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Acute lymphocytic leukemia (ALL)

Acute lymphocytic leukemia (ALL) is a fast-growing cancer of the white blood cells, specifically affecting lymphocytes, which are crucial for fighting infections. This condition occurs when the bone marrow produces abnormal lymphocytes that crowd out normal blood cells, leading to various symptoms such as anemia, frequent infections, and bone pain. While the exact causes are not fully understood, certain risk factors have been identified, including high doses of radiation, exposure to benzene, and genetic disorders. ALL is most common in children under five and is the predominant type of leukemia in this age group, accounting for 75 to 80% of pediatric leukemia cases.

Diagnosis typically involves blood and bone marrow tests, which help determine the specific type of ALL and guide treatment decisions. Treatment usually begins immediately and may include induction therapy to reach remission, followed by post-induction therapy to eliminate remaining cancer cells. The prognosis for children with ALL is generally favorable, with approximately a 90% five-year survival rate, while adults also see improvements in treatment outcomes. Ongoing advancements in gene therapy and other treatments continue to enhance the potential for successful management of ALL.

Full Article

ALSO KNOWN AS: Acute childhood leukemia, acute lymphoblastic leukemia, acute lymphoid leukemia

RELATED CONDITIONS: Acute myeloid leukemia, chronic lymphocytic leukemia, chronic myeloid leukemia

DEFINITION: Acute lymphocytic leukemia (ALL) is a cancer of the white blood cells. A lymphocyte is a type of white blood cell made in the bone marrow that helps fight infection. In this fast-growing type of cancer, for unknown reasons, the bone marrow begins to make lymphocytes that develop abnormally. “Acute” means that the disease affects lymphocytes before they are fully formed and that it progresses rapidly if not treated.

Risk factors: Few risk factors exist for ALL. Receiving high doses of radiation, usually as treatment for another type of cancer, is one risk factor. Exposure to benzene may also be a factor. Risk increases in people with certain other diseases, such as Down syndrome, Fanconi anemia, Bloom syndrome, Shwachman-Diamond syndrome, Li-Fraumeni syndrome, and some other genetic diseases.

In about 25 percent of ALL cases, the patient has a chromosome mutation in which parts of chromosome 9 and chromosome 22 have changed places. Having a sibling, especially a twin, with ALL also increases the risk for this disease. Researchers continue to explore lifestyle and environmental relationships, but it appears that many factors, including a combination of genetic and environmental factors, are involved in the development of ALL.

Etiology and the disease process: Through a genetic process that is not completely understood, cells in bone marrow begin to form abnormally. ALL can begin in two different types of lymphocytes, either B cells or T cells. As the abnormal lymphocytes quickly grow, they crowd out the red and white blood cells and platelets that the body needs and that are also created in the bone marrow. The symptoms of ALL come from the crowding out of these normal, healthy cells. These cells may then spread into the lining of the spine and brain.

Incidence: In 2025, the American Cancer Society estimated that about 6,100 new ALL cases were diagnosed annually in the US, including 3,450 males and 2,650 females. This was an increase from 2018 projections, which estimated 5,960 new cases of ALL in the US.

Those most at risk were children younger than five years of age. After age five, risk decreases, then increases again in people over age fifty. It is the most common type of leukemia in children under the age of fifteen, accounting for about 75 to 80 percent of childhood leukemias, according to the Dana-Farber Cancer Institute. It occurs more often in developed countries and in people with higher socioeconomic status. The National Cancer Institute reported in 2024 that the annual number of new cases of leukemia, including ALL, was 62,770. This was 14.1 per 100,000 men and women per year based on 2017-2021 data.

Symptoms: Symptoms of ALL include anemia, body aches, bone pain, bruises without any injury, enlarged lymph nodes, an enlarged spleen, excessive bleeding from minor injuries, fever with no illness or lasting low-grade fever, frequent infections, headaches, joint pain, nosebleeds, paleness, shortness of breath during activity, tiredness, vomiting, and unexplained weight loss.

Screening and diagnosis: There is no screening test for ALL. Blood and bone marrow tests are necessary to diagnose ALL. These tests look for abnormal lymphocyte cells. A bone marrow aspirate test and a bone marrow biopsy are two possible tests. The bone marrow aspirate test looks for abnormal cells in the bone marrow and can also be used for other types of analysis. A bone marrow biopsy can show how much disease is already in the bone marrow. The results of these tests help determine which type of drug therapy to use and how long treatment should last.

If a patient has been diagnosed with ALL, a lumbar puncture may be performed to see if the abnormal cells have moved into the fluid surrounding the spine and brain. Chest X-rays, ultrasounds, or additional blood tests may also be used to determine the spread of the disease.

Depending on where the cancer started and the results of testing, ALL may be categorized into early pre-B-cell ALL, common ALL, pre-B-cell ALL, mature B-cell ALL, pre-T-cell ALL, or mature T-cell ALL. The type of ALL helps determine which therapy to use and how long treatment should last. According to the American Cancer Society, about 85 percent of ALL cases begin in B cells, and these cases are generally classified as lower risk.

ALL may also be classified or staged using the French-American-British (FAB) classification system. In this older system, ALL is classified according to the type of abnormal cells as follows:

  • ALL-L1: small, uniform abnormal cells
  • ALL-L2: large, varied abnormal cells
  • ALL-L3: large, varied, bubble-like cells

This system, however, has largely been replaced, as newer tests allow for more accurate classification.

Treatment and therapy: Patients diagnosed with ALL should start treatment immediately. The course and length of treatment chosen depend on the results of the patient’s bone marrow tests, the patient’s age, the number of ALL cells in the blood, whether certain chromosomal changes have already happened, whether ALL cells began in the B cells or the T cells, and whether ALL has spread to the brain covering or spinal cord. During therapy, bone marrow tests may be repeated to confirm that the treatment is destroying cancer cells.

The first part of treatment for ALL is called induction therapy. This therapy helps kill ALL cells and get a patient’s blood counts back to normal (remission). Some of the drugs used in induction therapy are given by mouth. Others are given in a vein, usually through the patient’s chest. Most often, this chemotherapy for ALL involves combining drugs to improve the effects of the drugs. Often, ALL spreads into the lining of the spinal cord and the brain. To kill these ALL cells, drugs are injected directly into the spinal fluid. Radiation therapy may be used on the spine and brain either with or without the injected drugs.

Post-induction therapy, the second part of treatment for ALL, begins when a patient has reached remission. This type of therapy is needed because usually some ALL cells that cannot be detected by tests remain in the body. Post-induction therapy usually happens in two- or three-year cycles. The drugs used in post-induction therapy are usually different from those used in induction therapy, and the type of drugs used depends on how the patient responded to induction therapy and whether the patient has certain chromosome abnormalities. A patient may also need maintenance therapy after post-induction therapy to prevent the cells from regrowing.

T-cell ALL, infant ALL, and adult ALL are all forms of high-risk ALL. These types of ALL are usually treated with higher doses of drugs during both induction and post-induction therapy. Some patients with high-risk types of ALL may respond well to bone marrow or cord blood transplant therapy.

A bone marrow or cord blood transplant may be used when high doses of drugs are given to kill the ALL cells. These high doses of drugs may also kill healthy cells in the bone marrow. This transplant gives a patient healthy cells to replace the killed bone marrow cells. A transplant is a high-risk procedure and will probably not be used unless a patient does not have a good possibility of long-term remission with chemotherapy. High-risk ALL patients are more likely to have a transplant. The timing of a transplant is important; a patient has a better chance of a successful transplant when they are in remission at the time of transplant.

In August 2017, the US Federal Drug Administration approved a landmark treatment that genetically alters a patient's cells to fight cancer. Therapeutic modalities using gene therapy continue to be explored; they may offer benefits, including gene patterning to help identify and classify different cancers, reduced side effects from chemotherapies, and the ability to target personalized treatments.

Prognosis, prevention, and outcomes: There is no known way to prevent ALL. Most children with ALL can be cured of this disease with proper treatment. In 2024, the American Cancer Society reported that for children with ALL, the five-year survival rate is approximately 90 percent. This was an increase from 83.7 percent for those diagnosed between 1990 and 1994 and 85 percent in 2017.

Most adults also improve with treatment; the number of adults who achieve remission has increased, and the duration of remission has improved. According to the National Cancer Institute, in 2022, the rate of new cases of cancer had climbed to 1.9 per 100,000 people. Notably, the death rate had fallen to 0.4 per 100,00 people. The overall relative survival rate from cancer was estimated at 72 percent. The data reflected data collected between 2018-2022.


Bibliography

Advani, Anjali S., and Hillard M. Lazarus. Adult Acute Lymphocytic Leukemia: Biology and Treatment. Humana, 2011.

Angelescu, Silvana, et al. "Value of Multifaced Approach Diagnosis and Classification of Acute Leukemias." Maedica - a Journal of Clinical Medicine, Sept. 2012, www.ncbi.nlm.nih.gov/pmc/articles/PMC3566891. Accessed 28 Oct. 2025.

"Cancer Stat Facts: Leukemia." National Cancer Institute, 2024, seer.cancer.gov/statfacts/html/leuks.html. Accessed 28 Oct. 2025.

"Childhood Acute Lymphoblastic Leukemia (ALL)." Dana Farber Cancer Institute, 2024, www.dana-farber.org/cancer-care/types/childhood-acute-lymphoblastic-leukemia. Accessed 28 Oct. 2025.

Hillman, Robert S., et al. Hematology in Clinical Practice. 5th ed., McGraw-Hill Medical, 2011.

Hoffman, Ronald, et al. Hematology: Basic Principles and Practice. 8th ed., Elsevier, 2022.

Lichtman, M. A., et al., editors. William’s Hematology. 10th ed., McGraw-Hill, 2021.

Niederhuber, John E., et al. Abeloff's Clinical Oncology. 6th ed., Elsevier, 2020.

Pui, Ching-Hon, editor. Childhood Leukemias. 3rd ed., Cambridge UP, 2012.

Full Article

ALSO KNOWN AS: Acute childhood leukemia, acute lymphoblastic leukemia, acute lymphoid leukemia

RELATED CONDITIONS: Acute myeloid leukemia, chronic lymphocytic leukemia, chronic myeloid leukemia

DEFINITION: Acute lymphocytic leukemia (ALL) is a cancer of the white blood cells. A lymphocyte is a type of white blood cell made in the bone marrow that helps fight infection. In this fast-growing type of cancer, for unknown reasons, the bone marrow begins to make lymphocytes that develop abnormally. “Acute” means that the disease affects lymphocytes before they are fully formed and that it progresses rapidly if not treated.

Risk factors: Few risk factors exist for ALL. Receiving high doses of radiation, usually as treatment for another type of cancer, is one risk factor. Exposure to benzene may also be a factor. Risk increases in people with certain other diseases, such as Down syndrome, Fanconi anemia, Bloom syndrome, Shwachman-Diamond syndrome, Li-Fraumeni syndrome, and some other genetic diseases.

In about 25 percent of ALL cases, the patient has a chromosome mutation in which parts of chromosome 9 and chromosome 22 have changed places. Having a sibling, especially a twin, with ALL also increases the risk for this disease. Researchers continue to explore lifestyle and environmental relationships, but it appears that many factors, including a combination of genetic and environmental factors, are involved in the development of ALL.

Etiology and the disease process: Through a genetic process that is not completely understood, cells in bone marrow begin to form abnormally. ALL can begin in two different types of lymphocytes, either B cells or T cells. As the abnormal lymphocytes quickly grow, they crowd out the red and white blood cells and platelets that the body needs and that are also created in the bone marrow. The symptoms of ALL come from the crowding out of these normal, healthy cells. These cells may then spread into the lining of the spine and brain.

Incidence: In 2025, the American Cancer Society estimated that about 6,100 new ALL cases were diagnosed annually in the US, including 3,450 males and 2,650 females. This was an increase from 2018 projections, which estimated 5,960 new cases of ALL in the US.

Those most at risk were children younger than five years of age. After age five, risk decreases, then increases again in people over age fifty. It is the most common type of leukemia in children under the age of fifteen, accounting for about 75 to 80 percent of childhood leukemias, according to the Dana-Farber Cancer Institute. It occurs more often in developed countries and in people with higher socioeconomic status. The National Cancer Institute reported in 2024 that the annual number of new cases of leukemia, including ALL, was 62,770. This was 14.1 per 100,000 men and women per year based on 2017-2021 data.

Symptoms: Symptoms of ALL include anemia, body aches, bone pain, bruises without any injury, enlarged lymph nodes, an enlarged spleen, excessive bleeding from minor injuries, fever with no illness or lasting low-grade fever, frequent infections, headaches, joint pain, nosebleeds, paleness, shortness of breath during activity, tiredness, vomiting, and unexplained weight loss.

Screening and diagnosis: There is no screening test for ALL. Blood and bone marrow tests are necessary to diagnose ALL. These tests look for abnormal lymphocyte cells. A bone marrow aspirate test and a bone marrow biopsy are two possible tests. The bone marrow aspirate test looks for abnormal cells in the bone marrow and can also be used for other types of analysis. A bone marrow biopsy can show how much disease is already in the bone marrow. The results of these tests help determine which type of drug therapy to use and how long treatment should last.

If a patient has been diagnosed with ALL, a lumbar puncture may be performed to see if the abnormal cells have moved into the fluid surrounding the spine and brain. Chest X-rays, ultrasounds, or additional blood tests may also be used to determine the spread of the disease.

Depending on where the cancer started and the results of testing, ALL may be categorized into early pre-B-cell ALL, common ALL, pre-B-cell ALL, mature B-cell ALL, pre-T-cell ALL, or mature T-cell ALL. The type of ALL helps determine which therapy to use and how long treatment should last. According to the American Cancer Society, about 85 percent of ALL cases begin in B cells, and these cases are generally classified as lower risk.

ALL may also be classified or staged using the French-American-British (FAB) classification system. In this older system, ALL is classified according to the type of abnormal cells as follows:

  • ALL-L1: small, uniform abnormal cells
  • ALL-L2: large, varied abnormal cells
  • ALL-L3: large, varied, bubble-like cells

This system, however, has largely been replaced, as newer tests allow for more accurate classification.

Treatment and therapy: Patients diagnosed with ALL should start treatment immediately. The course and length of treatment chosen depend on the results of the patient’s bone marrow tests, the patient’s age, the number of ALL cells in the blood, whether certain chromosomal changes have already happened, whether ALL cells began in the B cells or the T cells, and whether ALL has spread to the brain covering or spinal cord. During therapy, bone marrow tests may be repeated to confirm that the treatment is destroying cancer cells.

The first part of treatment for ALL is called induction therapy. This therapy helps kill ALL cells and get a patient’s blood counts back to normal (remission). Some of the drugs used in induction therapy are given by mouth. Others are given in a vein, usually through the patient’s chest. Most often, this chemotherapy for ALL involves combining drugs to improve the effects of the drugs. Often, ALL spreads into the lining of the spinal cord and the brain. To kill these ALL cells, drugs are injected directly into the spinal fluid. Radiation therapy may be used on the spine and brain either with or without the injected drugs.

Post-induction therapy, the second part of treatment for ALL, begins when a patient has reached remission. This type of therapy is needed because usually some ALL cells that cannot be detected by tests remain in the body. Post-induction therapy usually happens in two- or three-year cycles. The drugs used in post-induction therapy are usually different from those used in induction therapy, and the type of drugs used depends on how the patient responded to induction therapy and whether the patient has certain chromosome abnormalities. A patient may also need maintenance therapy after post-induction therapy to prevent the cells from regrowing.

T-cell ALL, infant ALL, and adult ALL are all forms of high-risk ALL. These types of ALL are usually treated with higher doses of drugs during both induction and post-induction therapy. Some patients with high-risk types of ALL may respond well to bone marrow or cord blood transplant therapy.

A bone marrow or cord blood transplant may be used when high doses of drugs are given to kill the ALL cells. These high doses of drugs may also kill healthy cells in the bone marrow. This transplant gives a patient healthy cells to replace the killed bone marrow cells. A transplant is a high-risk procedure and will probably not be used unless a patient does not have a good possibility of long-term remission with chemotherapy. High-risk ALL patients are more likely to have a transplant. The timing of a transplant is important; a patient has a better chance of a successful transplant when they are in remission at the time of transplant.

In August 2017, the US Federal Drug Administration approved a landmark treatment that genetically alters a patient's cells to fight cancer. Therapeutic modalities using gene therapy continue to be explored; they may offer benefits, including gene patterning to help identify and classify different cancers, reduced side effects from chemotherapies, and the ability to target personalized treatments.

Prognosis, prevention, and outcomes: There is no known way to prevent ALL. Most children with ALL can be cured of this disease with proper treatment. In 2024, the American Cancer Society reported that for children with ALL, the five-year survival rate is approximately 90 percent. This was an increase from 83.7 percent for those diagnosed between 1990 and 1994 and 85 percent in 2017.

Most adults also improve with treatment; the number of adults who achieve remission has increased, and the duration of remission has improved. According to the National Cancer Institute, in 2022, the rate of new cases of cancer had climbed to 1.9 per 100,000 people. Notably, the death rate had fallen to 0.4 per 100,00 people. The overall relative survival rate from cancer was estimated at 72 percent. The data reflected data collected between 2018-2022.


Bibliography

Advani, Anjali S., and Hillard M. Lazarus. Adult Acute Lymphocytic Leukemia: Biology and Treatment. Humana, 2011.

Angelescu, Silvana, et al. "Value of Multifaced Approach Diagnosis and Classification of Acute Leukemias." Maedica - a Journal of Clinical Medicine, Sept. 2012, www.ncbi.nlm.nih.gov/pmc/articles/PMC3566891. Accessed 28 Oct. 2025.

"Cancer Stat Facts: Leukemia." National Cancer Institute, 2024, seer.cancer.gov/statfacts/html/leuks.html. Accessed 28 Oct. 2025.

"Childhood Acute Lymphoblastic Leukemia (ALL)." Dana Farber Cancer Institute, 2024, www.dana-farber.org/cancer-care/types/childhood-acute-lymphoblastic-leukemia. Accessed 28 Oct. 2025.

Hillman, Robert S., et al. Hematology in Clinical Practice. 5th ed., McGraw-Hill Medical, 2011.

Hoffman, Ronald, et al. Hematology: Basic Principles and Practice. 8th ed., Elsevier, 2022.

Lichtman, M. A., et al., editors. William’s Hematology. 10th ed., McGraw-Hill, 2021.

Niederhuber, John E., et al. Abeloff's Clinical Oncology. 6th ed., Elsevier, 2020.

Pui, Ching-Hon, editor. Childhood Leukemias. 3rd ed., Cambridge UP, 2012.

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