Acute lymphoblastic leukaemia

What is acute lymphoblastic leukaemia?

Acute lymphoblastic leukaemia, or ALL, occurs when the genetic material of cells in the bone marrow become damaged or changed, producing mutations that affect normal cell growth and division. The abnormal cells then replicate, causing cancer. If undetected, the cancer can spread beyond the bone marrow and move to other parts of the body.

Around 8,600 people are diagnosed with leukaemia each year in the UK. Despite being uncommon overall, acute lymphoblastic leukaemia is the most common type of cancer to affect children. Approximately one in every 2,000 children will develop it. About 85% of cases occur in children aged under 15, mostly between the ages of two and five years old.

Risks and causes of acute lymphoblastic leukaemia?

The cause or causes of acute leukaemia are uncertain, but known risk factors include exposure to high levels of radiation, genetic disorders such as Down’s Syndrome, obesity, having a weakened immune system or previous chemotherapy treatment.

Symptoms of acute lymphoblastic leukaemia?

Symptoms of ALL usually begin slowly before rapidly getting severe as the number of blast cells (immature white blood cells) in your blood increases. Most of the symptoms are caused by the lack of healthy blood cells in your blood supply. Symptoms of acute lymphoblastic leukaemia include:

• Pale skin
• Easily bruised skin
• Bone pain
• Feeling tired and breathless
• Having repeated infections over a short space of time
• Unusual and frequent bleeding, such as bleeding gums or nose bleeds
• Swollen lymph nodes (glands)
• Abdominal pain – caused by a swollen liver or spleen
• Unexplained weight loss
• A purple skin rash (purpura)

In some cases of ALL, the affected cells can spread from your bloodstream into your central nervous system. This can cause a series of neurological symptoms.

If any of these symptoms apply to you, or if you have any concerns about similar symptoms, it is essential that you see your doctor at once, as your chances of recovery are much higher if your cancer is diagnosed early.

How is acute lymphoblastic leukaemia diagnosed?

There are a number of different tests for ALL, including:

• Blood test: to check for a high number of abnormal white blood cells in the sample, which could indicate the presence of acute leukaemia
• Bone marrow biopsy: a haematologist will take a small sample of bone marrow to examine under a microscope. This involves inserting a needle into a large bone, usually the hip bone, to extract the marrow, and is done under local anaesthetic
• CT scan: which shows a 3D image of the area being looked at
• X-ray: which is when low-level radiation is used to create an image of the body
• Lumbar puncture: a needle is used to extract a sample of cerebrospinal fluid (fluid that surrounds and protects your spine) from your back. The fluid is tested to determine whether the leukaemia has reached your nervous system, and this test is carried out using local anaesthetic

Acute lymphoblastic leukaemia treatment

Patients with ALL are treated by a team of different specialists, called a multidisciplinary team. This team works together to create a treatment plan to suit the individual needs of the patient. Treatment for ALL usually begins a few days after diagnosis, and is carried out in the following stages:

• Induction – the aim of the initial stage of treatment is to kill the leukaemia cells in your bone marrow, restore the balance of cells in your blood and resolve any symptoms you may have
• Consolidation – this stage aims to kill any remaining leukaemia cells in your central nervous system
• Maintenance – the final stage involves taking regular doses of chemotherapy tablets to prevent the leukaemia from returning