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Acute Lymphoblastic Leukemia (ALL)

About Leukemia

Leukemia is a type of cancer that affects the body's white blood cells (WBCs).

Normally, WBCs help fight infection and protect the body against disease. But in leukemia, WBCs turn cancerous and multiply when they shouldn't, resulting in too many abnormal WBCs, which then interfere with organ function.

If too many lymphoblasts (a certain type of WBC) are produced, a child will develop acute lymphoblastic, or lymphoid, leukemia (ALL). This is the most common type of childhood leukemia, affecting about 75% of kids with this cancer of the blood cells. Kids ages 2 to 8 are more likely to be affected, but all age groups can develop ALL.

Thanks to advances in therapy and clinical trials, the outlook for kids with ALL is promising. With treatment, about 85% are cured.

Causes

The cause of ALL is not known. However, certain risk factors might increase a child's chance of developing it.

Kids with an identical twin who was diagnosed with the illness before age 6 have a 20% to 25% chance of developing ALL. Fraternal twins and other siblings of children with leukemia have two to four times the average risk of developing it, too.

Children who have inherited certain genetic problems (such as Li-Fraumeni syndrome, Down syndrome, Klinefelter syndrome, neurofibromatosis, ataxia telangiectasia, or Fanconi anemia) also have a higher risk of developing leukemia, as do those who are receiving medicines to suppress their immune systems after organ transplants.

Kids who have received radiation or chemotherapy for other types of cancer also have a higher risk, usually within the first 8 years after treatment.

In most cases, however, neither parents nor children have control over the factors that trigger leukemia. Current studies are investigating the possibility that some environmental factors may predispose a child to develop the disease. For example, prenatal radiation exposure (such as X-rays) may trigger ALL in a developing fetus. Women who are pregnant (or suspect they're pregnant) should inform their doctors before undergoing tests or medical procedures that involve radiation.

Signs and Symptoms

All types of leukemia generally have the same symptoms, which include:

Diagnosis

The subtypes of ALL are classified according to the proteins found in the leukemia cells. This requires special tests. A doctor who suspects a child has leukemia might order these tests:

Treatment

Most children with ALL are treated with chemotherapy (the use of special drugs to kill cancer cells). What drugs are used and in what combination will depend on which subtype of ALL is present and how aggressive the disease is.

Chemotherapy can be given intravenously as an injection into a muscle or orally in pill form. In intrathecal (IT) chemotherapy, a spinal tap is used to deliver chemotherapy drugs directly to the cerebrospinal fluid, where cancerous WBCs can collect.

After treatment begins, the goal is remission (when there is no longer evidence of cancer cells in the body). Once remission has occurred, chemotherapy is usually used to keep the child in remission.

Maintenance chemotherapy is given in cycles over a period of 2 to 3 years to keep the cancer from recurring. Leukemia will almost always relapse (recur) if this additional chemotherapy isn't given. Sometimes the cancer will return in spite of maintenance chemotherapy, and other forms of chemotherapy will be necessary.

Some more aggressive forms of ALL might require a stem cell transplant (sometimes called a bone marrow transplant). This procedure involves destroying cancer cells and normal bone marrow and immune system cells with high-dose chemotherapy and then re-introducing healthy donor stem cells into the body. The new stem cells can rebuild a healthy blood supply and immune system.

If a child needs a stem cell transplant, a test (called tissue typing or HLA [human leukocyte antigen] typing) will be done to help doctors find a suitable stem cell donor. This works by comparing the proteins on the surface of a child's blood cells with the proteins on a potential donor's cells. The more "HLA markers" a child and donor share, the greater the chance that the transplant will be successful.

Coping

Being told that a child has cancer can be a terrifying experience, and the stress of cancer treatment can be overwhelming for any family.

Although you might feel like it at times, you're not alone. To find out about support that may be available to you or your child, talk to your doctor or a hospital social worker. Many resources are available that can help you get through this difficult time.

Reviewed by: Christopher N. Frantz, MD
Date reviewed: October 2012

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Note: All information is for educational purposes only. For specific medical advice, diagnoses, and treatment, consult your doctor.
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