Youth Cancer

Acute Lymphoblastic Leukaemia (ALL)

Acute Lymphoblastic Leukaemia(ALL) is a rare type of cancer of the white blood cells. In acute lymphoblastic leukaemia there is an overproduction of immature lymphocytes, which are sometimes referred to as blast cells.

  • These immature cells fill up the bone marrow and stop it from making blood cells properly.
  • ALL occurs more frequently in people under the age of 15 and it is slightly more common in males than in females.

 

What causes acute lymphoblastic leukaemia?

  • Although a few cases are associated with inherited genetic conditions (Down Syndrome, Bloom syndrome, Fanconi anaemia), the cause of ALL is still largely unknown.
  • Environmental factors (e.g. exposure to radiation, electromagnetic fields or use of alcohol and tobacco by a patient’s parents) have been investigated as potential risk factors, but none has been definitively shown to cause ALL.

 

What are the symptoms?

Symptoms of ALL may appear very quickly over a few weeks, and treatment needs to be given as soon as possible.

The main signs and symptoms are:

  • Anaemia caused by a lack of red blood cells.
  • Feeling very tired or breathless.
  • Feeling generally unwell and run-down, perhaps with a sore throat or sore mouth.
  • Aching joints and bones.
  • Having various infections one after the other.
  • Unusual bleeding caused by a reduction in the number of platelets. This may include bruising very easily, heavy periods in women, bleeding gums, and frequent nose bleeds.

TIP: If you have any of these symptoms you should have them checked by your doctor - but remember, they are common to many illnesses other than leukaemia.

 

How is it diagnosed?

Usually, a GP will examine the patient and take a blood test. If the results of the test are abnormal, a referral will be made to hospital for advice from a doctor who specialises in the treatment of blood problems (a haematologist).

The haematologist will:

  • Ask questions about the patients health and about any previous illnesses they may have had.
  • Examine the patient to find out how they are physically, and take a blood sample to check the numbers of different types of blood cells in their blood (this is called a ‘full blood count’).

If the blood test shows that leukaemia cells are present, the doctor will want to take a sample of bone marrow. This is the most important test for finding out the exact type of leukaemia, and allows the doctors to plan the best treatment for the patient.

The tests on the blood and bone marrow sample will include:

  • Cytogenetic tests: a chromosome analysis to look for any particular changes in the chromosomes.
  • Immunophenotyping: tells the doctors whether the leukaemia developed from B-lymphocytes or T-lymphocytes. Knowing which type of lymphocyte is affected helps the doctors to plan the best treatment for the patient.

Other tests you might encounter include:

  • Lumbar puncture
  • CT
  • MRI
  • Ultrasound

 

How is it treated?

A team of doctors and other staff at the hospital will plan the treatment, taking into account a number of factors, including:

  • The type of ALL the patient has.
  • Any chromosomal abnormalities within the leukaemia cell.
  • The patients age and general health.

Treatment plans for ALL usually include chemotherapy and radiotherapy. This can be for up to two years. Some patients may also require a bone marrow transplant.

Chemotherapy can get rid of leukaemia cells in up to 8 out of 10 people (80%) with ALL, although in some people the ALL will come back.

If this happens it will usually be within a few years of the treatment, and further treatment can be given either with standard-dose chemotherapy or high dose chemotherapy with a stem cell transplant.