What is Acute Lymphocytic Leukemia?

Acute lymphocytic leukemia also known as acute lymphoblastic leukemia, is a cancer of the blood that develops from white blood cells called lymphocytes. Acute lymphocytic leukemia occurs when too many immature white blood cells are produced in the bone marrow and multiply out of control. It is the most common type of cancer in children.

Baptist Health is known for advanced, superior care for patients with cancer and the diagnosis, treatment and management of acute lymphocytic leukemia. You will appreciate timely appointments and a professional, friendly atmosphere where we take time to listen to your concerns. At Baptist Health, you have access to the region’s most comprehensive, multidisciplinary team of specialists and innovative therapies, including many available only through specialized clinical trials. In every way, we work to demonstrate the utmost in excellent care to those who trust us with their health.

Signs and Symptoms

Acute lymphocytic leukemia symptoms include:

• Bone pain or tenderness
• Frequent bleeding, especially from the gums or nose
• Fever
• Frequent or severe infections
• Pale skin
• Shortness of breath
• Swollen lymph nodes in the neck, underarm, abdomen or groin
• Weakness and/or fatigue

Diagnosis

A physician may be able to detect acute lymphocytic leukemia in a routine blood test before symptoms begin. If someone has symptoms of acute lymphocytic leukemia, the physician will perform a physical examination and ask the patient questions about their symptoms. A physician can diagnose, inform treatment and carefully monitor the patient’s condition using several different diagnostic procedures. These include:

Blood test: A physician examines a blood sample to determine if too many white blood cells and not enough red blood cells and/or platelets are present in the blood. Blood tests may also show if immature blast cells are in the blood, rather than in the bone marrow where they are normally found.

Bone marrow test: If leukemia is suspected, a bone marrow sample may be removed from the hip bone. The marrow is removed with a long, thin needle and tested for cancer cells. Lab technicians will classify cells into specific types based on their sizes, shapes and other features and determine whether leukemia cells began from the B lymphocytes or T lymphocytes. 

Lumbar puncture: Also, known as a spinal tap, this test involves a physician inserting a small needle into the spinal canal to collect fluid and check for leukemia cells.

Causes

Acute lymphocytic leukemia results from DNA mutations that occur in bone marrow cells, but the underlying causes of this cancer are unknown. Behaviors and lifestyle factors do not contribute to the development of acute lymphocytic leukemia, and in most cases, acute lymphocytic leukemia is not inherited.

Risk Factors

Risk factors that can contribute to acute lymphocytic leukemia include:

Exposure to radiation: People exposed to very high levels of radiation, such as survivors of a nuclear reactor accident, have an increased risk of developing acute lymphocytic leukemia.

Having a brother or sister with ALL: Having a sibling with acute lymphocytic leukemia can increase the risk of developing acute lymphocytic leukemia oneself.

Genetic disorders: Some genetic disorders, like Down syndrome, are associated with an increased risk of acute lymphocytic leukemia.

Previous cancer treatment: Acute lymphocytic leukemia sometimes develops in people who have been treated with chemotherapy and radiation for other types of cancer.

Prevention      

There is no known way to prevent acute lymphocytic leukemia.

Prognosis

In contrast to chronic lymphocytic leukemia, acute lymphocytic leukemia progresses rapidly. Children with acute lymphocytic leukemia tend to have a better prognosis and a better chance of successful treatment. Cases of acute lymphocytic leukemia in older patients generally have a less favorable prognosis. A person’s acute lymphocytic leukemia prognosis may be better if he or she:

• Has a lower white blood cell count at diagnosis
• Has B-cell acute lymphocytic leukemia, rather than T-cell acute lymphocytic leukemia
• Lacks a chromosome abnormality known as the Philadelphia chromosome
• Responds well to chemotherapy

Treatment and Recovery

Acute lymphocytic leukemia treatment depends on a person’s age, overall health and preferences. Treatments may include:

Chemotherapy

Special drugs designed to kill cancer cells can be given as a pill or injected into the bloodstream. If the first cycle of chemotherapy doesn’t lead to remission, it can be repeated.

Radiation Therapy

High-powered beams, such as X-rays, are administered to kill cancer cells. If cancer cells have spread to the central nervous system, the physician may recommend radiation therapy.

Stem Cell Transplant

This procedure replaces diseased bone marrow with healthy bone marrow. Before the transplant, a patient receives high doses of chemotherapy or radiation to destroy diseased bone marrow. Then, the patient receives an infusion of blood-forming stem cells to help rebuild the bone marrow from a healthy donor.  

Targeted Therapies

Targeted therapies are special drugs used to attack specific abnormalities that help the cancer cells to grow and multiply. One type of abnormality called the Philadelphia chromosome is found in some people with acute lymphocytic leukemia. Targeted drugs may be used to attack cells containing this abnormality.

Complications

Complications of acute lymphocytic leukemia can stem from the depletion of normal blood cells as well as from the treatments provided. Complications may include:

Anemia: This condition, which develops when blood lacks enough healthy red blood cells or hemoglobin, can be a complication of chemotherapy.

Bleeding: This occurs due to a low level of platelets, which are responsible for clotting.

Frequent infections: A shortage of lymphocytes — one type of white blood cell that helps the body fight infection – can weaken a person’s immune system and lead to frequent infections. This may be caused by acute lymphocytic leukemia or by acute lymphocytic leukemia treatments such as chemotherapy or immunosuppressive therapy given before stem cell transplants. Some of these infections can be serious.

Graft-versus-host disease: This disease can result from a stem cell or bone marrow transplant. It occurs when newly transplanted donor cells attack the transplant recipient’s body.

Infertility: High doses of chemotherapy and radiotherapy, especially in preparation for a bone marrow or stem cell transplant, can cause temporary or permanent infertility.

Relapse: Acute lymphocytic leukemia may return even after remission.

Weight loss: This can occur as a result of the disease itself or because of nausea and loss of appetite caused by chemotherapy or other treatments.