Massachusetts General Hospital

Acute Lymphocytic Leukemia

What is acute lymphocytic leukemia?

Acute lymphocytic leukemia (ALL) is a cancer of the blood in which too many lymphocytes, a type of white blood cell, are produced by the bone marrow and by organs of the lymph system.

Normally, the lymphocytes fight infection. But, in ALL, the cells are immature and overabundant. They crowd out other blood cells, and may collect in the blood, bone marrow, and lymph tissue.

Acute leukemia can grow quickly and requires treatment as soon as possible after it is found. Chromosome abnormalities (extra chromosomes and structural changes in the chromosome material) are present in the majority of patients.

ALL is more common in children than adults, with most children younger than five years of age when the cancer is found. According to the American Cancer Society, about 6,000 cases of ALL are expected in 2012. The average person has about a one in 800 chance of developing ALL.

What are the symptoms of acute lymphocytic leukemia?

The following are some of the most common symptoms of acute lymphocytic leukemia. However, each individual may experience symptoms differently. Symptoms may include:

• Bleeding

• Bruising

• Fever

• Infections

• Persistent weakness

• Fatigue

• Loss of appetite

• Aches in bones and joints

• Swollen lymph nodes

• Weight loss

• Night sweats

• Swelling in the abdomen

• Trouble breathing

The symptoms of acute lymphocytic leukemia may resemble other blood disorders or medical problems. Always consult your doctor for a diagnosis.

How is acute lymphocytic leukemia diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for acute lymphocytic leukemia may include the following:

• Blood tests and other evaluation procedures

• Bone marrow aspiration and/or biopsy. A procedure that involves taking a small amount of bone marrow fluid (aspiration) and/or solid bone marrow tissue (called a core biopsy), usually from the hip bones, to be examined for the number, size, and maturity of blood cells and/or abnormal cells.

• Spinal tap/lumbar puncture. A thin, hollow needle is placed into the lower back, into the spinal canal. This is the area around the spinal cord. A small amount of cerebral spinal fluid (CSF) can be removed and sent for testing to look for leukemia cells or determine if there is an infection or other problems. CSF is the fluid that bathes the brain and spinal cord.

Treatment for acute lymphocytic leukemia

Specific treatment for acute lymphocytic leukemia will be determined by your doctor based on:

• Your age, overall health, and medical history

• Extent of the disease

• The type of ALL and other prognostic factors

• Your tolerance for specific medications, procedures, or therapies

• Expectations for the course of the disease

• Your opinion or preference

Treatment may include:

• Chemotherapy

• Radiation therapy

• Stem cell transplant (from the peripheral blood or bone marrow)

• Targeted therapy