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Leukemia, Acute Lymphocytic (ALL)
Acute lymphoblastic leukemia (ALL) is a cancer of the blood and bone marrow. It often spreads quickly if left untreated. ALL is also the most common cause of leukemia in children.
Normally, the bone marrow makes blood stem cells that grow into mature blood cells over time. A blood stem cell may become a myeloid stem cell or a lymphoid stem cell.
The myeloid stem cell can grow into 3 types of mature blood cells:
- Red blood cells that carry oxygen and other materials throughout the body
- Platelets that prevent bleeding by creating blood clots
- White blood cells that fight infection
The lymphoid stem cell grows into a lymphoblast cell. From there it can grow into 3 types of lymphocytes (white blood cells):
- B lymphocytes that make antibodies to fight infection
- T lymphocytes that help B lymphocytes make antibodies
- Natural killer cells that attack cancer and viruses
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Vanderbilt is creating and using advanced therapies for certain types of cancer that target cancer cells without harming healthy ones. Learn more on our Healthcare Breakthroughs page.
These tests are used to help detect and diagnose ALL:
- Physical exam and history
Complete blood count (CBC) to check:
• 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: Blood is checked for presence of developing cells, number and kind of white blood cells, number of platelets and shape changes of blood cells
- Bone marrow aspiration and biopsy: Removal of bone marrow, blood and a small piece of bone using a needle
- Cytogenetic analysis: Lab test used to see chromosomal changes from tissue cells
- Immunophenotyping: Finds cells based on types of antigens and markers on cells’ surface
Although ALL may cause some of these symptoms, other conditions may cause them as well. See a doctor if you experience:
- Weakness or feeling tired
- Easy bruising or bleeding
- Petechiae (flat, pinpoint spots under the skin caused by bleeding).
- Shortness of breath
- Weight loss or loss of appetite
- Pain in the bones or stomach
- Pain or feeling of fullness below the ribs
- Painless lumps in the neck, underarm, stomach, or groin
Treatment usually involves 2 stages:
- Remission induction therapy: This kills leukemia cells in the blood and bone marrow, putting the cancer into remission.
- Post-remission therapy: This kills leukemia cells left after the first stage of treatment. These cells are dormant but able to reactivate later.
Central nervous system (CNS) sanctuary therapy is used during both stages. Treatment drugs may not reach some leukemia cells in the CNS (brain and spinal cord), so intrathecal chemotherapy (drugs placed in the spinal fluid) and radiation therapy are used to make sure these cells are killed as well. This is also called CNS prophylaxis.
There are 4 types of treatment:
Chemotherapy: Chemotherapy is a treatment using drugs that either kill cancer cells or slow their growth. There are several types of chemotherapy available, depending on the type and stage of the cancer.
Radiation therapy: Radiation therapy uses x-rays or other kinds of radiation to kill cancer cells or slow their growth.
There are 2 kinds of radiation therapy. The type of treatment used depends on the type and stage of the cancer.
- External radiation therapy: A machine beams radiation into the body, targeting the cancer. This can treat ALL that has spread to other parts of the body. When it’s used like this, it’s called CNS sanctuary therapy.
- Internal radiation therapy: Needles, seeds, wires or catheters containing a radioactive compound are put into or near the cancer.
Chemotherapy with stem cell transplant: Cancer treatments often kill certain types of healthy cells along with cancer cells. This treatment adds a step of growing new blood-forming cells to replace those lost during treatment. Stem cells (new blood cells) are taken from blood or bone marrow and frozen. After chemotherapy, the stem cells are thawed and put back through an infusion.
Targeted therapy: Targeted therapy uses drugs that kill cancer cells without hurting normal ones. To learn more about targeted therapy and other advanced ways of treating cancer, visit our Breakthroughs page.
Successful recovery depends on:
- Whether the cancer has spread to the brain or spinal cord
- Whether the Philadelphia chromosome is present
- Whether the cancer has been treated before or has recurred
- Being male
- Being white
- Being older than 70
- Past treatment with chemotherapy or radiation therapy
- Exposure to large doses of radiation
- Having a genetic disorder such as Down syndrome