Acute lymphoblastic leukemia

Overview

Acute lymphoblastic leukemia (ALL) is a rare type of cancer in which the bone marrow makes too many lymphoblasts (a primitive type of white blood cell). This type of cancer usually requires rapid and accurate diagnosis and appropriate therapy by an experienced team.

Our approach

Northwell Health takes a multifaceted approach to treating acute lymphoblastic leukemia (ALL), also known as acute lymphocytic lymphoma.

At the Hematologic Oncology Center, part of the Northwell Health Cancer Institute, highly regarded experts use the latest technology and research-backed therapies to treat newly diagnosed, relapsed and refractory acute lymphoblastic leukemia.

Highlights of acute lymphoblastic leukemia 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 FACT-accredited bone marrow/stem cell transplantation program for patients who require transplantation performing both autologous and allogeneic transplants.

Multidisciplinary Acute Lymphoblastic Leukemia Treatment

Within the first several days of a patient visit, the multidisciplinary team at Northwell Health will conduct comprehensive tests and develop a personalized cancer treatment program.

For patients in whom stem cell transplantation is the best strategy – a relatively minor but growing portion of patients with ALL – the Adult Bone Marrow and Stem Cell Transplant program is available. The program is one of the largest in the New York metropolitan area and is accredited by the Foundation for the Accreditation of Cellular Therapy (FACT).

Each patient requires unique, personalized treatment planning, so the clinical care and research team meets regularly to discuss diagnosis and therapy. The team holds weekly multidisciplinary conferences where acute lymphoblastic leukemia physicians at the cancer center share ideas and best practices for delivering collaborative patient care. The specialists review each treatment phase to constantly monitor and improve acute lymphoblastic leukemia care and ensure treatment milestones are reached.

From diagnosis through treatment, patients are the capable hands of experts every step of the way.

Symptoms

The early signs of ALL may be like the flu or other common diseases. A doctor should be contacted when someone has any of the following problems:

  • 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
  • Having many 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 if someone is experiencing them.

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, the patient will be sent for additional tests — usually administered on an outpatient basis — which include:

  • 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. Cytogenetics and a related procedure called FISH is used to identify whether or not the Philadelphia chromosome is present. More than 30 perecent of adults with ALL have the Philadelphia chromosome. Its presence demands very specific therapy strategies, which differ from the treatment of other patients with this disease.
  • Molecular genetics—The molecular genetics laboratory looks for traces of disease, particularly Philadelphia chromosome positive disease, that may have escaped destruction by 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.

Recurrent acute lymphoblastic leukemia

Recurrent acute lymphoblastic leukemia is leukemia that has recurred (returned) after going into remission. The ALL may come back in the blood, bone marrow, or other parts of the body.

With the data from these state-of-the-art tests for acute lymphoblastic leukemia diagnosis, a doctor will develop a customized treatment plan for the patient with the best possible outcomes.

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