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Questions and answers

Questions about ALL

Acute lymphoblastic leukemia (ALL) is the most common cancer in children, but it also occurs in adults.

Last updated: ~1 min read
ALL: lymphoblasts fill the marrow
Figure 1.ALL: lymphoblasts fill the marrow

01Short answer

ALL is an acute leukemia in which immature cells of the lymphoid line (lymphoblasts) multiply quickly. There are B-cell and T-cell forms. Treatment is long: induction, consolidation (intensification), prevention of central nervous system disease and a maintenance phase that usually lasts years. In Philadelphia chromosome-positive ALL, targeted drugs are added. For relapse or difficult cases there are immunotherapy, CAR-T and transplant options.

02Simple explanation

In ALL lymphoblasts fill the bone marrow.

These cells can reach the fluid around the brain and spine, so treatment covers that too.

03Scientific explanation

ALL is divided by immunophenotype (B or T) and genetics; Ph+ ALL and Ph-like ALL are separate groups.

MRD is one of the strongest outlook markers in ALL and is used to adjust how intensive treatment is.

04What happens in the body?

In children and adults

Childhood ALL has good results with modern protocols. In adults treatment is harder, but new drugs are improving results.

Why it takes so long

ALL cells can hide in “sanctuary” sites in the body. Long, phased treatment lowers the risk of relapse.

A long road with several gates
Figure 2.A long road with several gates

New options

Bispecific antibodies, antibody–drug conjugates and CAR-T cell therapy have opened new paths for some patients. Your doctor will say whether they suit you.

Protecting the brain and spinal cord
Figure 3.Protecting the brain and spinal cord

05The phases of ALL treatment

The main stops on a long road.

Lymphoblasts found — The diagnosis and subtype are set.1Lymphoblasts foundThe diagnosis and subtype are set.
Induction — The first phase to reach remission.2InductionThe first phase to reach remission.
CNS prevention — The brain and spinal cord are protected.3CNS preventionThe brain and spinal cord are protected.
Maintenance — Gentler treatment, usually for years.4MaintenanceGentler treatment, usually for years.
Know the phasesA calendar eases the load.
Ask about MRDIt can change the plan.

06Key points at a glance

TopicIn brief
In children and adultsChildhood ALL has good results with modern protocols. In adults treatment is harder, but new drugs are improving results.
Why it takes so longALL cells can hide in “sanctuary” sites in the body. Long, phased treatment lowers the risk of relapse.
New optionsBispecific antibodies, antibody–drug conjugates and CAR-T cell therapy have opened new paths for some patients. Your doctor will say whether they suit you.

07Key terms

Lymphoblast
An immature cell of the lymphoid line.
Ph+
ALL with the Philadelphia chromosome.
Maintenance therapy
Long-term treatment to keep remission.

08Key points

  • ALL is an acute leukemia of the lymphoid line.
  • Treatment is long and phased.
  • CNS protection is part of the plan.
  • MRD is a key marker.

09Frequently asked questions

Why is a lumbar puncture needed?

To check the spinal fluid and to give medicine there.

Are children’s protocols used in adults?

Young adults sometimes have child-style protocols; the doctor decides.

Who is CAR-T for?

Usually relapsed or resistant B-ALL; the team will explain the criteria.

10Questions for your doctor

Take these questions to your appointment. The ones you save are collected on the “My questions” page and stay on this device only.

  1. Why is a lumbar puncture needed?

  2. Are children’s protocols used in adults?

  3. Who is CAR-T for?

My questions

12Sources

  1. National Cancer Institute (NCI). Adult Acute Lymphoblastic Leukemia Treatment (PDQ®) – Patient Version
  2. NHS. Acute lymphoblastic leukaemia
  3. MedlinePlus (U.S. National Library of Medicine). Leukemia
  4. National Cancer Institute (NCI). CAR T Cells: Engineering Patients’ Immune Cells to Treat Their Cancers
  5. National Cancer Institute (NCI). Stem Cell and Bone Marrow Transplants for Cancer
  6. NHS. High temperature (fever) in adults
  7. NHS. How to wash your hands
  8. Cancer Research UK. Coping emotionally with cancer
  9. National Cancer Institute (NCI). When Someone You Love Is Being Treated for Cancer (booklet)
  10. National Cancer Institute (NCI). Managing Your Care
Medical disclaimerThis information is for educational purposes only and does not replace medical advice.
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