Acute lymphoblastic leukaemia

Acute lymphoblastic leukaemia (ALL) is a cancer of the white blood cells that begins in the bone marrow.

The bone marrow and blood cells

All of the blood cells in your body are produced in the bone marrow: the spongy tissue that is found in the middle of your bones. All blood cells start their lives as stem cells. These grow and divide within the bone marrow and mature into:

  • Red blood cells that carry oxygen around the body
  • White blood cells that help fight infection
  • Platelets that help clot the blood to control bleeding and bruising.

Leukaemia happens when immature white blood cells are overproduced. These do not work properly as they have not matured into the type of cell they were supposed to be. This prevents the normal production of healthy blood cells.

Who does it affect?

Acute lymphoblastic leukaemia (or ALL for short) can affect young people of any age, but it is most common in children aged one to four. It is slightly more common in males than females.

What are the symptoms?

When leukaemia happens, immature white blood cells are overproduced. This prevents the normal production of healthy blood cells. This can cause:

  • Anaemia: the number of red blood cells are reduced, leaving your child feeling tired, breathless and constantly run down
  • Bruising and bleeding: the number of platelets are reduced, which means blood is not able to clot as well as it did previously
  • Infections: infections might happen more often as there are less healthy blood cells to fight them.

How is it diagnosed?

ALL is usually suspected from a blood test, which may show changes in the numbers of healthy white blood cells, red cells and platelets. If the blood test suggests that leukaemia is present, a specialist will need to take a sample of bone marrow. The sample will be looked at under a microscope to work out what type the leukaemia is.

Your specialist will also need to do a lumbar puncture to see if the spinal fluid contains any leukaemia cells, which indicates whether it’s spread to other parts of the body.

Bone marrow tests and lumbar punctures will be done using a sedative or under general anaesthetic.

How is it treated?

Acute lymphoblastic leukaemia is treated with chemotherapy. There are four different phases of ALL treatment.

  1. The first phase aims to destroy the leukaemia cells with chemotherapy and get your child into remission. Remission means there are no leukaemia cells visible through a microscope in the blood or bone marrow.
  2. Consolidation therapy helps to stop the leukaemia coming back. This most often involves more chemotherapy.
  3. The next stage is interim maintenance therapy to help keep the leukaemia in remission, followed by a ‘delayed intensification’ block where a number of different anti-cancer drugs are given over several weeks.
  4. The final maintenance phase is a low-dose of chemotherapy. Girls will receive two years treatment after the start of interim maintenance and boys three years after the start of interim maintenance. This treatment is done in an out-patient setting and is much less disruptive to your normal life than earlier parts of the treatment.

A few young people require a bone marrow or stem cell transplant early in their treatment, once they are in remission. Others may require a transplant if the leukaemia comes back once they have finished the treatment.

Your particular treatment plan will depend on your leukaemia and how it responds to treatment, so it’s best to talk to your specialist about what will be involved.

What happens after treatment?

The standard treatment for ALL, received by most children and young people, carries a low risk for long-term health problems. However, if your child needs more intensive treatment or a transplant, they may later experience fatigue, a lower resistance to infections, infertility, heart or thyroid problems, or other health issues.

Talk to your specialist about the potential long-term side effects of your child’s treatment.

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