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Acute Lymphocytic Leukemia


Acute lymphocytic leukemia (ALL) is the most common childhood cancer, although it can also occur in adults. ALL is a cancer of the blood and bone marrow that occurs when abnormal cells in a part of your body begin to grow out of control. ALL is caused by an increase in white blood cells called lymphocytes. Because it’s an acute, or aggressive, form of cancer, it moves rapidly. Most types of ALL can be treated with a good chance of remission in children. However, adults with ALL don’t have as high of a remission rate as children.

According to the American Cancer Society (ACS), about 6,050 new cases of ALL, 3,450 males and 2,600 females, were diagnosed in the United States in 2012. Another 1,440 deaths, 820 in males and 620 in females, from ALL were also reported. Although most cases appeared in children, four out five deaths occurred in adults. Children younger than age 5 were at a higher risk of developing ALL. However, children are typically better than adults at tolerating aggressive treatment.

What Are the Symptoms of ALL?

Having ALL increases your chances of bleeding and developing infections. The symptoms of ALL may include:

  • paleness, or pallor
  • bleeding from the gums
  • a fever
  • bruises, purpura, or bleeding within the skin
  • petechiae, which are red or purple spots on the body
  • lymphadenopathy, which is characterized by enlarged lymph nodes in the neck, under the arms, or in the groin region
  • hepatomegaly, or enlargement of the liver
  • splenomegaly, or enlargement of the spleen
  • bone pain
  • joint pain
  • weakness
  • fatigue
  • shortness of breath
  • testicular enlargement
  • cranial nerve palsies

What Are the Risk Factors for Acute Lymphocytic Leukemia?

The cause of ALL isn’t known, but a few risk factors have been identified:

Radiation Exposure

People who’ve been exposed to high levels of radiation, such as those who’ve survived a nuclear reactor accident, have shown an increased risk for ALL. According to this study, Japanese survivors of the atomic bomb in World War II had an increased risk of acute leukemia six to eight years after exposure.

Studies done in the 1950s showed that fetuses exposed to radiation, such as X-rays, within the first months of development present an increased risk for ALL, however, more recent studies have failed to replicate these outcomes. Nevertheless, it’s still not recommended for pregnant women to undergo X-ray imaging.

Chemical Exposures

This study from the American Journal of Epidemiology shows that prolonged exposure to chemicals like hair dyes, benzene, and even chemotherapy drugs show a strong link to the development of ALL.

Viral Infections

The Indian Journal of Pathology and Microbiology reports that various viral infections have been linked to an increased risk for ALL. T-cells are a particular type of white blood cell. Infection with human T-cell leukemia virus-1 (HTLV-1) can cause a rare type of T-cell ALL. Epstein-Barr virus, which is usually responsible for infectious mononucleosis, has been linked to ALL and Burkitt’s lymphoma.

Inherited Syndromes

ALL doesn’t appear to be an inherited disease, but some inherited syndromes exist with genetic changes that raise the risk of ALL. These include:

  • Down syndrome
  • Klinefelter’s syndrome
  • Fanconi’s anemia
  • Bloom syndrome
  • ataxia-telangiectasia
  • neurofibromatosis

People who have siblings with ALL are also at an increased risk for the disease.

Race and Gender

African-Americans have shown a higher risk for ALL than Caucasians, and men have a higher risk than women. The reasons for these differences in risk aren’t well understood.

Other Risk Factors

The following have all been studied as possible links to ALL:

  • cigarette smoking
  • long exposure to diesel fuel
  • gasoline
  • pesticides
  • electromagnetic fields

How Is Acute Lymphocytic Leukemia Diagnosed?

Your doctor must complete a full physical exam and conduct blood and bone marrows tests to diagnose ALL. They’ll likely ask about bone pain, which is one of the first symptoms of ALL. Some of the possible diagnostic tests you might need include the following:

  • Your doctor may order a blood count. People who have ALL may have a blood count that shows low hemoglobin and a low platelet count, and their white blood cell count may or may not be increased.
  • A blood film may show immature cells circulating in the blood, which are normally found in bone marrow.
  • Bone marrow aspiration involves taking a sample of bone marrow from your pelvis or breastbone, and it provides a way to test for increased growth in marrow tissue and reduced production of red blood cells. It also allows your doctor to test for dysplasia, which is an abnormal development of immature cells, in the presence of leukocytosis, or increased white blood cells.
  • A chest X-ray can allow your doctor to see if the mediastinum, or the middle partition of your chest, is widened.
  • A CT scan helps your doctor determine whether cancer has spread to your brain, spinal cord, or other parts of your body.
  • A spinal tap is used to check if cancer cells have spread to your spinal fluid.
  • Tests on serum urea, renal, and liver biochemistry may be done.
  • An electrocardiogram and echocardiogram of your heart may be performed to check left ventricular function.

How Is Acute Lymphocytic Leukemia Treated?

Treatment of acute lymphocytic leukemia aims to bring your blood count back to normal. If this happens and your bone marrow looks normal under a microscope, your cancer is in remission.

Chemotherapy is used to treat this type of leukemia. For the first treatment, you may have to be hospitalized for a few weeks. Later, you may be able to continue treatment as an outpatient.

In the event you have a low white blood cell count, you’ll most likely have to spend time in an isolation room to ensure protection from contagious diseases and other problems.

A bone marrow or stem cell transplant may be recommended if your leukemia doesn’t respond to chemotherapy. The transplanted marrow may be taken from a sibling who is a complete match.

How Is Acute Lymphocytic Leukemia Prevented?

There’s no confirmed cause of acute lymphocytic leukemia. However, you should avoid the risk factors for it, which include:

  • radiation exposure
  • chemical exposure
  • exposure to viral infections
  • cigarette smoking
  • prolonged exposure to diesel fuel, gasoline, pesticides, and electromagnetic fields

Content licensed from:

Written by: Abdul Wadood Mohamed and Matthew Solan
Medically reviewed on: Feb 26, 2016: Graham Rogers, M.D.

This feature is for informational purposes only and should not be used to replace the care and information received from your health care provider. Please consult a health care professional with any health concerns you may have.
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