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Acute lymphoblastic leukaemia

Acute lymphoblastic leukemia
Synonyms Acute lymphocytic leukemia, acute lymphoid leukemia
Acute leukemia-ALL.jpg
Bone marrow aspirate smear from a person with precursor B-cell ALL. The large purple cells are lymphoblasts.
Specialty Hematology, oncology
Symptoms Feeling tired, pale color, fever, easy bleeding or bruising, bone pain, enlarged lymph nodes
Complications Infection, tumor lysis syndrome
Usual onset 2–5 years old
Types B-cell ALL, T-cell ALL
Causes Usually unknown
Risk factors Identical twin with ALL, Down syndrome, Fanconi anemia, ataxia telangiectasia, Klinefelter syndrome, high birth weight, significant radiation exposure
Diagnostic method Blood tests and bone marrow examination
Differential diagnosis Infectious mononucleosis, acute myeloid leukemia, lymphoblastic lymphoma, aplastic anemia
Treatment Chemotherapy, stem cell transplantation, radiation therapy, targeted therapy
Prognosis Children: 90% five-year survival rate
Adults: 35% five-year survival
Frequency 1 in 1,750 children
Deaths 111,000 (2015)
Classification
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External resources

Acute lymphoblastic leukemia (ALL) is a cancer of the lymphoid line of blood cells characterized by the development of large numbers of immature lymphocytes. Symptoms may include feeling tired, pale skin color, fever, easy bleeding or bruising, enlarged lymph nodes, or bone pain. As an acute leukemia, ALL progresses rapidly and is typically fatal within weeks or months if left untreated.

Most cases occur due to an unknown reason. Genetic risk factors may include Down syndrome, Li-Fraumeni syndrome, or neurofibromatosis type 1. Environment risk factors may include significant radiation exposure or prior chemotherapy. Evidence regarding electromagnetic fields or pesticides is unclear. Some hypothesize that an abnormal immune response to a common infection may be a trigger. The underlying mechanism involves multiple genetic mutations that results in rapid cell division. The excessive immature lymphocytes in the bone marrow interfere with the production of new red blood cells, white blood cells, and platelets. Diagnosis is typically based on blood tests and bone marrow examination.

ALL is typically treated initially with chemotherapy aimed at bringing about remission. This is then followed by further chemotherapy typically over a number of years. Additional treatments may include intrathecal chemotherapy or radiation therapy if spread to the brain has occurred.Stem cell transplantation may be used if the disease recurs following standard treatment. Additional treatments such as immunotherapy are being studied.


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