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While the health information and fact sheets on this website relate to world-wide situations, the drug names will vary between countries – therefore the advice of your local GP should be sought.
Acute lymphoblastic leukaemia (ALL)
Published by Bupa's health information team, March 2009.
This factsheet is for people who have acute lymphoblastic leukaemia (ALL), or who would like information about it.
Acute leukaemia is a cancer of the blood that can spread very rapidly. There are two types of acute leukaemia, depending on the type of cells affected: acute lymphoblastic leukaemia (ALL) or acute myeloid leukaemia (AML).
For more information about leukaemia in general, please see Related topics.
About ALL
According to Macmillan Cancer Support about 200 adults and 400 children are diagnosed with ALL each year. ALL tends to affect children who are under 15. In adults, it's most common under the age of 25 or over 75. The symptoms develop rapidly, and it can quickly become life-threatening if it's not treated.
The term leukaemia refers to a group of cancers of the blood cells. In leukaemia, white blood cells become abnormal and divide and grow in an uncontrolled way. Leukaemia is described as acute (growing rapidly) or chronic (growing slowly). Acute leukaemia is divided into two main types - acute lymphoblastic leukaemia (ALL) or acute myeloid leukaemia (AML). This factsheet focuses on acute lymphoblastic leukaemia (ALL).
The bone marrow produces two main types of white blood cells - lymphoid and myeloid - which work together to fight off infections. ALL is when too many immature lymphocytes (or lymphoblasts) are produced. These fill up the bone marrow so not enough normal blood cells can be made.
Symptoms of ALL
The symptoms of ALL are usually due to a lack of healthy white blood cells, red blood cells and platelets, but sometimes they result from the excessive growth of the abnormal immature cells (blasts) themselves. Many of the symptoms of ALL may be vague and seem like flu.
Symptoms of ALL can include:
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feeling generally run down and weak
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feeling very tired and breathless
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having frequent infections that don't get better
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unusual bleeding (eg frequent nosebleeds, heavy periods in women, bleeding from gums and cuts)
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increased bruising, or developing a fine rash of dark red spots (called purpura)
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blood in the urine or faeces
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fever
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losing weight unintentionally
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pain or discomfort in the tummy (abdomen), due to an enlarged spleen or liver
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swollen lymph glands (glands in your neck, groin and under the arms)
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aching bones and joints, due to the pressure of too many cells being produced
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swollen or bleeding gums
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swollen testes in boys
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neurological (nervous system) symptoms due to leukaemic cells attacking the brain and spinal cord such as depression.
These symptoms aren't always due to ALL but if you have them, you should visit your GP.
Causes of ALL
Some of the risk factors for developing ALL are:
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gender - men are slighly more likely than women to develop ALL
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radiation exposure - you are slighly more likely to develop leukaemia if you have been exposed to high levels of radiation
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chemical exposure - exposure to cancer-causing substances (carcinogens) such as benzene over a long period of time increases the risk of ALL
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smoking - this may slightly increase the risk of ALL
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previous cancer treatment - people who have had chemotherapy for some cancers are slightly more likely to develop acute leukaemia many years later, but it's important to weigh up the benefits of treating the cancer against the very small risk of leukaemia years later
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genetic conditions - children who have genetic conditions, such as Down's syndrome have a higher risk of developing acute leukaemia
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viruses - a virus called human T-cell leukaemia virus (HTLV-1) can cause a rare form of leukaemia in adults
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being overweight - people who have a body mass index (BMI) of 30 or above have a slightly increased risk of leukaemia
Diagnosis of ALL
Diagnosis, investigation, treatment and follow-up for people with leukaemia usually take place at specialist centres in hospitals.
You may be referred to a doctor that specialises in the treatment of blood disorders called a haematologist. Tests often include:
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blood tests (to test for problems with the normal cells and the presence of abnormal cells)
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X-rays
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removal of a sample of bone marrow for analysis under a microscope (biopsy)
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a lumbar puncture - the doctor draws off a small sample of the fluid from around the spine with a needle for analysis
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specific tests on the leukaemic cells to determine their exact nature (immunophenotyping)
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genetic analysis of the chromosomes in the leukaemic cells (cytogenetics)
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CT (computerised tomography) scans
Other tests that your doctor may carry out include:
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MRI (magnetic resonance imaging) scans
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ultrasound scans
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tissue typing - if your doctor recommends having a bone marrow transplant
These tests are all very important because they help determine which treatment is best for you.
Classification of ALL
Your leukaemia may also be given a name or letter and number to help plan your treatment. This is called classification. This may be done using two different systems, the World Health Organization (WHO) system or the French American British (FAB) system.
WHO system
ALL affects only the lymphocyte (lymphoblast) cells, which are called either B cells or T cells. Using the WHO system, ALL is separated into three subtypes:
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early (precursor) B-lymphoblastic leukaemia, which affects about 75 in 100 people with ALL
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mature B-lymphoblastic leukaemia (sometimes called Burkitt's lymphoma), which affects five in 100 people with ALL
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early (precursor) T-lymphoblastic leukaemia, which affects about 20 in every 100 people with ALL
FAB system
The FAB system is used to classify ALL but is not used by doctors to plan treatment as often as the WHO system.
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L1 - the leukaemia cells are quite mature and similar to normal lymphocytes.
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L2 - the lymphocytes are more immature and look less like normal cells but don't look as they do if you had L3. The majority of people have L2 ALL.
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L3 - the lymphocytes are very immature, don't look like normal and don't function as they should.
A mixture of types of leukaemia
AML and ALL can occur together. This is called acute biphenotypic leukaemia.
Treatment of ALL
The treatment you will receive for ALL depends on the type of cancer you have and the classification of the cancer.
Chemotherapy
Chemotherapy is the first and main treatment used to destroy the abnormal white blood cells in ALL. If you are having chemotherapy for ALL, you will probably need to stay in hospital. This is because it's a very demanding treatment - larger doses of chemotherapy medicines are needed for acute leukaemia than for other types of cancer.
For ALL, you will need to have a mixture of chemotherapy medicines, as this has been shown to work better than just one medicine on its own. You will normally have these different medicines in cycles, with a rest period in-between.
There are over 50 chemotherapy medicines, all with slightly different side-effects. Your doctor will give you advice about your specific chemotherapy medicines, and may prescribe other medicines to help reduce any side-effects. Your hair may fall out during treatment but it re-grows once the chemotherapy has stopped.
Steriods such as prednisolone and dexamethasone may be given with chemotherapy medicines to help treat ALL.
Central line
The chemotherapy medicines are usually fed into a vein and they travel through your bloodstream to nearly all parts of your body. Because people with leukaemia need to have so much treatment, sometimes a central line can be used to deliver the chemotherapy medicines to the bloodstream. A central line is a long plastic tube that leads to a large blood vessel near the heart. The only part of the tube you can see is where it runs out through a small hole in your chest. A central line can be useful because it means you don't have to have a new drip every time you need a dose of chemotherapy. It can also be used to give fluids, blood and blood products (eg certain types of cell) and to take blood samples.
Intrathecal chemotherapy
Intrathecal therapy (lumbar puncture) is a necessary part of the treatment of ALL. Chemotherapy is given directly into your spine to treat the central nervous system which can also have cancerous cells which can't be reached using the central line method.
Radiotherapy
The only parts of the body chemotherapy medicines can't treat well are the brain and spinal cord, and in men, the testes. Radiotherapy may be used to get to the places that the chemotherapy can't reach.
Remission and relapse
The effectiveness of treatment for leukaemia depends on the type and stage of the disease. ALL often goes into remission (the symptoms go away; the disease is under control but not necessarily cured). However, many people with ALL, particularly adults, have a relapse (the disease returns).
If the leukaemia returns (relapses), you may need further intensive treatment. This may involve a bone marrow or a stem cell transplant. Bone marrow or stem cell transplants allow much higher doses of chemotherapy to be given.
Bone marrow transplant
A bone marrow transplant is where healthy bone marrow - either from another person (normally a close relative) or from your own bones - is fed into your bloodstream through a drip. High doses of chemotherapy and sometimes radiotherapy are given before the transplant to destroy all the bone marrow, both abnormal and normal. Bone marrow from another person may also, itself, fight your leukaemia (the transplant cells are healthy and will target the leukaemia).This improves the chance of completely curing the disease.
Peripheral blood stem cell transplant
Peripheral blood stem cell transplant involves transplanting stem cells (the most basic type of cell, from which all types of blood cells develop) which have been taken from the blood. Stem cells can be collected (harvested) from your own blood or from another person.
New treatments
There are some new treatments available, some of which are currently still being tested in clinical trials. Many people with leukaemia take part in clinical trials as new treatments are constantly changing. Your doctor can give you more information about these trials.
Living with ALL
After treatment for the cancer, you will have regular check ups with your doctor to detect any evidence of the cancer returning.
Being diagnosed with cancer can be distressing for you and your family. Specialist cancer doctors and nurses are experts in providing the care and support you need. There may be support groups so you can meet people who may have similar experiences to you. Ask your doctor for advice.
Further information
Related topics
Sources
This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
Publication date: March 2009