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What is A.L.L?

Acute Lymphoblastic Leukemia (ALL)

What is acute lymphoblastic leukemia?

Acute lymphoblastic leukemia (ALL) is a cancer that affects the white blood cells. These cells fight infection and help protect the body against disease.

Patients with ALL have too many immature white blood cells in their bone marrow. These cells crowd out normal white blood cells. Without enough normal white blood cells, the body has a harder time fighting infections.

ALL affects a type of white blood cell called lymphocytes, causing them to build up in the liver, spleen and lymph nodes.

How common is acute lymphoblastic leukemia?

ALL is the most common type of childhood cancer. It most often occurs in children ages 3 to 5 and affects slightly more boys than girls. ALL is most common in Hispanic children, followed by those of white and African-American descent.

About 3,000 people younger than age 20 are found to have ALL each year in the United States.

Siblings of children with leukemia have a slightly higher risk of developing ALL, but the rate is still quite low: no more than 1 in 500.

What are the symptoms of acute lymphoblastic leukemia?

Symptoms of ALL include:

  • Frequent infections
  • Fever
  • Easy bruising
  • Bleeding that is hard to stop
  • Flat, dark-red skin spots (petechiae) due to bleeding under the skin
  • Pain in the bones or joints
  • Lumps in the neck, underarm, stomach or groin
  • Pain or fullness below the ribs
  • Weakness, fatigue
  • Paleness
  • Loss of appetite
  • Shortness of breath

How is acute lymphoblastic leukemia treated?

Expect your child’s ALL treatment to include three phases:

  • Induction — to kill the leukemia cells in the blood and bone marrow and put the disease into remission (a return to normal blood cell counts)
  • Consolidation/intensification — to rid the body of any remaining cells that could begin to grow and cause the leukemia to return (relapse)
  • Maintenance — to destroy any cancer cells that might have survived the first two phases

Four types of treatment may be used during any of these treatment phases:

  • Chemotherapy (“chemo”) — uses powerful medicines to kill cancer cells or stop them from growing (dividing) and making more cancer cells.
    • Chemo may be injected into the bloodstream, so that it can travel throughout the body.
    • Some chemo may be given by mouth.
    • Combination therapy uses more than one type of chemo at a time.
  • Stem cell transplant — includes replacing blood-forming cells in the bone marrow that have been killed by chemo and/or radiation therapy:
    • A stem cell transplant gives the patient new blood cells from a donor’s blood or bone marrow. These cells grow into healthy blood cells to replace the ones the patient lost.
    • Some types of stem cell transplants may be called “bone marrow transplants” because the cells come from the donor’s bone marrow.
  • Radiation therapy — uses high-energy X-rays or other types of radiation to kill cancer cells or stop them from growing.
  • Targeted therapy — uses medicines or other treatments that target and attack specific cancer cells without harming normal cells.

What are the survival rates for ALL?

The National Cancer Institute (NCI) estimates 5,960 people will receive a diagnosis of ALL in the United States in 2018. About 1,470 people will die from the disease in 2018.

Several factors can determine survival rates, such as age at diagnosis and subtype of ALL.

The five-year survival rate in the United States is 68.1 percent, reports the NCI. However, these numbers are steadily improving. From 1975 to 1976, the five-year survival rate for all ages was under 40 percent.

Although most people who receive a diagnosis of ALL are children, the highest percentage of Americans with ALL who pass away are between the ages of 65 and 74.

In general, about 40 percent of adults with ALL are considered cured at some point during their treatment, estimates American Cancer Society. However, these cure rates depend on a variety of factors, such as the subtype of ALL and age at diagnosis.

A person is “cured” of ALL if they’re in complete remission for five years or more. But because there’s a chance of the cancer coming back, doctors can’t say with 100 percent certainty that a person is cured. The most they can say is whether or not there are signs of cancer at the time.

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