All to Know about Acute Lymphoblastic Leukemia


Acute Lymphoblastic Leukemia (ALL) or Acute lymphocytic leukemia, is a type of cancer that starts from the early version of white blood cells known as lymphocytes in the bone marrow.


Typically leukemia cells attack the blood fairly rapidly. After that they can spread to the other sections of the body, like the lymph nodes, spleen, liver, central nervous system, and men’s testicles. The other types of the cancer can also start in these parts and afterward spread to the bone marrow. However, these cancers are not accounted as leukemia.

Acute means that this leukemia grow fast, killing the patient in a few months (if not treatd). Lymphocytic means the cancer comes from primary (immature) forms of a kind of white blood cell called lymphocytes. Do not confuse it with acute myeloid leukemia (AML), which grows out of the other blood cell exist in the bone marrow.

Other kinds of cancer that start in lymphocytes are called as lymphomas (non-Hodgkin lymphoma or Hodgkin disease). The chief difference between these kinds of cancers is that leukemias like ALL mostly has impact on the bone marrow and the blood, and might extent to other spots, whereas lymphomas mostly affect the lymph nodes or other parts but could include the bone marrow. When at first the cancer is diagnosed, sometimes cancerous lymphocytes are observed in the bone marrow as well as lymph nodes. It can make it difficult to know if the cancer is leukemia or lymphoma. If higher than 25 percent of the bone marrow is substituted by cancerous lymphocytes, then the condition will typically be regarded as leukemia. Also, the size of lymph nodes is the subject of importance. The bigger the cells are, the more likely the disease will be regarded a lymphoma.

As a matter of fact, there are many kinds of leukemia. They vary on the bases of the type of cells they start in, how fast they develop, on whom they have impact, and how they are treated.



Some of these symptoms are as the follows:

  • Fever
  • Reduced neutrophil count
  • Symptoms of anemia, like pallor, exhaustion, faintness, trembling, cardiac flow murmur, and shortness of breath with even slight exertion
  • Hemorrhage (due to marrow replacement for instance from thrombocytopenia)
  • Disseminated intravascular coagulation (DIC) at diagnosis (about 10% of cases)
  • Tangible lymphadenopathy
  • signs associated to a big mediastinal mass (for instance, difficulty in respiration), specially with T-cell ALL
  • Feeling pain in the Bone (severe and usually uncommon)
  • Feeling fullness in left upper quadrant and early satiety due to splenomegaly (about 10-20 percent of all cases)
  • Signs of leukostasis (for example, respiratory distress, altered mental status)
  • Kidney failure among the individuals with a high tumor burden
  • Contagions, including pneumonia
  • Petechiae (specilly on lower extremities) and ecchymoses
  • Signs associated to body part infiltration with leukemic cells and lymphadenopathy
  • Rashes from skin infiltration with leukemic cells



For the very first step in diagnosing acute lymphoblastic leukemia, people should check for physical signs of the disorder, like swollen glands, and take a blood test.

As obvious as it is, if the blood sample incluses a high number of abnormal white blood cells, then the person could have acute leukaemia. This way the doctor will refer the individual to a haematologist (a professional in terms of treating blood disorders).

Bone marrow biopsy

In order to confirm the diagnosis, the haematologist will take a small sample of the bone marrow to study it under a microscope.

The haematologist will employ a local anaesthetic to make the over a skin bone (typically the hip bone), emotionless and then removes a sample of bone marrow with use of a needle. The patient could experience some pain after the anaesthetic goes off and some discomfort and bruising may come up for a few days after anaesthetic. This simple procedure takes only about 15 minutes and the patient wouldn’t stay in hospital overnight.

The bone marrow actually will be checked for cancerous cells and, if the cancerous cells found, the kind of acute leukaemia will be determined as well simultaneously.

Some the patients suffering from acute leukaemia will be required to have a bone marrow test every three months to check for cancerous cells for at least two years during maintenance treatment or after taking a bone marrow transplant.

Further tests

Mentioned blew are the other tests can be employed to learn about the development and the size of the leukaemia. They may also help in treatment and management.

  • Cytogenetic testing

  • Immunophenotyping

  • Polymerase chain reaction (PCR)

  • Lymph node biopsy

  • CT scans

  • Chest X-ray

  • Lumbar puncture


The exact causes of ALL have mainly remain unknown so far, though it is thought that mutations in some of the genes that usually control the blood cell development are the main causes. Ongoing researches on possible causes and factors have carried out and some factors have been identified to put people at risk. These factors include:

  • exposure to very high amounts of radiation either unintentionally (nuclear accident) or therapeutically (to treat other cancers)
  • exposure to some chemicals like benzene, pesticides and specific kinds  of chemotherapy employed to treat the other cancers.

Some specific kinds of contagions and the means through which the immune system responds might have a role in the expansion of some kinds of ALL. Individuals suffering from some specific genetic disorders like Down's syndrome and Fanconi's anaemia might be at a higher risk of developing ALL.



Since ALL develops rapidly, the treatment should begin soon after the condition is diagnosed. The kind of treatment and management that will be employed has to do with the several factors including the sub-type of ALL, the genetic make-up of the leukaemic cells, and the age as well as the overall health of the person.

Chemotherapy is the key method of treatment for ALL. A combination of medications, like steroids, is typically recommended in some cycles with a rest time of a few weeks in the middle. Originally, the goal of treatment is destroy leukaemic cells and cause a remission. Remission means that there is no evidence of leukaemic cells in the blood as well as in bone marrow; the production of blood cell is typical and blood is back to its normal way. When a remission is achieved, additional treatment is required till the complete treatment of the disease, and to avoid the return and relapse of leukaemia.

Chemotherapy comes in several different ways to help the treatment of ALL. This includes instillation into a vein (intravenous injection), into a muscle (intramuscular injection) or swallowed in the form of pills.

Leukaemic cells may be collected in the central nervous system (brain as well as spinal cord). In order to prevent and treat those disease affecting this area, chemotherapy is inserted straight into the liquid that is around these structures (intrathecal tissues). Of course sometimes the area is also treated with the help of radiotherapy. Radiotherapy, could be given to the testicles in males to treat the relapsed disease in this area. This may induce infertility.

The treatment is by and large risky. It means that the patient will be given a specific treatment plan based on several factors, most importantly the risk of return of the disease in the future. Treatment could last two or three or even several years. The duration of the treatment, largely, depends on the treatment protocol which is going to be followed and the quality of individual’s response to the procedure and his progresses.

Those individuals with Philadelphia chromosome (a specific genetic abnormality in the leukaemic cells) are given imatinib mesylate (Glivec®) medications. This drug blocks the effects caused by the abnormal enzyme (tyrosine kinase) which induces the leukaemic cells to demolish.

Sometimes, a stem cell transplant is employed to treat relapsed the acute lymphoblastic leukemia, or at the time when there is a high possibility of its relapse in the future.

Most of the children treated for ALL may be cured completely. However, the adults cure rates for this condition is much more variable.



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