What is acute lymphoblastic leukemia (ALL)?

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Leukemia happens when the body produces too many immature white blood cells, or blast cells. In the case of ALL, it produces too many lymphoblasts or lymphocytes. These become leukemia cells.

As the concentration of these blast cells increases in the bone marrow and the blood, they crowd out the healthy cells that enable the body to function. As the numbers of red blood cells and platelets fall, symptoms start to appear.

They usually start slowly but grow increasingly more severe as the concentration of blast cells rises in the blood.

The symptoms may include:

• excessive sweating
• a fever
• fatigue
• dizziness
• easy bruising or frequent bleeding, such as nosebleeds
• difficulty breathing
• painful joints, bones, or both
• frequent infections
• swollen lymph nodes
• pale skin
• reduced appetite and weight loss
• purpura and petechiae, which are small spots or patches that appear where bleeding occurs under the skin

Purpura and petechiae appear red or purple on light skin. On dark skin, they may be harder to see, but they will likely be visible on lighter areas, such as the palms of the hands or inside the mouth.

As ALL progresses, it can affect other organs. If it reaches the liver and spleen, there may be abdominal swelling and discomfort.

If the disease starts to affect the brain and spinal cord, the person may experience headaches, weakness, and other symptoms.

What does a leukemia rash look like?

Progression

Leukemia can be chronic or acute.

Chronic leukemia develops slowly. As it grows, it allows the body to produce more mature, useful cells.

ALL is an acute leukemia. Acute leukemia develops rapidly. It quickly crowds out the good cells, leaving less room for healthy cells. As immature, useless blast cells accumulate in the marrow and blood, it becomes harder for the body to function properly.

Doctors do not know exactly why ALL happens, but there are some common risk factors.

These include:

• age, as it is more common in children and in adults aged over 50 years
• some genetic factors and conditions, including Down syndrome, Fanconi anemia, and Klinefelter syndrome
• exposure to radiation, for instance, during a nuclear accident or treatment for a previous cancer
• exposure to chemicals, notably benzene, present in cigarette smoke and petroleum products
• some viruses, such as the Epstein-Barr virus (EBV) or the human T-cell leukemia virus, may increase the risk

Can EBV cause leukemia?

A 2018 study suggests that proximity to overhead power cables may pose a “small and imprecise” risk of childhood leukemia. The authors note the need for more research to confirm this link.

What is the link between benzene and leukemia?

If a person has symptoms that could indicate ALL, a doctor will take a medical history, perform a physical examination, and carry out some tests.

These tests may include:

• blood tests
• bone marrow tests
• genetic tests
• a lumbar puncture
• a lymph node biopsy
• imaging tests

A biopsy can confirm whether cancer is present and, if so, the type. Imaging tests can show whether it has spread to other parts of the body.

The treatment options will depend on the type of ALL, the individual’s age, and their overall health.

There are several treatment options.

Chemotherapy

Chemotherapy is a type of medication that kills cancer cells effectively. However, it can also kill healthy cells, meaning that there is a high risk of adverse effects. These usually pass after the treatment finishes.

What are the adverse effects of chemotherapy?

Radiation therapy

Radiation therapy targets affected areas with a radioactive beam. A doctor may recommend this treatment if ALL has spread to the central nervous system, which comprises the brain and spinal cord.

Bone marrow or stem cell transplant

A bone marrow transplant or stem cell transplant can support chemotherapy. As chemotherapy can kill both healthy bone marrow cells and cancer cells, a transplant can help boost the renewal of these cells and the body’s ability to recover from chemotherapy.

Targeted therapy

Targeted therapy is a relatively new strategy that involves targeting specific proteins, genes, or other factors that encourage cancer to grow. Blocking these factors can delay or prevent the growth of cancer. As the treatment has a specific target, it should produce fewer side effects than chemotherapy, but adverse effects are still possible.

Immunotherapy

Immunotherapy is another new treatment option. It aims to help the body defeat cancer by boosting the action of the immune system.

Treatment for children

The primary form of treatment for children with leukemia is chemotherapy.

The initial treatment is intense, and the child will usually need to spend time in the hospital. However, more than 95% of children with ALL enter remission after 1 month of initial treatment.

The Dana-Farber Cancer Institute notes that 15–20% of children achieve remission but experience a relapse later. However, it also states that the cure rate is more than 90%.

Surveillance, Epidemiology, and End Results Program (SEER) data from 2012–2018 suggest that 70.8% of people with ALL will live another 5 years or more after their diagnosis, compared with those without the disease.

The outlook for children is better. According to the ACS, the 5-year survival rate for children with ALL is 90%.

Factors that affect a person’s outlook include:

• age
• overall health
• type of ALL
• individual genetic factors

The outlook for different types of cancer has improved dramatically in recent years. As scientists find new ways of diagnosing and treating leukemia, the chance of surviving continues to increase.

ALL can be life threatening, but it is also highly treatable, especially in children. Treatment aims to achieve remission, which is when tests show that there is no more evidence of ALL.

In some cases, treatment can remove all evidence of ALL, and the cancer does not come back.

In others, ALL does not go away completely, and the person may live for many years with chronic leukemia. They will continue to have medical checks and tests and may need more treatment if ALL starts to return.

People often ask the following questions about ALL.

What is the survival rate for acute ALL?

Based on data from 2012–2018, the 5-year relative survival rate for ALL is 70.8%.

How serious is ALL?

All cancers are serious and need medical attention. However, with prompt and effective treatment, a person has a good chance of surviving at least another 5 years after their diagnosis. The outlook is more positive for children.

In many cases, complete remission is possible. Some people also live for many years with chronic leukemia.

What is the main cause of ALL?

It is not always clear why ALL happens, although genetic factors may play a role. Radiation exposure is a known cause, but most people will not experience radiation at a high enough level to develop ALL. Exposure to certain toxins, such as benzene, also increases the risk.

ALL is a type of leukemia, meaning that it is a cancer of the blood and bone marrow. It is a common type of cancer among children, but the 5-year survival rate for children is close to 90%. ALL is more likely to be life threatening for adults than for children, but it is also possible for adults to live for many years with chronic leukemia.

The treatment options include chemotherapy, radiation therapy, and targeted therapy. Some people reach complete remission after treatment, and the cancer does not return. Others will continue to live with chronic ALL. These individuals will need ongoing follow-ups to ensure that their condition remains stable.