Acute Lymphoblastic Leukemia (Pediatric)

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What is acute lymphoblastic leukemia?

Acute lymphoblastic leukemia (ALL) is a type of cancer that affects the bone marrow, which is where the body manufactures the cells that make up the blood. ALL is the most common cancer in children; about 1 in 5 childhood cancer cases are diagnosed as having ALL.

The most frequent signs and symptoms of ALL include:

  • Fever
  • Tiredness
  • Easy bruising
  • Enlarged lymph nodes
  • Pain of the hands, feet, or other extremities
  • Pain of the abdomen

When a patient shows signs of ALL, the health care provider may perform a blood test that counts the number of types of cells in the blood. Blood tests that show any of these results point toward a diagnosis of ALL:

  • A blood cell count that is similar to patients with anemia
  • A low number of blood platelets (the cells that help with clotting)
  • Abnormal white blood cells (the cells that help with immune response)
  • The presence of lymphoblasts (the immature cancer cells)

Our approach to acute lymphoblastic leukemia

In order to confirm the diagnosis, the health care provider must examine the bone marrow by performing a bone marrow aspiration and biopsy. In a bone marrow aspiration, a small amount of bone marrow is removed through a needle that goes into the bone. In a biopsy, a small part of bone is removed with the bone marrow inside to be looked at under a microscope.

A lumbar puncture (also called a spinal tap) is also required to detect whether cancer cells exist in the fluid in the spine (cerebrospinal fluid or CSF). In this procedure, a needle is carefully inserted into part of the spine in the lower back to collect fluid to be examined.

Both of these procedures are performed with light anesthesia to help make sure the patient more comfortable.

The treatment approach for each patient is determined based on the risk that ALL poses to the patient. In making treatment decisions, the health care provider will consider factors including the patient’s age, their white blood cell count, the type of cancer cells they have and whether they are present in the CSF, the genetic background of the patient, and how well the patient has done on any previous treatments.

The typical treatment for ALL is chemotherapy, in which anti-cancer drugs are used to attack the cancer cells. Medication for ALL is usually intrathecal, meaning the medication is delivered directly into the CSF using a needle or a tube under light anesthesia. In some cases, the health care provider might also recommend radiation treatment to the head, although this is used much less often than in the past.

Treatment usually lasts between 2-3 years. The cure rates in ALL are excellent and are between 80-90% of all cases.