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Acute lymphoblastic leukaemia (ALL)

Acute lymphoblastic leukaemia (ALL) is a fast-growing cancer of a type of white blood cell called a lymphoblast.

ALL occurs when the bone marrow produces a large number of immature lymphoblasts. Bone marrow is the soft tissue in the center of bones that helps form all blood cells. The abnormal lymphoblasts grow quickly and replace normal cells in the bone marrow. ALL prevents healthy blood cells from being made. Life-threatening symptoms can occur as normal blood counts drop.

What are the causes of Acute lymphoblastic leukaemia (ALL)?

Most of the time, no clear cause can be found for ALL.

The following factors may play a role in the development of all types of leukemia:

  • Certain chromosome problems
  • Exposure to radiation, including x-rays before birth
  • Past treatment with chemotherapy drugs
  • Receiving a bone marrow transplant
  • Toxins, such as benzene

The following factors are known to increase the risk for ALL:

  • Down syndrome or other genetic disorders
  • A brother or sister with leukemia

This type of leukemia usually affects children ages 3 to 7. ALL is the most common childhood cancer, but it can also occur in adults.

What are the symptoms of Acute lymphoblastic leukaemia (ALL)?

ALL makes a person more likely to bleed and develop infections. Symptoms include:

  • Bone and joint pain
  • Easy bruising and bleeding (such as bleeding gums, skin bleeding, nosebleeds, abnormal periods)
  • Feeling weak or tired
  • Fever
  • Loss of appetite and weight loss
  • Paleness
  • Pain or feeling of fullness below the ribs from an enlarged liver or spleen
  • Pinpoint red spots on the skin (petechiae)
  • Swollen lymph nodes in the neck, underarms, and groin
  • Night sweats

These symptoms can occur with other conditions. Talk to a health care provider about the meaning of specific symptoms.

Which tests done for Acute lymphoblastic leukaemia (ALL)?

The provider will perform a physical exam and ask about your symptoms.

Blood tests may include:

Tests are also done to look for changes in the DNA inside the abnormal white cells. Certain DNA changes may determine how well a person does (prognosis), and what kind of treatment is recommended.

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What treatment options are available for Acute lymphoblastic leukaemia (ALL)?

The first goal of treatment is to get blood counts back to normal. If this occurs and the bone marrow looks healthy under the microscope, the cancer is said to be in remission.

Chemotherapy is the first treatment tried with the goal of achieving a remission.

  • The person may need to stay in the hospital for chemotherapy. Or it can be given at a clinic and the person goes home afterwards.
  • Chemotherapy is given into the veins (by IV) and sometimes into the fluid around the brain (the spinal fluid).

After remission is achieved, more treatment is given to achieve a cure. This treatment can include more IV chemotherapy or radiation to the brain. Stem cell or bone marrow transplant from another person may also be done. Further treatment depends on:

  • Age and health of the person
  • Genetic changes in the leukaemia cells
  • How many courses of chemotherapy it took to achieve remission
  • If abnormal cells are still detected under the microscope
  • Availability of donors for stem cell transplant

You and your provider may need to manage other concerns during your leukaemia treatment, including:

  • Having chemotherapy at home
  • Managing your pets during chemotherapy
  • Bleeding problems
  • Dry mouth
  • Eating enough calories
  • Safe eating during cancer treatment

What’s the prognosis of Acute lymphoblastic leukaemia (ALL)?

Those who respond to treatment right away tend to do better. Most children with ALL can be cured. Children often have a better outcome than adults.

Possible Complications

Both leukemia itself and the treatment can lead to many problems such as bleeding, weight loss, and infections.

Prevention

The risk of developing ALL may be reduced by avoiding contact with certain toxins, radiation, and chemicals.

After chemotherapy – discharge

You had chemotherapy treatment for your cancer. Your risk for infection, bleeding, and skin problems may be high. To stay healthy after chemotherapy, you’ll need to take good care of yourself. This includes practising mouth care, preventing infections, among other measures.

What to Expect at Home

After chemotherapy, you may have mouth sores, an upset stomach, and diarrhoea. You will probably get tired easily. Your appetite may be poor, but you should be able to drink and eat.

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Mouth Care

Take good care of your mouth. Chemotherapy can cause dry mouth or sores. This can lead to an increase in bacteria in your mouth. The bacteria can cause infection in your mouth, which can spread to other parts of your body.

  • Brush your teeth and gums 2 to 3 times a day for 2 to 3 minutes each time. Use a toothbrush with soft bristles.
  • Let your toothbrush air dry between brushings.
  • Use a toothpaste with fluoride.
  • Floss gently once a day.
  • Rinse your mouth 4 times a day with a salt and baking soda solution (Mix one-half teaspoon, or 2.5 grams, of salt and one-half teaspoon, or 2.5 grams, of baking soda in 8 ounces or 240 mL of water). Your doctor may prescribe a mouth rinse. DO NOT use mouth rinses with alcohol in them.
  • Use your regular lip care products to keep your lips from drying and cracking. Tell your doctor if you develop new mouth sores or pain.
  • DO NOT eat foods and drinks that have a lot of sugar in them. Chew sugarless gums or suck on sugar-free popsicles or sugar-free hard candies.
  • Take care of your dentures, braces, or other dental products.
  • If you wear dentures, put them in only when you are eating. Do this for the first 3 to 4 weeks after your chemotherapy. Do not wear them at other times during the first 3 to 4 weeks.
  • Brush your dentures 2 times a day. Rinse them well.
  • To kill germs, soak your dentures in an antibacterial solution when you are not wearing them.

Preventing Infections

Take care not to get infections for up to one year or more after your chemotherapy.

Practice safe eating and drinking during cancer treatment.

  • DO NOT eat or drink anything that may be undercooked or spoiled.
  • Make sure your water is safe.
  • Know how to cook and store foods safely.
  • Be careful when you eat out. DO NOT eat raw vegetables, meat, fish, or anything else you are not sure is safe.

Wash your hands with soap and water often, including after:

  • being outdoors
  • touching body fluids, such as mucus or blood
  • changing a diaper
  • Before handling food
  • After using the telephone
  • doing housework
  • going to the bathroom

Keep your house clean. Stay away from crowds. Ask visitors who have a cold to wear a mask, or not to visit. Don’t do yard work or handle flowers and plants.

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Be careful with pets and animals.

  • If you have a cat, keep it inside.
  • Have someone else change your cat’s litter box every day.
  • Don’t play rough with cats. Scratches and bites can get infected.
  • Stay away from puppies, kittens, and other very young animals.

Ask your doctor what vaccines you may need and when to get them.

Other Self-care

Other things you can do to stay healthy include:

  • If you have a central venous line or PICC (peripherally inserted central catheter) line, know how to take care of it.
  • If your health care provider tells you your platelet count is still low, learn how to prevent bleeding during cancer treatment.
  • Stay active by walking. Slowly increase how far you go based on how much energy you have.
  • Eat enough protein and calories to keep your weight up.
  • Ask your provider about liquid food supplements that can help you get enough calories and nutrients.
  • Be careful when you are in the sun. Wear a hat with a wide brim. Use sunscreen with SPF 30 or higher on any exposed skin.
  • DO NOT smoke.

Follow-up

You will need close follow-up care with your cancer providers. Be sure to keep all your appointments.

When to Call the Doctor

Call your doctor if you have any of these symptoms:

  • Signs of infection, such as fever, chills, or sweats
  • Diarrhoea that does not go away or is bloody
  • Severe nausea and vomiting
  • Inability to eat or drink
  • Extreme weakness
  • Redness, swelling, or drainage from any place where you have an IV line inserted
  • A new skin rash or blisters
  • Jaundice (your skin or the white part of your eyes looks yellow)
  • Pain in your abdomen
  • A very bad headache or one that does not go away
  • A cough that is getting worse
  • Trouble breathing when you are at rest or when you are doing simple tasks
  • Burning when you urinate

Alternative Names

ALL; Acute lymphoblastic or lymphoid leukaemia; Acute childhood leukaemia; Cancer – acute childhood leukaemia (ALL); Leukemia – acute childhood (ALL); Acute lymphocytic leukaemia

References

Carroll WL, Bhatla T. Acute lymphoblastic leukaemia. In: Lanzkowsky P, Lipton JM, Fish JD, eds. Lanzkowsky’s Manual of Pediatric Hematology and Oncology. 6th ed. Cambridge, MA: Elsevier Academic Press; 2016:chap 18.

National Cancer Institute website. Adult acute lymphoblastic leukaemia treatment (PDQ) – health professional version.

National Cancer Institute website. Childhood acute lymphoblastic leukaemia treatment (PDQ) – health professional version. 

National Comprehensive Cancer Network website. NCCN clinical practice guidelines in oncology: acute lymphoblastic leukaemia. Version 4.2017.

Doroshow JH. Approach to the patient with cancer. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 169.

Freifeld AG, Kaul DR. Infection in the patient with cancer. In: Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, PA: Elsevier; 2020:chap 34.

Majithia N, Hallemeier CL, Loprinzi CL. Oral complications. In: Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, PA: Elsevier; 2020:chap 40.

National Cancer Institute website. Chemotherapy and you: support for people with cancer. www.cancer.gov/publications/patient-education/chemotherapy-and-you.pdf