Acute lymphocytic leukemia (ALL), also known as acute childhood leukemia, acute lymphoid leukemia and acute lymphoblastic leukemia, is a cancer of the blood and bone marrow (the tissue inside of bones, where cell development occurs). It is caused by a cell mutation in bone marrow. Errors in the DNA of the cell cause it to continually divide and multiply, rather than die as it would normally. When this results in abnormal blood cell activity, the cells are unable to function and leave little room for healthy cells, taking over the body.

The term “acute” is attributed to the rapid progression of this disease. ALL does not affect older, mature cells; instead, it attacks immature blood cells. Lymphocytes, or white blood cells, are the actual cells that ALL disease impacts.

ALL is the most common type of cancer affecting children under age 15. It generally has a positive prognosis, leading to a cure, if detected and treated. In the instances of adult cases, however, a cure is less likely.

Acute Lymphocytic Leukemia Risk Factors

Common factors that contribute to acute lymphocytic leukemia risk are few. Some risk factors can include:

• Age: People of any age can get ALL, and it commonly affects children under the age of 15. Risk also increases after age 45.
• Gender: Males have a higher risk for leukemia in general.
• Radiation: High doses of radiation can cause ALL. This can be either in the form of previous cancer treatments, or exposure to an atomic bomb blast or a nuclear reactor accident (including during prenatal development).
• Location: Living in a more developed country
• Background: Living in a higher socioeconomic group
• Phosphocol P32: This drug, used to treat symptoms of adult infections and cancers, has been linked to ALL in children.
• Genetic Disorders: Disorders such as Down syndrome may increase the risk of ALL.
• Siblings with ALL: Risk slightly increases for people who may have a sibling, including a twin, with ALL. However, doctors have determined that the disease is usually not inherited.

Other potential risk factors, many linked to lifestyle, are currently under study. ALL is not contagious.

Acute Lymphocytic Leukemia Signs and Symptoms

ALL symptoms mirror flu symptoms in many ways. One important distinction is that while the flu is typically short-lived, ALL symptoms will persist for a lengthy period of time. Signs and symptoms can include:

• Unexplained Fever
• Weight Loss
• Loss of Appetite
• Pale Skin
• Gum Bleeding
• Vomiting
• Unexplained Black-and-Blue Marks on Body
• Lumps Around Neck, Stomach, Underarm, or Groin: These lumps may be caused by swollen lymph nodes.
• Fatigue, Weakness, or Decrease of Energy
• Shortness of Breath
• Continuous or Prolonged Bleeding from Minor Cuts
• Red Spots Beneath Skin: These spots are the size of pinheads.
• Aching of Legs, Back, or Arms
• Headaches
• Recurrent or Frequent Infections
• Severe or Frequent Nosebleeds

Acute Lymphocytic Leukemia Diagnosis

About 5,430 people within the United States are thought to have been diagnosed with acute lymphocytic leukemia within the last year. To diagnose ALL, specific blood and bone marrow tests are conducted.

• A CBC, or Complete Blood Count: This is used to determine whether or not a patient has ALL.
• A Bone Marrow Aspirate: A bone marrow aspirate tests the cells in the bone marrow by removing a small amount of marrow with a needle. This procedure can be completed in a doctor’s office, and the patient is given a local anesthesia, or a medication to numb the specific area from which the marrow is drawn. This area is typically the hipbone. The cells are then studied beneath a microscope to determine what kind of abnormality they contain, if any.
• Bone Marrow Biopsy: This procedure involves taking an actual piece of bone (still containing marrow) and performing a similar examination with a microscope. It is important that both procedures be completed, as an aspirate does not always yield conclusive information. Some cells detected, such as leukemic blast cells, can help provide a diagnosis. The biopsy can also inform the doctor about how much of the marrow is infected with the disease. Finally, the bone marrow tests can also help a doctor decide what kind of treatment the patient needs. During post-treatment, bone marrow biopsy can be used to discover whether or not the treatment is working.
• Cytogenetic Analysis: This test examines the chromosomal makeup of the blood, bone marrow and lymph node cells. A cytogenetic analysis can be crucial in determining whether cells are cancerous or malignant. This test may also be used to help determine the patient’s treatment strategy.
• Immunophenotyping: This procedure is used to determine whether the patient’s leukemia cells, once detected, are B cells or T cells (both are types of white blood cells). Most patients with ALL will have B-type cells.
• Spinal Tap: This test may be conducted to check the spine for cancer cells, as many patients develop ALL in the spine.

Acute Lymphocytic Leukemia Treatment

Patients with acute lymphocytic leukemia must begin chemotherapy immediately after the disease is detected. While children are typically cured following treatment, adults have a larger chance of remission. Doctors refer to bone marrow tests to decide which type and lengthy of treatment is best. Other considerations prior to treatment include:

• Number of ALL Cells in Patient’s Blood
• Patient’s Age
• ALL Cell Location: Whether or not the cells have spread to the brain or spinal cord
• Patient Chromosomal Changes

Two forms of treatment will commence following the patient assessment:

• Induction Therapy: This first part of treatment includes ridding the patient of as many ALL cells as possible and stabilizing blood counts back to normal. This includes administering multiple drugs – either orally or through a catheter through the chest – to kill the cancerous cells. These drugs may include but are not limited to methotrexate, imatinib mesylate, pegaspargase, mitoxantrone, clofarabine, vincristine, cytarabine, cyclophosphamide, daunorubicin, dexamethasone and prednisone. Drugs may also be administered into spinal fluid if needed. Radiation therapy may also be given to the patient’s spine or brain if necessary. As ALL patients tend to develop uric acid (a chemical waste created by the body) within their blood, they may also be given medication to prevent kidney stones that may develop.
• Post-Induction Therapy: Once a patient is in remission (free from all signs of the disease for a lengthy period of time), more treatment must be given. In cycles of two to three years, patients are routinely tested, given medication to kill any possible remaining infected cells and prevent further recurrence.

These treatments may result in a number of side effects, including:

• Anemia
• Drop in Platelet Production
• Infection (including sore throat, pain during urination, coughing and loose bowel movements)
• Hair Loss
• Diarrhea
• Rashes
• Mouth Sores
• Nausea
• Vomiting

Not all patients will experience side effects. Doctors can aid patients in managing the side effects that do occur, if any.

Acute Lymphocytic Leukemia Outlook (Prognosis)

Most children are cured following a successful treatment. Though survival rates are high, treatment typically lasts two to three years; the first six months are usually the most difficult. 66% of patients survive overall, with children under 5 having the highest survival rate at 91%.

Acute Lymphocytic Leukemia Prevention

With so few risk factors, there is little that can be done to prevent ALL. Limiting or eliminating exposure to radiation, as well as keeping children away from the drug Phosphocol P32, are the only precise measures that can be taken for prevention.

Resources

• Mayo Foundation for Medical Education and Research (MFMER). 1998-2009. Retrieved May 1, 2009 from .
• The Leukemia & Lymphoma Society. April 30, 2009. Retrieved May 1, 2009 from .
• MedicineNet, Inc. April 29, 2000. Retrieved May 1, 2009 from.