Leukaemia is a cancer of the white blood cells, which help fight infection in the body. Normally, white blood cells develop, repair and reproduce themselves in an orderly and controlled way but in leukaemia cells, the process gets out of control.
ALL is a cancer of immature lymphocytes, called lymphblasts or blast cells. There are two different types of lymphocytes: T-cells and B-cells. Often, leukaemia occurs at a very early stage in the immature lymphocytes, before they have developed into either T-cells or B-cells. However, if the cells have developed this far before becoming leukaemic, the type of leukaemia may be known as T-cell or B-cell leukaemia.
Watch Dr Mike Gattens, Consultant Haematologist, talk about acute lymphoblastic leukaemia (ALL).
The exact cause of ALL is unknown and research is going on all the time into possible causes of this disease. Children with certain genetic disorders, such as Down's syndrome or Li-Fraumeni syndrome, are known to have a higher risk of developing leukaemia.
Brothers and sisters of a child with ALL have a slightly increased risk of developing ALL themselves, although this risk is still very small.
Like all cancers, ALL is not infectious and cannot be passed on to other people. It is important to remember that nothing you have done has caused your child’s cancer.
As the leukaemia cells multiply in the bone marrow, the production of normal blood cells is reduced. Children may:
- become tired and lethargic
- develop bruises
- take longer to stop bleeding
- have bleeding gums or heavy nosebleeds
- have a purplish rash on the skin that does not disappear when you press a glass against it
- have infections
- develop fevers and sweating, especially at night
- have swollen lymph glands
At first, the symptoms may be like those of a viral infection. This can make it hard to diagnose but over time the diagnosis usually becomes clear.
A variety of tests and investigations may be needed to diagnose ALL. A blood test usually shows low numbers of normal white blood cells and the presence of the abnormal leukaemia cells. A sample of bone marrow is usually needed to confirm the diagnosis. A sample is also tested to look for any abnormal genetic changes and measurable residual disease (MRD) analysis.
A test called a lumbar puncture is done to see if the spinal fluid contains any leukaemia cells. A chest X-ray is also done, which will show if there are any enlarged glands in the chest. Other tests may be necessary, depending on your child’s symptoms.
These tests will help to identify the precise type of leukaemia and help doctors decide on the best treatment. Any tests and investigations your child needs will be explained to you.
The aim of treatment for ALL is to destroy the leukaemia cells and enable the bone marrow to work normally again. Chemotherapy is the main treatment for ALL which uses anti-cancer drugs to destroy cancer cells. It is given according to a treatment plan (often called a protocol or regimen). The treatment is given in several phases, or ‘blocks’, which are explained below.
Depending on a number of factors including your child’s age, initial white blood cell count, genetic changes in the leukaemia cells and response, they will be assigned to a specific treatment group. The first six months or so involve more intensive treatment, followed by a lower intensity phase. The majority of treatment will be given as an outpatient, usually in a dedicated Day Case Unit.
This phase involves intensive treatment, aimed at destroying as many leukaemia cells as possible and is usually started within days of being diagnosed. The induction phase lasts 4 to 6 weeks. A bone marrow test is taken at the end of induction treatment to confirm whether or not your child still has leukaemia. The sample that is taken is looked at under a microscope and when there is no evidence of leukaemia, your child’s condition is referred to as being in ‘remission’.
During induction, your child will receive chemotherapy into the spinal fluid (intrathecal chemotherapy). This is an essential part of treatment, even if leukaemia cells are not visible on the lumbar puncture test. Children who have visible leukaemia cells or signs of blood cells in the spinal fluid will receive extra doses.
The next phase of treatment is aimed at maintaining the remission by giving additional chemotherapy directed at the central nervous system.
After this consolidation treatment, there is a recovery period which is called 'interim maintenance'. This is when more drugs will be given to try to keep the leukaemia in remission. The exact details will depend on which arm of treatment your child follows and will be discussed in depth by your child’s doctor as it depends on your child’s response to treatment so far. This is followed by a block of more intensive chemotherapy called ‘delayed intensification’, before going into maintenance.
The remainder of treatment consists of lower intensity chemotherapy known as maintenance. Although this phase is of lower intensity, it is hugely important as part of the overall treatment plan. This consists of:
- daily and weekly tablets
- monthly chemotherapy injections and oral steroids
- three monthly intrathecal treatment
Your child will have regular hospital visits and have their blood counts monitored to check that they are having the optimal chemotherapy doses during this phase.
Children will be able to take part in their normal daily activities as soon as they feel able to. Most children return to school before beginning maintenance treatment.
A minority of children who have ALL that is likely to come back following standard chemotherapy may need a bone marrow transplant.
Sometimes boys need to have radiotherapy to their testicles. This is because leukaemia cells can survive in the testicles despite chemotherapy.
Most children with ALL are cured. If the leukaemia recurs after initial treatment, it usually does so within the first three years. Further treatment can then be given.
Long-term side effects (late side effects) are rare, and most children with ALL grow and develop normally.
Once treatment has finished, the doctors will monitor your child closely with regular appointments to be sure that the cancer has not come back and there are no complications. After a while, you will not need to visit the clinic so often.
If you have specific concerns about your child’s condition and treatment, it’s best to discuss them with your child’s doctor, who knows the situation in detail.
This information is about acute lymphoblastic leukaemia (ALL) in children (age 0-14 years). Find out about acute lymphoblastic leukaemia (ALL) in teenagers and young adults (age 15-24 years)