Acute lymphoblastic leukemia

First appointment

Your first appointment at Fred Hutchinson Cancer Center is a time for you and your hematologist-oncologist to meet. You might meet your advanced practice provider, too. You will talk about your diagnosis, subtype and likely treatment . This visit is also a time for us to start getting to know you as a person. This helps us fit our recommendations to you. Together, you and your care team will decide what needs to happen next.

We encourage you to bring a family member or friend to your first appointment (and any future visits).

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

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What to expect

Your first appointment usually takes one to two hours. You will spend about one hour with your physician. Here’s what you can expect to happen.

Confirming your diagnosis

Most of our new patients have already had a blood test or bone marrow test that shows they have ALL and which subtype it is. A Fred Hutch hematopathologist will check your tests before your first appointment to see if they agree with the test results.

Knowing your subtype is important because it helps your physicians decide which treatments are most likely to work. Our hematopathologists may run more tests to confirm your diagnosis or to narrow down your subtype. They will give the results to your Fred Hutch physician, who will explain your diagnosis and what it means.

Classifying your disease

Most cancers are given a numbered stage based on the size of the tumor and how far the disease has spread. But because leukemia often doesn’t form a solid tumor and is found throughout the body, there is no official staging system for ALL.

Discussing your treatment

The treatment we recommend for you depends mainly on your ALL subtype, classification, overall health and age. Treatment for ALL is highly complex and intense. Because the disease progresses quickly, treatment often starts very soon after diagnosis, sometimes in just a few hours or days.

These appointments are also a time to tell us about yourself. Each patient and family have their own needs and preferences. We want to get to know you so we can understand the best way to care for you.

Answering your questions

Starting with your first appointment (and after), we are here to answer your questions. We want to help you understand as much as you want to know about your disease, your treatment and how care happens at Fred Hutch. We invite you to bring a friend or family member with you to help keep track of your questions and the information that your team gives you.

We also encourage you to talk with your care team about your hopes and concerns. Knowing more about you helps your team recommend the right treatment for you. Before you leave, we will make sure you know what is going to happen next and how you can reach us if you have questions later. We will also schedule your next visit.

Classifying ALL

Most cancers are given a numbered stage based on the size of the tumor and how far the disease has spread. Because leukemia often doesn’t form a solid tumor and it is found throughout the body, there is no official staging system for ALL. Instead, ALL is classified as:

Newly diagnosed ALL, or untreated ALL. Treatment may have begun for relief of symptoms, such as fever and bleeding, but treatment has not begun for the leukemia.
ALL in remission. After treatment, you may be considered in remission if your complete blood count is normal, there are no leukemia cells in your bone marrow and you have no signs or symptoms of leukemia.
Relapsed ALL, or recurrent ALL. This means your leukemia returned after going into remission (the disease got better but then got worse).
Refractory ALL. This means the leukemia has not responded to treatment.

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. Refractory In medicine, refractory disease is a disease or condition that does not respond to treatment. Relapse The recurrence (return) of disease after an apparent recovery. Remission A decrease in, or disappearance of, signs and symptoms of cancer. A decrease in, or disappearance of, signs and symptoms of cancer. In partial remission, some (but not all) signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although cancer still may be in the body. Sign In medicine, a sign is something found during a physical exam or from a laboratory test that shows that a person may have a condition or disease. In medicine, a sign is something found during a physical exam or from a laboratory test that shows that a person may have a condition or disease. Some examples of signs are fever, swelling, skin rash, high blood pressure and high blood glucose. Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body. Staging Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from where it first formed to other parts of the body. Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from where it first formed to other parts of the body. It is important to know the stage of the disease in order to plan the best treatment. Symptom A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. Some examples of symptoms are headache, fatigue, nausea and pain.

Resources for patients and caregivers

Here are tips about how to prepare for your first appointment at Fred Hutch and what to bring.

Preparing for Your First Visit

Resources for New Patients

Just like every patient’s situation is different, every caregiver may be asked to help with different tasks. Learn how you can offer support during a first visit.

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.

Caregiving at the first appointment

As a caregiver, you can give your loved one both emotional and practical support for their first appointment. Ask them if you can help with things like these:

Helping them manage their stress, worry or other feelings.
Planning how to get to and from the appointment, what time to leave home and where to park.
Making a list of questions they want to ask the physician. Fred Hutch’s Guide to Your Care (PDF) has a list of questions they may want to ask the care team. At the appointment, make sure that all their questions get answered.
Taking notes during the visit. The physician will be giving a lot of details, which can be hard to remember later without notes.

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