute neutrophil count or ANC, which is the number of neutrophils, a type of white cell a person has to fight an infection. Fever or chills may be the only signs of infection.

To lower the risk of infection:

  • The patient, the patient's visitors and medical staff need to wash their hands well.
  • Patients on chemotherapy should take good care of their teeth and gums.

Chemotherapy affects the parts of the body where new cells form quickly. This includes the inside of mouth and bowel, and the skin and hair. Some other chemotherapy side effects are:

  • Mouth sores
  • Diarrhea
  • Hair loss
  • Rashes
  • Nausea
  • Vomiting.

Drugs and other therapies can be given to prevent or treat nausea or vomiting.

Follow-up Visits
Patients who have finished all of their therapy still need to go to their doctors regularly for exams and tests. The doctor may recommend longer periods of time between follow-up visits if a patient continues to be disease free.

Treatment for ALL can cause long-term or late effects. Children should be checked for treatment effects on growth or learning that may not take place right away. It is important to identify problems early. Talk to the doctor about when your child's learning skills should be assessed. Some children will need special help with schoolwork during and after treatment.

Relapsed or Refractory ALL

Some patients have a remission after treatment but then ALL cells return later - this is called a relapse. Other patients with ALL may still have ALL cells in the marrow even after treatment (refractory leukemia). 

Clinical Trials

Clinical trials are used to study new drugs, new treatments or new uses for approved drugs or treatments. These are some of the types of trials under way:

Leukemia-specific therapy, based on a patient's specific type of leukemia - such as the type of chromosome changes - is being studied.

The ALL cells of some patients are not as easily killed by drugs as those of other patients. This is called drug resistance. Scientists are trying to understand why some ALL cells are resistant to the effects of chemotherapy. This will help them develop better treatments.

Scientists are studying ways to boost the body's natural defenses, called immunotherapy. The goal is to kill or prevent the growth of ALL cells.

Scientists are studying the exact genetic changes that cause a normal cell to become an ALL cell. This research is leading to the development of new treatments. These treatments could block the effects of cancer-causing genes called oncogenes.

Gene profiling will be used more in the future to design more specific treatments for the different types of leukemia. New targeted treatments are being developed for ALL.