Acute lymphocytic leukaemia (ALL) is a form of cancer affecting the blood and blood-forming tissues of the body. It progresses rapidly if left untreated and is the most common leukaemia in children, while being the rarest of the four common types overall.
ALL develops from lymphoid stem cells. These cancerous cells multiply quickly and are poor at fighting infection. They crowd out healthy cells, leaving patients weak and prone to illness.
The two main subtypes are B cell ALL, which accounts for approximately 85% of cases, and T cell ALL, accounting for 15%. These are further categorised based on genetic markers. An important subtype is Philadelphia chromosome-positive B-ALL, which occurs when segments of chromosome 9 and chromosome 22 swap places in a blood cell. This genetic change causes the cancerous cell to produce a protein (from the tyrosine kinase family) that encourages rapid multiplication. Leukaemias with the Philadelphia chromosome can be treated with targeted therapies known as tyrosine kinase inhibitors, which interfere with this protein.
In India, around many cases are diagnosed annually, with over half affecting paediatric patients. Among adults, the risk begins to increase around age 50. The five-year survival rate for ALL is about 70%, largely due to a 90% survival rate among paediatric patients. For adults, the survival rate declines with age, partly due to chromosome changes linked to poorer outcomes, which are more prevalent in adults, as well as the presence of other health conditions in older patients that can affect care and prognosis.
The body produces millions of blood cells daily, primarily in the bone marrow, which contains immature stem cells. These stem cells first become either lymphoid stem cells or myeloid stem cells.
Lymphoid stem cells develop into white blood cells (lymphocytes, including B cells and T cells) that are part of the immune system. B cells produce antibodies, while T cells alert other immune cells or directly fight infection.
Myeloid stem cells develop into other white blood cells (monocytes and granulocytes, such as neutrophils, which also fight disease), red blood cells (which transport oxygen), and platelets (which aid blood clotting).
Leukaemia occurs when a mutation in the DNA of a bone marrow stem cell causes it to become cancerous, multiplying uncontrollably and crowding out healthy cells. These diseased cells can also gather in areas like the liver, lymph nodes, spleen, and skin.
Leukaemias are typically classified by the type of cancerous stem cell (lymphoid or myeloid) and by their progression rate (acute or chronic):
Acute leukaemia affects immature cells, preventing them from developing properly. These cells multiply rapidly, making acute leukaemia more aggressive.
Chronic leukaemia involves mature or partially mature cells. These cells multiply more slowly and are less aggressive than acute leukaemia.
A risk factor is anything that increases the likelihood of developing a disease, though not everyone with risk factors will develop it. Risk factors for ALL include:
Men are slightly more likely to develop ALL than women.
The risk for adults starts to increase around age 50.
Past treatment with chemotherapy or radiation therapy for a previous cancer (though the benefits of these therapies far outweigh this risk).
Including Ataxia telangiectasia, Bloom syndrome, Down syndrome, Fanconi anaemia, Klinefelter syndrome, Li-Fraumeni syndrome (a hereditary cancer syndrome), and Wiskott-Aldrich syndrome.
Long-term exposure to benzene, a chemical used in the petroleum industry (more commonly linked to acute myeloid leukaemia).
Important Note: Some cases of leukaemia can be passed down through generations. Genetic counselling may be right for you. Learn more about the risk to you and your family on our genetic testing page at SSCHRC.
While there are many different types of leukaemia, the symptoms are often similar. Many symptoms arise from a lack of properly functioning blood cells needed to carry oxygen, fight infection, and stop bleeding, or from low levels of haemoglobin (a protein that helps move oxygen).
Common leukaemia symptoms include:
Important Note: Some cases of leukaemia can be passed down through generations. Genetic counselling may be right for you. Learn more about the risk to you and your family on our genetic testing page at SSCHRC.
A definitive diagnosis of leukaemia is often achieved through a bone marrow biopsy, which involves using a needle to take a sample of bone marrow from the hip.
A diagnosis typically begins with a complete blood count (CBC), ordered after a doctor evaluates a patient's symptoms or as part of a routine check-up.
If the test results show the presence of leukaemia cells or abnormal levels of red blood cells, white blood cells, or platelets, doctors will order additional tests. These tests offer a definitive diagnosis, determine the extent of the disease, and are used to monitor progress and track response to treatment.
For leukaemia, a bone marrow biopsy is performed, requiring a sample from the hip to check for cancerous cells.
If leukaemia is diagnosed, additional tests (sometimes called molecular profiling) determine if specific chromosomes, gene mutations, proteins, or molecules are present in the diseased cells. This helps determine the exact type of leukaemia and prognosis, enabling doctors to create the most effective, individualised treatment plan.
As leukaemia can spread to the central nervous system (brain and spinal cord), most commonly in ALL, a lumbar puncture is performed to examine the patient's spinal fluid for evidence of spread. A small dose of chemotherapy may also be administered into the spinal fluid during this procedure.
Doctors may order various imaging exams to look for the presence of cancer in different parts of the body.
Successful leukaemia treatment begins with an accurate and precise diagnosis. At SSCHRC, suspected leukaemia cells are examined by pathologists who focus exclusively on diagnosing leukaemia and its many subtypes. This specialisation allows SSCHRC to offer patients the most effective treatment for their specific disease.
Staging is the process of determining how far a cancer has spread, impacting the patient's prognosis and treatment plan. There is no standard staging system for adult ALL; instead, the disease is described as:
Newly diagnosed ALL that has not been treated (except for symptom relief). The complete blood count is abnormal, more than 5% of cells in the bone marrow are blasts (leukaemia cells), and there are signs and symptoms of leukaemia.
The ALL has been treated. The complete blood count is normal, 5% or fewer of the cells in the bone marrow are blasts, and there are no signs or symptoms of leukaemia outside of the bone marrow.
Cancer that has returned after going into remission. It may come back in the blood, bone marrow, or other parts of the body.
Important Note: Some cases of leukaemia can be passed down through generations. Genetic counselling may be right for you. Learn more about the risk to you and your family on our genetic testing page at SSCHRC.
The goal of leukaemia treatment is to achieve remission and ultimately cure the patient. Complete remission usually means no detectable microscopic evidence of the disease in the bone marrow and a return to normal blood counts. Even with normal blood counts, ongoing maintenance therapy may be required to sustain remission, sometimes involving a stem cell transplant. Patients who remain in continuous complete remission for an extended period, typically measured in years, are considered cured with an extremely low chance of recurrence.
As home to a leading leukaemia programme, SSCHRC bring together internationally renowned physicians with a specialised support team to customise patient care. These highly experienced experts communicate and collaborate daily, ensuring comprehensive leukaemia treatment. Many doctors focus on specific types of leukaemia, offering a deep level of knowledge and experience for designing treatment plans.
Newly diagnosed adult ALL patients typically undergo chemotherapy, administered in three phases. Depending on the features of the cancer, targeted therapy may also be prescribed. If the cancer returns or does not respond to treatment, patients may undergo a stem cell transplant. Patients who have been treated unsuccessfully with other therapies may also qualify for CAR T cell therapy.
Drugs used to kill cancer cells, control their growth, or relieve symptoms. Chemotherapy for ALL is usually given in three phases:
An intense phase, often requiring a hospital stay, designed to kill leukaemia cells in the blood and bone marrow and bring the cancer into remission.
A phase, usually lasting a few months, meant to kill any remaining cancer cells that survived the induction phase.
A lower dose of chemotherapy given to stop the cancer from returning. ALL patients receive maintenance chemotherapy for approximately two years.
Chemotherapy may also be administered directly into the central nervous system to prevent the disease from spreading there, or it may be used to prepare the body for a stem cell transplant.
Drugs designed to interfere with specific molecules (often proteins) that cancer cells need to survive, multiply, and spread. They are designed to 'target' these molecules or the cancer-causing genes that create them.
A procedure that replaces cancerous bone marrow with new, healthy stem cells. It is typically performed after intense chemotherapy to eliminate the patient's existing bone marrow cells. A transplant may be recommended for patients whose leukaemia has returned, has not responded to standard treatments, or if they have a high-risk form of leukaemia. This treatment can be physically challenging and is typically not given to older or otherwise unhealthy patients.
Uses powerful beams of energy to kill cancer cells. Since leukaemia cells travel in the bloodstream, radiation is primarily used when the disease has spread to the central nervous system.
A treatment option for ALL patients who have been treated unsuccessfully with other therapies. T cells, a type of immune system cell, are modified so they can specifically recognise and attack cancer cells.
SSCHRC offers multiple clinical trials for ALL, exploring new drug combinations and new drugs, including targeted therapies and immunotherapies, many of which are exclusive to the centre.
Important Note: Some cases of leukaemia can be passed down through generations. Genetic counselling may be right for you. Learn more about the risk to you and your family on our genetic testing page at SSCHRC.