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What is acute lymphocytic leukemia?

Acute lymphoblastic leukemia (ALL), sometimes referred to as acute lymphocytic leukemia, is a type of cancer that causes the body to make too many white blood cells (lymphocytes). Unlike regular white blood cells, these lymphocytes, called leukemia cells, cannot fight infection very well. When leukemia cells build up in the blood and bone marrow, there is less room for healthy blood cells. This can cause infections, anemia and easy bleeding.

ALL is the most common–and most successfully treated–type of childhood leukemia. It usually occurs in children ages two through five years, though it may also occur in adults. It usually advances quickly.

Our approach

At Northwell Health Cancer Institute, our experts use the latest technology and research-backed therapies to treat newly diagnosed, relapsed and refractory ALL. Highlights of our treatments and services include:

  • Personalized acute lymphoblastic leukemia treatments from a team of physicians with extensive experience with hematologic malignancies
  • Advanced therapies that deliver maximum effects with the least impact on the body, including National Cancer Institute and highly selected pharmaceutical industry-sponsored clinical trials
  • A prestigious Foundation for the Accreditation of Cellular Therapy (FACT)-accredited bone marrow/stem cell transplantation program–one of the largest in the New York metropolitan area–for patients who require transplantation, performing both autologous and allogeneic transplants

Since every patient requires unique, personalized treatment planning, our team of specialists will conduct comprehensive tests and develop a personalized cancer treatment program just for you. Our clinical care and research team meets regularly to discuss each patient's diagnosis and therapy, share ideas and discuss best practices. From diagnosis through treatment, you’re in the capable hands of experts every step of the way.

Research at Northwell

Through collaboration with leading research laboratories, you or your child may have the opportunity to participate in clinical trials as part of your treatment for ALL. While not every patient is a candidate for clinical trials, your care team will work with you to determine eligibility. Learn more about clinical trials at Northwell Health.

Symptoms

Early signs of ALL may be like the flu or other common diseases. You should contact your doctor if you experience any of the following symptoms:

  • Weakness or feeling tired
  • Fever or night sweats
  • Easy bruising or bleeding
  • Petechiae (flat, pinpoint spots under the skin, caused by bleeding)
  • Shortness of breath
  • Weight loss or loss of appetite
  • Pain in the bones or stomach
  • Pain or feeling of fullness below the ribs
  • Painless lumps in the neck, underarm, stomach or groin
  • Several infections
  • Headaches

Be aware that these symptoms could be due to conditions other than acute lymphoblastic leukemia, so it’s best to see a doctor right away.

Causes

Individuals with Down syndrome or other genetic disorders are at an increased risk of developing ALL. Learn more about genetic counseling at Northwell Health.

Diagnosis

The first step to making an acute lymphoblastic leukemia diagnosis is usually a physical exam. A doctor will also consider personal and family medical history. If acute lymphoblastic leukemia is suspected, additional tests will be needed, including:

  • Complete blood count (CBC) with differential—Blood is drawn to measure the number of red blood cells, white blood cells and platelets in the blood. The amount of hemoglobin (substance in the blood that carries oxygen) and the hematocrit (the amount of whole blood that is made up of red blood cells) are also measured. The differential will count the different types of white blood cells that may be present.
  • Peripheral blood smear—A blood sample is checked for blast cells (immature cells in blood marrow, an increase of which could be a sign of leukemia), the number and kinds of white blood cells, the number of platelets and changes in the shape of blood cells.
  • Bone marrow aspiration and biopsy—A small sample of bone marrow and bone is removed. The sample is examined by a pathologist for signs of leukemia.
  • Immunophenotyping—A process used to identify cells, based on the types of antigens or markers on the surface of the cell. This process is used to diagnose specific types of leukemia and lymphoma by comparing the cancer cells to normal cells of the immune system. Flow cytometry and immunohistochemistry are the two tests used to provide optimal immunophenotyping.
  • Blood chemistry studies—A blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that makes it.
  • Cytogenetic analysis—The chromosomes in the cells of a blood sample are examined. Abnormalities in the chromosomes could be a sign of acute lymphoblastic leukemia or other kinds of leukemia.
  • Molecular genetics—The molecular genetics laboratory looks for traces of disease that may have escaped treatment. Such methods can measure how well patients respond and detect early recurrence.
  • Lumbar puncture (spinal tap)—If a diagnosis of acute lymphoblastic leukemia is made, then during the course of treatment, a thin needle called a spinal needle is put into the lower part of the spinal column to collect cerebrospinal fluid. If the cancer has spread, leukemia cells may be found here. Chemotherapy drugs can be given directly through the spinal needle.

Imaging Tests

  • Chest X-rays—X-rays help doctors look for tumors in the chest and lungs or evidence of infection.
  • CT or CAT scan (computerized axial tomography)—More detailed than an X-ray, this procedure uses a combination of X-rays and computer technology to produce detailed images if needed.
  • MRI (magnetic resonance imaging)—A powerful magnet, radio waves and computer imaging combine to create highly detailed pictures of areas inside the body, if needed.

Treatment types

Most treatment plans for acute lymphoblastic leukemia (ALL) have three steps. These are induction, consolidation and maintenance.

  1. Induction therapy—Kills leukemia cells in the blood and bone marrow to induce remission. Treatments include chemotherapy and corticosteroids. Induction usually lasts 4 weeks and is done in a hospital.
  2. Consolidation therapy—Kills any leukemia cells that may be present even though they don't show up in tests. If these cells regrow, they could cause a relapse. Treatments include more chemotherapy and may include stem cell transplant. This step may also include preventive treatment of the brain or spinal cord with radiation or chemotherapy. Consolidation usually takes several months but doesn't require staying overnight in the hospital.
  3. Maintenance therapy—Prevents any remaining leukemia cells from growing. This may be done using lower doses of chemotherapy than those used during induction or consolidation. Chemotherapy is given with pills and once-a-month intravenous (IV) treatment. Maintenance is often continued for up to three years, but during this time, most people are able to go back to being as active as they were before beginning treatment.

When there are no signs of leukemia for five years, a person is usually considered cured. But if the leukemia doesn't go into remission, or if it comes back within the first few years, treatments may include more chemotherapy, a stem cell transplant, or joining a clinical trial for new treatments.

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