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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% of children with ALL go into remission within weeks after starting treatment.
  • About 90% 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% survival rate.
  • 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.

Associated Clinical Trials

ALTE1631: Web-based Exercise Study for Children and Adolescents with Cancer

Web-based Physical Activity Intervention among Children and Adolescents with Cancer

Diseases Treated:

leukemia, solid tumor, brain tumor, lymphoma, carcinoma


This is a non-therapeutic clinical trial open to patients receiving treatment at a Children’s Oncology Group (COG)-affiliated institution.

  • At least 8 years old and younger than 16 years old
  • Diagnosed with childhood cancer, in remission
  • Completed therapy within the past 12 months
  • Performance status corresponding to ECOG scores of 0, 1, 2
  • Fewer than 420 minutes of moderate to vigorous physical activity (MVPA) over the last week
  • Able to write and read English, Spanish or French (patient and at least one parent/guardian)
  • Not pregnant
View Trial

CN160: Ruxolitinib Therapy in Children after Bone Marrow Transplant

A Phase II Pediatric Study of a Graft-vs.-host disease (GVHD) prophylaxis regimen with no calcineurin inhibitors after day +60 post first allogeneic hematopoietic cell transplant for hematological malignancies

Diseases Treated:


  • Ages 12–21 years
  • Lymphoid or myeloid-based cancer that requires a bone marrow transplant


View Trial

DIRECT70: CAR T–Cell Therapy for Children with Blood Malignancies

CAR T–Cell Therapy Directed to CD70 for Pediatric Patients with Hematological Malignancies (DIRECT70)

Diseases Treated:



  • Up to 21 years old
  • CD70+ acute myeloid leukemia, acute lymphoblastic leukemia (B-ALL, T-ALL), lymphoma, or myelodysplastic syndrome
  • If prior allogeneic hematopoietic cell transplant, no graft vs. host disease
  • Has an identified hematopoietic cell transplantation donor
  • Has adequate organ function
View Trial

DSCOG: Learning, Behavior and Social Skills in Survivors of Childhood Leukemia with Down syndrome

Neurocognitive and Psychosocial Outcomes in Survivors of Childhood Leukemia with Down syndrome

Diseases Treated:



This is a non-therapeutic clinical trial that is open only to patients who were treated at St. Jude Children’s Research Hospital since 1980 and are currently followed at the hospital.

  • St. Jude Children’s Research Hospital patient with acute leukemia (i.e., ALL or AML)
  • Trisomy 21 Down syndrome diagnosis
  • Completed all cancer therapy at St. Jude since 1980 and at least six months prior to study visit
  • English as the primary language
View Trial

G4K: Genomes for Kids

Next Generation Sequencing of Normal Tissue Prospectively in Pediatric Oncology Patients

Diseases Treated:



This is a non-therapeutic clinical trial that is open to St. Jude patients.

  • Solid tumor or liquid tumor (cancerous or non-cancerous)
View Trial

HAP2HCT: Partially Matched Family Donor Bone Marrow Transplant in Children and Young Adults with High Risk Cancer

TCRαβ-depleted Progenitor Cell Graft with Additional Memory T-Cell DLI, plus Selected Use of Blinatumomab, in Naïve T-Cell depleted Haploidentical Donor Hematopoietic Cell Transplantation for Hematologic Malignancies

Diseases Treated:


For transplant recipient:

  • 21 years or younger
  • Does not have a suitable sibling donor or volunteer unrelated donor
  • Has a suitable single haplotype matched family member donor
  • Diagnosed with high risk hematologic malignancy
  • No prior allogeneic hematopoietic cell transplant
View Trial

HAPNK1: Blood and Marrow Transplant (BMT) for Children with Leukemia/Lymphoma

Haploidentical Donor Hematopoietic Progenitor Cell and Natural Killer Cell Transplantation with a TLI-Based Conditioning Regimen in Patients with Hematologic Malignancies

Diseases Treated:

Leukemia and lymphoma


  • 21 years and younger
  • Does not have a suitable HLA-matched sibling donor or volunteer HLA-matched unrelated donor or is not a candidate for conventional matched donor transplant due to refractory disease
  • Has a suitable single haplotype-matched family member donor
  • High-risk hematologic malignancy, including certain diagnoses of:
    • Acute lymphoblastic leukemia (ALL)
    • Acute myeloid leukemia (AML)
    • Chronic myelogenous leukemia (CML)
    • Myelodysplastic syndrome (MDS)
    • Hodgkin lymphoma
    • Non-Hodgkin lymphoma
View Trial

INOMRD: Inotuzumab Ozogamicin for Children with High-Risk B-Cell ALL

Inotuzumab Ozogamicin for Children with MRD Positive CD22+ Acute Lymphoblastic Leukemia

Diseases Treated:

Acute lymphoblastic leukemia


  • Younger than 22 years old
  • Diagnosis of B-cell acute lymphoblastic leukemia (B-ALL) with minimal residual disease (MRD) between 0.1 and 4.99% after prior chemotherapy, relapse or stem cell transplant
View Trial

MEMCAR19: Allogeneic CAR T-Cell Therapy for Relapsed/Refractory CD19-Positive Leukemia

Phase I Study Evaluating Allogeneic Memory T Cells Engineered to Express Chimeric Antigen Receptors Specific for CD19 for the Treatment of Pediatric and Young Adult Patients with Relapsed or Refractory CD19-positive Leukemia

Diseases Treated:

Acute lymphoblastic leukemia


Donor eligibility includes:

  • At least 18 years old
  • At least single haplotype matched family member
  • HIV negative
  • Not pregnant or breastfeeding
  • Completed the process of donor eligibility determination as defined in the study


Recipient eligibility includes:

  • 21 years old or younger*
  • Diagnosed with relapsed and/or refractory CD19-positive leukemia (as defined in the study)
  • Cohort A only – Relapsed and/or refractory CD19-positive leukemia AND previously received a hematopoietic cell transplant from the selected CAR-T donor
  • Cohort B only: Can not receive autologous CD19-CAR T-cell therapy (as defined in the study)
  • Detectable CD19+ leukemia in the bone marrow
  • Adequate organ function (as defined in the study)

* Initial 3 participants must be at least 12 years old.

View Trial

NCBP01: Safety Study of Unlicensed, Investigational Cord Blood Units Manufactured by the NCBP for Unrelated Transplantation

A Multicenter Safety Study of Unlicensed, Investigational Cryopreserved Cord Blood Units (CBUs) manufactured by the National Cord Blood Program (NCBP) and provided for Unrelated Hematopoietic Stem Cell Transplantation of Pediatric and Adult Patients

Diseases Treated:

Leukemia and other blood diseases


This is a non-therapeutic clinical trial that is only open to St. Jude patients.

  • Participant is receiving an allogeneic hematopoietic stem cell (HSC) transplant at St. Jude Children's Research Hospital using an unlicensed cord blood unit (CBU).
  • Participant may be of any age and either gender.
  • Participant has a medical disorder affecting the hematopoietic system that is inherited, acquired, or a result from myeloablative treatment.
  • Participant is receiving HPC-CORD BLOOD product manufactured by NCBP (at least one, if the graft contains more than one units).
View Trial

PAINBDY1: Treating Pain in Children with Cancer: Pain Buddy

Treating Pain in Children with Cancer: A 21st Century Innovative Approach (Pain Buddy)

Diseases Treated:

Endocrine Tumors
Ewing Sarcoma


This is a research study open only to St. Jude patients and their caregivers.

  • 8 to 18 years old
  • Within 16 weeks of initial cancer diagnosis
  • Receiving outpatient chemotherapy treatment for cancer
  • Can speak, read and write English. Parents who can speak, read, and write in English and Spanish
  • Have Internet access
View Trial

RAVEN: Clinical Trial to Treat Relapsed Acute Lymphoblastic Leukemia with Venetoclax and Navitoclax

A Phase I/II Trial Treating Relapsed Acute Lymphoblastic Leukemia with Venetoclax and Navitoclax

Diseases Treated:

Acute Lymphoblastic Leukemia and Lymphoma


  • Diagnosed with relapsed or refractory acute lymphoblastic leukemia or lymphoma
  • Between 4 and 22 years old
  • Weigh more than 20 kg (44.09 lbs.)
  • Able to swallow pills
  • No prior exposure to navitoclax
  • Fully recovered from effects of any prior treatment


View Trial

REF2HCT: Haploidentical Bone Marrow Transplant for Leukemia and Lymphoma

Provision of TCRγδ T Cells and Memory T Cells plus Selected Use of Blinatumomab in Naïve T-cell Depleted Haploidentical Donor Hematopoietic Cell Transplantation for Hematologic Malignancies Relapsed or Refractory despite Prior Transplantation

Diseases Treated:


  • 21 years old and younger
  • Diagnosed with one of the following that has come back or did not improve after bone marrow transplant
    • Acute lymphoblastic leukemia (ALL)
    • Acute myeloid leukemia
    • Myeloid sarcoma
    • Chronic myeloid leukemia (CML)
    • Juvenile myelomonocytic leukemia (JMML)
    • Myelodysplastic syndrome (MDS)
    • Non-Hodgkin lymphoma (NHL)
  • Has a family member who is a suitable stem cell donor
View Trial

SJCAR19: CAR T-Cell Therapy for Children and Young Adults with Acute Lymphoblastic Leukemia

A Phase I/II Study Evaluating CD19-Specific CAR Engineered Autologous T-Cells in Pediatric and Young Adult Patients with Relapsed or Refractory CD19+ Acute Lymphoblastic Leukemia

Diseases Treated:

Acute lymphoblastic leukemia




View Trial

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