National Cancer Institute
Last Modified: June 3, 2003
Adult acute lymphoblastic leukemia (also called acute lymphocytic leukemia or ALL) is a disease in which too many infection-fighting white blood cells called lymphocytes are found in the blood and bone marrow. Lymphocytes are made by the bone marrow and by other organs of the lymph system. The bone marrow is the spongy tissue inside the large bones in the body. The bone marrow makes red blood cells (which carry oxygen and other materials to all tissues of the body), white blood cells (which fight infection), and platelets (which make the blood clot). Normally, the bone marrow makes cells called blasts that develop (mature) into several different types of blood cells that have specific jobs to do in the body.
Lymphocytes are found in the lymph which is a colorless, watery fluid present in the lymph vessels. The lymph vessels are part of the lymph system which is made up of thin tubes that branch, like blood vessels, into all parts of the body. Along the network of vessels are groups of small, bean-shaped organs called lymph nodes. Clusters of lymph nodes are found in the underarm, pelvis, neck, and abdomen. The spleen (an organ in the upper abdomen that makes lymphocytes and filters old blood cells from the blood), the thymus (a small organ beneath the breastbone), and the tonsils (an organ in the throat) are also part of the lymph system.
Lymphocytes fight infection by making substances called antibodies, which attack germs and other harmful bacteria in the body. In ALL, the developing lymphocytes do not mature and become too numerous. These immature lymphocytes are then found in the blood and the bone marrow. They also collect in the lymph tissues and make them swell. Lymphocytes may crowd out other blood cells in the blood and bone marrow. If the bone marrow cannot make enough red blood cells to carry oxygen, then anemia may develop. If the bone marrow cannot make enough platelets to make the blood clot normally, the bleeding or bruising may develop more easily. The cancerous lymphocytes can also invade other organs, the spinal cord, and the brain.
Leukemia can be acute (progressing quickly with many immature cancer cells) or chronic (progressing slowly with more mature looking leukemia cells). ALL progresses quickly and can occur in adults and children. Treatment is different for adults than it is for children. (For more information on childhood ALL, refer to the PDQ patient information summary on Childhood Acute Lymphoblastic Leukemia. Separate PDQ patient information summaries are also available on Chronic Lymphocytic Leukemia, Chronic Myelogenous Leukemia, Adult or Childhood Acute Myeloid Leukemia, and Hairy Cell Leukemia Treatment.)
ALL is often difficult to diagnose. The early signs may be similar to the flu or other common diseases. A doctor should be seen if the following signs or symptoms won't go away: fever, persistant weakness or tiredness, achiness in the bones or joints, or swollen lymph nodes.
If there are symptoms, a doctor may order blood tests to count the number of each of the different kinds of blood cells. If the results of the blood tests are not normal, a doctor may do a bone marrow biopsy. During this test, a needle is inserted into a bone and a small amount of bone marrow is taken out and looked at under the microscope. A doctor may also do a spinal tap in which a needle is inserted through the back to take a sample of the fluid that surrounds the brain and spine. The fluid is then looked at under a microscope to see if leukemia cells are present. A doctor can then tell what kind of leukemia is present and plan the best treatment.
The chance of recovery (prognosis) depends on how the leukemia cells look under a microscope, how far the leukemia has spread, and the patient's age and general health.
There is no staging for ALL. Your choice of treatment depends on whether a patient has been treated before.
Untreated ALL means that no treatment has been given except to treat symptoms. There are too many white blood cells in the blood and bone marrow, and there may be other signs and symptoms of leukemia.
Remission means that treatment has been given and that the number of white blood cells and other blood cells in the blood and bone marrow is normal. There are no signs or symptoms of leukemia.
Recurrent disease means that the leukemia has come back after going into remission. Refractory disease means that the leukemia has failed to go into remission following treatment.
There are treatments for all patients with ALL. The primary treatment of ALL is chemotherapy. Radiation therapy may be used in certain cases. Bone marrow transplantation is being studied in clinical trials.
Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in a vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells throughout the body. Chemotherapy may sometimes be put into the fluid that surrounds the brain by inserting a needle in the brain or back (intrathecal chemotherapy).
Radiation therapy uses x-rays or other high-energy rays to kill cancer cells and shrink tumors. Radiation for ALL usually comes from a machine outside the body (external radiation therapy).
There are two phases of treatment for ALL. The first stage is called induction therapy. The purpose of induction therapy is to kill as many of the leukemia cells as possible and make patients go into remission. Once in remission with no signs of leukemia, patients enter a second phase of treatment (called continuation therapy), which tries to kill any remaining leukemia cells. A patient may receive chemotherapy for up to several years to stay in remission.
Radiation therapy or chemotherapy to the brain may be given to patients if leukemia cells have spread to the brain. Patients may also receive central nervous system (CNS) prohylaxis, another type of therapy, to prevent leukemia cells from growing in the brain during induction therapy and remission.
Bone marrow transplantation is used to replace bone marrow with healthy bone marrow. First, all of the bone marrow in the body is destroyed with high doses of chemotherapy with or without radiation therapy. Healthy marrow is then taken from another person (a donor) whose tissue is the same as or almost the same as the patient's. The donor may be a twin (the best match), a brother or sister, or a person who is not related. The healthy marrow from the donor is given to the patient through a needle in the vein, and the marrow replaces the marrow that was destroyed. A bone marrow transplant using marrow from a relative or person not related to the patient is called an allogeneic bone marrow transplant.
Another type of bone marrow transplant, called autologous bone marrow transplant, is being studied in clinical trials. To do this type of transplant, bone marrow is taken from the patient and treated with drugs to kill any cancer cells. The marrow is frozen to save it. Next, high-dose chemotherapy is given with or without radiation therapy to destroy all of the remaining marrow. The frozen marrow that was saved is then thawed and given to the patient through a needle in a vein to replace the marrow that was destroyed.
A greater chance for recovery occurs if the doctor chooses a hospital that does more than five bone marrow transplantations per year.
Treatment of adult ALL depends on the type of disease, the patient's age and overall condition.
Standard treatment may be considered based on its effectiveness in past studies, or participation in a clinical trial may be considered. Not all patients are cured with standard therapy, and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical trials are ongoing in most parts of the country for most stages of ALL. For more information, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.
Treatment will probably be systemic chemotherapy. This may be intrathecal chemotherapy alone or combined with either radiation therapy to the brain or high doses of systemic chemotherapy to treat or prevent leukemia in the brain. Treatment may also include blood transfusions, antibiotics, and instructions to keep the body and teeth especially clean. Clinical trials are testing new drugs.
Treatment may be one of the following:
Radiation therapy may be given to reduce symptoms. Patients may also choose to take part in a clinical trial of bone marrow transplantation.
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Editorial changes were made to this summary.
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