Acute Lymphocytic Leukemia

Diagnosis of Acute Lymphocytic Leukemia

Doctors use several tests and procedures to detect acute lymphocytic leukemia and understand how advanced the disease is.

• Blood Tests: Blood tests may show abnormal counts of white blood cells, low red blood cells, and a low number of platelets. The presence of blast cells — immature cells typically found only in the bone marrow — may indicate leukemia.

• Bone Marrow Test: A bone marrow aspiration and biopsy involve using a needle to take a sample from the hipbone or breastbone. Lab specialists then examine the cells to look for leukemia and classify the blood cells based on size, shape, and genetic or molecular markers. This also determines whether the leukemia started in B lymphocytes or T lymphocytes, helping doctors choose the most effective treatment.

• Imaging Tests: Imaging such as X-rays, CT scans, or ultrasound may be used to check whether leukemia has spread to the brain, spinal cord, or other parts of the body.

• Spinal Fluid Test: A lumbar puncture (spinal tap) collects fluid from around the brain and spinal cord to check for leukemia cells in the spinal fluid.

Determining Your Prognosis

Unlike many cancers, ALL doesn’t use numbered stages. Instead, your prognosis depends on key factors such as:

• The type of lymphocytes involved — B cells or T cells

• Specific genetic changes in the leukemia cells

• Your age and overall health

• Blood test results, including white blood cell count

This information helps doctors design a personalized treatment plan for the best possible outcome.

Treatment for Acute Lymphocytic Leukemia

Treatment for ALL typically takes place in phases over two to three years. Each phase has a specific goal — from killing leukemia cells to preventing the disease from returning.

• Induction Therapy: The first phase aims to kill most leukemia cells in the blood and bone marrow, helping restore normal blood cell production.

• Consolidation Therapy: Also called post-remission therapy, this phase targets any remaining leukemia cells.

• Maintenance Therapy: The third phase prevents leukemia cells from returning. Treatments are usually given at lower doses over a long period, often years.

• Preventive Treatment to the Spinal Cord: During each phase, patients may receive chemotherapy directly into the spinal fluid to kill leukemia cells in the central nervous system.

Treatments Used for ALL

• Chemotherapy: Chemotherapy drugs are commonly used in all three treatment phases — induction, consolidation, and maintenance — to kill leukemia cells.

• Targeted Therapy: These treatments block specific abnormalities in cancer cells, making them die. Targeted therapy can be used alone or with chemotherapy.

• Radiation Therapy: High-energy beams, like X-rays or protons, are used if cancer has spread to the brain or spinal cord.

• Bone Marrow Transplant: Also called a stem cell transplant, this treatment replaces diseased bone marrow with healthy marrow from a compatible donor. It’s often used during consolidation or for treating relapse.

• CAR-T Cell Therapy: This advanced therapy engineers your body’s T cells to attack leukemia cells. It’s an option for children and young adults and may be used during consolidation or relapse treatment.

• Clinical Trials: Participating in clinical trials may give patients access to the latest treatments and targeted therapies not yet widely available.

Treatment Considerations for Older Adults

Older adults may face more complications from aggressive treatments and often have a different prognosis compared to children. Treatment choices depend on age, overall health, and personal preferences. Some may choose a less aggressive approach focused on symptom relief and improving quality of life.