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Acute lymphocytic leukemia (ALL)

Definition

Acute lymphocytic leukemia (ALL) is a fast-growing cancer of a type of white blood cells called lymphocytes. These cells are found in the bone marrow and other parts of the body.

Acute lymphocytic leukemia (ALL) occurs when the body produces a large number of immature lymphocytes. The cancer cells grow quickly and replace normal cells in the bone marrow. Bone marrow is the soft tissue in the center of bones that helps form all blood cells. ALL prevents healthy blood cells from being made. Life-threatening symptoms can occur.

Alternative Names

ALL; Acute lymphoblastic leukemia; Acute lymphoid leukemia; Acute childhood leukemia; Cancer - acute childhood leukemia (ALL); Leukemia - acute childhood (ALL)

Causes, incidence, and risk factors

Most of the time, no clear cause can be found for ALL. But the following may play a role in the development of leukemia in general:

  • Certain chromosome problems
  • Exposure to radiation, including x-rays before birth
  • Past treatment with chemotherapy drugs
  • Receiving a bone marrow transplant
  • Toxins such as benzene

The following increase the risk of ALL:

  • Down syndrome or other genetic disorders
  • A brother or sister with leukemia

This type of leukemia usually affects children ages 3 to 7. ALL is the most common childhood cancer, but it can also occur in adults.

Symptoms

ALL makes the person more likely to bleed and develop infections. Symptoms include:

  • Bone and joint pain
  • Easy bruising and bleeding (such as bleeding gums, skin bleeding, nosebleeds, abnormal periods)
  • Feeling weak or tired
  • Fever
  • Loss of appetite and weight loss
  • Paleness
  • Pain or feeling of fullness below the ribs
  • Pinpoint red spots on the skin (petechiae)
  • Swollen glands (lymphadenopathy) in the neck, under arms, and groin
  • Night sweats

Note: These symptoms can occur with other conditions. Talk to the doctor about the meaning of specific symptoms.

Signs and tests

A physical exam may reveal the following:

Blood tests may include:

Tests are also done to look for changes in the DNA inside the abnormal white cells. Certain DNA changes may determine what kind of treatment the person receives and the outlook.

Treatment

The first goal of treatment is to get blood counts back to normal. If this occurs and the bone marrow looks healthy under the microscope, the cancer is said to be in remission.

Chemotherapy is the first treatment tried with the goal of achieving complete remission.

  • The person may need to stay in the hospital for chemotherapy. Or it can be given at a clinic and the patient goes home afterward.
  • Chemotherapy is given into the veins (by IV) and sometimes next to the spine and brain.

After remission, more treatment is needed to be cured. This treatment can include more chemotherapy or radiation to the brain. Stem cell transplant from another person may also be done. Further treatment depends on:

  • Age and health of the person
  • Type of leukemia cells, including the DNA changes found
  • How many courses of chemotherapy it took to achieve remission
  • Availability of donors for stem cell transplant

Support Groups

You can ease the stress of illness by joining a cancer support group. Sharing with others who have common experiences and problems can help you not feel alone.

Expectations (prognosis)

Those who respond to treatment right away tend to do better. Most children with ALL can be cured. Children often have a better outcome than adults.

Complications

Both leukemia itself and the treatment can lead to many problems such as bleeding, weight loss, and infections.

Calling your health care provider

Call your health care provider if you develop symptoms of ALL.

 

Prevention

You may reduce your risk of ALL by avoiding contact with certain toxins, radiation, and chemicals.

References

Jeha S, Pui CH. Clinical manifestations and treatment of acute lymphoblastic leukemia in children. In: Hoffman R, Benz EJ Jr, Silberstein LE, et al., eds. Hematology: Basic Principles and Practice. 6th ed.Philadelphia, PA: Elsevier Saunders; 2012: chap 64.

National Cancer Institute: PDQ Adult Acute Lymphoblastic Leukemia Treatment. Bethesda, MD: National Cancer Institute. Date last modified 07/10/2012. Available at http://www.cancer.gov/cancertopics/pdq/treatment/adultALL/HealthProfessional. Accessed 01/03/2013.

National Cancer Institute: PDQ Childhood Acute Lymphoblastic Leukemia Treatment. Bethesda, MD: National Cancer Institute. Date last modified 11/01/2012. Available at http://cancer.gov/cancertopics/pdq/treatment/childALL/HealthProfessional. Accessed 01/03/2013.

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Acute Lymphoblastic Leukemia. Version 2.2012. Available at http://www.nccn.org/professionals/physician_gls/pdf/all.pdf. Accessed 01/03/2013.


Review Date: 2/8/2013
Reviewed By: Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Blackman, Stephanie Slon, and Nissi Wang.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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