Acute Lymphoblastic Leukemia (ALL)

Also called: acute lymphocytic leukemia, acute lymphoid 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 acute lymphoblastic leukemia?

  • About 98 percent of children with ALL go into remission within weeks after starting treatment.
  • About 90 percent of those children can be cured. Patients are considered cured after 10 years in remission.

Why choose St. Jude for your child’s ALL treatment?

  • St. Jude is the only National Cancer Institute-designated Comprehensive Cancer Center devoted solely to children.
  • St. Jude has created more clinical trials for cancer than any other children’s hospital in the United States.
  • The nurse-to-patient ratio at St. Jude is unmatched—averaging 1:3 in hematology and oncology, and 1:1 in the Intensive Care Unit.
  • The hospital’s leukemia studies have pioneered the way the world treats childhood leukemia.
  • St. Jude patients with ALL have a 94 percent survival rate, the best worldwide outcomes for that disease.
  • St. Jude was the first hospital in the U.S. to remove cranial irradiation from treatment for ALL (and, later, for acute myeloid leukemia and non-Hodgkin lymphoma) without harming survival rates.
  • St. Jude researchers found unexpected genetic changes in a deadly type of childhood leukemia called ETP-ALL that could change diagnosis and treatment for children with this disease. The finding was made possible by the St. Jude Children’s Research Hospital-Washington University Pediatric Cancer Genome Project. This project is uncovering the genetic basis for some of the deadliest childhood cancers.
  • St. Jude pioneered outpatient clinical trials for children with leukemia, reducing the need for inpatient stays.

Acute Lymphoblastic Leukemia (ALL) Clinical Trials

ALLR18: Therapy for Pediatric Relapsed or Refractory Precursor B-Cell Acute Lymphoblastic Leukemia and Lymphoma

A Phase II Study of Therapy for Pediatric Relapsed or Refractory Precursor B-Cell Acute Lymphoblastic Leukemia and Lymphoma

Diseases Treated:

Relapsed or refractory precursor B-cell acute lymphoblastic leukemia and lymphoma

Eligibility:

  • B-cell acute lymphoblastic leukemia or lymphoblastic lymphoma that has:
    • Come back after treatment the first time
    • Did not respond to treatment the first time
  • Less than 22 years of age
  • Does not have HIV or hepatitis B infection
View Trial

DVALL: Leukemia Lymphoma Clinical Trial: A Pilot Study of Decitabine and Vorinostat With Chemotherapy for Relapsed ALL

A Pilot Study of Decitabine and Vorinostat with Chemotherapy for Relapsed ALL (TACL protocol T2009-003)

Diseases Treated:

Relapsed ALL

Eligibility:

  • Participant is equal to or greater of 1 year of age and less or equal to 25 years of age at the time of study enrollment. 
  • Participant has a diagnosis of acute lymphoblastic leukemia (ALL) with > 25% blasts in the bone marrow (M3), with or without extramedullary disease.
  • Participants may have CNS 1, 2 or 3 disease.
View Trial

NHL16: Study for Newly Diagnosed Patients with Acute Lymphoblastic Lymphoma

Combination Chemotherapy in Treating Younger Patients with Newly Diagnosed Acute Lymphoblastic Lymphoma

Diseases Treated:

Acute lymphoblastic leukemia

Eligibility:

  • 21 years of age or younger
  • Newly diagnosed lymphoblastic lymphoma
  • Has received one week or less prior treatment for lymphoblastic lymphoma
View Trial

PANSTAT: A Study Of Panobinostat In Children With Refractory Hematologic Malignancies

A Phase I Dose Finding Study Of Panobinostat In Children With Refractory Hematologic Malignancies

Diseases Treated:

Relapsed acute lymphoblastic leukemia [ALL], acute myelogenous leukemia [AML], Hodgkin disease [HD] and non-Hodgkin’s lymphomas [NHL]

Eligibility:

  • Patient must be greater than 1 and less than or equal to 21 years of age at the time of enrollment;
  • Patients will be excluded if they have significant concurrent disease, illness, psychiatric disorder or social issue that would compromise patient safety or compliance, interfere with consent, study participation, follow up, or interpretation of study results.
  • Patients with known positivity for human immunodeficiency virus (HIV) or hepatitis C; baseline testing for HIV and hepatitis C is not required.
View Trial

SELHEM: Selinexor With Fludarabine and Cytarabine for Treatment of Refractory or Relapsed Leukemia or Myelodysplastic Syndrome

Phase I/II Study of the Selective Inhibitor of Nuclear Export Selinexor (KPT-330) in Combination with Fludarabine and Cytarabine in Patients with Refractory or Relapsed Leukemia or Myelodysplastic Syndrome

Diseases Treated:

Relapsed or refractory leukemia or hematologic malignancies

Eligibility:

  • Up to 21 years of age
  • Acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), myelodysplastic syndrome (MDS) or mixed phenotype acute leukemia (MPAL) that has come back or did not respond to previous treatment
  • No history of HIV infection
View Trial

TOTXVI: Total Therapy Study XVI For Newly Diagnosed Patients With Acute Lymphoblastic Leukemia

Diseases Treated:

Acute Lymphoblastic Leukemia

Eligibility:

  • 18 years of age or younger
  • Newly diagnosed acute lymphoblastic leukemia (ALL)
View Trial

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