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Adult acute lymphocytic leukemia


Table of Contents

OVERVIEW OF PDQ
What is PDQ?
How to use PDQ
DESCRIPTION
What is adult acute lymphocytic leukemia?
STAGE EXPLANATION
Stages of adult acute lymphocytic leukemia
Untreated
In remission
Recurrent/refractory
TREATMENT OPTION OVERVIEW
How adult acute lymphocytic leukemia is treated
Treatment by stage
UNTREATED ADULT ACUTE LYMPHOCYTIC LEUKEMIA
ADULT ACUTE LYMPHOCYTIC LEUKEMIA IN REMISSION
RECURRENT ADULT ACUTE LYMPHOCYTIC LEUKEMIA
TO LEARN MORE

OVERVIEW OF PDQ


What is PDQ?

PDQ is a computer system that gives up-to-date information on cancer and its prevention, detection, treatment, and supportive care. It is a service of the National Cancer Institute (NCI) for people with cancer and their families and for doctors, nurses, and other health care professionals.

To ensure that it remains current, the information in PDQ is reviewed and updated each month by experts in the fields of cancer treatment, prevention, screening, and supportive care. PDQ also provides information about research on new treatments (clinical trials), doctors who treat cancer, and hospitals with cancer programs. The treatment information in this summary is based on information in the PDQ summary for health professionals on this cancer.


How to use PDQ

PDQ can be used to learn more about current treatment of different kinds of cancer. You may find it helpful to discuss this information with your doctor, who knows you and has the facts about your disease. PDQ can also provide the names of additional health care professionals who specialize in treating patients with cancer.

Before you start treatment, you also may want to think about taking part in a clinical trial. PDQ can be used to learn more about these trials. A clinical trial is a research study that attempts to improve current treatments or finds information on new treatments for patients with cancer. Clinical trials are based on past studies and information discovered in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help patients with cancer. Information is collected about new treatments, their risks, and how well they do or do not work. When clinical trials show that a new treatment is better than the treatment currently used as "standard" treatment, the new treatment may become the standard treatment. Listings of current clinical trials are available on PDQ. Many cancer doctors who take part in clinical trials are listed in PDQ.

To learn more about cancer and how it is treated, or to learn more about clinical trials for your kind of cancer, call the National Cancer Institute's Cancer Information Service. The number is 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. The call is free and a trained information specialist will be available to answer cancer-related questions.

PDQ is updated whenever there is new information. Check with the Cancer Information Service to be sure that you have the most up-to-date information.


DESCRIPTION


What is adult acute lymphocytic leukemia?

Adult acute lymphocytic leukemia (also called acute lymphoblastic leukemia or ALL) is a disease in which too many infection-fighting white blood cells called lymphocytes are found in the blood and bone marrow. Lymphocytes are made by the bone marrow and by other organs of the lymph system. The bone marrow is the spongy tissue inside the large bones in the body. The bone marrow makes red blood cells (which carry oxygen and other materials to all tissues of the body), white blood cells (which fight infection), and platelets (which make the blood clot). Normally, the bone marrow makes cells called blasts that develop (mature) into several different types of blood cells that have specific jobs to do in the body.

Lymphocytes are found in the lymph which is a colorless, watery fluid present in the lymph vessels. The lymph vessels are part of the lymph system which is made up of thin tubes that branch, like blood vessels, into all parts of the body. Along the network of vessels are groups of small, bean-shaped organs called lymph nodes. Clusters of lymph nodes are found in the underarm, pelvis, neck, and abdomen. The spleen (an organ in the upper abdomen that makes lymphocytes and filters old blood cells from the blood), the thymus (a small organ beneath the breastbone), and the tonsils (an organ in the throat) are also part of the lymph system.

Lymphocytes fight infection by making substances called antibodies, which attack germs and other harmful bacteria in the body. In ALL, the developing lymphocytes do not mature and become too numerous. These immature lymphocytes are then found in the blood and the bone marrow. They also collect in the lymph tissues and make them swell. Lymphocytes may crowd out other blood cells in the blood and bone marrow. If the bone marrow cannot make enough red blood cells to carry oxygen, then anemia may develop. If the bone marrow cannot make enough platelets to make the blood clot normally, the bleeding or bruising may develop more easily. The cancerous lymphocytes can also invade other organs, the spinal cord, and the brain.

Leukemia can be acute (progressing quickly with many immature cancer cells) or chronic (progressing slowly with more mature looking leukemia cells). ALL progresses quickly and can occur in adults and children. Treatment is different for adults than it is for children. (For more information on childhood ALL, refer to the PDQ patient information statement on childhood acute lymphocytic leukemia. Separate PDQ patient information statements are also available for chronic lymphocytic leukemia, chronic myelogenous leukemia, adult or childhood acute myeloid leukemia, and hairy-cell leukemia).

ALL is often difficult to diagnose. The early signs may be similar to the flu or other common diseases. A doctor should be seen if the following signs or symptoms won't go away: fever, persistant weakness or tiredness, achiness in the bones or joints, or swollen lymph nodes.

If there are symptoms, a doctor may order blood tests to count the number of each of the different kinds of blood cells. If the results of the blood tests are not normal, a doctor may do a bone marrow biopsy. During this test, a needle is inserted into a bone and a small amount of bone marrow is taken out and looked at under the microscope. A doctor may also do a spinal tap in which a needle is inserted through the back to take a sample of the fluid that surrounds the brain and spine. The fluid is then looked at under a microscope to see if leukemia cells are present. A doctor can then tell what kind of leukemia is present and plan the best treatment.

The chance of recovery (prognosis) depends on how the leukemia cells look under a microscope, how far the leukemia has spread, and the patient's age and general health.


STAGE EXPLANATION


Stages of adult acute lymphocytic leukemia

There is no staging for ALL. Your choice of treatment depends on whether a patient has been treated before.


Untreated

Untreated ALL means that no treatment has been given except to treat symptoms. There are too many white blood cells in the blood and bone marrow, and there may be other signs and symptoms of leukemia.


In remission

Remission means that treatment has been given and that the number of white blood cells and other blood cells in the blood and bone marrow is normal. There are no signs or symptoms of leukemia.


Recurrent/refractory

Recurrent disease means that the leukemia has come back after going into remission. Refractory disease means that the leukemia has failed to go into remission following treatment.


TREATMENT OPTION OVERVIEW


How adult acute lymphocytic leukemia is treated

There are treatments for all patients with ALL. The primary treatment of ALL is chemotherapy. Radiation therapy may be used in certain cases. Bone marrow transplantation is being studied in clinical trials.

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in a vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells throughout the body. Chemotherapy may sometimes be put into the fluid that surrounds the brain by inserting a needle in the brain or back (intrathecal chemotherapy).

Radiation therapy uses x-rays or other high-energy rays to kill cancer cells and shrink tumors. Radiation for ALL usually comes from a machine outside the body (external radiation therapy).

There are two phases of treatment for ALL. The first stage is called induction therapy. The purpose of induction therapy is to kill as many of the leukemia cells as possible and make patients go into remission. Once in remission with no signs of leukemia, patients enter a second phase of treatment (called continuation therapy), which tries to kill any remaining leukemia cells. A patient may receive chemotherapy for up to several years to stay in remission.

Radiation therapy or chemotherapy to the brain may be given to patients if leukemia cells have spread to the brain. Patients may also receive central nervous system (CNS) prohylaxis, another type of therapy, to prevent leukemia cells from growing in the brain during induction therapy and remission.

Bone marrow transplantation is used to replace bone marrow with healthy bone marrow. First, all of the bone marrow in the body is destroyed with high doses of chemotherapy with or without radiation therapy. Healthy marrow is then taken from another person (a donor) whose tissue is the same as or almost the same as the patient's. The donor may be a twin (the best match), a brother or sister, or a person who is not related. The healthy marrow from the donor is given to the patient through a needle in the vein, and the marrow replaces the marrow that was destroyed. A bone marrow transplant using marrow from a relative or person not related to the patient is called an allogeneic bone marrow transplant.

Another type of bone marrow transplant, called autologous bone marrow transplant, is being studied in clinical trials. To do this type of transplant, bone marrow is taken from the patient and treated with drugs to kill any cancer cells. The marrow is frozen to save it. Next, high-dose chemotherapy is given with or without radiation therapy to destroy all of the remaining marrow. The frozen marrow that was saved is then thawed and given to the patient through a needle in a vein to replace the marrow that was destroyed.

A greater chance for recovery occurs if the doctor chooses a hospital that does more than five bone marrow transplantations per year.


Treatment by stage

Treatment of adult ALL depends on the type of disease, the patient's age and overall condition.

Standard treatment may be considered based on its effectiveness in past studies, or participation in a clinical trial may be considered. Not all patients are cured with standard therapy, and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical trials are ongoing in most parts of the country for most stages of ALL. For more information, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.


UNTREATED ADULT ACUTE LYMPHOCYTIC LEUKEMIA

Treatment will probably be systemic chemotherapy. This may be intrathecal chemotherapy alone or combined with either radiation therapy to the brain or high doses of systemic chemotherapy to treat or prevent leukemia in the brain. Treatment may also include blood transfusions, antibiotics, and instructions to keep the body and teeth especially clean. Clinical trials are testing new drugs.


ADULT ACUTE LYMPHOCYTIC LEUKEMIA IN REMISSION

Treatment may be one of the following:

1. Clinical trials of short-term, high-dose chemotherapy followed by long-term, low-dose chemotherapy.
2. Clinical trials of allogeneic bone marrow transplantation.
3. Clinical trials of autologous bone marrow transplantation.
4. Intrathecal chemotherapy alone, or combined with either radiation to the brain or high doses of systemic chemotherapy, to prevent leukemia cells from growing in the brain (CNS prophylaxis).

RECURRENT ADULT ACUTE LYMPHOCYTIC LEUKEMIA

Radiation therapy may be given to reduce symptoms. Patients may also choose to take part in a clinical trial of bone marrow transplantation.


TO LEARN MORE

TO LEARN MORE..... CALL 1-800-4-CANCER

To learn more about adult ALL, call the National Cancer Institute's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. By dialing this toll-free number, trained information specialists can help answer your questions.

The Cancer Information Service also has a variety of booklets about cancer that are available to the public and can be sent on request.

The following booklets about leukemia may be helpful:

What You Need To Know About Leukemia
Research Report: Bone Marrow Transplantation
The following general booklets on questions related to cancer may also be helpful:

Taking Time: Support for People with Cancer and the People Who Care About
Them
What Are Clinical Trials All About?
Chemotherapy and You: A Guide to Self-Help During Treatment
Radiation Therapy and You: A Guide to Self-Help During Treatment
Eating Hints for Cancer Patients
Advanced Cancer: Living Each Day
When Cancer Recurs: Meeting the Challenge Again
What You Need To Know About Cancer
There are many other places where people can get materials and information about cancer treatment and services. The social service office at a hospital can be checked for local and national agencies that help with getting information about finances, getting to and from treatment, getting care at home, and dealing with problems.

For more information from the National Cancer Institute, please write to this address:

National Cancer Institute
Office of Cancer Communications
31 Center Drive, MSC 2580
Bethesda, MD 20892-2580
Date Last Modified: 09/97


If you want to know more about cancer and how it is treated, or if you wish to know about clinical trials for your type of cancer, you can call the NCI's Cancer Information Service at 1-800-422-6237, toll free. A trained information specialist can talk with you and answer your questions.