Understanding Acute Lymphocytic Leukemia

Doctor with a young woman patient with red hair

Acute lymphocytic leukemia, or ALL, is a type of cancer that starts in the lymphocytes. These small white blood cells, which help the body’s immune system detect and destroy germs, are classified as either B lymphocytes or T lymphocytes, depending on their function.

Ordinarily, the bone marrow (the soft inner part of the bones) produces immature cells known as lymphoblasts, which are precursors to B and T lymphocytes. Eventually, lymphoblasts develop into fully functioning, mature cells. In the case of acute lymphocytic leukemia, however, the bone marrow produces abnormal lymphocytes that are unable to mature properly. The word “acute” indicates that this process happens quickly; the resulting abnormal cells can steadily accumulate in the blood until treated.

Both adults and children can develop acute lymphocytic leukemia, although the condition is much more common in children. Treatment typically varies from patient to patient, but in many cases, complete remission is possible with an aggressive, individualized treatment plan.

What are the symptoms of acute lymphocytic leukemia? 

Acute lymphocytic leukemia symptoms usually stem from a lack of healthy blood cells, which can occur when leukemia cells overtake normal blood-producing cells in the bone marrow. The symptoms can vary considerably from patient to patient, but often include:

  • A sensation of pain within the bones
  • Bleeding gums
  • Fever
  • Pale skin
  • Easy bruising 
  • Tiny blood spots (petechiae) underneath the skin
  • Fatigue and general malaise
  • Swollen lymph nodes
  • Shortness of breath
  • Weight loss and reduced appetite 

Several of these symptoms are associated with very common benign conditions like the common cold and flu, which can make acute lymphocytic leukemia difficult to recognize early. In many cases, a more serious problem is discovered only after routine bloodwork is performed.

What causes acute lymphocytic leukemia to develop? 

The root cause of acute lymphocytic leukemia is not yet fully understood. However, significant strides have been made in uncovering how subtle changes in the DNA of healthy bone marrow cells can transform them into leukemia cells. Essentially, these changes tell normal cells to keep growing and dividing instead of dying, triggering rapid and abnormal lymphocyte cell production that can crowd out healthy cells. The majority of acute lymphocytic leukemia cases are not believed to be inherited (passed down from a parent).

Researchers have identified a few factors that may leave an individual at a slightly higher risk of developing acute lymphocytic leukemia. These include:

  • Having a sibling, particularly a twin, with acute lymphocytic leukemia
  • Certain genetic disorders, including Down syndrome, neurofibromatosis and Fanconi anemia
  • Exposure to certain chemicals, including benzene, or high amounts of radiation
  • A personal history of cancer and cancer treatments, including chemotherapy and radiation therapy

How is acute lymphocytic leukemia diagnosed?

The Malignant Hematology Program uses many advanced strategies to identify leukemia.

The first step in diagnosing acute lymphocytic leukemia is usually a blood test. If a doctor believes a patient may have leukemia, he or she may order one of several tests to examine the number and appearance of the patient’s red blood cells, white blood cells and platelets underneath a microscope.  

If further testing is warranted, the next step is to obtain a sample of bone marrow. This can be done through aspiration with a thin, hollow needle that draws out a small amount of marrow from a bone (usually the hip bone or breast bone). This is typically followed by a bone marrow biopsy, which involves removing a tiny portion of bone and marrow for careful evaluation. Bone marrow testing can often confirm a diagnosis of leukemia, although further lab tests may be performed to identify its subtype and stage as well as the patient’s prognosis.

What does acute lymphocytic leukemia treatment involve? 

At Moffitt Cancer Center, we take an individualized approach to chemotherapy treatment.

For adult patients, many acute lymphocytic leukemia treatment plans include an aggressive and long-term regimen of chemotherapy to destroy cancer cells in the blood. Because chemotherapy can often impact healthy white blood cell counts and cause side effects, medication to help prevent or treat any discomfort may be given. Chemotherapy is sometimes supplemented with radiation therapy to target cancer cells in a specific area.

Targeted therapies like tyrosine kinase inhibitors (TKIs) and immunotherapy drugs can also be helpful for treating acute lymphocytic leukemia in patients with certain genetic mutations or whose cancer has not responded well to chemotherapy. These approaches work by promoting a patient’s immune response to specific cancer cells.

Moffitt’s approach to acute lymphocytic leukemia

At Moffitt Cancer Center, our Malignant Hematology Program is dedicated to helping patients achieve long-term remission from cancers of the blood and bone marrow. Our team has extensive experience in treating a variety of hematologic malignancies, including acute lymphocytic leukemia and other types of leukemia. At Moffitt, patients can access:

  • Advanced diagnostic services, with all blood work processed on-site by our specially trained pathologists
  • Comprehensive, completely individualized treatment plans that incorporate today’s most effective leukemia treatments, such as chemotherapy, radiation therapy and radioimmunotherapy
  • Opportunities to access novel treatments that are not yet widely available elsewhere through our robust clinical trials program
  • Consultations with a collaborative team of medical professionals ranging from medical oncologists and radiation oncologists to hematologists, transplant specialists and immunologists, all in a single, convenient location
  • Supportive care services to address each patient’s emotional and social needs, manage the side effects of treatment and improve quality of life outcomes
  • Follow-up care and consistent monitoring once the cancer is in remission

Patients can benefit from our unique, multispecialty approach to acute lymphocytic leukemia treatment with or without a referral. To schedule an appointment with our Malignant Hematology Program, call 1-888-663-3488 or complete a new patient registration form online.