Acute Lymphoblastic Leukemia (ALL): Causes, Risk Factors, Symptoms, Diagnosis, Treatment, Prognosis

Medically Reviewed by Dr. K on 20 May 2022

What is Acute Lymphoblastic Leukemia?

Acute lymphoblastic leukaemia (ALL) is a form of blood cancer that begins with white blood cells in your bone marrow, which is the soft inner portion of your bones. It appears from immature lymphocytes, a type of white blood cell that plays an important role in the immune system.

Acute lymphocytic leukaemia (ALL) is also classified as acute lymphoid leukaemia. The term “acute" refers to a condition that rapidly worsens. In adults, it's a rare form of leukaemia, or blood cancer, but it's the most frequent in children.

Acute lymphoblastic leukaemia infiltrates the bloodstream and will spread through the liver, spleen, and lymph nodes. However, unlike other forms of cancer, it seldom causes tumours.

Acute Lymphoblastic Leukemia Causes and Risk Factors

Doctors are unsure as to what causes the majority in ALL cases. However, certain factors can increase your risk, including:

  • Radiation treatments for other cancers or conditions;
  • Contact with chemicals such as benzene, cleaning materials, detergents, and paint strippers;
  • Infection with the human T-cell lymphoma/leukemia virus-1 (HTLV-1) or the Epstein-Barr virus (EBV);
  • Having a genetic disorder like Down syndrome;
  • Caucasian;
  • Male;
Acute Lymphoblastic Leukemia Symptoms

Some symptoms of ALL can be vague. They include:

  • Fatigue
  • Fever
  • Loss of appetite  
  • Weight loss
  • Night sweats
  • Tiny red spots just under your skin (petechiae)
  • Abdominal pain

Many of the symptoms occur as a result of the body's inability to produce enough healthy blood cells. In your bone marrow, leukaemia cells will crowd them out.

A lack of red blood cells may cause symptoms of anaemia, including:

  • Fatigue 
  • Weakness
  • Dizziness or light-headedness
  • Feeling cold
  • Shortness of breath
  • Pale skin

Without enough healthy white blood cells, you may have:

  • Fevers
  • More infections than usual

A lack of platelets, tiny cells that help your blood clot, may cause:

  • Lots of bruising for no clear reason
  • Frequent or severe nosebleeds, bleeding gums, or other unusual bleeding, such as from minor cuts

Depending on where the leukemia cells are, you might also have:

  • Cancer cells in your liver or spleen trigger a full or swollen abdomen.
  • Lymph nodes have grown in sizes, such as those in your neck or groin, under your arms, or above your collarbone.
  • Bone or joint pain
  • If cancer has spread to the brain, you may have headaches, trouble with balance, vomiting, seizures, or blurred vision.
  • Trouble breathing if it’s spread to your chest

Acute Lymphoblastic Leukemia Diagnosis

Your doctor will inquire about your symptoms as well as your medical records. A physical test may be performed to check for enlarged lymph nodes, bleeding and bruising, and symptoms of infection.

If your doctor suspects leukemia, they may do tests, including:

  • Blood tests: The number of each type of blood cell in your body is determined by a full blood count (FBC). A smear of your peripheral blood searches for differences in the appearance of your blood cells.
  • Bone marrow tests: A needle will be inserted into a bone in your chest or hip and a sample of bone marrow will be taken. A leukaemia specialist will examine it under a microscope for symptoms of the disease.
  • Imaging tests: Your doctor will use X-rays, CT scans, or ultrasounds to see if the cancer has spread.
  • Spinal tap: A lumbar puncture is another name for this procedure. Your doctor will take a sample of fluid from around your spinal cord using a needle. It should be examined by a doctor to determine whether the disease has spread to the brain or spinal cord.

Your doctor may also examine your blood or bone marrow for chromosome changes or look for cancer cell markers. The findings will reveal more about the type of leukaemia you have and aid them in treatment planning.

Acute Lymphoblastic Leukemia Treatment Stages

Most cancers are categorized into stages depending on the extent to which they have spread. Doctors, on the other hand, define ALL in terms of treatment.

  • Untreated: This is a brand-new diagnosis. You may have had treatment for the symptoms, but not for the cancer itself.
  • Remission: You've undergone treatment aimed at eradicating as many leukaemia cells as possible. Your FBC blood test is normal, and leukaemia cells make up less than 5% of the cells in your bone marrow.
  • Recurrence: This is cancer that has returned following a period of treatment and remission.

Acute Lymphoblastic Leukemia Treatment

Treatment occurs in two phases: induction therapy, to put you in remission, and post-remission therapy.

You may have more than one type of treatment. These include:

  • Chemotherapy: Over the course of a few years, you could take a mixture of medications that kill or slow cancer cells.
  • Targeted therapy: Some medications specifically kill cancer cells and have fewer or milder side effects than chemotherapy. There include:
  • Dasatinib (Sprycel) 
  • imatinib (Gleevec) 
  • nilotinib (Tasigna) 
  • ponatinib (Iclusig) 
  • Radiation therapy: If cancer cells have entered the brain or bone, or if before you undergo a stem cell transplant, your doctor may use high-energy radiation to destroy them.
  • Immunotherapy: These medications work by boosting the immune system to destroy or delay cancer cells' development. These include:
  • Blanatumomab (Blincyto)  
  • Inotuzumab Ozogamicin  (Besponsa
  • A stem cell transplant: You get stem cells that can grow into healthy blood cells after receiving high doses of chemotherapy and potentially radiation. They could be yours or they could come from a donor. If you can't take high doses of chemotherapy or radiation, a “mini-transplant" might be an option.

After treatment, about 80% to 90% of adults achieve remission. The cancer will not return in around 30% to 40% of cases. However, many patients relapse, which means the disease returns.

To prevent the cancer from returning, you'll need post-remission therapy. This entails two or three years of treatment periods. Its aim is to eliminate leukaemia cells from the body.

CAR T-cell therapy, a type of treatment, has also been licenced by the FDA. It treats cancer by using T cells, which are your own immune cells. Doctors extract cells from the blood and insert genes into them. The new T cells are more effective at detecting and killing cancer cells.

The drug, tisagenlecleucel (Kymriah), is only licensed for children and young adults under the age of 25 who have a specific type of  ALL which hasn't responded to other treatments. However, scientists are developing CART cell therapy for adults and other types of cancer.

Joining a clinical trial to try new treatments that aren't readily accessible is another choice. Consult the doctor to determine which option is better for you and what to expect.

Acute Lymphoblastic Leukemia Prognosis

The prognosis for acute lymphoblastic leukaemia is determined by a number of factors, including:

  • Age: Patients that are younger have a better prognosis.
  • Test results: When you're diagnosed, a reduced white blood count means a positive prognosis.
  • Genetics: People that don't have a problem with their chromosomes named the Philadelphia chromosome have a higher chance of successful recovery.
  • Response to chemotherapy: There is a better prognosis there is no evidence of leukemia 4 to 5 weeks after starting treatment.

Following chemotherapy, you'll require follow-up tests for many years to ensure your general wellbeing and that the cancer hasn't returned.

When you've been diagnosed with cancer, it's normal to be concerned. For support and guidance, turn to loved ones, faith leaders, psychologists, or support groups. Speak to your doctor to connect you to local support groups in your community. 

Source:

Referenced on  27/4/2021 

  1. American Cancer Society: “What is acute lymphocytic leukemia?"  “How is acute lymphocytic leukemia classified?"  “What are the risk factors for acute lymphocytic leukemia?" “How is acute lymphocytic leukemia diagnosed?"  “Treating Leukemia — Acute Lymphocytic (ALL) in Adults;" and “Response rates to treatment," “Tests for Acute Lymphocytic Leukemia (ALL),” “Living as an Acute Lymphocytic Leukemia (ALL) Survivor,” “Immunotherapy for Acute Lymphocytic Leukemia (ALL),” “Typical Treatment of Acute Lymphocytic Leukemia (ALL).”
  2. The Leukemia & Lymphoma Society: “Acute Lymphocytic Leukemia" and “Leukemia Facts & Statistics."
  3. ARIAD Pharmaceuticals, Inc.
  4. FDA: “FDA approval brings first gene therapy to the United States.”
  5. National Cancer Institute: “Adult Acute Lymphoblastic Leukemia Treatment (PDQ) — Patient Version.”
  6. Mayo Clinic: “Acute lymphocytic leukemia.”
  7. https://www.webmd.com/cancer/lymphoma/acute-lymphoblastic-leukemia

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