Acute lymphoblastic leukemia

Acute lymphoblastic leukemia (ALL) is also called acute lymphocytic leukemia. It's a type of leukemia that causes the body to make too many lymphoblasts.

Lymphoblasts are a type of young white blood cell. They usually become mature infection-fighting cells called lymphocytes. But if those young cells don't mature like they should, they can become leukemia cells. These leukemia cells grow out of control in the bone marrow, crowding out normal blood-making cells. The leukemia cells can make their way into the blood and travel to other parts of the body. This causes swollen glands, lumps, and other problems.

Symptoms of ALL in children and adults include:

• Fever.
• Weakness.
• Paleness.
• Headaches.
• Feeling tired.

Other symptoms include:

• Bruising or bleeding easily.
• Pinpoint spots under the skin from bleeding.
• Bone pain.
• Painless lumps in the neck, armpit, stomach, or groin.
• Losing weight for no clear reason.

Your doctor will ask you about any current symptoms, your medical history, and your family history. You'll have a physical exam, where your doctor will check your lymph nodes, liver, and spleen to feel if they are larger than normal.

You'll have tests, which may include:

• Lab tests, including a complete blood count.
• Imaging tests, such as a CT scan, an MRI, or an X-ray.
• A lumbar puncture, to find out if leukemia cells are in the fluid in your spine.
• Tissue tests, such as a bone marrow aspiration and biopsy.
• Genetic tests that look for changes in your genes and chromosomes.

If the exam and test results point to leukemia, the doctor may do more tests on the blood or bone marrow samples to learn more about the type or subtype of the leukemia.

Most treatment plans for acute lymphoblastic leukemia (ALL) have three steps.

1. Induction therapy. This kills leukemia cells in the blood and bone marrow to induce remission.
2. Consolidation therapy. This kills any leukemia cells that might remain after induction.
3. Maintenance therapy. This helps prevent relapse.

Treatments may include:

• Chemotherapy.
• Medicines, such as corticosteroids.
• Radiation, including preventive treatment of the brain or spinal cord.
• Chemotherapy with stem cell transplant.
• Targeted therapy. This is used to treat people with ALL who have the Philadelphia chromosome.
• Immunotherapy, such as monoclonal antibodies and chimeric antigen receptor T (CAR-T) cell therapy.

Treatments for ALL have improved greatly over time. But treatment may take several years to complete.

A clinical trial may be a good choice. Your medical team can tell you if there's a clinical trial that might be right for you.

• Have your child take any medicines exactly as prescribed. Call your doctor if you think your child is having a problem with a medicine. Your child may get medicine for nausea and vomiting.
• Give your child healthy food. If your child does not feel like eating, serve food that has protein and calories to keep up your child's strength and weight. Try a liquid meal replacement for extra calories and protein. Milk shakes are also good choices. Your child's appetite may be better early in the day. Try giving your child the main meal early.
• Let your child have plenty of time to play during the day. Cancer treatment can be hard, but children still need to feel like kids.
• Put your child to bed early enough to get plenty of rest.
• Give your child lots of fluids. This is very important if your child is vomiting or has diarrhea. Give your child sips of water or drinks such as Pedialyte or Infalyte. These drinks contain a mix of salt, sugar, and minerals. You can buy them at drugstores or grocery stores. Give these drinks as long as your child is throwing up or has diarrhea. Do not use them as a sole source of liquids or food for more than 12 to 24 hours. Call your doctor if diarrhea or vomiting lasts longer than a day.
• When your child is feeling better, offer clear soups, mild foods, and liquids until all symptoms are gone for 12 to 48 hours. Other good choices include dry toast, crackers, cooked cereal, and gelatin dessert, such as Jell-O.
• Try to keep your child away from people who have a cold, the flu, or other diseases that can be spread. Wash your hands often.