General Information About Adult Acute Lymphoblastic LeukemiaKey Points
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Adult acute lymphoblastic leukemia (ALL) is a type of cancer in which the bone marrow makes too many lymphocytes (a type of white blood cell).Adult acute lymphoblastic leukemia (ALL; also called 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. Enlarge Anatomy of the bone. The bone is made up of compact bone, spongy bone, and bone marrow. Compact bone makes up the outer layer of the bone. Spongy bone is found mostly at the ends of bones and contains red marrow. Bone marrow is found in the center of most bones and has many blood vessels. There are two types of bone marrow: red and yellow. Red marrow contains blood stem cells that can become red blood cells, white blood cells, or platelets. Yellow marrow is made mostly of fat.Leukemia may affect red blood cells, white blood cells, and platelets.Normally, 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:
A lymphoid stem cell becomes a lymphoblast cell and then one of three types of lymphocytes (white blood cells):
In ALL, too many stem cells become lymphoblasts, B lymphocytes, or T lymphocytes. These cells are also called leukemia cells. These leukemia cells are not able to fight infection very well. 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 cause infection, anemia, and easy bleeding. The cancer can also spread to the central nervous system (brain and spinal cord), lymph nodes, spleen, liver, testicles, and other organs. This summary is about adult acute lymphoblastic leukemia. See the following PDQ summaries for information about other types of leukemia: Previous chemotherapy and exposure to radiation may increase the risk of developing ALL.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 doctor if you think you may be at risk. Possible risk factors for ALL include the following:
Signs and symptoms of adult ALL include fever, feeling tired, and easy bruising or bleeding.The early signs and symptoms of ALL may be like the flu or other common diseases. Check with your doctor if you have any of the following:
These and other signs and symptoms may be caused by adult acute lymphoblastic leukemia or by other conditions. Tests that examine the blood and bone marrow are used to diagnose adult ALL.The following tests and procedures may be used:
Certain factors affect prognosis (chance of recovery) and treatment options.The prognosis and treatment options depend on the following:
Stages of Adult Acute Lymphoblastic Leukemia
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Once adult ALL has been diagnosed, tests are done to find out if the cancer has spread to the central nervous system (brain and spinal cord) or to other parts of the body.The extent or spread of cancer is usually described as stages. It is important to know whether the leukemia has spread outside the blood and bone marrow in order to plan treatment. The following tests and procedures may be used to find out if the leukemia has spread:
There is no standard staging system for adult ALL.The disease is described as untreated, in remission, or recurrent. Untreated adult ALL The ALL is newly diagnosed and has not been treated except to relieve signs and symptoms such as fever, bleeding, or pain.
Adult ALL in remission The ALL has been treated.
Recurrent adult ALL Recurrent adult ALL is cancer that has recurred (come back) after going into remission. The ALL may come back in the blood, bone marrow, or other parts of the body. Treatment Option OverviewKey Points
There are different types of treatment for patients with adult ALL.Different types of treatment are available for patients with adult acute lymphoblastic leukemia (ALL). Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment. The treatment of adult ALL usually has two phases.The treatment of adult ALL is done in phases:
Treatment called central nervous system (CNS) prophylaxis therapy is usually given during each phase of therapy. Because standard doses of chemotherapy may not reach leukemia cells in the CNS (brain and spinal cord), the leukemia cells are able to hide in the CNS. Systemic chemotherapy given in high doses, intrathecal chemotherapy, and radiation therapy to the brain are able to reach leukemia cells in the CNS. These treatments are given to kill the leukemia cells and lessen the chance the leukemia will recur (come back). Four types of standard treatment are used:ChemotherapyChemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid (intrathecal chemotherapy), an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is treatment using more than one anticancer drug. Intrathecal chemotherapy may be used to treat adult ALL that has spread, or may spread, to the brain and spinal cord. When used to lessen the chance leukemia cells will spread to the brain and spinal cord, it is called CNS prophylaxis. Enlarge Intrathecal chemotherapy. Anticancer drugs are injected into the intrathecal space, which is the space that holds the cerebrospinal fluid (CSF, shown in blue). There are two different ways to do this. One way, shown in the top part of the figure, is to inject the drugs into an Ommaya reservoir (a dome-shaped container that is placed under the scalp during surgery; it holds the drugs as they flow through a small tube into the brain). The other way, shown in the bottom part of the figure, is to inject the drugs directly into the CSF in the lower part of the spinal column, after a small area on the lower back is numbed.See Drugs Approved for Acute Lymphoblastic Leukemia for more information. Radiation therapyRadiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer. External radiation therapy may be used to treat adult ALL that has spread, or may spread, to the brain and spinal cord. When used this way, it is called central nervous system (CNS) sanctuary therapy or CNS prophylaxis. Total-body irradiation may be used to send radiation toward the whole body when preparing for a stem cell transplant. External radiation therapy may also be used as palliative therapy to relieve symptoms and improve quality of life. ChemotherapyChemotherapy is given to kill cancer cells. Healthy cells, including blood-forming cells, are also destroyed by the cancer treatment. Stem cell transplant is a treatment to replace the blood-forming cells. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the patient completes chemotherapy or total-body radiation therapy, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells. See Drugs Approved for Acute Lymphoblastic Leukemia for more information. Targeted therapyTargeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells. Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy do.
See Drugs Approved for Acute Lymphoblastic Leukemia for more information. New types of treatment are being tested in clinical trials.This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website. ImmunotherapyImmunotherapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This cancer treatment is a type of biologic therapy.
Patients may want to think about taking part in a clinical trial.For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment. Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment. Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward. Patients can enter clinical trials before, during, or after starting their cancer treatment.Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment. Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCI’s clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website. Treatment for adult acute lymphoblastic leukemia may cause side effects.For information about side effects that begin during treatment for cancer, see our Side Effects page. Side effects from cancer treatment that begin after treatment and continue for months or years are called late effects. Late effects of treatment for ALL may include the risk of second cancers (new types of cancer). Regular follow-up exams are very important for long-term survivors. Follow-up tests may be needed.Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups. Treatment of Untreated Adult Acute Lymphoblastic LeukemiaTreatment of Adult Acute Lymphoblastic Leukemia in RemissionTreatment of Recurrent Adult Acute Lymphoblastic LeukemiaTo Learn More About Adult Acute Lymphoblastic LeukemiaFor more information from the National Cancer Institute about adult acute lymphoblastic leukemia, see the following: For general cancer information and other resources from the National Cancer Institute, see the following: About This PDQ SummaryPhysician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical
language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish. PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of
biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH. This PDQ cancer information summary has current information about the treatment of adult acute lymphoblastic leukemia. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health
care. Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Updated") is the date of the most recent change. The information in this patient summary was taken from
the health professional version, which is reviewed regularly and updated as needed, by the PDQ Adult Treatment Editorial Board. A clinical trial is a study to answer a scientific question, such as whether one treatment is better than
another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a
clinical trial. Some clinical trials are open only to patients who have not started treatment. Clinical trials can be found online at NCI's website. For more information, call the Cancer
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cancer prevention states the risks in the following way: [include excerpt from the summary].” The best way to cite this PDQ summary is: PDQ® Adult Treatment Editorial Board. PDQ Adult Acute Lymphoblastic Leukemia Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at:
https://www.cancer.gov/types/leukemia/patient/adult-all-treatment-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389283] Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are
not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in Visuals Online. Visuals Online is a collection of more than 3,000 scientific images. The
information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page. More information about contacting us or receiving help with the Cancer.gov website can be found on our
Contact Us for Help page. Questions can also be submitted to Cancer.gov through the website’s E-mail Us. What happens when leukemia spreads to the CNS?Leukemia can spread to the central nervous system
Leukemia cells can spread to the central nervous system and build up in the fluid surrounding the spine and the brain. This can cause symptoms like headaches, seizures, balance problems, and abnormal vision.
Can you survive CNS leukemia?Survival of patients with CNS leukemia is particularly poor with AML, with a reported 5-year overall survival (OS) of 11% [6].
How does leukemia get into the CNS?In order to access CNS, leukemic cells can move along the walls of the vascular channels connecting the bone marrow of the skull bones and vertebrae with the pachymeninges, cross the vascular endothelium by transendothelial migration or endothelium destruction, diffusely infiltrate the arachnoid, migrate and ...
What happens if leukemia is on the brain?Sometimes leukemia can spread, or metastasize. If it spreads to the brain, symptoms may include headaches, seizures, balance problems, or vision problems. If it spreads to the lymph nodes in the chest, symptoms may include breathing problems and chest pain.
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