Acute lymphoblastic leukemia/lymphoma

Acute lymphoblastic leukemia overview

Acute lymphoblastic leukemia/lymphoma (ALL), also called acute lymphocytic leukemia and acute lymphoid leukemia, is a type of blood cancer that starts with a change to a single cell in the bone marrow. ALL is the most common type of leukemia in children but is the least common type in adults. Only one-quarter of ALL cases are diagnosed in people aged 20 or older. Some patients will have these cancerous blood cells in their blood or bone marrow (leukemia), while others will develop them mostly in tumor masses (lymphoma). Treatment for ALL is highly complex and intense, so it’s important to be treated at a specialized center with expertise in ALL.

Learning that you have ALL can be shocking and overwhelming. Things can move very quickly — you may go from being diagnosed to starting treatment in just a few hours or days. Fred Hutchinson Cancer Center experts offer comprehensive ALL care, including advanced treatments and new options that are available only through clinical trials. Our deep experience means the best treatment plan for you.

Bone marrow The soft, spongy material in the center of your bones that produces all your blood cells, such as white blood cells, red blood cells and platelets. Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.

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“Our ALL team at Fred Hutch is one of only a very few clinical teams in the U.S. whose sole clinical charge is to treat this disease. The only new patients we see have this specific ALL diagnosis, and we've been doing it for years.”

— Ryan Cassaday, MD, hematologist-oncologist

Fred Hutch: A leader in leukemia treatment

Fred Hutch is a world leader in leukemia research. Our physicians and scientists pioneered a very important leukemia treatment — bone marrow transplant — and are constantly working on new therapies. We provide expert care, day after day, to make sure you have the best possible outcome.

Bone marrow The soft, spongy material in the center of your bones that produces all your blood cells, such as white blood cells, red blood cells and platelets.

Learning about ALL

What is acute lymphoblastic leukemia?

In people with ALL, something goes wrong with a type of blood stem cell called a lymphoblast. Instead of maturing into fully functioning lymphocytes — important immune-system cells — the lymphoblasts multiply out of control, and they don’t die off like normal blood cells do.

The underdeveloped (leukemic) cells can’t do their normal infection-fighting functions. They build up in your bone marrow and blood, crowding out the normal, healthy blood cells that your body needs.

Low levels of normal blood cells can lead to infection, anemia and excessive bleeding. The leukemic cells can travel around your body through your bloodstream and keep your organs from working right. ALL gets worse quickly if it is not treated, which makes it important to start treatment soon after diagnosis.

Understanding your bone marrow and blood

To understand leukemia, it helps to know the basics about your bone marrow and blood cells.

What are stem cells?

Stem cells are cells in your body that are able to turn into any kind of cell, such as a skin cell, liver cell, brain cell or blood cell. Stem cells that turn into blood cells are called hematopoietic stem cells, or blood stem cells.

Why are blood stem cells important?

When blood cells become old or damaged, they die, and blood stem cells make new blood cells to replace them. Blood stem cells are mainly found in bone marrow (the soft, spongy tissue inside your bones), but some are also found in the blood that circulates in your body. Blood stem cells make lymphoid stem cells and myeloid stem cells.

Lymphoid stem cells make lymphoblasts. Lymphoblasts make several types of white blood cells.
Myeloid stem cells make myeloblasts. Myeloblasts make white blood cells, red blood cells and platelets.

What do healthy blood cells do?

Healthy white blood cells, red blood cells and platelets are very important.

White blood cells fight infection. The main types of white blood cells are B lymphocytes (B cells), T lymphocytes (T cells), natural killer (NK) cells and granulocytes.
Red blood cells carry oxygen from your lungs to other parts of your body and take carbon dioxide back to your lungs to get rid of it (by breathing it out).
Platelets make your blood clot and slow or stop bleeding.

Blood cells

What causes ALL?

We do not know what causes ALL. The disease is more common in children aged 5 or younger, and the risk is also higher after age 50. It is more common in males than females, and it is more common in white people than Black people.

There are a few risk factors we know about:
Being exposed to high levels of radiation
Being exposed to certain chemicals, such as chemotherapy or benzene
Having certain viral infections, although this is more common outside the U.S.
Having certain genetic conditions, such as Down syndrome
Having an identical twin who develops ALL as an infant or young child

However, keep in mind that many people who develop ALL do not have any of these risk factors, and most people with these risk factors do not develop the disease.

Anemia A condition in which the number of red blood cells is below normal. B cell A type of white blood cell that makes antibodies. B cells are part of the immune system and develop from stem cells in the bone marrow. Bone marrow The soft, spongy material in the center of your bones that produces all your blood cells, such as white blood cells, red blood cells and platelets. Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Lymphocyte A type of immune cell that is made in the bone marrow and is found in the blood and in lymph tissue. The two main types of lymphocytes are B lymphocytes and T lymphocytes. A type of immune cell that is made in the bone marrow and is found in the blood and in lymph tissue. The two main types of lymphocytes (white blood cells) are B lymphocytes and T lymphocytes. B lymphocytes make antibodies, and T lymphocytes help kill tumor cells and help control immune responses. Platelet A tiny, disc-shaped piece of a cell that is found in the blood and spleen. Platelets help form blood clots to slow or stop bleeding and to help wounds heal. A tiny, disc-shaped piece of a cell that is found in the blood and spleen. Platelets are pieces of very large cells in the bone marrow called megakaryocytes. They help form blood clots to slow or stop bleeding and to help wounds heal. Having too many or too few platelets, or having platelets that do not work as they should, can cause problems. Checking the number of platelets in the blood may help diagnose certain diseases or conditions. Red blood cell A type of blood cell that carries oxygen in the body. Stem cell A cell from which other types of cells develop. For example, blood cells develop from blood-forming stem cells. Stem cell A cell from which other types of cells develop. For example, blood cells develop from blood-forming stem cells. T lymphocyte A type of white blood cell. T lymphocytes are part of the immune system and develop from stem cells in the bone marrow. They help protect the body from infection and may help fight cancer. A type of white blood cell. T cells are part of the immune system and develop from stem cells in the bone marrow. They help protect the body from infection and may help fight cancer. Also called T cells and thymocyte.

Learning about ALL

Acute lymphoblastic leukemia (ALL) is one type of cancer of the bone marrow and blood. ALL is also called acute lymphocytic leukemia and acute lymphoid leukemia. Fred Hutch offers comprehensive treatment from a team of experts for every type of leukemia, including ALL.

Your first appointment

From the first time you come to see us, your ALL team will begin getting to know you and your family. What are your questions? What are your concerns?

At your first appointment, your hematologist-oncologist will explain your disease, including your subtype. They will tell you how it’s treated and which tests you need to help plan your care. Before you leave, your team will make sure you understand the next steps.

Hematologist A physician who specializes in diseases of the blood and blood-forming tissues.

“ALL is both treatable and curable. So, despite what sounds like a very scary and intimidating diagnosis, ALL is something that we can make go away forever.”

— Ryan Cassaday, MD, hematologist-oncologist

ALL First Appointment

Care at Fred Hutch

How does Fred Hutch approach treatment?

The safest, most effective and most widely accepted therapies for cancer are known as the “standard of care.” For many patients, these therapies will be a large part of their treatment. At Fred Hutch, we provide all standard therapies for ALL. We know how to choose the right ones for you and how to deliver them to give you the best chance at a full recovery.

Our physicians and researchers are always asking how we can make ALL treatments more effective and reduce side effects as much as possible. This is why we do clinical trials (also called clinical studies). Through these studies, we are able to offer you therapies that aren’t offered everywhere. A therapy that is going through trials now may become the new standard of care tomorrow.

Along with treating your cancer, a group of world-class professionals is here to support you. This team includes nurses, dietitians, physical therapists, social workers and psychologists. We use supportive care services to promote your physical, mental and emotional well-being.

Clinical trial A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis or treatment of a disease. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores. Standard care A treatment or other intervention currently being used and considered to be of proven effectiveness based on past studies. Standard care A treatment or other intervention currently being used and considered to be of proven effectiveness based on past studies.

“We have everything from nutrition to mental health providers, social work and other layers of support that are right at our fingertips. We really excel at addressing the whole patient and not just the disease aspects.”

— Christen N. Martino, ARNP, lymphoma survivor

Treatment plan and process

At Fred Hutch, we think of treatment as a collaborative effort. Your physician will explain all your options and recommend a treatment plan based on your ALL subtype and classification, as well as your health, lifestyle and personal preferences.

Fred Hutch offers comprehensive treatment plans that may include chemotherapy, targeted therapy, immunotherapy, bone marrow transplant or clinical trials. Access to clinical trials is one reason many people come to us for care.

Your care team at Fred Hutch is here to walk you through treatment and support you for as long as you need . The treatment for ALL is usually done in three phases: induction therapy, consolidation therapy and maintenance therapy.

As you go through treatment, your needs may change. Your care team at Fred Hutch is with you each step of the way to help meet your needs. For example, we will help you deal with any side effects you may have. We may suggest adding a new therapy that was just approved. Even after your treatment is done, we will keep seeing you to protect your health over the long term.

Bone marrow The soft, spongy material in the center of your bones that produces all your blood cells, such as white blood cells, red blood cells and platelets. Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Immunotherapy A type of therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. A therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. Some immunotherapies only target certain cells of the immune system. Others affect the immune system in a general way. Types of immunotherapy include cytokines, vaccines, bacillus Calmette-Guerin (BCG) and some monoclonal antibodies. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores. Targeted therapy A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. Some targeted therapies block the action of certain enzymes, proteins or other molecules involved in the growth and spread of cancer cells. Other types of targeted therapies help the immune system kill cancer cells, or they deliver toxic substances directly to cancer cells and kill them. Targeted therapy may have fewer side effects than other types of cancer treatment. Most targeted therapies are either small molecule drugs or monoclonal antibodies. Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.

“No matter your diagnosis or treatment, we’re here by your side, every step of the way. If there’s anything we can do to make your experience with cancer better, we will try in every way to do that.”

— Christen N. Martino, ARNP, lymphoma survivor

Treatment for ALL

For caregivers

When someone close to you is diagnosed with ALL, you might step into the role of caregiver. Being a caregiver can mean many things, from lending a hand with daily living tasks to helping with medical decisions. It can also mean dealing with your own emotions and stress.

At Fred Hutch, caregivers are valuable members of a patient’s care team. We see every day that your presence and support make a difference. We know that what your friend or family member is going through affects you, too.

Part of our mission is to help you take care of yourself. Caring for yourself is good for your physical, mental and emotional health. It also helps you give your best to your loved one. Our social workers, Spiritual Health team and Patient and Family Resource Center staff are here to help support you.

Caregiver A person who gives care to people who need help, such as children, older people or patients who have chronic illnesses or disabilities. A person who gives care to people who need help taking care of themselves, such as children, older people or patients who have chronic illnesses or disabilities. Caregivers may be health professionals, family members, friends, social workers or members of the clergy. They may give care at home, in a hospital or in another health care setting.

For Caregivers

Resources for Caregivers

Other resources

Care team

At Fred Hutch, a team of dedicated people surrounds you and your family to give you the highest level of care and support. You are the most important person on your care team. Our patients are at the center of everything we do.

ALL Care Team

Care team

Research

From pioneering bone marrow transplants to current studies in the areas of targeted therapies and immunotherapies, Fred Hutch is a national leader in ALL research.

ALL Research

Research

Resources

There are many resources for learning about your disease, as well as organizations that provide support. Health educators at the Fred Hutch Patient and Family Resource Center have put together a list of trusted sources to help you get started.

ALL Resources

Resources

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