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Acute lymphoblastic leukemia (ALL) is the most common cancer in children and represents about one quarter of all cancers among persons younger than 15 years. Acute lymphoblastic leukemia is a cancer of the blood and bone marrow (spongy tissue in the center of bone). In ALL, too many marrow stem cells develop into a type of white blood cell called lymphocytes. These abnormal lymphocytes are not able to fight infection very well. Also, as the number of these lymphocytes increases, there is less room for healthy white blood cells, red blood cells, and platelets. This may lead to infection, fatigue, and easy bleeding. The March 21, 2007, issue of JAMA includes an article about the number of secondary cancers increasing over 30 years after successful treatment for ALL. The results suggest that lifelong follow-up of ALL survivors is needed.
Complete blood count (CBC)—a blood test that checks the number of red blood cells, white blood cells, and platelets.
Bone marrow aspiration—a needle is placed into the hip bone or breastbone and a sample of bone marrow is taken and examined for signs of cancer.
Cytogenetic analysis—lymphocytic cells taken from blood or bone marrow are examined to see if there are any changes in their chromosomes (genetic material).
Immunophenotyping—a test to see if cancer lymphocytes originated from B lymphocytes or T lymphocytes. This information is helpful in treating ALL.
Prognosis (chance of recovery) from childhood ALL is usually very good; however, both prognosis and treatment depend on
Age and white blood cell count at diagnosis
Response to initial treatment
Origin of leukemia cells (from B or T lymphocytes)
Certain changes in the chromosomes of the lymphocytes
Involvement of the brain and spinal cord
Different types of treatment programs are available. Some programs are standard (currently used) and some are being tested in clinical trials (experimental). Most use chemotherapy (drug therapy). In addition, some patients may also need radiation therapy (use of high-energy x-rays) or bone marrow transplantation.
Children's Oncology Group/National Childhood Cancer Foundationhttp://www.curesearch.org
American Academy of Pediatricshttp://www.aap.org
To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA's Web site at http://www.jama.com. Many are available in English and Spanish. A previous Patient Page on childhood leukemia was published in the January 28, 2004, issue.
Sources: American Cancer Society, American Academy of Pediatrics
Photo credit: Mihaela Onciu, MD/St Jude Children's Research Hospital
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TOPIC: CHILDHOOD ILLNESSES
Zeller JL, Lynm C, Glass RM. Acute Lymphoblastic Leukemia. JAMA. 2007;297(11):1278. doi:10.1001/jama.297.11.1278