Acute lymphoblastic leukemia (ALL)

Most of the time, no clear cause can be found for ALL.

The following factors may play a role in the development of all types of leukemia:

• Certain chromosome problems
• Exposure to radiation
• Past treatment with chemotherapy drugs
• Receiving a bone marrow transplant
• Toxins, such as benzene

The following factors are known to increase the risk for 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.

ALL makes a 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 from an enlarged liver or spleen
• Pinpoint red spots on the skin (petechiae)
• Swollen lymph nodes in the neck, under arms, and groin
• Night sweats

These symptoms can occur with other conditions. Talk to your health care provider about the meaning of specific symptoms.

Your provider will perform a physical exam and ask about your symptoms.

Blood tests may include:

• Complete blood count (CBC), including white blood cell (WBC) count
• Platelet count
• Bone marrow biopsy
• Lumbar puncture (spinal tap) to check for leukemia cells in the spinal fluid

Tests are also done to look for changes in the DNA inside the abnormal white cells. Certain DNA changes may determine how well a person does (prognosis), and what kind of treatment is recommended.

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 a remission.

• The person may need to stay in the hospital for chemotherapy. Or it can be given at a clinic and the person goes home afterward.
• Chemotherapy is given into the veins (by IV) and sometimes into the fluid around the brain (the spinal fluid). Oral chemotherapy may be given after a remission to maintain it.

After a remission is achieved, more treatment is given to achieve a cure. This treatment can include more IV chemotherapy or radiation to the brain. Stem cell or bone marrow transplant from another person may also be done. Further treatment depends on:

• Age and health of the person
• Genetic changes in the leukemia cells
• How many courses of chemotherapy it took to achieve remission
• If abnormal cell DNA is detected in the bone marrow after remission
• Availability of donors for stem cell or bone marrow transplant

You and your provider may need to manage other concerns during your leukemia treatment, including:

• Having chemotherapy at home
• Managing your pets during chemotherapy
• Bleeding problems
• Dry mouth
• Eating enough calories
• Safe eating during cancer treatment

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.

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.

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

Contact your provider if you or your child develops symptoms of ALL.

The risk for developing ALL may be reduced by avoiding contact with certain toxins, radiation, and chemicals.