TABLE OF CONTENTS

What Is Acute Lymphoblastic Leukemia (ALL)?

Acute lymphoblastic leukemia (ALL) is a type of cancer in which lymphoblasts, immature cells that form lymphocytes in the bone marrow, multiply uncontrollably due to genetic damage in a single stem cell.

These abnormal cells accumulate in the bone marrow and may spread to the bloodstream and other organs such as the brain and spinal cord.

Key facts about ALL:

Accounts for approximately 80% of childhood leukemias
Can also occur in adults
Lymphoblasts lose their ability to mature and differentiate

Leukemic blast cells cannot function like normal blood cells and suppress healthy blood cell production in the bone marrow. This may lead to:

Anemia
Thrombocytopenia
Neutropenia

Causes of Acute Lymphoblastic Leukemia

In most patients, a clear cause cannot be identified. However, certain factors are known to contribute to the development of the disease.

Radiation exposure
Toxic substances such as benzene
Some chemotherapy drugs
Chromosomal abnormalities

Risk factors include:

Down syndrome
Family history of leukemia
Chemical exposure
Radiation

ALL is not contagious.

Symptoms of Acute Lymphoblastic Leukemia

Symptoms usually occur because normal blood cell production in the bone marrow is impaired.

Symptoms Related to Anemia

Fatigue
Weakness
Shortness of breath
Pale skin

Symptoms Related to Low Platelet Count

Easy bruising
Red spots on the skin
Nosebleeds
Gum bleeding

Signs of Infection

High fever
Tonsillitis
Pneumonia

Organ Involvement

Headache and vomiting
Enlarged lymph nodes
Enlarged liver and spleen
Testicular involvement (rare)

Other Symptoms

Bone and joint pain
Tenderness in the breastbone
Loss of appetite
Nausea and vomiting
Weight loss

Diagnosis of Acute Lymphoblastic Leukemia

During physical examination, the following findings may be present:

Enlarged liver and spleen
Signs of bruising and bleeding
Fever

Diagnostic methods include:

Complete blood count
Peripheral smear
Bone marrow biopsy

Advanced analyses:

Cytogenetic analysis
Genetic tests (PCR)
Immunophenotyping

These tests are important for determining the subtype and planning treatment.

Subtypes of Acute Lymphoblastic Leukemia

ALL is classified according to cellular and genetic characteristics.

Cellular Types

B-cell ALL
T-cell ALL

Morphological Classification

L1
L2
L3

Genetic Features

Hyperdiploidy (good prognosis)
Hypodiploidy (poor prognosis)
Philadelphia chromosome (poor prognosis)

Treatment of Acute Lymphoblastic Leukemia

Treatment planning depends on the following factors:

Genetic features
Age
White blood cell count
Type of lymphoblast

Treatment consists of four main phases:

Remission induction
Consolidation therapy
Central nervous system prophylaxis
Maintenance therapy

Remission Induction and Consolidation

Induction therapy is applied at the beginning of treatment, usually lasts 4–8 weeks, and is performed in the hospital. High remission rates can be achieved.

However, the disease may not be completely eliminated and relapse may occur. Therefore, consolidation therapy is used.

Chemotherapy
Stem cell transplantation

Stem Cell Transplantation and CNS Prophylaxis

May be applied after high-dose treatment
Uses donor cells
Preferred for high-risk patients
May include spinal injections or radiotherapy

Maintenance Therapy and Long-Term Follow-Up

Includes lower-dose chemotherapy
May continue for 2–3 years
Can be managed on an outpatient basis
Requires regular check-ups
Relapse risk is higher during the early years

Conclusion

Acute lymphoblastic leukemia is a blood cancer that can often be successfully managed with early diagnosis and appropriate treatment. Regular monitoring, specialist care, and individualized treatment planning are essential.

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