Acute lymphocytic leukemia (ALL) starts in your bone marrow, the spongy center of most bones that produces blood cells. In ALL, immature white blood cells called lymphocytes grow out of control and replace healthy white blood cells in the bone marrow and other lymphoid tissues. If untreated, ALL gets worse quickly and needs to be treated right away. ALL is more common in children than adults. It happens more often in boys than girls and three times as often in Caucasians as in African-Americans.
Symptoms of ALL may include easy or spontaneous bruising or bleeding, fatigue, lack of energy, and fevers that don’t go away. Kids with ALL can have low numbers of platelets, which are tiny blood cells that help clot blood and stop bleeding after a cut or an injury. They can also have trouble fighting infections because their white blood cells aren’t working properly.
Doctors diagnose ALL by doing a complete blood count and other blood tests to see how your body is working. They may also use imaging studies, such as X-rays, CT scans or an MRI, to look for a mass of cancer in your chest that could interfere with breathing or blood flow, or for any other problem. They can also do a sample of your bone marrow to check how the blood-forming cells are growing. Blood chemistry tests can also provide important information about your kidneys and liver. Your chromosomes are also studied. People whose chromosomes don’t have a specific problem, such as the Philadelphia chromosome, do better with treatment than those who do.
The first treatment for ALL is chemotherapy, which is a group of drugs that kills cancer cells. The type of chemo you get depends on your subtype of ALL and how fast the cancer cells are growing. The goal of therapy is to put you into remission, which means that tests don’t find any cancer cells left in your body. After remission, you get maintenance chemotherapy to keep the cancer from coming back.
Researchers are using new tools, including DNA sequencing and other molecular techniques, to understand better how ALL develops and how it responds to treatment. This helps doctors predict which patients are more likely to have a relapse and which treatments will work best for them.
Most kids with ALL go into remission within weeks of starting treatment. Kids ages 1 to 10 have the best chance of getting cured of ALL, especially those who are diagnosed early. It is more difficult to cure older teens and adults because the cancer grows faster in them than it does in kids. If the cancer spreads into the central nervous system, the prognosis is poorer.