Acute Lymphoblastic Leukaemia

Leukaemia is a cancer of the white blood cells which begins in the bone marrow.

The bone marrow is the spongy tissue that is found in the middle of the bones which produces all of the body’s blood cells. There are three types of blood cell:

Red blood cells – which carry oxygen around the body.
White blood cells – which help fight infection.
Platelets – which help clot the blood, controlling bleeding and bruising.

Stem cells, or ‘mother’ blood cells, divide and grow within the bone marrow to become mature red, white or platelet cells. When leukaemia occurs the bone marrow produces a large amount of immature rather than mature blood cells. The immature cells do not work properly as they have not yet grown to what they were supposed to be. They stay immature.

Leukaemia usually affects the production of white blood cells and is named after the type of cells that have been affected.

Acute Myeloid Leukaemia is named after the early white myeloid blood cells it affects.

Acute Lymphoblastic Leukaemia is named after the early lymphoid white blood cells (known as lymphoblasts) it affects.

The immature white blood cells ‘squeeze out’ the production of healthy white blood cells which reduces the body’s ability to fight infection. Red blood cells and platelets also are reduced in numbers resulting in symptoms such as anaemia and bruising.

Acute Lymphoblastic Leukaemia is a cancer of the white blood cells, known as the lymphocytes.

ALL is most common in children aged between two and four. It is the most common childhood cancer and it affects boys more than girls.

Anaemia – caused by the leukaemia cells 'crowding out' the production of healthy red blood cells and reducing their numbers. This will make the child tired, breathless and feel quite poorly.

Bruising and bleeding – caused by the reduced number of platelet cells produced within the bone marrow. These cells normally clot the blood.

Infections – caused by the lack of healthy white blood cells.

A blood test can reveal changes in the numbers of healthy white blood cells. A bone marrow aspirate (where a full sample of bone marrow is taken and tested) will also be necessary.

ALL is treated mainly with chemotherapy, which aims to kill the leukaemia cells, allowing the bone marrow to work normally.

The treatment is given in stages:

The first stage aims to eliminate the leukaemia using a combination of chemotherapy drugs over a period of weeks or even months.  When the leukaemia is eliminated the child is in remission.

The second stage aims to consolidate the remission with chemotherapy.

The third stage maintains the remission with a daily tablet of chemotherapy, antibiotics and steroids which are mainly in tablet form and administered at home along with regular hospital appointments to monitor progress.  The therapy lasts two years for girls and three years for boys. Most children are back at school before maintenance therapy begins. 

The side-effects associated with chemotherapy are tiredness, sickness and diarrhoea, temporary hair loss and infection, all of which can be managed with help from the child’s Consultant or nursing team.  For more information about side-effects please visit our side-effects section.

Most children with ALL achieve remission. However for some children the leukaemia returns. In these cases further treatment can be offered, including a stem cell, or bone marrow transplant. There is general information about the procedure in our stem cell support section but as cases are likely to be highly individual, parents might want to talk to a member of their child’s care team about it.

Long term side-effects
Some children do develop more long-term side effects after their treatment for ALL. Please remember that all children are different and only a small number develop long-term problems as a result of their treatment. Parents can talk to their child’s consultant if they are concerned about them and can visit our beyond treatment section for general information.

Follow-up care
All children will need to be monitored regularly at an outpatients clinic. The Consultant will be looking for any signs that the cancer has returned (recurrent cancer) and checking the functions of major organs to make sure that they have not been affected by the cancer treatment. top of page