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About Acute Lymphoblastic Leukemia (ALL)
Acute lymphoblastic leukemia (ALL), one of two major lymphoid leukemias, is the most common type of cancer in children, though it may also occur in adults. It is also referred to as acute lymphocytic or acute lymphoid leukemia.
In ALL, too many stem cells develop into lymphoblasts, which would ordinarily develop into mature lymphocytes. However, in ALL, these blasts do not ever fully develop. These abnormal cells are known as leukemic cells, and are not able to fight infection. As the number of leukemic cells increases in the blood and bone marrow, there is less room for healthy white blood cells, red blood cells and platelets. This may cause infection, anemia and easy bleeding. The cancerous leukemic cells can also spread to the central nervous system (brain and spinal cord). ALL is an aggressive, acute leukemia, and progresses rapidly without treatment. However, modern combination chemotherapy protocols have made childhood ALL highly treatable, with remission achieved in a majority of patients.
Four of the subgroups of childhood ALL are based on the type of blood cell that is affected, whether there are certain changes in the chromosomes, and age at diagnosis:
- T cell ALL (most ALL is B cell in origin)
- Philadelphia chromosome-positive ALL
- ALL diagnosed in an infant
- ALL diagnosed in children age 10 and older and adolescents (teenagers)
These subgroups are treated differently from other types of ALL.
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Risk Factors
Possible risk factors include the following:
- Having a brother or sister with leukemia
- Caucasian or Hispanic descent
- Exposure to X-rays before birth
- Exposure to radiation
- Past treatment with chemotherapy or other drugs that weaken the immune system. Certain types of chemotherapeutic drugs are known to be carcinogens (cause cancer) or leukemogens (cause leukemia) in their own right
- Certain genetic disorders, such as Down's syndrome
Possible risk factors include the following:
- Male gender
- Caucasian descent
- Older than 70 years of age
- Past treatment with chemotherapy or radiation therapy. This is because certain chemotherapy drugs, particularly those known as alkylating agents, and ionizing radiation, while successfully treating a cancer initially, may produce a secondary malignancy such as leukemia
- Treatment with Thorotrast (a commonly used contrast medium for diagnostic X-rays from the 1930s through the 1950s). Leukemia risk in patients exposed to just one injection of Thorotrast is over 20 times that of the normal population
- Exposure to atomic bomb radiation or other ionizing radiation sources, e.g., workplace or other environmental contamination
- Having certain genetic disorders such as Down's syndrome
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Symptoms
The early signs of ALL may be similar to the flu or other common diseases. Symptoms include:
- Weakness or feeling tired
- Fever
- Easy bruising or bleeding
- Petechiae (flat, pinpoint spots under the skin caused by bleeding)
- Shortness of breath
- Weight loss or loss of appetite
- Bone or joint pain
- Pain or feeling of fullness below the ribs
- Painless lumps in the neck, underarm, stomach, or groin
- Leukemia cutis – multiple pink, red, red-brown or blue-to-violet skin lesions (papules, nodules or plaques) with a firm or rubbery consistency. These lesions form from dense infiltrates of leukemic cells into the skin. While patients with this symptom often have significant disease, leukemia cutis may be an early symptom, presenting even before the disease is detectable in blood or bone marrow.
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