Acute lymphoblastic leukaemia

Published by Bupa's Health Information Team, December 2010.

This factsheet is for people who have acute lymphoblastic leukaemia, or who would like information about it.

Acute leukaemia is a cancer of the blood that can spread very quickly. Acute lymphoblastic leukaemia (ALL) affects a type of white blood cells known as lymphocytes. It is the most common type of leukaemia to affect children.

About acute lymphoblastic leukaemia

The term leukaemia refers to a group of cancers of the blood cells and bone marrow. If you have leukaemia, your white blood cells become abnormal and divide and grow in an uncontrolled way.

Leukaemia can be described as either acute (growing rapidly) or chronic (growing slowly). Acute leukaemia is divided into two main types – ALL and acute myeloid leukaemia (AML). This factsheet focuses on ALL.

ALL affects the cells in your blood known as lymphocytes. Lymphocytes are produced by your bone marrow and allow you to fight off infection. In ALL, your body produces abnormal lymphocytes, which are unable to carry out their normal function properly. They also build up in your bone marrow, meaning that your body may not be able to make enough of other types of blood cells (red cells, neutrophils and platelets).

ALL is the most common type of leukaemia to affect children under 15. Around 300 children are diagnosed each year in the UK. The condition affects around the same number of adults a year, most commonly affecting those under 20 or over 75. The symptoms develop rapidly and become life-threatening if not treated.

Types of acute lymphoblastic leukaemia

There are several different forms or subtypes of ALL. Your doctor will tell you which type you have.

Occasionally, acute leukaemia appears to be a mixture of ALL and AML, This type of leukaemia is known as acute biphenotypic leukaemia.

Symptoms of acute lymphoblastic leukaemia

Symptoms of ALL include:

• feeling generally run down and weak
• tiredness and breathlessness
• frequent infections that don't get better
• unusual bleeding (eg frequent nosebleeds, heavy periods in women, bleeding from gums and blood in your urine or faeces)
• increased bruising, or a fine rash of dark red spots (called purpura)
• fever
• weight loss

Your symptoms can come on very quickly – over a matter of days or weeks. They can seem vague and you may confuse them with common illnesses like flu.

Less common symptoms of ALL include:

• swollen lymph glands (glands in your neck, groin, chest and under the arms)
• aching bones
• swollen painful joints
• swollen testicles in boys
• neurological (nervous system) symptoms, such as headaches

These symptoms aren’t always caused by ALL, but if you have them see your GP.

Causes of acute lymphoblastic leukaemia

The exact reasons why you may develop ALL aren't fully understood at present. However, doctors do know that there are several risk factors for developing ALL.

Risk factors include:

• exposure to radiation
• smoking – this includes passive smoking
• genetic conditions such as Down's syndrome
• viruses – a virus called human T-cell leukaemia virus (HTLV-1) can cause a rare form of leukaemia in adults
• being overweight – if you have a body mass index (BMI) of 30 or above
• being male – you’re slightly more likely to develop ALL if you’re male
• not being exposed to common infections from birth – some research shows that not catching common infections when very young can increase a child’s risk of getting ALL

Diagnosis of acute lymphoblastic leukaemia

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history. If your GP thinks you may have leukaemia, he or she will take a blood test. He or she may then refer you to a haematologist (a doctor who specialises in conditions of the blood).

You will then have some tests to confirm the diagnosis and investigate which type of leukaemia you have. These may include:

• more blood tests
• bone marrow biopsy – your doctor removes a small sample of your bone marrow to be examined under a microscope
• specific tests on the leukaemic cells to determine their exact nature (immunophenotyping)
• genetic analysis of the chromosomes in the leukaemic cells (cytogenetics)
• a chest X-ray – to look for enlarged glands in your chest
• lumbar puncture – your doctor removes a small sample of the fluid from around your spine with a needle to look for the presence of leukaemic cells
• tissue typing, if your doctor thinks that a stem cell transplant may be an option in the future

Treatment of acute lymphoblastic leukaemia

You may hear your doctor referring to your treatment in three phases. These are:

• remission induction – to get rid of the cancer
• consolidation treatment – to keep the cancer away
• maintenance therapy – to prevent a relapse (the cancer coming back)

Treatment for ALL often takes over two years.

Remission induction and consolidation

Chemotherapy
Chemotherapy uses medicines to destroy cancer cells in your bone marrow. It’s the main treatment used in ALL. Initially, you will probably need to stay in hospital for about a month because larger doses of chemotherapy medicines are used to treat acute leukaemia than other types of cancer.

You will need to have a mixture of chemotherapy medicines, as this has been shown to work better than just one medicine on its own. You will usually have these different medicines in cycles, with rest periods in between.

Your treatment will include medicines called steroids, such as prednisolone and dexamethasone, given as tablets or injections alongside chemotherapy medicines.

Biological therapies
Biological therapies are medicines that are manufactured to mimic or inhibit our natural body substances, such as antibodies, in order to help fight cancer cells. If your leukaemia has a chromosome change called the Philadelphia chromosome you may be given a medicine called imatinib. Research has shown that the medicine is more effective when it’s given in the first phase of treatment.

Stem cell transplantation
Following consolidation chemotherapy you may be considered for a bone marrow (stem cell) transplant if you’re in general good health. This is when somebody else (preferably a brother or sister) donates healthy bone marrow or stem cells, which are transferred into your body. This aims to keep the leukaemia away long term without the need for further therapy.

Alternatively, you may go on to receive maintenance therapy.

Maintenance therapy
Maintenance therapy aims to keep your leukaemia in long-term remission. You will be given lower doses of chemotherapy and steroids mainly in tablet form, for up to two years.

New treatments
New potential treatments being investigated for ALL include stem cell transplants from cord blood and newer biological therapies and chemotherapy medicines. They are currently being tested in clinical trials. Many people with leukaemia take part in clinical trials as new treatments are constantly becoming available and need to be assessed. Your doctor can give you more information about clinical trials.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.