Acute lymphoblastic leukemia (ALL)

What you should do if you are diagnosed with ALL 

• Choose a doctor who specializes in treating ALL, known as a hematologist-oncologist. Your local cancer specialist can also work with a leukemia specialist. Learn how to choose a blood cancer specialist or treatment center.
• Talk with your doctor about your diagnostic tests and what the results mean.
• Talk to your doctor about all your treatment options, treatment goals, and the results you can expect from treatment.
• Obtain and keep records of your test results and the treatment you receive as this information is useful for long-term follow-up of your condition. Find out how.  

Learn more about communicating with your blood care specialist or find a list of suggested questions to ask your healthcare providers.

How does ALL develop?

 ALL starts with a change in the bone marrow to a single stem cell—the cells responsible for forming healthy blood cells such as red and white blood cells and platelets. This means a normal stem cell mutates (changes into an ALL cell) and then multiplies, producing many ALL cells. 

Although ALL starts in a stem cell in the bone marrow, it can spread to other areas such as the central nervous system, the lymph nodes, and more rarely, the testes. This damaged stem cell becomes a leukemic cell and multiplies uncontrollably into billions of cells called “leukemic lymphoblasts.”  

Leukemic lymphoblasts: 

• Do not function normally
• Block the production of normal cells
• Grow and survive better than normal cells 

As a result, the number of healthy blood cells is usually lower than normal, and can result in the following conditions: 

• Anemia: a condition where there is a low number of red cells in the blood, which can cause fatigue and shortness of breath
• Neutropenia: a condition where there is a low number of neutrophils (a type of white blood cell), so the immune system cannot effectively guard against infection
• Thrombocytopenia: a condition where there is a low number of platelets, which can cause bleeding and easy bruising with no apparent cause
• Pancytopenia: a condition resulting from low numbers of all three blood cell counts 

View a 3D model of ALL’s impact on the body. Click the "Interact in 3D" button to begin. 

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Risk factors for ALL 

Doctors do not know why some cells become leukemic cells and others do not. Usually, DNA (Deoxyribonucleic acid) mutations associated with ALL occur during a person's lifetime rather than being inherited from a parent.  

For most people who have ALL, there are no obvious reasons why they developed the disease, nor is there any way to prevent it. You cannot catch ALL from someone else. 

Risk factors associated with the disease include:  

• Previous exposure to chemotherapy and radiation therapy
• Genetic disorders, including: Down syndrome, neurofibromatosis, Klinefelter syndrome, Fanconi anemia, Shwachman-Diamond syndrome, Bloom syndrome, Li-Fraumeni syndrome, and ataxia telangiectasia have been associated with an increased risk of developing ALL
• Age: the highest incidence rates for ALL are seen in children and adolescents younger than 15 years
• Sex: males are more likely to develop ALL than females
• Race/ethnicity: in the United States, ALL is more common in people of Latino/Latinx/Hispanic and European descent  

Source: Acute Lymphoblastic Leukemia (ALL) in Adults. Reviewed by Wendy Stock, MD.