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Acute Lymphocytic Leukemia (ALL)

Acute lymphocytic leukemia (ALL), also known as acute lymphoblastic leukemia, is a blood cancer arising from white blood cells. In ALL, the bone marrow produces abnormal cells called lymphoblasts. These lymphoblasts are “immature” and unable to grow into a healthy population of cells for the immune system. ALL develops quickly and grows rapidly, and many times, the diagnosis may appear to be a different disease. Skilled hematologists are advised during the immediate diagnosis to coordinate care, confirm the diagnosis, and initiate therapy.

ALL is described as being either positive or negative for the “Philadelphia chromosome” (Ph) . This refers to a certain mutation that some patients may have, and is also called translocation (9;22). Patients who have this disease mutation make an oncogene called BCR/Abl. Because we have medication that can target the protein made by this oncogene, patients with Ph+ ALL are treated slightly different than those without the mutation. This is one of the many factors considered in determining the best treatment strategy for patients with ALL.

Acute lymphocytic leukemia causes

While it is unclear why many patients get ALL, research continues to investigate the causes for disease, as well as novel therapeutic options. Patients who have had a previous malignancy and treated with chemotherapy and/or radiation may be at a slightly higher risk of developing ALL. Having certain genetic diseases may also increase the risk of developing leukemia. If a sibling has ALL, there is a slight increase in risk in developing the disease.

Acute lymphocytic leukemia symptoms

ALL is most often seen in children, young adults, and in those approximately 50 years of age and higher. However, the disease may present at any age. Common signs and symptoms include:

  • Fever
  • Frequent infections
  • Bleeding (such as from the gums or nose)
  • Bony or diffuse pain
  • Enlarged lymph nodes
  • General fatigue

The diagnosis of ALL requires a physical examination, laboratory studies, and a bone marrow biopsy. The biopsy provides genetic and molecular information on the disease. Additional studies may include a CT scan of the neck, chest, abdomen, and pelvis as well as a lumbar puncture to study whether disease is present in the cerebrospinal fluid.

Acute lymphocytic leukemia treatment

As a disease of both younger and older patients, treatment strategies for ALL are tailored to the patient for the best outcomes. Our experienced hematologists at Colorado Blood Cancer Institute will ensure the most appropriate treatment is recommended and administered to the patient. Clinical trials are often available at CBCI featuring novel therapies; a hematologist will discuss these options at the initial encounter.

Standard treatment includes the administration of chemotherapy, adjusted based upon the patient’s age and presence of disease mutations and/or genetic abnormalities. The goal of treatment is provide the deepest level of disease control. In many patients, a hematopoietic stem cell transplant is indicated after the disease has responded to initial chemotherapy.

The diagnosis and treatment of ALL is often difficult for younger adult patients. CBCI has a Young Adult program designed to support and encourage this group through various activities.. The Young Adult program is championed by our Psychosocial team, dedicated to supporting all patients with a diagnosis of a hematologic malignancy.

Hematopoietic stem cell transplant and immunotherapy

Hematopoietic cell transplant using allogeneic (donor) stem cells is often recommended in patients with a diagnosis of ALL. Stem cells from a donor are used to repopulate a patient’s immune system, which may provide an additional way to fight the disease. This is called the “graft versus malignancy” effect. The physicians at CBCI continue to advance new methods in allogeneic hematopoietic stem cell transplant to effectively treat ALL.

Other methods of manipulating the body’s own immune system are being used and investigated at CBCI. These treatment options are called “immunotherapy”. Your CBCI hematologist may discuss these options with you, based upon your disease and response to prior therapies.