Childhood Acute Lymphocytic Leukemia (ALL): Symptoms, Causes, Diagnosis, Treatment, and Prevention

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Acute lymphocytic leukemia (ALL), also known as acute lymphoblastic leukemia, is a type of blood cancer that starts in the bone marrow — the spongy tissue in bones that’s responsible for making blood cells. With ALL, a person’s bone marrow produces immature lymphocytes (a type of white blood cell). These abnormal cells crowd out healthy white blood cells, which normally fight infections. ALL is the most common type of cancer in children. When ALL affects children, it’s known as pediatric ALL or childhood ALL. The Children’s Hospital of Philadelphia notes that ALL accounts for about 30 percent of all pediatric cancers. In children, this cancer has a positive prognosis and a high cure rate. ALL can also affect adults, but when it does, the outcomes aren’t as favorable.
Causes and Risk Factors for Childhood ALL Causes According to the MedlinePlus , ALL occurs when there are changes in the DNA in bone marrow cells. Though researchers don’t know exactly what causes these alterations, they have identified risk factors that may increase a child’s chances of developing this cancer. Risk factors for childhood ALL include: Exposure to X-rays before birth Previous exposure to radiation Previous treatment with chemotherapy Certain gene or chromosome mutations Some genetic conditions that may increase a child’s odds of developing ALL include: Down syndrome With this genetic disorder, an individual is born with an extra copy of chromosome 21. Neurofibromatosis type 1 This genetic condition causes tumors to grow on the skin and along nerves. Ataxia-telangiectasia This rare disease affects muscle control and weakens the immune system. Fanconi anemia People with this condition may experience physical abnormalities, bone marrow failure, organ problems, and an increased risk of certain cancers. Bloom syndrome This rare inherited disorder causes short stature and a skin rash after sun exposure. Li-Fraumeni syndrome This rare disorder is caused by a gene mutation and increases the risk of developing several types of cancer. Constitutional mismatch repair deficiency This happens when mutations in genes prevent DNA from repairing itself.
Types of Childhood ALL Types The two main types of ALL are: B-cell ALL This type develops in immature lymphocytes that would normally develop into B-cells, which provide immunity. B-cell ALL is more common in children, accounting for about 88 percent of pediatric cases, notes the Leukemia & Lymphoma Society . There are several subtypes of B-cell ALL. T-cell ALL This type develops in immature lymphocyte cells that would normally develop into T-cells, which help fight infections. T-cell ALL occurs more often in adults and older children.
Signs and Symptoms of Childhood ALL Symptoms Symptoms of childhood ALL are similar to those of adult ALL, and many times, they come on quickly. Some possible signs and symptoms include: Anemia (a low red blood cell count) Bleeding or bruising Fatigue Weakness Dizziness Cough Fever Night sweats Frequent infections, including viral and bacterial infections Joint pain Petechiae (small, red spots on the skin) Weight loss Appetite loss Swollen lymph nodes Pale skin Shortness of breath Abdominal pain
How Is Childhood ALL Diagnosed? Diagnosis Doctors may diagnose childhood ALL by performing a complete physical exam and ordering the following tests. Blood tests A blood test can provide information about the child’s blood cell numbers and their liver and kidney function. Bone marrow aspiration and biopsy A needle is inserted into a bone in the pelvis or spine to remove a small sample of bone marrow. The sample is sent to a lab to look for leukemia cells. Spinal tap A small sample of spinal fluid (the fluid that surrounds the spinal cord and brain) is collected from between the bones of your spinal column to see whether it contains cancer cells. Cytogenetic analysis This test checks for chromosome abnormalities in a sample of blood or bone marrow. Immunophenotyping A sample of blood or bone marrow is used to help diagnose specific types of leukemia. For instance, doctors might use this test to determine if cancer cells are B lymphocytes or T lymphocytes. Imaging tests A chest X-ray, computed tomography (CT) scan, magnetic resonance imaging (MRI), or positron emission tomography (PET) scan may be performed to see if the cancer has affected different areas of the body.
Risk Groups for Childhood ALL Risk Groups Doctors categorize children with ALL by assigning them a risk group. These groups can help health providers devise an appropriate treatment plan. The risk group is based on a child’s age, white blood cell count at diagnosis, the subtype of ALL, whether there are certain chromosome changes, and other prognostic factors. The three risk groups for childhood ALL are: Standard (low) risk This group includes children who are between ages 1 and 9 and have a white blood cell count less than 50,000 per microliter (mcL) at the time of diagnosis . High risk This group comprises children who are 10 years or older and/or have a white blood cell count of 50,000/mcL or more at the time of diagnosis. Very high risk This group includes children who are younger than 1 year old, have certain alterations in their genes, show a slow response to treatment, and exhibit signs of cancer after the first four weeks of treatment.
Treatment Options for Childhood ALL Treatment Treatment for childhood ALL is typically done in the following phases: Remission induction The goal of this first phase of treatment is to kill as many leukemia cells in the blood and bone marrow as possible, which puts the cancer into remission. Consolidation intensification This second phase begins when the leukemia is in remission. Doctors aim to kill any leukemia cells remaining in the body that could cause a relapse. Maintenance With the final maintenance phase, treatments are often given in lower doses to kill any remaining cancer cells that may regrow. The standard therapies used for childhood ALL include chemotherapy, radiation therapy, chemotherapy with stem cell transplant, and targeted treatments. Chemotherapy Chemotherapy involves using drugs to kill cancer cells in the body. When it comes to pediatric ALL, chemo may be injected into a vein or muscle; taken by mouth; or placed directly into the cerebrospinal fluid, an organ, or a body cavity. The type and delivery method depends on the child’s risk group and other factors. Radiation Therapy Radiation therapy uses high beams of energy to kill cancer cells. The National Cancer Institute says radiation therapy may be recommended for childhood ALL that has spread or may spread to the spinal cord, brain, or testicles. This treatment may also be given before a stem cell transplant to prepare the bone marrow. Stem Cell Transplant A stem cell transplant is a procedure that replaces blood-forming cells. A donor provides a sample of blood or bone marrow, from which stem cells are removed. The cells are then frozen and stored. After the child completes a chemotherapy and radiation regimen, the stored stem cells are thawed and given to the patient via an infusion. The cells then work to restore the body’s lost blood cells. This treatment is rarely used as a first-line approach for childhood ALL, but it’s often recommended for ALL that relapses. Targeted Treatments Targeted treatments identify and destroy specific cancer cells in the body. There are different types of targeted treatments, and many are being studied for pediatric ALL. The following targeted drugs may be an option for some children with ALL: Imatinib (Gleevec) Dasatinib (Sprycel) Ruxolitinib (Jakafi) Blinatumomab (Blincyto) Inotuzumab (Besponsa) Nivolumab (Opdivo) Bortezomib (Velcade) Clinical Trials Clinical trials are studies that are conducted to test the safety and effectiveness of new treatments. According to the National Cancer Institute, investigators are examining several new therapies for pediatric ALL. One of these is a type of immunotherapy called CAR T-cell therapy. With this treatment, a patient’s T cells are trained to attack certain proteins on the surface of cancer cells.
Complications of Childhood ALL Complications ALL that spreads to the brain and spine may cause the following complications: Blurred vision Balance issues Headaches Nausea Vomiting Facial muscle weakness or numbness Seizures Enlarged liver Enlarged spleen Superior vena cava (SVC) syndrome (a condition that happens when the vein that carries blood from the upper body to the heart becomes blocked)
Childhood ALL Prognosis Prognosis The Children’s Hospital of Philadelphia reports that ALL has one of the highest cure rates of any childhood cancer. According to St. Jude Children’s Research Hospital , about 98 percent of children with ALL go into remission within weeks of starting treatment. More than 90 percent of patients can be cured, which is defined as five years in complete remission, says Cleveland Clinic . A child’s prognosis will depend on the subtype of the disease, their risk group, the treatments they receive, their response to treatment, and other factors, explains the American Cancer Society .
Research and Statistics: Who Has Childhood ALL? Research and Statistics There are about 3,000 cases of ALL in individuals 21 years old and younger each year in the United States. This accounts for less than half of 1 percent of all cancers in the country. The American Cancer Society notes that the risk of ALL is highest in children who are younger than 5. Then, the risk rises again slowly after age 50. According to Cleveland Clinic, most cases of ALL occur in children between ages 2 and 5. St. Jude Children’s Research Hospital reports that pediatric ALL affects slightly more boys than girls. The cancer is most common in Hispanic children. While the majority of ALL cases occur in children, adults account for the most deaths. The American Cancer Society explains that the favorable prognosis in the pediatric population may be due to the nature of the disease in younger patients, the fact that children can often tolerate more aggressive treatments, or a combination of these reasons.
Childhood ALL Screening and Prevention Prevention According to Cleveland Clinic, there’s no way to prevent pediatric ALL. While the American Cancer Society points out that exposure to chemotherapy and radiation may increase the risk of ALL in some children, the benefits of treating life-threatening cancers with these treatments outweigh the small chance a child will develop leukemia. Parents of children with ALL should know that there’s nothing they could have done to prevent the cancer.

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