Acute lymphocytic leukemia (ALL)

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What is acute lymphocytic leukemia (ALL)?

Leukemia is a blood cancer of the bone marrow, which is the organ responsible for blood cell development. Normally, there are three types of cells in your blood stream:

  • White blood cells
  • Red blood cells
  • Platelets

Acute leukemia is considered lymphoid or myeloid based on the type of blood cell that is involved. Lymphoid cells are cells that, under normal development, would have become lymphocytes, which are types of white blood cells. Myeloid cells are cells that would have become other blood cells (white blood cells other than lymphocytes, red blood cells or platelets) under normal development. In patients with acute leukemia, immature cells called "blasts" overtake the bone marrow. In patients with acute lymphocytic leukemia (ALL), the bone marrow is overtaken by lymphoid blasts.

ALL is the most common type of childhood cancer, but it is more common in adults than children. There are approximately 3,000 to 5,000 new cases of ALL per year in the United States. Once diagnosed, a person will ALL will need to receive treatment as soon as possible. If left untreated, the disease progresses rapidly and can be fatal.

ALL may also be referred to as acute lymphoblastic leukemia or acute lymphoid leukemia.

Types of acute lymphocytic leukemia

Acute lymphocytic leukemia (ALL) can be characterized into different sub-types:

  • Philadelphia chromosome-positive ALL
  • Philadelphia chromosome-negative ALL
  • B cell ALL
  • T cell ALL

B cell ALL is more common than T cell ALL. Other names and sub-types of B cell and T cell ALL include:

  • Acute B-lymphocytic leukemia
  • Acute precursor B cell leukemia
  • Pre-B cell lymphocytic leukemia
  • Acute T-lymphoblastic leukemia

Your individual treatment plan will depend on your ALL sub-type.

The Philadelphia chromosome

Some people with ALL have a genetic abnormality referred to as the Philadelphia chromosome. If you have the Philadelphia chromosome, you will receive chemotherapy and targeted therapies designed specifically for you and the genetic makeup of your leukemia. The Philadelphia chromosome, discovered more than 50 years ago at Penn, provided the first evidence that genetic abnormalities were linked to cancer. The discovery ushered in the modern period of cytogenetics in the understanding of leukemia. Now, the Center for Personalized Diagnostics builds on this legacy and is set to pave the way for precision medicine.

ALL symptoms and signs

The signs and symptoms of ALL may resemble other diseases or conditions. If you have any, some, or all of these symptoms*, please speak with your physician:

  • Body aches
  • Bruising easily, or not remembering how you got a bruise
  • Enlarged lymph nodes
  • High fever without a reason, or a persistent low-grade fever
  • Headaches
  • Pale skin
  • Pinhead-sized red spots under the skin
  • Excessive bleeding
  • Shortness of breath
  • Tiredness, lethargy
  • Vomiting
  • Unexplained weight loss

*From the Leukemia and Lymphoma Society

How is acute lymphocytic leukemia diagnosed?

Receiving an accurate acute lymphocytic leukemia (ALL) diagnosis, and identifying its sub-type is extremely important in determining the treatment for your ALL. Different sub-types of ALL respond to different drugs and treatment therapies.

If you were diagnosed at another health care center, and are coming to Penn Medicine for treatment or a second opinion, repeat diagnostic tests may be necessary. Penn utilizes the latest diagnostic imaging tools, tests and procedures to develop your personalized treatment plan.

Acute lymphocytic leukemia diagnosis at Penn Medicine

X-ray
We use X-rays to diagnose broken bones, lung problems, and many other conditions.
Lumbar puncture
This test collects and analyzes cerebrospinal fluid to diagnose certain health conditions.
Blood Tests
Blood Tests
Bone Marrow Biopsy
Bone Marrow Biopsy
Physical Examination
Physical Examination

Acute lymphocytic leukemia treatment

Penn hematologists and medical oncologists are part of large multidisciplinary teams whose approach to cancer and blood disorders is to treat the entire individual — not just the disease. The following are possible treatments for people diagnosed with acute lymphocytic leukemia (ALL). Your treatment will depend on the sub-type of your ALL. Specialists at Penn Medicine can help you understand the various leukemia treatments.

Stem cell (bone marrow) transplant
Penn Medicine provides bone marrow transplants to replace abnormal plasma cells with healthy cells.
Immunotherapy
This treatment boosts the immune system, enhancing its ability to recognize and eliminate abnormal cells.
Chemotherapy
This treatment uses strong medicines to target and eliminate cancer cells and to prevent their spread.
Targeted therapy
This cancer treatment uses powerful medications to help identify and disable certain types of cancer cells.
National Cancer Institute Designated Comprehensive Cancer Center badge on top of shot of hospital

Rated “exceptional” by The National Cancer Institute

Penn Medicine’s Abramson Cancer Center is a world leader in cancer research, patient care, and education. Our status as a national leader in cancer care is reflected in our continuous designation as a Comprehensive Cancer Center by the National Cancer Institute (NCI) since 1973, one of 7 such centers in the United States. The ACC is also a member of the National Comprehensive Cancer Network, one of a select few cancer centers in the U.S., that are working to promote equitable access to high-quality, advanced cancer care.

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