Acute Lymphoblastic Leukemia

Acute Lymphoblastic Leukemia

What is Acute Lymphoblastic Leukemia?

Acute lymphoblastic leukemia (ALL) is a cancer that starts in blood stem cells. Stem cells are basic cells that transform into different types of cells that have distinct functions. As they develop, the blood stem cells become blast cells (blasts), which are immature blood cells. In the case of leukemia, there is an overproduction of blast cells. These blast cells develop abnormally and do not become mature blood cells. The Cells Blood Cells, the Blue Cells Normal, thus preventing them from performing their tasks. When diagnosed with leukemia, these cells may be called leukemic cells.

Lymphoid leukemia (also known as lymphoblastic leukemia) originates in abnormal lymphoid stem cells. Lymphoid stem cells normally transform into lymphocytes, a type of white blood cell. Lymphocytes are found in the blood and in different parts of the lymphatic system, including the lymph nodes and the spleen. The 3 types of lymphocytes are B lymphocytes, T lymphocytes and natural killer cells (NK). Lymphocytes help fight infections and destroy abnormal cells.

Acute Lymphoblastic Leukemia

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Some cases of ALL are associated with the mutation of a lymphocyte occurring during the prenatal period (in utero). Leukemia is usually diagnosed during infancy or in the first years after birth. However, some cases may take several years to appear. According to the experts, it seems that in some cases other genetic abnormalities that occur after birth may combine to trigger the ALL.

Types of leukemia

There are several types of leukemia. They can be classified according to the speed of evolution of the disease (acute or chronic) and according to the stem cells of the bone marrow from which they develop (myeloid or lymphoblastic). Leukemia usually refers to cancers of white blood cells (lymphocytes and granulocytes, the cells responsible for immunity), although some very rare cancers can affect red blood cells and platelets.

Acute leukemia

Abnormal blood cells are immature (= blasts). They do not perform their normal function and multiply rapidly so that the disease evolves quickly too. The treatment must be aggressive and applied as soon as possible.

Chronic leukemia

The cells involved are more mature. They multiply more slowly and remain functional for a certain time. Some forms of leukemia may go unnoticed for several years.

Myeloid leukemia

It affects granulocytes and blood stem cells present in the bone marrow. They make abnormal white blood cells (myeloblasts). There are two types of myeloid leukemia:

Acute myeloid leukemia (AML)

This form of leukemia begins suddenly, often in a few days or weeks.

AML is the most common form of acute leukemia in adolescents and young adults.

AML can occur at any age, but is more likely to develop in adults 60 years of age and older.

Chronic myeloid leukemia (CML)

Chronic myelogenous leukemia is also called chronic myelocytic leukemia or chronic granular leukemia. This type of leukemia develops slowly, over months or even years. The symptoms of the disease are manifested as the amount of leukemic cells in the blood or bone marrow increases.

It is the most common form of chronic leukemia in adults between 25 and 60 years old. It sometimes requires no treatment for several years.

Lymphoblastic leukemia

Lymphoblastic leukemia affects lymphocytes and produces lymphoblasts. There are two types of lymphoblastic leukemia:

Acute Lymphoblastic Leukemia (ALL)

This form of leukemia begins suddenly and evolves rapidly in a few days or weeks.

Also called acute lymphocytic leukemia or acute lymphocytic leukemia, this is the most common form of leukemia in young children. There are several subtypes of this form of leukemia.

Chronic lymphoblastic leukemia (CLL)

This form of leukemia most often affects adults, especially between 60 and 70 years. Affected individuals may have no or very few symptoms for years, and then have a phase in which the leukemic cells grow rapidly.

Acute Lymphoblastic Leukemia

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Causes of leukemia

The causes of leukemia are still poorly understood. Scientists agree that the disease is a combination of genetic and environmental factors.


In Canada, one in 53 men and one in 72 women will develop leukemia in their lifetime. In 2013, an estimated 5800 Canadians will be affected. (Canadian Cancer Society)

In France, leukemia affects around 20,000 people each year. Leukemia accounts for about 29% of childhood cancers, 80% of which are acute lymphoblastic leukemias (ALL).

Diagnosis of leukemia

Blood test. The analysis of a blood sample can detect whether the levels of white blood cells or platelets are abnormal, suggesting leukemia.

Biopsy of the bone marrow. A bone marrow sample removed from the hip can detect certain characteristics of leukemic cells that can then provide options for the treatment of the disease.

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Treatments of Acute Lymphoblastic Leukemia

If you have acute lymphoblastic leukemia (ALL) It will be based on your needs and could move to the combination of different treatments. When your healthcare team decides what treatments you offer for LAL, they take the following into consideration:

your age

the presence of changes, or abnormalities, chromosomes

the subtype of leukemia

your overall health

Treatment options

The following treatments can be proposed for LAL.


The main treatment for ALL is chemotherapy for a long time. The treatment is usually divided into 3 phases, induction, consolidation and maintenance. In general, the total duration of treatment is 2 to 3 years.

Central nervous system (CNS) prophylaxis plays an important role in the treatment of ALL because we want to make sure that leukemia does not spread to the fluid around or inside the brain or brain. spinal cord, cerebrospinal fluid (CSF), or will not remain there.

Targeted treatment

People with Philadelphia chromosome-positive ALL (Ph + ALL) often receive a drug called tyrosine kinase inhibitor as part of their chemotherapy. A new targeted therapy could be given to some people with Philadelphia-chromosome-free ALL (Ph-LAL).


Radiation therapy can be proposed for the treatment of ALL:

to prevent or treat the spread of ALL to the central nervous system (CNS);

in preparation for a stem cell transplant;

to relieve pain where leukemia has spread to bone (if chemotherapy has not been effective).

Radiotherapy is also sometimes used to reduce the size of the tumor if it puts pressure on the trachea or other vital organs.

Stem cell transplant

A stem cell transplant can be offered to people with ALL while they are in remission. It is also used after a recurrence if we can achieve a complete or partial remission.

Stem cell transplantation and chemotherapeutic agents used in transplant preparation can cause serious side effects, so not all people are able to receive this treatment. Reduced intensity grafting may be an option for some.

Support treatment

Supportive therapy is used to control the complications that usually occur because of the treatment of ALL and the disease itself. These are among others:

antibiotics, antivirals or antifungals to prevent or control infections;

transfusions of blood products to replace low blood cells;

growth factors, such as filgrastim (Neupogen), to induce the body to produce white blood cells;

medicines to reduce high levels of certain chemicals in the blood that increase when many cancer cells die at the beginning of treatment (tumor lysis syndrome);

leukapheresis to remove a lot of white blood cells.

Response to treatment

Knowing how well leukemia responds to treatment helps doctors establish the prognostic risk category and plan for future care. The goal of treatment is to achieve complete remission.

A complete remission, or complete response, means that the number of blood cells (red blood cells, white blood cells and platelets) is normal again and that less than 5% of the cells in the bone marrow are immature white blood cells (blast cells, or blasts). There are no general signs or symptoms of ALL, nor any sign or symptom indicating that ALL has spread to the brain or spinal cord (central nervous system, or CNS) or elsewhere in the body.

Minimal residual disease (MRD) means that there are blasts in the bone marrow, but they can only be observed using highly sensitive tests such as flow cytometry and polymerase chain reaction (PCR) . It is not possible to detect blasts with standard tests such as observation of cells under the microscope.

Active disease means that the disease is still present during treatment or has reappeared (recurrence) after treatment. When the disease is active, more than 5% of the cells in the bone marrow are blasts.


Post-treatment follow-up is an important component of caring for people with cancer. You will need regular follow-up visits, especially during the first 5 years after treatment, even if there is no sign of illness. The interval between exams will increase over time, but you will need to take follow-up exams for a long time. These visits allow the care team to monitor your progress and find out how you are recovering from the treatment.

Clinical tests

Some clinical trials on ALL are underway in Canada and accept participants. Clinical trials aim to find new, better methods for cancer prevention, detection and treatment. Learn more about clinical trials

Questions to ask about treatment

In order to make the right decisions for you, ask questions about treatment to your team.

Acute Lymphoblastic Leukemia

Please if you have any questions about Acute Lymphoblastic Leukemia, you can ask us by commenting below this text, we'll answer you as soon as possible.

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