Leukemias

Acute Lymphocytic Leukemia

Acute lymphocytic leukemia (ALL), also called acute lymphoblastic leukemia, is a fast-growing cancer of the blood and bone marrow. It starts in the cells that become lymphocytes, a type of white blood cell that normally helps protect people from infections.

Diagnosing ALL

In addition to performing a thorough history and physical exam, your doctor may order these or other additional tests.

  • Complete blood count (CBC) measures the levels of white blood cells, red blood cells (including hematocrit and hemoglobin levels) and platelets in the blood. Other blood tests, such as a blood smear or blood chemistry, may also be done.
  • Bone marrow aspiration and biopsy involve removing the liquid within the bone marrow (aspirate) as well as a sample of marrow from within the bone, usually taken from the hip.
  • Flow cytometry, or immunophenotyping, identifies specific types of cancer cells in the blood, bone marrow or lymph nodes, and can help determine the exact diagnosis and best treatment options. It also helps determine whether an increase in the number of white blood cells in the blood is caused by leukemia, some other blood disorder or a reaction to another condition, such as an infection.
  • Genetic tests determine whether there are chromosomal or other genetic changes in lymphocytes.
  • Lumbar puncture, also called spinal tap, may be performed to look for leukemia cells in the cerebrospinal fluid (CSF). CSF is the fluid that surrounds the brain and spinal cord.

A pathologist will analyze blood, bone marrow or tissue samples and provide your doctor with a pathology report of the findings. Imaging tests, such as computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET) and X-rays, are not necessary to diagnose ALL but may be used to help determine the extent of disease.

Classifying ALL

Staging and classification is how doctors determine the extent of cancer. To classify ALL, doctors use the diagnostic test results to divide ALL into groups, taking into account the type of lymphocyte the leukemia comes from (B-cell or T-cell, which are the two main types of lymphocytes) and how mature these leukemia cells are. The majority of ALL cases are B-cell.

Treating ALL

Because acute leukemia progresses quickly, treatment is recommended soon after diagnosis (see Forms of Leukemia).

Chemotherapy

Chemotherapy is the main treatment for ALL. Chemotherapy drugs are systemic, which means that they travel throughout the body to destroy cancer cells and stop their growth. Because chemotherapy also affects healthy cells, some side effects will likely occur. People with ALL commonly receive many different chemotherapy drugs (multi-agent therapy) in a specific regimen for a certain amount of time.

ALL treatment with chemotherapy spans approximately three years and is given in three phases:

  1. Induction. The goal of this phase is remission. Remission occurs when leukemia cells are no longer found in blood or bone marrow samples, and blood counts are normal. This phase typically lasts about one month.
  2. Consolidation. After ALL goes into remission, consolidation takes place. Higher-dose treatments are given to destroy remaining leukemia cells. This phase typically lasts for a few months.
  3. Maintenance. During maintenance, lower-dose treatments are given to prevent new leukemia cells from growing. This phase typically lasts for two years for females and three years for males.

Targeted Therapy

Targeted therapy drugs are systemic, which means they travel throughout the body; however, they target a specific part of a cancer cell to block its growth and ability to spread. This makes the drugs less likely to affect healthy cells, which means fewer side effects could occur.

Tyrosine kinase inhibitor (TKI) therapy is often used to treat people who have the Philadelphia chromosome, which is present in 25 percent of people with B-cell ALL. The Philadelphia chromosome contains the BCR-ABL gene, which makes a protein that helps leukemia cells to grow. TKIs may be used with or after chemotherapy.

Immunotherapy

Immunotherapy is a treatment that works with or stimulates a person’s own immune system to recognize and destroy cancer cells. This approach typically involves destroying only cancer cells, which may result in fewer side effects. Monoclonal antibodies are a type of immunotherapy drug that can be used to treat ALL. Antibodies (proteins) are made by the immune system to help fight infection. Monoclonal antibodies are artificial antibodies that are designed to attack a specific target, such as proteins found on cancer cells.

Stem Cell Transplantation

Stem cell transplantation is an infusion of healthy stem cells into the body. Allogeneic stem cell transplantation is the preferred type of transplantation for treating ALL. With this type of transplantation, the stem cells come from a related donor (usually a brother or sister) or a volunteer donor whose tissue type closely matches that of the patient. If a family member is not a good match, an unrelated volunteer donor may be found through a national registry. People receiving allogeneic transplantation may experience a serious side effect called graft-versus-host disease (GvHD), which can occur when white blood cells from the donor (the graft) recognize cells in the body (the host) as foreign and attack them. GvHD can cause damage to the skin, liver, intestines and other organs. It can be treated with steroids or other drugs that suppress your immune system.

Clinical Trials

Clinical trials are a valuable treatment option to consider. Many of the advances in cancer treatment are helping save lives today because of the research conducted through clinical trials. By participating in a trial, you may have access to cutting-edge treatments that are not yet widely available. Ask your doctor if a trial might be right for you.

Radiation Therapy

Radiation therapy can be used to treat leukemia cells that have spread to other areas of the body, such as the fluid surrounding the brain, spine or testicles.

Refractory ALL

Treatment may not always result in complete remission. ALL that does not result in complete remission after treatment is called refractory ALL. If you receive this diagnosis, talk with your medical team about options, which could include consulting with a specialist who has experience treating refractory ALL, trying a different treatment or investigating clinical trials.

Additional Resources

 

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