Acute lymphocytic leukemia (ALL) is a cancer of the blood and blood-forming tissues of the body that quickly gets worse when left untreated. It is most prevalent in children and the rarest of the four common leukemias.
About acute lymphocytic leukemia (ALL)
ALL forms from lymphoid stem cells. These disease cells multiply rapidly and are poor at fighting infection. They also crowd out healthy cells, leaving people with ALL weak and prone to infection.
The two main subtypes of ALL are B cell, which makes up about 85% of ALL cases, and T cell, which makes up 15%.
Both these subtypes are also divided into smaller groups based on chromosome and other genetic markers. An important subtype of B cell ALL is Philadelphia chromosome-positive B-ALL.
Chromosomes are sections of DNA found in every cell; each person’s DNA contains his or her unique genetic instructions. The Philadelphia chromosome forms when pieces of chromosome 9 and chromosome 22 swap places in a blood cell.
As a result, the now-cancerous cell produces a protein (in the tyrosine kinase family of proteins) that encourages it to multiply rapidly. Leukemias with the Philadelphia chromosome can be treated with targeted therapies called tyrosine kinase inhibitors. These drugs interfere with the tyrosine kinase protein and therefore the multiplication of cancerous white blood cells.
About 6,000 ALL cases are diagnosed in the United States each year. More than half of these are in pediatric patients. Among adults, the risk of developing ALL begins increasing around age 50.
The five-year survival rate for ALL is about 70%. This is largely due to a 90% survival rate among pediatric patients. For adults, the survival rate lowers with age.
This is partly due to chromosome changes that are connected with worse outcomes. Many of these changes are more common in adult ALL patients than pediatric patients. In addition, the chance of developing ALL increases as people enter their 50s and beyond. Older patients often have other health problems that can impact their care and prognosis.
Blood cell creation
The body produces millions of blood cells each day. Most develop in the bone marrow, the spongy interior of bones that contains immature stem cells.
In a healthy person, these immature stem cells first become either lymphoid stem cells or myeloid stem cells.
Lymphoid stem cells develop into white blood cells, which are immune system cells. They start by becoming immature white blood cells known as lymphoblasts, then mature into lymphocytes. The two types of lymphocytes that are usually involved in leukemia are B cells and T cells. B cells produce the antibodies responsible for attacking bacteria and viruses that invade the body. T cells help alert other immune cells to the presence of infection or fight infection directly.
Myeloid stem cells also develop into white blood cells. The myeloid stem cells first become immature white blood cells known as myeloblasts. They then mature into monocytes and granulocytes, including neutrophils, all of which fight disease. Other myeloid stem cells develop into red blood cells, which carry oxygen throughout the body; and platelets, which help the blood clot.
Leukemia occurs when the DNA (the genetic instructions that control cell activity) of a bone marrow stem cell mutates at some point in its development. The cell becomes cancerous, begins multiplying rapidly and crowds out healthy cells in the blood and bone marrow. These diseased cells can also gather in specific parts of the body, including the liver, lymph nodes, spleen and skin.
How is leukemia classified?
While there are many types of leukemia, they are typically classified by the type of stem cell that has turned cancerous, either lymphoid or myeloid.
Many types are also classified as either chronic or acute. Acute leukemia impacts immature cells, preventing them from developing and carrying out their function. These cells tend to multiply rapidly, making acute leukemia more aggressive.
Chronic leukemia involves mature or partially mature cells. These cells multiply more slowly and are less aggressive, making chronic leukemia less aggressive than acute leukemia.
Risk factors
A risk factor is anything that increases the risk of developing a disease. Knowing a disease’s risk factors can be an important step towards catching it early. It's important to note that not everyone with risk factors will develop the disease.
Risk factors for acute lymphocytic leukemia (ALL) include:
- Sex: Men are slightly more likely to develop ALL than women.
- Age: While more than half of ALL cases are in pediatric patients, among adults, the risk of ALL begins increasing around age 50.
- Past treatment with chemotherapy or radiation therapy for a previous cancer. While these therapies are risk factors for ALL, their benefits as cancer treatments far outweigh their risks.
- Genetic disorders: Individuals with certain genetic disorders are at a higher risk of developing ALL. These include:
- Ataxia telangiectasia
- Bloom syndrome
- Down syndrome
- Fanconi anemia
- Klinefelter syndrome
- Li-Fraumeni syndrome, a hereditary cancer syndrome
- Wiskott-Aldrich syndrome
- Ataxia telangiectasia
- Chemical exposure: Long-term exposure to benzene, a chemical used in the petroleum industry, can cause ALL, though it is more commonly connected to acute myeloid leukemia.
Some cases of leukemia can be passed down from one generation to the next. Genetic counseling may be right for you. Learn more about the risk to you and your family on our genetic testing page.
Blood cell creation (click to enlarge).
When I was 27, I was diagnosed with acute lymphocytic leukemia (ALL). It's a type of blood cancer usually found in children and the elderly.
I started treatment near my home in Louisiana and came to MD Anderson for a second opinion when it seemed like I was moving too quickly toward a stem cell transplant.
My husband, Andrew, and I thought we’d be at MD Anderson for maybe two or three days. We ended up staying for almost five months. It worked out better than either of us could’ve anticipated.
My acute lymphocytic leukemia diagnosis
Looking back, I can see that the nose bleeds, dry cough and fatigue I’d been experiencing were all symptoms of acute lymphocytic leukemia. But I was only 27 at the time and otherwise very healthy. Cancer didn’t run in my family. I was also just starting my career as an attorney, and I was going to a lot of weddings. So, I attributed everything to being busy, traveling and allergies.
When my routine bloodwork first came back abnormal, the lab called and asked me to return for another blood draw. They thought my sample had gotten mixed up with someone else’s. But when the second, third and fourth blood draws came back abnormal, too, there was no mistaking it: my white blood cell count was elevated, and my platelet count was very low.
I didn’t understand what that meant until my doctor said, “The only time we see this is in patients with leukemia.”
I was so stunned I couldn’t even process it.
Why I sought a second opinion at MD Anderson
Normally, someone with blood test results like mine would need to be transported to a cancer facility in an ambulance. But I was feeling and acting OK, so the doctor allowed me to go home, pack a suitcase and drive myself to the hospital.
I was admitted as an inpatient immediately and started receiving IV chemotherapy just two days later. I went through three rounds of high-dose chemotherapy before requesting a second opinion.
It wasn’t that I didn’t trust my local oncologists. I felt confident that the care I was receiving from them was what I’d be getting anywhere else in the nation. It was only the fact that they wanted to move forward with a stem cell transplant so quickly that gave me a little pause. I wanted to be sure it was warranted before taking such a big step.
Fortunately, my local oncologist was completely supportive of my decision. He even gave me Dr. Hagop Kantarjian’s name and said that he was the absolute best specialist to see for leukemia.
How I benefitted from a clinical trial I couldn’t join
My husband and I called MD Anderson and made an appointment. The scheduler worked around my existing chemotherapy appointments and got me in pretty quickly. I felt like Dr. Kantarjian’s team answered all of our questions before we even got there.
The first thing Dr. Kantarjian told us when we met him at the clinic was that I wasn’t going to be doing chemotherapy anymore. He had an amazing new immunotherapy drug for me to try called blinatumomab, and he believed it was going to change the way leukemia was treated going forward.
Dr. Kantarjian wanted me to join a clinical trial using that drug, but because I’d already had three rounds of chemo, I didn’t meet the eligibility criteria. Even so, he created a treatment plan for me that closely mirrored it. He felt it would be morally wrong to put someone through the rigors of intense chemotherapy if a better option existed, and this drug was showing much better results than the previous standard of care.
My husband and I went over the data from the clinical trial with Dr. Kantarjian, and afterward, we felt we had all the information we needed to switch treatment plans. I received my first immunotherapy infusion at MD Anderson on May 31, 2022.
Immunotherapy changed my life
I wasn’t sorry to see the last of chemo. Every round knocked me down. My hair fell out less than two weeks after the first infusion. I also had to take two months off work, wear an NK95 mask and be extremely careful about what I was eating and who I was seeing.
My life did a complete 180 once I started immunotherapy. My hair started growing back, I was able to resume working part-time and I didn’t have to wear a mask anymore. The only real negative was that I had to be connected to an infusion 24/7 for four weeks at a time. But I just wore the pump as a fanny pack and made it a fashion statement.
The best part of immunotherapy
The best part of immunotherapy was how significantly it shortened my treatment period. My original plan called for eight months of chemotherapy, followed by a stem cell transplant, which would impact me significantly for most of a year, and potentially have side effects for the rest of my life.
With immunotherapy, all of my treatment was finished within nine months of my diagnosis, though I’ll continue to take a targeted therapy drug called a tyrosine kinase inhibitor once a day in pill form for another four years. I haven’t had any noticeable side effects. I didn’t need a stem cell transplant. And, I’ve been in complete remission since June 27, 2022.
What my leukemia diagnosis has taught me about clinical trials and blood donations
I always thought clinical trials were a last resort, something you did only when no other options were available or your current treatment wasn’t working. But even though I didn’t qualify to join it, a clinical trial at MD Anderson still had a massive impact on me. It changed the trajectory of my treatment plan as well as the rest of my life — and that’s pretty amazing. It’s even more comforting to know that in the event the leukemia ever returns, I still have many more treatment options.
Today, I’m also much more aware of how important blood donations are. While I was undergoing chemotherapy, I needed some type of transfusion almost every other day. Whether it was platelets or whole blood, every infusion made such an impact on me and significantly improved how I was feeling.
Before my diagnosis, I donated blood a few times myself, but back then, it was just one of those things I did without really thinking about it. Today, I am so incredibly grateful for blood donors. My need for transfusions during treatment has totally changed how I perceive their gift. Donating blood is such a little thing people can do, and yet it makes such a huge difference in a cancer patient’s life.
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Why choose MD Anderson for your leukemia treatment?
Choosing the right cancer center may be the most important decision you can make as a leukemia patient. At MD Anderson’s Leukemia Center and Stem Cell Transplantation and Cellular Therapy Center, you’ll get treatment from one of nation’s the largest, most experienced leukemia teams at a top-ranked cancer center.
Using a comprehensive team approach, we work together to give you customized care that includes the most advanced diagnostic methods and treatments. These include clinical trials of new drugs and drug combinations. We offer clinical trials for all situations – from patients receiving their first treatment, to patients who have exhausted all standard treatment options.
As a leading center for leukemia care, we offer access to innovative new therapies and clinical trials that may help increase your chances for successful treatment. Many of these were developed by our own researchers.
We are constantly striving to find new and better ways to fight leukemia. We are one of the few cancer centers in the nation to house a prestigious federally-funded SPORE (Specialized Program of Research Excellence) focused on leukemia. We offer a wide range of clinical trials and innovative, advanced leukemia treatment for all patients who seek care at MD Anderson.
Treatment designed specifically for you
Successful leukemia treatment begins with accurate and precise diagnosis. Many of our leukemia patients have been misdiagnosed before they come to MD Anderson. We have the expertise and experience gained from being one of the most active programs in the world, and our specialized pathologists are highly skilled in diagnosing leukemia.
Our approach to leukemia is customized especially for you. We carefully evaluate your risk factors and the specific characteristics of your leukemia to determine if immediate treatment is necessary. If it is, we recommend the most effective therapies while aiming to limit treatment side effects.
Whether you are treated as an inpatient or outpatient, our comprehensive program offers all the services needed to care for leukemia and respond to its impact on your body. We aim to accomplish as much care as possible on an outpatient basis. If hospitalization is needed, our expert staff is specially trained to care for patients at every phase of the treatment journey.
MD Anderson is my hope. I know that without it, I wouldn’t be alive today.