Acute Lymphoblastic Leukemia

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 infections. 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.

  • Causes

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

  • 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 infections. 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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  • 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

  • Prevention

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

  • 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

  • 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: