Acute lymphoblastic leukemia, or ALL, is a quickly progressing disease in which too many abnormal white blood cells are found in the bone marrow, the soft, spongy center of long bones. ALL accounts for about 75 to 80 percent of childhood leukemias and over 80 percent of newly diagnosed patients go on to become event-free survivors.
Children and adolescents with acute lymphoblastic leukemia are treated at Dana-Farber/Boston Children’s Cancer and Blood Disorders Center through the Leukemia Program. Continue reading to learn more about ALL or visit the Leukemia Program homepage to learn about our expertise and treatment options for this condition.
In ALL, lymphocyte stem cells (a type of blood stem cell) become immature white blood cells called lymphoblasts or “blasts.” These blasts do not become healthy white blood cells. Instead, they build up in the bone marrow, so there is less room for healthy white blood cells, red blood cells and platelets. In addition, these abnormal cells are unable to fight off infection.
Blasts arise from either B-cells, which make antibodies to fight infection, or T-cells, which also help fight viruses and other infections. B-cell ALL is the more common type, especially in infants, preschool and school-age children. T-cell ALL tends to occur more frequently in children and teenagers.
Symptoms of ALL usually occur over a short period of days to weeks, arising when “blasts” crowd out healthy cells in the bone marrow, including:
A doctor may order a variety of different tests to determine if or what type of ALL a child has, including:
After all tests are completed, doctors will be able to outline the best treatment options.
Treatment of ALL, which can take up to two years or more to complete, usually begins by addressing symptoms such as anemia, bruising and/or fever, and may include the following:
In children with ALL, leukemia cells travel everywhere in the body, including into the brain and spinal fluid. Not all chemotherapy drugs given by mouth, vein or in the muscle can get into the brain effectively to treat any leukemia hiding there. In these cases, a child receives sanctuary therapy—either chemotherapy drugs delivered directly into the spinal canal (intrathecal) or radiation to the head to destroy cells that may have moved into the central nervous system.
The first stage of treatment, called the induction stage, is usually a four-week course of chemotherapy to clear the bone marrow of visible leukemia cells. If remission is not achieved, the treatment may be repeated with another drug.
The next stage of treatment, called the intensification or consolidation stage, involves continued chemotherapy to kill any remaining leukemia cells and may include radiation therapy.
In the maintenance stage, which may last for many months, less intensive chemotherapy is given, often at home, to eradicate all leukemia from the body.
Stephen Sallan, MD describes symptoms, diagnosis and treatment for acute lymphoblastic leukemia (ALL) in children.