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Cancer Types

Acute Lymphocytic Leukemia

Acute Lymphocytic Leukemia Facts

What is Acute Lymphocytic Leukemia?

What is Acute Lymphocytic Leukemia

Acute lymphocytic leukemia (ALL) is a cancer of lymphocytes, cells that live in the spongy inner mass of bone called the marrow. ALL is also called acute lymphoid leukemia or acute lymphoblastic leukemia. ALL is most common in young children and adults over age 50.

The lymph nodes are small, bean-shaped organs of the immune system. They are found in clusters in the abdomen, pelvis, underarms, and neck. Lymph nodes are part of the lymph system, which is made up of thin tubes that branch to all parts of the body. The job of the lymph system is to filter impurities from the body. The lymph system carries lymph, a colorless fluid containing white blood cells.

In ALL, non-inherited genetic changes cause the body to produce too many marrow cells called lymphoblasts. In normal bone marrow, lymphoblasts make lymphocytes, a kind of white blood cell found in the blood and lymph. Lymphocytes mature to help the body defend itself from infection. In people with ALL, these cells never mature.

Because blood carries cancer cells throughout the body, the cancer will spread around the body and may invade other organs, including the brain, liver and spleen. Unlike solid tumors, spread of ALL to other parts of the body does not always mean the cancer is in an advanced stage, but leukemia that has spread may require special treatment.

ALL is one of four types of leukemia. Like acute myelogenous leukemia (AML), ALL appears and progresses quickly, but begins in a different type of cell. Chronic lymphocytic leukemia and chronic myelogenous leukemia both progress more slowly.

Leukemia is either acute or chronic. In acute leukemia, the abnormal blood cells are blasts that remain very immature and cannot carry out their normal functions. The number of blasts increases rapidly, and the disease becomes worse quickly. In chronic leukemia, some blast cells are present, but in general, these cells are more mature and can carry out some of their normal functions. Also, the number of blasts increases less rapidly than in acute leukemia. As a result, chronic leukemia worsens gradually.

Acute Lymphocytic Leukemia Risk Factors

Possible risk factors for Acute Lymphocytic Leukemia include the following:

Previous chemotherapy and exposure to radiation may affect the risk of developing Acute Lymphocytic Leukemia.

  • Being male
  • Being white
  • Being older than 70 years of age
  • Past treatment with chemotherapy or radiation therapy
  • Exposure to atomic bomb radiation
  • Having a certain genetic disorder such as Down syndrome

Acute Lymphocytic Leukemia, What to Look For

Possible signs of adult ALL include fever, feeling tired, and easy bruising or bleeding.

The early signs of ALL may be similar to the flu or other common diseases. A doctor should be consulted if any of the following problems occur:

  • Weakness or feeling tired
  • Fever
  • Easy bruising or bleeding
  • Petechiae (flat, pinpoint spots under the skin caused by bleeding)
  • Shortness of breath
  • Loss of appetite or weight loss
  • Pain in the bones or stomach
  • Pain or feeling of fullness below the ribs
  • Painless lumps in the neck, underarm, stomach, or groin

These and other symptoms may be caused by adult acute lymphoblastic leukemia or by other conditions.

Acute Lymphocytic Leukemia Tests

Tests that examine the blood and bone marrow are used to detect (find) and diagnose adult ALL.

The following tests and procedures may be used:

Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient's health habits and past illnesses and treatments will also be taken.

Complete blood count: A procedure in which a sample of blood is drawn and checked for the following:

  • The number of red blood cells, white blood cells, and platelets
  • The amount of hemoglobin (the protein that carries oxygen) in the red blood cells
  • The portion of the blood sample made up of red blood cells

Peripheral blood smear: A procedure in which a sample of blood is checked for the presence of blast cells, number and kinds of white blood cells, the number of platelets, and changes in the shape of blood cells.

Bone marrow biopsy and aspiration: The removal of a small piece of bone and bone marrow by inserting a needle into the hipbone or breastbone. A pathologist views the samples under a microscope to look for abnormal cells.

Cytogenetic analysis: A test in which the cells in a sample of blood or bone marrow are looked at under a microscope to find out if there are certain changes in the chromosomes in the lymphocytes. For example, sometimes in ALL, part of one chromosome is moved to another chromosome. This is called the Philadelphia chromosome.

Immunophenotyping: A test in which the cells in a sample of blood or bone marrow are looked at under a microscope to find out if malignant (cancerous) lymphocytes began from the B lymphocytes or the T lymphocytes.

Acute Lymphocytic Leukemia Stages

The extent or spread of cancer is usually described as stages. There is no standard staging system for adult ALL.

The disease is classified as untreated, in remission, or recurrent.

Once adult ALL has been diagnosed, tests are done to find out if the cancer has spread to the central nervous system (brain and spinal cord) or to other parts of the body.


It is important to know whether the leukemia has spread outside the blood and bone marrow in order to plan treatment. The following tests and procedures may be used to determine if the leukemia has spread:

Chest X-Ray:An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.

Lumbar puncture: A procedure used to collect cerebrospinal fluid from the spinal column. This is done by placing a needle into the spinal column. This procedure is also called an LP or spinal tap.

Ultrasound: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs in the abdomen and make echoes. The echoes form a picture of body tissues called a sonogram.

CT Scan (CAT Scan): A procedure that makes a series of detailed pictures of the abdomen, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

Acute Lymphocytic Leukemia Treatment

There are different types of treatment for patients with adult Acute Lymphoblastic Leukemia

Different types of treatment are available for patients with adult acute lymphoblastic leukemia (ALL). Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the "standard" treatment, the new treatment may become the standard treatment.

The treatment of adult ALL (usually) is done in 2 phases...

Remission induction therapy - This is the first phase of treatment. Its purpose is to kill the leukemia cells in the blood and bone marrow. This puts the leukemia into remission.

Maintenance therapy - This is the second phase of treatment. It begins once the leukemia is in remission. The purpose of maintenance therapy is to kill any remaining leukemia cells that may not be active but could begin to regrow and cause a relapse. This phase is also called remission continuation therapy.

Central Nervous System (CNS) Sanctuary Therapy (also called CNS Prophylaxis) is usually given during each phase of therapy. Because chemotherapy that is given by mouth or injected into a vein may not reach leukemia cells in the CNS (brain and spinal cord), the cells are able to find "sanctuary" (hide) in the CNS. Intrathecal chemotherapy and radiation therapy are able to reach leukemia cells in the CNS and are given to kill the leukemia cells and prevent the cancer from recurring (coming back).

 

Three types of standard treatment are used:

– Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, a body cavity such as the abdomen, or an organ, the drugs mainly affect cancer cells in those areas. Combination chemotherapy is treatment using more than one anticancer drug. The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Intrathecal chemotherapy may be used to treat adult ALL that has spread, or may spread, to the brain and spinal cord. When used to prevent cancer from spreading to the brain and spinal cord, it is called central nervous system (CNS) sanctuary therapy or CNS prophylaxis. Intrathecal chemotherapy is given in addition to chemotherapy by mouth or vein.

– Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. External radiation therapy may be used to treat adult ALL that has spread, or may spread, to the brain and spinal cord. When used this way, it is called central nervous system (CNS) sanctuary therapy or CNS prophylaxis.

– High-dose chemotherapy with stem cell transplantation

Stem cell transplantation is a method of giving chemotherapy and replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of a donor and are frozen for storage. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells.


Untreated Adult Acute Lymphoblastic Leukemia

Standard treatment of adult acute lymphoblastic leukemia (ALL) during the remission induction phase includes the following:

  • Combination chemotherapy
  • CNS prophylaxis therapy including chemotherapy (intrathecal and/or systemic) with or without radiation therapy to the brain

 


Adult Acute Lymphoblastic Leukemia in Remission


Standard treatment of adult ALL during the maintenance phase includes the following:

  • Combination chemotherapy
  • High-dose chemotherapy with stem cell transplantation
  • CNS prophylaxis therapy including chemotherapy (intrathecal and/or systemic) with or without radiation therapy to the brain

 


Recurrent Adult Acute Lymphoblastic Leukemia

Standard treatment of recurrent adult ALL may include the following:

  • Combination chemotherapy followed by stem cell transplantation
  • Low-dose radiation therapy as palliative care to relieve symptoms and improve the quality of life
Some of the treatments being studied in clinical trials for recurrent adult ALL include the following:
  • A clinical trial of stem cell transplantation using the patient's own stem cells
  • A clinical trial of biologic therapy
  • A clinical trial of new chemotherapy drugs

Acute Lymphocytic Leukemia Risk Factors

Possible risk factors for Acute Lymphocytic Leukemia include the following:

Previous chemotherapy and exposure to radiation may affect the risk of developing Acute Lymphocytic Leukemia.

  • Being male
  • Being white
  • Being older than 70 years of age
  • Past treatment with chemotherapy or radiation therapy
  • Exposure to atomic bomb radiation
  • Having a certain genetic disorder such as Down syndrome

What to Look for

Possible signs of adult ALL include fever, feeling tired, and easy bruising or bleeding.

The early signs of ALL may be similar to the flu or other common diseases. A doctor should be consulted if any of the following problems occur:

  • Weakness or feeling tired
  • Fever
  • Easy bruising or bleeding
  • Petechiae (flat, pinpoint spots under the skin caused by bleeding)
  • Shortness of breath
  • Loss of appetite or weight loss
  • Pain in the bones or stomach
  • Pain or feeling of fullness below the ribs
  • Painless lumps in the neck, underarm, stomach, or groin

These and other symptoms may be caused by adult acute lymphoblastic leukemia or by other conditions.

Acute Lymphocytic Leukemia Tests

Tests that examine the blood and bone marrow are used to detect (find) and diagnose adult ALL.

The following tests and procedures may be used:

Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient's health habits and past illnesses and treatments will also be taken.

Complete blood count: A procedure in which a sample of blood is drawn and checked for the following:

  • The number of red blood cells, white blood cells, and platelets
  • The amount of hemoglobin (the protein that carries oxygen) in the red blood cells
  • The portion of the blood sample made up of red blood cells

Peripheral blood smear: A procedure in which a sample of blood is checked for the presence of blast cells, number and kinds of white blood cells, the number of platelets, and changes in the shape of blood cells.

Bone marrow biopsy and aspiration: The removal of a small piece of bone and bone marrow by inserting a needle into the hipbone or breastbone. A pathologist views the samples under a microscope to look for abnormal cells.

Cytogenetic analysis: A test in which the cells in a sample of blood or bone marrow are looked at under a microscope to find out if there are certain changes in the chromosomes in the lymphocytes. For example, sometimes in ALL, part of one chromosome is moved to another chromosome. This is called the Philadelphia chromosome.

Immunophenotyping: A test in which the cells in a sample of blood or bone marrow are looked at under a microscope to find out if malignant (cancerous) lymphocytes began from the B lymphocytes or the T lymphocytes.

Stages of Acute Lymphocytic Leukemia

The extent or spread of cancer is usually described as stages. There is no standard staging system for adult ALL.

The disease is classified as untreated, in remission, or recurrent.

Once adult ALL has been diagnosed, tests are done to find out if the cancer has spread to the central nervous system (brain and spinal cord) or to other parts of the body.


It is important to know whether the leukemia has spread outside the blood and bone marrow in order to plan treatment. The following tests and procedures may be used to determine if the leukemia has spread:

Chest X-Ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.

Lumbar puncture: A procedure used to collect cerebrospinal fluid from the spinal column. This is done by placing a needle into the spinal column. This procedure is also called an LP or spinal tap.

Ultrasound: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs in the abdomen and make echoes. The echoes form a picture of body tissues called a sonogram.

CT Scan (CAT Scan): A procedure that makes a series of detailed pictures of the abdomen, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

Types of Treatment for Acute Lymphocytic Leukemia

There are different types of treatment for patients with adult Acute Lymphoblastic Leukemia

Different types of treatment are available for patients with adult acute lymphoblastic leukemia (ALL). Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the "standard" treatment, the new treatment may become the standard treatment.

The treatment of adult ALL (usually) is done in 2 phases...

Remission induction therapy - This is the first phase of treatment. Its purpose is to kill the leukemia cells in the blood and bone marrow. This puts the leukemia into remission.

Maintenance therapy - This is the second phase of treatment. It begins once the leukemia is in remission. The purpose of maintenance therapy is to kill any remaining leukemia cells that may not be active but could begin to regrow and cause a relapse. This phase is also called remission continuation therapy.

Central Nervous System (CNS) Sanctuary Therapy (also called CNS Prophylaxis) is usually given during each phase of therapy. Because chemotherapy that is given by mouth or injected into a vein may not reach leukemia cells in the CNS (brain and spinal cord), the cells are able to find "sanctuary" (hide) in the CNS. Intrathecal chemotherapy and radiation therapy are able to reach leukemia cells in the CNS and are given to kill the leukemia cells and prevent the cancer from recurring (coming back).

 

Three types of standard treatment are used:

– Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, a body cavity such as the abdomen, or an organ, the drugs mainly affect cancer cells in those areas. Combination chemotherapy is treatment using more than one anticancer drug. The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Intrathecal chemotherapy may be used to treat adult ALL that has spread, or may spread, to the brain and spinal cord. When used to prevent cancer from spreading to the brain and spinal cord, it is called central nervous system (CNS) sanctuary therapy or CNS prophylaxis. Intrathecal chemotherapy is given in addition to chemotherapy by mouth or vein.

– Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. External radiation therapy may be used to treat adult ALL that has spread, or may spread, to the brain and spinal cord. When used this way, it is called central nervous system (CNS) sanctuary therapy or CNS prophylaxis.

– High-dose chemotherapy with stem cell transplantation

Stem cell transplantation is a method of giving chemotherapy and replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of a donor and are frozen for storage. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells.


Untreated Adult Acute Lymphoblastic Leukemia

Standard treatment of adult acute lymphoblastic leukemia (ALL) during the remission induction phase includes the following:

  • Combination chemotherapy
  • CNS prophylaxis therapy including chemotherapy (intrathecal and/or systemic) with or without radiation therapy to the brain

 


Adult Acute Lymphoblastic Leukemia in Remission


Standard treatment of adult ALL during the maintenance phase includes the following:

  • Combination chemotherapy
  • High-dose chemotherapy with stem cell transplantation
  • CNS prophylaxis therapy including chemotherapy (intrathecal and/or systemic) with or without radiation therapy to the brain

 


Recurrent Adult Acute Lymphoblastic Leukemia

Standard treatment of recurrent adult ALL may include the following:

  • Combination chemotherapy followed by stem cell transplantation
  • Low-dose radiation therapy as palliative care to relieve symptoms and improve the quality of life
Some of the treatments being studied in clinical trials for recurrent adult ALL include the following:
  • A clinical trial of stem cell transplantation using the patient's own stem cells
  • A clinical trial of biologic therapy
  • A clinical trial of new chemotherapy drugs

Side Effects of Acute Lymphocytic Leukemia

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