Acute Lymphoblastic Leukaemia

Overview

Acute lymphoblastic leukaemia (ALL) is a cancer of the blood and bone marrow. It affects a type of white blood cell called lymphocytes, which normally help fight infection. In ALL, the bone marrow makes too many immature lymphocytes that don't work properly. These abnormal cells crowd out healthy blood cells. The word 'acute' means the disease can get worse quickly, so it needs treatment soon.

ALL is the most common cancer affecting children, but it is rare in adults. Overall, it accounts for only a small fraction of all cancers worldwide.

ALL can affect anyone, but it is most often diagnosed in children aged 2 to 5. A second peak occurs in adults over 50. It is slightly more common in males than females.

Symptoms

Common symptoms

• Feeling very tired or weak
• Pale skin
• Fever or sweating, especially at night
• Frequent infections that don't clear up easily
• Easy bruising or bleeding, such as nosebleeds or bleeding gums
• Bone or joint pain
• Swollen lymph nodes in the neck, armpit, or groin

Symptoms in children

• All of the common symptoms listed above
• Poor appetite and weight loss
• A swollen or painful tummy
• Difficulty walking or a limp
• Frequent nosebleeds
• Small red spots on the skin, called petechiae

Symptoms in older adults

• All of the common symptoms listed above
• Shortness of breath during light activity
• Dizziness or feeling faint
• Chest discomfort
• Persistent bone pain in the back or ribs
• Severe tiredness that doesn't improve with rest

Causes

Main causes

• The exact cause of ALL is not yet known.
• It starts when the DNA of a white blood cell in the bone marrow changes (a mutation) and the cell multiplies out of control.
• These DNA changes are not passed from parents to children in most cases.

Risk factors

• Having certain genetic conditions, such as Down syndrome
• Being exposed to high levels of radiation
• Having received certain chemotherapy drugs in the past
• Having sibling with leukaemia (very slightly increases risk)
• Being male

When to see a doctor

See a doctor urgently if:

• You or your child has unexplained high fever
• Unusual bruising or bleeding
• Persistent bone pain
• Extreme paleness or tiredness

Book a routine appointment if:

• Swollen lymph nodes that last more than 2–3 weeks
• Ongoing fatigue or frequent infections
• Unexplained weight loss

Diagnosis

To diagnose ALL, a doctor will ask about symptoms and examine you. They will usually arrange blood tests. If those tests suggest leukaemia, they will refer you to a haematologist, a specialist in blood disorders. More tests are done to confirm the diagnosis and plan treatment.

Tests that may be done

• Full blood count: measures the numbers of red cells, white cells, and platelets
• Blood smear: looks at blood cells under a microscope
• Bone marrow biopsy: a small sample of marrow is taken from the hip bone
• Lumbar puncture (spinal tap): checks for cancer cells in the fluid around the brain and spine
• Imaging scans such as chest X-ray or CT scan

What to expect at your appointment

These tests can take a few days to a few weeks. You may feel nervous, but the care team will explain each step. If ALL is confirmed, treatment starts quickly. You or your child will be under the care of a specialist team and receive clear information throughout.

Treatment

Treatment for ALL is intensive and usually starts soon after diagnosis. The goal is to destroy the leukaemia cells and allow healthy blood cells to grow again. It often lasts for 2 to 3 years in children and a shorter period in adults, with different phases: induction, consolidation, and maintenance.

Self-care at home

• Follow your healthcare team's advice about avoiding infections
• Eat well if you can, and drink fluids
• Take all prescribed medicines exactly as directed
• Rest when you need to, and ask for help with daily tasks
• Speak to the team if you have any new symptoms or side effects

Medical treatments

Medical treatment for ALL is planned by a specialist team and may include chemotherapy (drugs that kill cancer cells), targeted therapy (drugs that block specific proteins in cancer cells), radiation therapy (high-energy rays aimed at areas with leukaemia), and stem cell transplantation (replacing cells in the bone marrow after high-dose treatment). The exact plan depends on the person's age, the type of ALL, and how far it has spread. Doctors will always discuss options and side effects before starting.

When is surgery considered?

Surgery is not a standard treatment for acute lymphoblastic leukaemia. In rare cases, a small operation might be used to place a central line (a tube into a vein) to give medicines, but it does not remove the cancer.

Living with this condition

Living with ALL involves regular hospital appointments, blood tests, and treatment sessions. You may feel tired and need extra rest. During some phases, you may be more prone to infections and might be advised to avoid crowds. It can help to keep a calendar of appointments and ask family or friends to support you.

Lifestyle tips

• Keep good hygiene, especially handwashing, to reduce infection risk
• Avoid contact with people who are sick, like those with colds or chickenpox
• Protect your skin from cuts and bruises, and tell your doctor if you have bleeding that won't stop
• Stay connected with friends and family, even if by phone or video
• Maintain a daily routine as much as possible

Diet and exercise

Eating a balanced diet during treatment supports your strength. If your immunity is low, follow any food-safety advice, such as avoiding raw meat, unpasteurised milk, and unwashed fruits or vegetables. You can do light activities like short walks if you feel well, but always check with your care team before starting new exercise.

Mental health and emotional wellbeing

A diagnosis of ALL is emotionally hard for both the person affected and their family. You may feel fear, sadness, or stress during treatment. These feelings are normal and common. Talk to your care team; many hospitals offer psychological support or counselling. For children, play specialists and child psychologists are often part of the team.

Prevention

There is currently no way to prevent most cases of acute lymphoblastic leukaemia. Because the cause is not fully understood, and most people with ALL have no known risk factors, there is no proven strategy to avoid it.

Vaccines

No vaccine prevents leukaemia. However, it is important to stay up to date on regular vaccines (such as flu) and to receive any vaccines recommended by your healthcare team, especially if your immunity is weakened.

Screening programmes

There is no routine screening test for ALL in the general population. The disease has no clear early screening tool, so it is usually found when symptoms prompt a visit to the doctor.

Complications

If left untreated

• Anaemia, which causes severe tiredness and shortness of breath
• Life-threatening infections due to a lack of healthy white blood cells
• Heavy bleeding due to low platelets
• Spread of leukaemia to the brain, spinal cord, or other organs

Long-term outlook

The outlook for acute lymphoblastic leukaemia has improved greatly in recent decades. In children, more than 85% are cured with modern treatment. Adults have lower cure rates, but newer targeted therapies and stem cell transplants are helping to improve survival. Even if the disease comes back, many people can be treated again. It is important to remember that every person is different, and the care team will share a more personal outlook based on your or your child's exact situation.

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