Acute lymphocytic leukemia (ALL) is a type of leukemia in which immature cells called "blasts" overtake a person's bone marrow. ALL is the most common type of childhood cancer, but it is more common in adults. Because ALL progresses rapidly, once a person is diagnosed with the disease, they must begin treatment as soon as possible.
ALL can be characterized into subtypes based on the presence of the Philadelphia chromosome, which was discovered at Penn Medicine. Knowing the type of ALL can help customize a treatment plan.
What is Acute Lymphocytic Leukemia (ALL)?
Leukemia is a blood cancer of the bone marrow, which is the organ responsible for blood cell development. Normally, there are three types of cells in your blood stream:
- White blood cells
- Red blood cells
- Platelets
Acute leukemia is considered lymphoid or myeloid based on the type of blood cell that is involved. Lymphoid cells are cells that, under normal development, would have become lymphocytes, which are types of white blood cells. Myeloid cells are cells that would have become other blood cells (white blood cells other than lymphocytes, red blood cells or platelets) under normal development. In patients with acute leukemia, immature cells called "blasts" overtake the bone marrow. In patients with acute lymphocytic leukemia (ALL), the bone marrow is overtaken by lymphoid blasts.
ALL is the most common type of childhood cancer, but it is more common in adults than children. There are approximately 3,000 to 5,000 new cases of ALL per year in the United States. Once diagnosed, a person will ALL will need to receive treatment as soon as possible. If left untreated, the disease progresses rapidly and can be fatal.
ALL may also be referred to as acute lymphoblastic leukemia or acute lymphoid leukemia.
ALL Symptoms and Signs
The signs and symptoms of ALL may resemble other diseases or conditions. If you have any, some, or all of these symptoms*, please speak with your physician:
- Body aches
- Bruising easily, or not remembering how you got a bruise
- Enlarged lymph nodes
- High fever without a reason, or a persistent low-grade fever
- Headaches
- Pale skin
- Pinhead-sized red spots under the skin
- Excessive bleeding
- Shortness of breath
- Tiredness, lethargy
- Vomiting
- Unexplained weight loss
*From the Leukemia and Lymphoma Society
Types of Acute Lymphocytic Leukemia
Acute lymphocytic leukemia (ALL) can be characterized into different sub-types:
- Philadelphia chromosome-positive ALL
- Philadelphia chromosome-negative ALL
- B cell ALL
- T cell ALL
B cell ALL is more common than T cell ALL. Other names and sub-types of B cell and T cell ALL include:
- Acute B-lymphocytic leukemia
- Acute precursor B cell leukemia
- Pre-B cell lymphocytic leukemia
- Acute T-lymphoblastic leukemia
Your individual treatment plan will depend on your ALL sub-type.
The Philadelphia Chromosome
Some people with ALL have a genetic abnormality referred to as the Philadelphia chromosome. If you have the Philadelphia chromosome, you will receive chemotherapy and targeted therapies designed specifically for you and the genetic makeup of your leukemia. The Philadelphia chromosome, discovered more than 50 years ago at Penn, provided the first evidence that genetic abnormalities were linked to cancer. The discovery ushered in the modern period of cytogenetics in the understanding of leukemia. Now, the Center for Personalized Diagnostics builds on this legacy and is set to pave the way for precision medicine.
How Is Acute Lymphocytic Leukemia Diagnosed?
Receiving an accurate acute lymphocytic leukemia (ALL) diagnosis, and identifying its sub-type is extremely important in determining the treatment for your ALL. Different sub-types of ALL respond to different drugs and treatment therapies.
If you were diagnosed at another health care center, and are coming to the Abramson Cancer Center for treatment or a second opinion, repeat diagnostic tests may be necessary. Penn utilizes the latest diagnostic imaging tools, tests and procedures to develop your personalized treatment plan.
ALL Diagnostic Tools and Tests
The following are tests and diagnostic procedures that may be used to diagnose leukemia and ALL to determine its sub-type and allow us to best evaluate its effects on you to choose the best treatment.
- A physical exam and full medical history evaluation
- A complete blood count (CBC)
- Blood chemistry studies to evaluate the liver and kidneys
- Blood cultures or X-rays for infection
- Peripheral blood smear
- A bone marrow aspiration and biopsy
- Cytogenetic and molecular RT-PCR (reverse transcriptase polymerase chain reaction) studies
- A lumbar puncture or spinal tap
Staging ALL
Currently, there is no staging system for acute lymphocytic leukemia (ALL). Since there is no staging system for ALL, oncologists focus on your individual features and features of the disease that help us better understand the natural history of the disease and the likelihood to respond to different therapies.
Today, with advances in research, diagnostic tools, and gene sequencing, cancer researchers and clinicians are getting a better picture of leukemia and its genetic markers and chromosomal abnormalities. With this knowledge, oncologists can determine what type of treatment a person with leukemia will best respond to, and as a result, will have a better chance of avoiding a relapse.
Precision genomic diagnostics can identify patients who might benefit from current, often cutting edge therapies, while sparing those who do not have a particular genetic signature from the costs and side effects of certain treatments.
Acute Lymphocytic Leukemia Treatment
Penn hematologists and medical oncologists are part of large multidisciplinary teams whose approach to cancer and blood disorders is to treat the entire individual — not just the disease.
The following are possible treatments for people diagnosed with acute lymphocytic leukemia (ALL). Your treatment will depend on the sub-type of your ALL. Specialists at Penn Medicine can help you understand the various leukemia treatments.
Living with Acute Lymphocytic Leukemia
You may experience physical and emotional side effects as you go through your cancer treatment. Though treatment affects each person differently, it's important to understand the wide variety of changes and side effects that may occur. The more you know, the better you can prepare and manage symptoms.
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