Acute lymphocytic leukemia (ALL) is a cancer of the lymphoid cells in the bone marrow that grows quickly. It most commonly affects children between ages 3-7. Treatment involves intensive chemotherapy over 2-3 years including induction, consolidation, maintenance, and central nervous system prophylaxis phases. Outcomes are best in children and worse in older patients, though cure rates have improved significantly over time. Risk factors include exposure to radiation, genetics, and certain chemotherapy drugs.

1. Acute
Lymphocytic
Leukemia

2. What is Leukemia?
• The word Leukemia comes from the Greek leukos
which means "white" and aima which means
"blood".
• It’s the cancer of the blood or bone marrow
• A person who has leukemia suffers from an abnormal
production of blood cells, generally leukocytes (white
blood cells).

3. Types Of Leukemia
• Chronic lymphocytic Leukemia(CLL): CLL affects
lymphoid cells and usually grows slowly.
• Chronic myeloid leukemia (CML): CML affects
myeloid cells and usually grows slowly at first.
• Acute lymphocytic (lymphoblastic) leukemia(ALL):
ALL affects lymphoid cells and grows quickly.
• Acute myeloid leukemia (AML): AML affects myeloid
cells and grows quickly.

4. Acute lymphocytic leukemia
Background Info
• type of cancer in which the bone marrow makes too
many lymphocytes (a type of white blood cell)
• 1400 deaths per year
• About 3 out of 4 cases of leukemia among children
and teens are acute lymphocytic leukemia (ALL).
• Symptoms of ALL will usually start slowly, and then
escalate in severity as the number of blast cells in the
blood rises.

5. What’s Bone Marrow?
• Bone marrow is the soft, spongy material that fills
the centre of most bones (where blood cells are
made).

6. 2 Types Of Bone Marrow
1. Red marrow, made up mainly of myeloid
tissue, produces blood cells and is found in flat
bones and at the end of long bones
2. Yellow marrow, made up mostly of fat cells is found
in the middle of flat bones. It can convert yellow
marrow to red marrow to raise blood cell
production
Types of bone marrow in
cross section of a bone

8. Causes
• No single known cause for any types of leukemia
exists
• Results from mutations in the DNA.
• Certain mutations can trigger leukemia by activating
oncogenes or deactivating tumor suppressor genes
may occur spontaneously or as a result of exposure
to radiation or carcinogenic substances
• Main causes of ALL is exposure to high levels of
radiation or benzene. Smokers are three times as
likely to develop ALL

9. Possible Risk Factors
• Being male—slight increase in risk
• Being Caucasian—slight increase in risk
• Exposure to high levels of radiation
• Having certain genetic disorders such as Down
syndrome(Involved in about 1/20 cases)
• Having a sibling with leukemia
• Having had certain types of chemotherapy such as
alkylating agents

10. Prevention
• Some scientists wonder if early exposure to germs
might protect children from developing ALL.
• A significantly lower percentage of children who
went to playgroups at an early age develop ALL
compared to those who didn't.
*Note, as of 2012, there are still no known preventions

11. Treatments
• The treatment of ALL varies according to age, general
condition at diagnosis, and the results of the cytogenetic
testing.
• A complete remission is achieved when the blood and bone
marrow show no evidence of persistent leukemia and blood
counts have returned to normal.
Treatment can be divided into four phases:
• First phase — induction chemotherapy
• Second phase — consolidation chemotherapy
• Third phase — maintenance chemotherapy
• Fourth phase — central nervous system (CNS) prophylaxis

12. Stage 1 treatment
Induction Chemotherapy
• The most common drugs used for induction treatment of
ALL are daunorubicin, vincristine, prednisone and
asparaginase
• Intensive supportive care accompanies the chemotherapy
(ex transfusion of red blood cells and platelets)
• Antibiotics are needed as treatment for bacterial and
fungal infections. The agent G-CSF (Neupogen) can be
useful in rapidly re-establishing a normal white blood
count.
• Once blood counts have returned to normal, a repeat bone
marrow biopsy is performed to determine whether the
patient has entered complete remission.

13. Stage 2
Consolidation Chemotherapy
• multiple cycles of intensive chemotherapy given over
a six- to nine-month period.
• Frequent hospitalizations are required, intensive
supportive care is still needed
• Stem cell transplantation isn’t used unless abnormal
cytogenetics are present.
• Chemotherapy agents used during consolidation
include the same agents used during induction, as
well as Ara-C, etoposide, methotrexate and 6-
mercaptopurine

14. Stage 3
Maintenance Chemotherapy
• Once patient’s intensive chemotherapy has been
completed, oral chemotherapy pills are needed for
an additional 18 to 24 months.
• The pills — typically methotrexate and 6-
mercaptopurine — are usually well-tolerated with
minimal side effects
• Patients need to have their blood tests checked once
a month while taking chemotherapy pills.
• Most patients can return to work during
maintenance therapy.

15. Stage 4
Central Nervous System (CNS) Prophylaxis
• ALL can reoccur in the fluid that bathes the spinal
column and brain(spinal fluid).
• To prevent relapse at this location, chemotherapy
must be injected directly into the fluid that bathes
the spinal column. (intrathecal chemotherapy).
• Patients are given six or more injections of
intrathecal chemotherapy to prevent recurrence of
ALL. More may be necessary if leukemia cells are
detected in the spinal fluid.
• Most people complete intrathecal therapy within 2-4
months of starting their treatment. Headaches and
nausea are occasional side effects.

16. What about abnormal cytogenetics?
• Cytogenetics is the most important
component of deciding whether or not a
person should have a bone marrow transplant
for ALL.
• Stem cell transplantation, also called blood or
marrow transplantation (BMT), is performed
only in patients who have abnormal
cytogenetics, chromosome testing or other
high-risk ALL features.

17. Who gets ALL the most
• ALL is the most common childhood cancer(3/4
cases of leukemia in children/teens are ALL)
• Usually affects children ages 3 - 7. It is the most
common childhood acute leukemia.
• People living in America have a higher chance of
getting ALL because of radiation, pollution, and being
exposed to x-rays before work

18. Prominence in society
• It is estimated that 3,450 men and 2,600
women will be diagnosed with ALL
• 1,440 people will die of ALL in 2012
rates are based on cases diagnosed in 2005-
2009 from 18 SEER geographic areas.

19. Lifetime Risk
• Based on rates from 2007-2009, 0.13% of people (1
in 798 ) born today will be diagnosed with ALL at
some time during their lifetime.
• The 5-year survival rate for children with ALL has
greatly increased over time and is now more than
85%
• 45%-60% of adults have long-term disease-free
survival
• Cure rates tend to be higher in younger patients and
lower in older patients