Acute lymphoblastic leukaemia information

Acute lymphoblastic leukaemia (ALL) is a form of cancer that affects the lymphocyte-producing cells in the bone marrow. The leukaemia is termed ‘acute’ because it develops quickly. 

In this section

Lymphocytes are white blood cells that produce antibodies and are vital parts of the body’s immune system. When a patient develops ALL, there is an accumulation in the bone marrow of immature lymphocyte precursor cells, called blast cells. Eventually the production of normal blood cells is affected by this, resulting in a reduction in the numbers of red cells, normal white cells and platelets in the blood.

ALL is the only form of leukaemia that is more common in children than adults. It is the single most common form of paediatric cancer accounting for about one-third of all cases in children. About 85% of cases of childhood leukaemia are ALL, which occurs in about 400 children in the UK each year. The peak incidence of ALL occurs between the ages of about two and four years. Males are affected more often than females at all ages.

While this type of leukaemia is much more common in children than in adults, some 10% to 20% of new cases are in people over the age of ten years.

The following information relates to adults with ALL.

Symptoms

Many of the symptoms are related to the fact that the leukaemia cells multiply in the bone marrow and stop the production of healthy blood cells. Common symptoms include:

  • tiredness
  • pallor (pale skin)
  • bruising
  • fever and infection
  • swollen glands
  • limb pains.

Diagnosis

A series of tests or investigations will be done to confirm or rule out a diagnosis of acute lymphoblastic leukaemia (ALL) and to check on your general health. These tests may include:

Blood tests

The results will show if there are any leukaemia cells in the bloodstream and how the other blood cells are affected.

Chest X-ray

The image will tell show whether any of the lymph nodes in the chest are enlarged.

Bone marrow sample

In order to confirm what type of leukaemia you have and to plan your treatment, it is necessary to examine a small sample of bone marrow. This is normally taken from your hip bone and is examined under a microscope to determine whether abnormal white blood cells are present and if so what type they are.

The process is conducted under local anaesthetic and is not painful, although some patients find it uncomfortable. The procedure will be explained to you before it is carried out and you will be able to ask any questions or raised any concerns you might have.

Lumbar puncture

A lumbar puncture is a procedure that uses a small needle to take a sample of your spinal fluid. The process is conducted under a local anaesthetic and is not painful. The procedure will be explained to you before it is carried out.

Treatment

Adult patients with a diagnosis of acute lymphoblastic leukaemia require an intensive treatment plan. Your treatment plan will be fully explained to you by your consultant or clinical nurse specialist. It may take the form of chemotherapy given to you over a few cycles with the aim of controlling your leukaemia.

Chemotherapy

Chemotherapy means treatment with anti-cancer drugs, which destroy cells by damaging them so that they can't divide and grow. Normal cells recover quickly, the leukaemia cells do not. As the drugs circulate in the blood, they reach leukaemia cells all over the body.

Chemotherapy is normally given as tablets to be swallowed or intravenously into your arm over several weeks or months.

Stem cell transplant

You may be offered high-dose chemotherapy which is intensive treatment. In addition to destroying leukaemia cells, this treatment will also destroy healthy bone marrow cells. A peripheral stem cell transplant will give you a source of healthy bone marrow that will produce normal white blood cells.

If a transplant forms part of your treatment, your consultant and clinical nurse specialist will explain the procedure in more detail and discuss the benefits and side effects with you.

After treatment

Having acute lymphoblastic leukaemia (ALL) and being treated for it will have an effect on your life.

Checkups

Treatment for ALL, as with other leukaemia, is very effective and can control the condition and the symptoms you experience for many years.

After your treatment is finished you will continue to be monitored with regular checkups and blood tests. If you notice new symptoms or have any concerns about your health between appointments, contact your doctor.

Sex and fertility

Some chemotherapy drugs can damage the ovary or testes, leading to an increased risk of infertility and, in women, early menopause.

Chemotherapy may affect sexual organs or functions in various ways. You may experience changes in your desires or desired level of sexual activity or you may notice no difference. Loss of libido (sex drive) is not uncommon in both women and men. However, chemotherapy in itself doesn’t usually affect sexual performance or cause impotence.

Fatigue

During your treatment you may start to feel tired and listless. This may be general fatigue or it may be that you become tired more easily after normal activities. This is quite normal and usually occurs with leukaemia and its treatments.

Do talk about how you are feeling with your consultant or clinical nurse specialist. They will be able to suggest ways of conserving your energy or may be able to treat the causes of your tiredness, such as not being able to sleep or anaemia.

If you are at home, try to plan your day so that light activities are spaced between more energetic activities. Do get enough rest and only do what you feel you can cope with.

People will often be willing to lend their support. If you get tired easily, limit your activities and conserve your energy for the things that mean the most to you. Ask your family and friends to help with household chores.