Disease Information

Leukemias / Lymphomas: Acute Lymphoblastic Leukemia (ALL)

Alternate Names: ALL, acute lymphocytic leukemia, acute lymphoid leukemia

Definition

Acute lymphoblastic leukemia (ALL) is the most common form of childhood cancer. It affects lymphocytes, a type of white blood cells. Leukemic cells accumulate in the bone marrow, replace normal blood cells and spread to other organs including liver, spleen, lymph nodes, central nervous system, kidneys and gonads.

Incidence

In the United States, about 3,000 children each year are found to have acute lymphoblastic leukemia. Peak incidence occurs from 3 to 5 years of age.

Influencing Factors

ALL affects slightly more boys than girls. It occurs more frequently among whites than blacks. Although siblings of leukemic children have a slightly higher risk of developing the disease, the incidence is relatively low (no more than one in 500).

Survival Rates

About 98 to 99 percent of children with newly diagnosed acute lymphoblastic leukemia attain initial complete remissions (absence of detectable leukemic cells by microscopic examination) in four to six weeks. About 90 percent of children can be cured. Patients who remain leukemia-free for 10 years or more can be considered cured.

Treatment Strategies

Chemotherapy is used to kill leukemia cells. All chemotherapy is stopped after two to three years of treatment. Radiation therapy, which used to be a standard component of leukemia treatment, can now safely be eliminated for the majority of children with ALL. Hematopoietic stem cell transplantation is an option for very high-risk cases (e.g., Philadelphia chromosome-positive ALL or slow responders to remission induction therapy) or those who develop an early relapse in the bone marrow.

Current Research

• Research aims to improve treatment outcome by optimizing dosage and scheduling of antileukemic agents based on the individual patient’s leukemic cell genetic features and host normal cell pharmacogenetics characteristics.
• Molecular genetic abnormalities and the measurement of the level of minimal residual leukemia after remission induction therapy are used to help direct the type of treatment. Research on the profile of gene and protein expression in leukemia cells using microarray technology is providing new insights to the genomics of leukemia and the effects of treatment; this research may lead to unique molecular targets for developing new therapies that are more specific and effective. Pharmacogenomic studies are providing new insights to inherited differences in drug response and to individualize treatment.
• Methods are under study to improve the efficacy and safety of stem cell transplantation and to increase the number of potential of donors.
• Use of novel agents in children at a high risk of relapse.
• Development of effective treatment regimens for relapsed ALL.

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