Childhood Acute Lymphoblastic Leukemia (ALL)

• Childhood acute lymphoblastic leukemia (ALL) facts*
• What is childhood acute lymphoblastic leukemia (ALL)?
• What are signs and symptoms of childhood ALL?
• What are risk factors for childhood ALL?
• What tests detect and diagnose childhood ALL?
• What determines the prognosis of childhood ALL?
• What are the risk groups in childhood ALL?
• What is recurrent childhood acute lymphoblastic leukemia (ALL)?
• What are the different types of treatment for childhood acute lymphoblastic leukemia (ALL)?
• What are side effects of treatment of childhood acute lymphoblastic leukemia (ALL)?
• What are treatment options for childhood acute lymphoblastic leukemia that has metastasized?
• What types of treatment are being tested in clinical trials for childhood acute lymphoblastic leukemia?
• What are treatment options for childhood acute lymphoblastic leukemia?

*Childhood acute lymphoblastic leukemia (ALL) facts medical author: Melissa Conrad Stöppler, MD

• Childhood acute lymphoblastic leukemia (C-ALL) is a common type of cancer in children. Like all leukemias, it is a cancer of blood-forming cells in the bone marrow.
• Symptoms and signs of C-ALL include
  • fever,
  • bruising,
  • bleeding,
  • weakness,
  • loss of appetite, and
  • painless lumps in the neck, groin, or armpits (enlarged lymph nodes).
• Bone marrow aspiration and biopsy, cerebrospinal fluid analysis, imaging studies, and blood counts are all tests used to diagnose C-ALL.
• Results of diagnostic tests are used to establish risk groups that help plan the best treatment for each child with C-ALL.
• Treatment options include chemotherapy, radiation therapy, stem cell transplant, and targeted therapy.
• New types of treatment include CAR T-cell therapy, a type of immunotherapy that changes the patient's T cells (a type of immune system cell).
• The majority of children with ALL can be cured with modern treatments.

Childhood acute lymphoblastic leukemia (also called ALL or acute lymphocytic leukemia) is a cancer of the blood and bone marrow. This type of cancer usually gets worse quickly if it is not treated.

ALL is the most common type of cancer in children.

Leukemia may affect red blood cells, white blood cells, and platelets.

In a healthy child, the bone marrow makes blood stem cells (immature cells) that become mature blood cells over time. A blood stem cell may become a myeloid stem cell or a lymphoid stem cell.

A myeloid stem cell becomes one of three types of mature blood cells:

• Red blood cells that carry oxygen and other substances to all tissues of the body.
• Platelets that form blood clots to stop bleeding.
• White blood cells that fight infection and disease.

A lymphoid stem cell becomes a lymphoblast cell and then one of three types of lymphocytes (white blood cells):

• B lymphocytes that make antibodies to help fight infection.
• T lymphocytes that help B lymphocytes make the antibodies that help fight infection.
• Natural killer cells that attack cancer cells and viruses.

In a child with ALL, too many stem cells become lymphoblasts, B lymphocytes, or T lymphocytes. The cells do not work like normal lymphocytes and are not able to fight infection very well. These cells are cancer (leukemia) cells. Also, as the number of leukemia cells increases in the blood and bone marrow, there is less room for healthy white blood cells, red blood cells, and platelets. This may lead to infection, anemia, and easy bleeding.

These and other signs and symptoms may be caused by childhood ALL or by other conditions. Check with your child's doctor if your child has any of the following:

• Fever.
• Easy bruising or bleeding.
• Petechiae (flat, pinpoint, dark-red spots under the skin caused by bleeding).
• Bone or joint pain.
• Painless lumps in the neck, underarm, stomach, or groin.
• Pain or feeling of fullness below the ribs.
• Weakness, feeling tired, or looking pale.
• Loss of appetite.

Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. Talk with your child's doctor if you think your child may be at risk.

Possible risk factors for ALL include the following:

• Being exposed to x-rays before birth.
• Being exposed to radiation.
• Past treatment with chemotherapy.
• Having certain genetic conditions, such as:
  • Down syndrome.
  • Neurofibromatosis type 1.
  • Bloom syndrome.
  • Fanconi anemia.
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