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Acute Lymphocytic Leukemia

The Wake Forest Baptist Approach Our Leukemia Program, which began in 1986, is widely recognized for excellence in patient care, teaching and clinical research. As one of the largest adult leukemia services in the Southeast, we are active in national research studies. Active collaboration between basic science laboratory research faculty and our own clinical researchers ensures that patients are offered cutting edge therapies. Among the research studies currently underway is a clinical trial evaluating the use of arsenic trioxide as part of a front line therapy for patients with acute promyelocytic leukemia (APL), a subtype that accounts for approximately 10 percent of all acute myeloid leukemia.  This research study is sponsored by Cancer and Leukemia Group B (CALGB), one of three major adult national cancer research groups. In addition to access to the latest treatments, some of the multidisciplinary services offered for our leukemia patients are nutritional consults, recreational therapy, pastoral care services and the Cancer Patient Support Program. Additionally, our oncology staff works with patients and families to identify support and resources in their home communities. Lymphomas, including Hodgkin’s Disease and the array of non-Hodgkin’s lymphomas, represent a growing area of clinical interest at the Comprehensive Cancer Center. Treatment ranges from standard “treatment guideline” protocols to local and national research trials investigating cutting edge therapies. One particular area of emphasis is dose-intensive therapy followed by either bone marrow or peripheral stem cell transplantation.   Acute lymphocytic leukemia (ALL) Bone marrow aspiration Acute lymphocytic leukemia - photomicrograph Auer rods Bone marrow from hip   Definition: Acute lymphocytic leukemia (ALL) is a fast-growing cancer in which the body produces a large number of immature white blood cells (lymphocytes). These cells can be found in the blood, bone marrow, lymph nodes, spleen, and other organs. Alternative Names: ALL; Acute childhood leukemia; Cancer - acute childhood leukemia (ALL); Leukemia - acute childhood (ALL) Causes, incidence, and risk factors: ALL makes up 80% of childhood acute leukemias. Most cases occur in children ages 3 - 7. The disease may also occur in adults. In acute leukemia, cancerous cells multiply quickly and replace normal cells. Cancerous cells take over normal parts of bone marrow, causing bone marrow failure. A person with ALL is more likely to bleed and have infections because there are fewer normal blood cells. Most cases of ALL have no obvious cause. However, chromosome problems, radiation, toxins such as benzene, and some chemotherapy drugs may play a role in the development of leukemia. Persons with Down syndrome or who have a brother or sister with leukemia have an increased risk for ALL. Symptoms: Bleeding gums Bone pain or tenderness Easy bruising Excessive or prolonged bleeding Fatigue Fever Joint pain Infection Menstrual irregularities Nosebleeds Paleness Palpitations Pinpoint red spots on the skin Shortness of breath (made worse by exercise) Swollen glands (lymphadenopathy) Swollen gums Unintentional weight loss Signs and tests: A physical exam may reveal the following: Bruising Enlarged liver and spleen Signs of bleeding (petechiae, purpura) Blood tests may show the following: Abnormal WBC count Anemia on a CBC Low platelet count A bone marrow aspiration may be show abnormal levels of certain cells. ALL may also change the results of the following tests: T-lymphocyte count B-cell leukemia/lymphoma panel White blood cell differential If you are diagnosed with ALL, genetic tests will be done to determine the specific type of ALL. Doctors can look for chromosome changes in the cells of some leukemias. Leukemias with certain types of chromosome changes have a poor outlook, while those with other types of genes can have a very good outlook. Treatment: The goal of treatment is to get the blood counts and the bone marrow to normal. If this occurs, the cancer is considered to be in remission. If you have acute lymphocytic leukemia, you'll need chemotherapy. For the first round of chemotherapy, you may need to go to the hospital for 3 - 6 weeks, but may later get chemotherapy on an outpatient basis. If you have a low white blood cell count, you may need to be placed in a room by yourself so you do not catch an infection. Additional treatments depend on other symptoms. They may include: Transfusion of blood products, such as platelets or special red blood cells, to fight anemia Antibiotics to fight infection If you go into remission, you may receive additional chemotherapy or radiation therapy to kill any cancer cells that are in the spinal fluid. You may also receive chemotherapy from time to time to prevent relapse. If your leukemia returns or does not respond to other treatments, your doctor may recommend a bone marrow transplant after high-dose chemotherapy. High-risk patients may need bone marrow or stem cell transplants. Support Groups: Patients can ease the stress of their illness by joining a support group where members share common experiences and problems. See also: Cancer - support group Expectations (prognosis): Children usually have a better outcome than adults. The majority of adults go into complete remission. Without treatment, a person with ALL can expect to live for about 3 months. Complications: Bleeding DIC (disseminated intravascular coagulation) Relapse of ALL Severe infection Calling your health care provider: Call your health care provider if you develop ALL-like symptoms, or if you have ALL and you have a persistent fever or other signs of infection. Prevention: Because the cause is usually unknown, it is not possible to prevent most cases. You may reduce your risk of ALL by avoiding exposure to toxins, radiation, and chemicals. References: American Cancer Society. Cancer Facts and Figures 2007. Atlanta, GA: American Cancer Society; 2007. National Cancer Institute. Adult acute lymphoblastic leukemia treatment (PDQ). 2008. Accessed June 10, 2008.

Review Date:6/10/2008 Reviewed By:James R. Mason, MD, Oncologist, Director, Blood and Marrow Transplantation Program and Stem Cell Processing Lab, Scripps Clinic, Torrey Pines, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.