When Your Child Has Acute Lymphoblastic Leukemia (ALL)

Your child has been diagnosed with acute lymphoblastic leukemia (ALL). It is a common type of childhood cancer. It is often curable with treatment. ALL is also called acute lymphocytic leukemia. Your child’s healthcare team will help you as you make important decisions about your child’s health. Read on to learn more about ALL and how it's treated.

What is ALL?

ALL is a fast-growing cancer that affects the bone marrow (the spongy space inside of bones where new blood cells are made) and blood. The blood is made up of 3 main types of cells:

• White blood cells fight infection.

• Red blood cells carry oxygen throughout the body, which gives a person energy.

• Platelets help the blood to clot, which helps stop bleeding when a person is cut.

ALL affects the white blood cells. When a person is healthy, white blood cells form and mature in the bone marrow. With ALL, large numbers of abnormal, immature white blood cells called leukemic blasts are made. Leukemic blasts crowd out healthy cells in the bone marrow. As time goes on, there are more blasts than healthy cells, so that blood cells can't be made and the blood can’t do its job. This leads to problems, including infections and bleeding. Anemia can also occur. This is when there aren't enough red blood cells in the body.

Who gets ALL?

ALL is the most common type of childhood cancer. It is most common in younger children. But it can occur at any age. ALL is not contagious, meaning your child can’t pass it to another person.

What causes ALL?

ALL occurs when a certain type of white blood cell called lymphocytes grows abnormally. What causes this to happen is not fully known. In rare cases, factors such as certain inherited conditions or exposure to certain chemicals might play a role. But most often, the cause of leukemia in children is unknown.

What are the symptoms of ALL?

Some common symptoms of ALL are:

• Fever

• Infections

• Easy bruising or bleeding

• Pale skin

• Tiredness

• Weakness

• Bone pain

• Weight loss

Your child may have some of these symptoms, or other symptoms.

How is ALL diagnosed?

Your child’s healthcare provider examines your child. You will be asked about your child’s health history. Your child may also have one or more of these:

• Blood tests to check the number of different blood cells in the blood and look at them under a microscope

• Imaging tests, such as a chest X-ray, to take detailed images of areas inside the body to see if the leukemia cells have formed a mass in the chest or if there is an infection

• Bone marrow aspiration and biopsy to take a sample of bone marrow from the hipbone so it can be tested in the lab

• Lumbar puncture, also called spinal tap, to take a sample of the fluid that surrounds the spinal cord from the child’s lower back so it can be checked for cancer cells

How is ALL treated?

Chemotherapy (“chemo”) is the main treatment used for ALL. Chemo is strong cancer-fighting medicine that destroys cancer cells. Treatment is a combination of chemo and other supportive medicines. They may be given by mouth, injection, or through a tube (IV) that’s often put into a vein in the arm or chest. Your child’s healthcare provider can tell you more. For some children who are at higher risk for their leukemia coming back, high-dose chemo may be given along with a stem cell transplant. In certain cases, other treatments such as radiation therapy may be used. 

Supportive treatments

The goal of supportive treatments is to protect the child from infection, prevent discomfort, and bring the body’s blood counts to a healthy range. For example, during your child’s treatment, he or she may be given antibiotics. These help prevent and fight infection. Anti-nausea and other medicines may also be given. These help ease side effects caused by chemo. Your child may receive blood product transfusions to restore the blood cells destroyed by treatment.

What are the long-term concerns?

With treatment, ALL is often curable. But chemo and radiation therapy may cause some problems, such as damage to certain organs. So your child’s health will need to be monitored for life. This may involve clinic visits, blood tests, and other follow-up monitoring.

Coping

Receiving a cancer diagnosis for your child is scary and confusing. Remember that you are not alone. Your child’s healthcare team will work with you and your child throughout your child’s illness and care. You may also wish to seek information and support for yourself. Doing so can help you cope with the changes cancer brings. Learning about and talking with others who also have a child with cancer may help you and your family cope. Some helpful resources are:

• American Cancer Society
  www.cancer.org

• Children's Oncology Group
  www.childrensoncologygroup.org

• Leukemia Research Foundation
  www.leukemia-research.org

• The Leukemia & Lymphoma Society
  www.lls.org