Acute Lymphoblastic Leukemia (ALL)

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After completing a thorough lab analysis of your recent biopsy, a specialized doctor called a pathologist reported a diagnosis of acute lymphoblastic leukemia (ALL), the most common type of leukemia in children but least common in adults, who account for about one-third of all cases.

About the Condition

Leuk Diag 12-21-09The soft inner tissue that fills the cavities of bones is called bone marrow. In adults, certain bones such as the skull, shoulder blades, ribs, pelvis and vertebrae (backbones) contain red bone marrow, which is the site of the body’s blood stem cells. These cells develop into blood-forming cells that then produce various components of the blood such as red and white blood cells and platelets. (Blood stem cells are not the same as embryonic stem cells.)

Lymphocytes are a type of white blood cell made in the bone marrow that fight infection and include B- and T-cells and natural killer cells. Acute lymphoblastic leukemia is cancer that occurs when lymphocytes in the bone marrow do proliferate and mature in a normal manner. The extra cells that result can spread beyond the bone marrow to lymph nodes and organs such as the spleen or liver, which can become enlarged, as well as to the central nervous system (brain and spinal cord).

The term acute refers to the fact that the disease is comprised of immature lymphocytes and progresses quickly without treatment. Symptoms of ALL may include fatigue, shortness of breath, weight loss, swollen lymph nodes, fever, excessive bruising or bleeding, upper abdominal discomfort and increased risk of infection.

There are two main types of ALL, which reflect the type of lymphocytes where the cancer begins. B-cell ALL makes up about 85% of cases; T-cell ALL, about 15%. In very rare cases, the condition arises in the natural killer cells. There are several subtypes of the disease determined largely by the cancer’s genetics. Your doctor can tell you more about your particular subtype.

Treatment Options

Deciding on a treatment plan for ALL can be complex and depends upon a variety of factors such as your age, general health condition, ALL subtype, white blood cell count, other test results and personal preferences.

There are two phases of treatment for ALL — induction therapy and consolidation therapy. Induction therapy focuses on bringing about (inducing) a remission, which is the elimination of visible signs of the disease. Consolidation therapy, also known as post-remission therapy, seeks to destroy any remaining cancer cells and prevent a relapse.

The following treatment possibilities are available:

Chemotherapy – The use of anti-cancer drugs, or chemotherapy, is the main treatment for ALL and provides a way to kill leukemia cells systemically (throughout the body) via the bloodstream, often through a combination of several drugs. Intrathecal chemotherapy is often used in the treatment of ALL, where it is injected directly into the cerebrospinal fluid of the central nervous system to kill leukemia cells that are not reached by standard forms of chemo. This helps prevent cancer from spreading to the brain or spinal cord, or treats it when it has already spread there.

Radiation Therapy – Radiation therapy is used to treat ALL that has spread to the brain and spinal cord, or to prevent its spread there. External beam radiation is generally used, in which a high energy X-ray machine directs radiation at the affected area(s).

(Hematopoietic) Stem Cell Transplant – Stem cell transplant involves the transfer of specific blood-forming (hematopoietic) cells after high-dose chemotherapy (and at times added radiation therapy). Cancer cells in the body along with healthy blood-forming cells in the bone marrow are destroyed by chemotherapy. Stem cells harvested from the bone marrow or blood of a matched donor are frozen and later thawed when needed for infusion into the body to help the bone marrow regenerate. When the stem cells come from a matched donor it is called an allogeneic transplant. When an ALL patient is in remission, an autologous transplant may be performed instead, which harvests stem cells from the patient rather than a donor.

Targeted Therapy – This newer form of anti-cancer therapy targets specific abnormalities within just the cancer cells to slow or stop their growth using drugs such as imatinib, dasatinib and nilotinib. It is used for certain ALL patients who may benefit from this type of treatment.

You may also consider participating in clinical trials. These investigative studies help doctors learn about new treatments and better ways to use established treatments.

What You Can Do

You can choose to take an active role in your health and well-being. Learn as much as you can about your condition and have a list of questions ready each time you meet with your doctor. Join a cancer support group, and talk with your family, friends, clergyperson or counselor as you feel comfortable. Keep all of your doctor’s appointments and promptly report any new symptoms or treatment side effects that develop. Also be sure to eat well including fruits and vegetables, get plenty of sleep and stay as active as you can.

Additional Resources

American Cancer Society, 800.227.2345, www.cancer.org
The Leukemia & Lymphoma Society, 800.955.4572, www.leukemia-lymphoma.org

This patient resource sheet is provided to you as a service of CBLPath® and is intended for information purposes only. It may not fully describe all aspects of your diagnosis and is not meant to serve as medical advice or a substitute for professional medical care. Your physician can provide you with a thorough explanation of your diagnosis and appropriate treatment options, which may vary. Only you and your physician can determine your best treatment plan.

Updated 8.12