Acute Lymphocytic Leukemia (ALL)

Leukemia is a cancer of white blood cells. White blood cells have many jobs, including helping your body's immune system fight off infection. White blood cells form in your bone marrow, the spongy tissue inside your bones.

With leukemia, you have a very high white blood cell count. However, the cancerous white blood cells don't work properly, so you're likely to get infections. Those infections may be life-threatening.

Also, the cancerous white blood cells fill up your bone marrow so it can't make normal blood cells such as:

• Red blood cells (causing anemia)

• Normal white blood cells (increasing the risk of infection)

• Platelets (increasing the risk of bleeding)

There are many different types of white blood cells but only 2 main types of leukemia:

• Lymphocytic leukemia: cancer of lymphocytes, which are one type of white blood cell

• Myelogenous leukemia: cancer of all the other types of white blood cells

Lymphocytic and myelogenous leukemia can be acute or chronic:

• Acute: cancer of young cells that spreads quickly and can cause death in 3 to 6 months if untreated

• Chronic: cancer of mature cells that spreads more slowly

Acute lymphocytic leukemia (ALL), also called acute lymphoblastic leukemia, involves very young cells that should develop into lymphocytes but instead become cancerous. ALL is life-threatening.

• ALL is the most common type of cancer in children, but it can happen at any age

• ALL starts in bone marrow but can spread throughout the body and damage your organs

• You may have symptoms like fever, weakness, and paleness

• Doctors usually test your blood and bone marrow to find the cancer

• Doctors treat ALL with chemotherapy

• About 8 in 10 children and 4 in 10 adults with ALL are cured (survive at least 5 years)

Early symptoms may include:

• Fever and heavy sweating at night (from infection or the leukemia)

• Feeling weak and tired (from anemia)

• Fast heartbeat or chest pain

• Easy bruising and bleeding, such as nosebleeds or bleeding gums

• Swollen lymph nodes (pea-sized organs throughout the body that help fight off infection)

Later symptoms may include:

• Bone or joint pain

• Headaches, throwing up, and problems seeing, hearing, balancing, and using the muscles of your face

• Pain or a "full" feeling in your upper belly (from a large liver and spleen)

Also, leukemia cells start to take over other organs, such as the liver, spleen, lymph nodes, testicles, and brain.

To tell if you have ALL, doctors will:

• Do blood tests

• Take a sample of your bone marrow to test (bone marrow exam)

Other tests to see if ALL has spread to major organs may include:

• Urine tests

• CT (computed tomography) scan or MRI (magnetic resonance imaging)

• Chest x-ray

• Ultrasound

Doctors treat ALL with chemotherapy. Chemotherapy, often called “chemo,” is one or more very strong medicines to kill your cancer cells. Other types of medicines and treatments are often used along with chemotherapy. The goal is cure. If you're cured, you have no cancer cells left in your body. If a cure isn't possible, then the goal is to decrease the number of cancer cells and keep that number low for as long as possible.

Chemotherapy may make you sicker before you get better. The medicines may:

• Make you more likely to get infections

• Make you need a blood transfusion

• Make you throw up, feel weak and tired, or lose your hair

Treatment for ALL goes through 3 phases:

• Induction

• Consolidation

• Maintenance

Induction involves getting several strong chemotherapy drugs. The goal of induction is to kill most or all of your cancer cells (called remission).

During induction, doctors may also give you treatments to kill any cancer cells in your brain:

• Chemotherapy drugs in your spinal fluid (fluid that surrounds your brain and spinal cord)

• Radiation therapy to your brain

Consolidation involves getting different chemotherapy drugs for a few months to keep the leukemia from coming back. Doctors may also give you:

• Stem cell treatment, if needed

Maintenance involves getting:

• Chemotherapy for 2 to 3 years, sometimes in low amounts