Acute Lymphocytic Leukemia
Acute lymphocytic leukemia, also known as ALL, is a type of cancer that starts in a person’s bone marrow, the soft, inner part of the bones where white blood cells called “lymphocytes” are made. Ordinarily, the bone marrow produces immature cells known as lymphoblasts that eventually develop into fully functioning lymphocytes. But for those with acute lymphocytic leukemia, the bone marrow produces abnormal lymphoblasts that don’t mature properly. Because this type of blood cancer affects the immature lymphoblast cells, it’s sometimes referred to as acute lymphoblastic leukemia. The word “acute” indicates that this form of leukemia progresses quickly, and the resulting abnormal cells can steadily accumulate in the blood until treated.
The accumulation of abnormal lymphoblasts and the resulting scarcity of normal lymphocytes can seriously impair the body’s immune system and increase a person’s risk of developing severe infections and illnesses. This is because normally functioning lymphocytes play a key role in helping the immune system detect and destroy germs.
Acute lymphoblastic leukemia is rare, with only about 6,500 new cases diagnosed annually in the U.S. Both adults and children can develop acute lymphocytic leukemia, but the condition is much more common in children, especially those younger than 5.
Causes and risk factors of acute lymphocytic leukemia
The root cause of acute lymphocytic leukemia is not yet fully understood. However, significant strides have been made in uncovering how subtle changes in the DNA of healthy bone marrow cells can transform them into leukemia cells. Essentially, these changes tell normal cells to keep growing and dividing instead of dying, triggering rapid and abnormal lymphocyte cell production that can crowd out healthy cells. The majority of acute lymphocytic leukemia cases are not believed to be inherited (passed down from a parent).
Researchers have identified a few factors that may leave an individual at a slightly higher risk of developing acute lymphocytic leukemia. These include:
- Having a sibling, particularly a twin, with acute lymphocytic leukemia
- Certain genetic disorders, including Down syndrome, neurofibromatosis and Fanconi anemia
- Exposure to certain chemicals, including benzene, or high amounts of radiation
- A personal history of cancer and cancer treatments, including chemotherapy and radiation therapy
Signs and symptoms of acute lymphocytic leukemia
Acute lymphocytic leukemia symptoms usually stem from a lack of healthy blood cells, which can occur when leukemia cells overtake normal blood-producing cells in the bone marrow. The symptoms can vary considerably from patient to patient but often include:
- A sensation of pain within the bones
- Bleeding gums
- Pale skin
- Easy bruising
- Tiny blood spots (petechiae) underneath the skin
- Fatigue and general malaise
- Swollen lymph nodes
- Shortness of breath
- Weight loss and reduced appetite
Several of these symptoms are associated with common benign conditions like the common cold and flu, which can make acute lymphocytic leukemia difficult to recognize early. In many cases, a more serious problem is discovered only after routine bloodwork is performed.
Diagnosing acute lymphocytic leukemia
The first step in diagnosing acute lymphocytic leukemia is usually a blood test. If a physician suspects that a patient has leukemia, he or she may order one of several tests to examine the number and appearance of the patient’s red blood cells, white blood cells and platelets underneath a microscope.
If further testing is warranted, the next step is to obtain a sample of bone marrow. This can be done through aspiration with a thin, hollow needle that draws out a small amount of marrow from a bone (usually the hip bone or breast bone). This is typically followed by a bone marrow biopsy, which involves removing a tiny portion of bone and marrow for careful evaluation. Bone marrow testing can often confirm a diagnosis of leukemia, although further lab tests may be performed to identify its subtype and stage as well as the patient’s prognosis.
Acute lymphocytic leukemia treatment
At Moffitt Cancer Center, we take an individualized approach to cancer treatment. This means our team of leukemia specialists will consider many factors—including each patient’s age, type of leukemia and whether it has metastasized (spread to other areas of the body) and overall health—when tailoring a treatment plan to meet the patient’s needs.
For adult patients, many acute lymphocytic leukemia treatment plans include an aggressive and long-term regimen of chemotherapy (chemo) to destroy cancer cells in the blood. Chemo treatment may continue for two years or so and is often divided into three phases:
During this phase, which typically lasts about a month, different combinations of chemo drugs may be used in high doses for treatment that aims to get the leukemia into remission. This means that the abnormal lymphoblasts are no longer found in bone marrow samples and healthy white blood cell counts return to normal.
Also known as the intensification phase, this stage of treatment continues over a few months and often includes shorter courses of chemo drugs in high doses. Some patients may also receive targeted drug therapy, and physicians may explore the possibility of a stem cell transplant for those who are considered at high risk for the leukemia coming back.
The maintenance phase of acute lymphocytic leukemia treatment takes up the lion’s share of the typical two-year chemotherapy regimen. During this time, leukemia specialists will consider how the patient is responding to determine which combination of chemo drugs and possibly other therapy options to use in treatment. Because chemotherapy can often impact healthy white blood cell counts and cause side effects, medication to help prevent or treat any discomfort may be given. Chemotherapy is sometimes supplemented with radiation therapy to target cancer cells in a specific area.
Targeted therapies like tyrosine kinase inhibitors (TKIs) and immunotherapy drugs can also be helpful in treating acute lymphocytic leukemia in patients with certain genetic mutations or whose cancer has not responded well to chemotherapy. These approaches work by promoting a patient’s immune response to specific cancer cells.
Moffitt’s approach to acute lymphocytic leukemia
At Moffitt Cancer Center, our Malignant Hematology Program is dedicated to helping patients achieve long-term remission from cancers of the blood and bone marrow. Our team has extensive experience in treating a variety of hematologic malignancies, including acute lymphocytic leukemia and other types of leukemia. At Moffitt, patients can access:
- Advanced diagnostic services, with all blood work processed on-site by our specially trained pathologists
- Comprehensive, completely individualized treatment plans that incorporate today’s most effective leukemia treatments, such as chemotherapy, radiation therapy and radioimmunotherapy
- Opportunities to access novel treatments that are not yet widely available elsewhere through our robust clinical trials program
- Consultations with a collaborative team of medical professionals ranging from medical oncologists and radiation oncologists to hematologists, transplant specialists and immunologists, all in a single, convenient location
- Supportive care services to address each patient’s emotional and social needs, manage the side effects of treatment and improve quality of life outcomes
- Follow-up care and consistent monitoring once the cancer is in remission
Patients can benefit from our unique, multispecialty approach to acute lymphocytic leukemia treatment with or without a referral. When patients entrust their cancer care to Moffitt, they become a top priority of a cancer center that delivers nationally ranked care in new and transformative ways. In fact, we’re committed to connecting every new patient with a cancer expert within a day of their reaching out!
American Cancer Society – What Is Acute Lymphocytic Leukemia (ALL)?
MedicalNewsToday – How Does Leukemia Affect the Immune System?
American Cancer Society – Typical Treatment of Acute Lymphocytic Leukemia (ALL)
American Society of Clinical Oncology – Leukemia: Acute Lymphocytic - ALL