Acute Lymphoblastic Leukemia (ALL)

Our hemato-oncology team offers detailed diagnosis and tailored, up-to-date treatment for adults with acute lymphoblastic leukemia (ALL). Hematologists, medical oncologists, transplant physicians and laboratory specialists review every case together to plan the most effective therapy.

Where it is needed we provide advanced options such as targeted drugs, immunotherapy, CAR T-cell therapy and bone marrow (stem cell) transplantation, supported by HLA typing and molecular testing to find the best donor match. Throughout treatment we look after the whole person — physical health, emotional wellbeing and the needs of the family.

About acute lymphoblastic leukemia

ALL is an aggressive, fast-growing cancer of the blood and bone marrow. It can develop at any age; it is most common in children, but a significant number of adults are diagnosed every year and adult ALL usually needs intensive, carefully monitored treatment.

What is ALL?

In ALL the bone marrow makes too many immature lymphocytes called lymphoblasts. These abnormal cells do not work like normal white blood cells. They multiply quickly and crowd the marrow, so it cannot make enough red blood cells, healthy white cells and platelets.

What are the risk factors for ALL?

For most people the exact cause is not known, and ALL is usually not inherited. Factors that can raise the risk include:

• Previous chemotherapy or radiation therapy for another cancer
• High levels of radiation exposure
• Certain genetic conditions, such as Down syndrome
• Having an identical twin with ALL
• Some viral infections, such as HTLV-1 (rare in most parts of the world)

What are the symptoms of ALL?

• Tiredness, weakness and pale skin caused by anemia
• Fever, night sweats and repeated infections
• Easy bruising, nosebleeds or bleeding gums; tiny red spots on the skin (petechiae)
• Bone or joint pain
• Swollen lymph nodes; fullness under the ribs from an enlarged spleen or liver
• Loss of appetite and weight loss
• Headache, vomiting or blurred vision if the leukemia reaches the brain and spinal fluid

Are there different types of ALL?

• B-cell ALL — the most common type in adults, arising from early B-lymphocytes.
• T-cell ALL — arises from early T-lymphocytes and may cause a mass in the chest.
• Philadelphia chromosome-positive (Ph+) ALL — carries the BCR-ABL1 gene change; it is treated with targeted tyrosine kinase inhibitors as well as chemotherapy.
• Ph-like ALL and other genetic subtypes that help predict how the leukemia will respond to treatment.

A precise diagnosis tells us the exact type of ALL, its genetic features and whether it has spread to the brain or spinal fluid. These results decide the treatment plan and whether a transplant may be needed later.

Blood tests

A complete blood count (CBC) and blood smear show abnormal white cell counts, low red cells or platelets, and leukemic blasts. Chemistry tests check kidney and liver function, uric acid and clotting before treatment begins.

Bone marrow aspiration and biopsy

A small sample of liquid marrow and a thin core of bone are taken from the back of the hip bone under local anesthesia. The samples confirm the diagnosis and show the percentage of blasts.

Laboratory tests on the leukemia cells

• Flow cytometry (immunophenotyping) — identifies B-cell or T-cell ALL from the markers on the cell surface.
• Cytogenetics and FISH — look for chromosome changes such as the Philadelphia chromosome.
• Molecular tests (PCR / next-generation sequencing) — detect gene changes that affect prognosis and targeted treatment.

Lumbar puncture (spinal tap)

A small amount of cerebrospinal fluid is taken from the lower back to check for leukemia cells around the brain and spinal cord. Chemotherapy may be given into the fluid at the same time.

Imaging: CT, MRI and chest X-ray

Imaging looks for enlarged lymph nodes, a chest (mediastinal) mass or an enlarged liver and spleen, and checks the brain when symptoms suggest it.

Measurable residual disease (MRD)

During and after treatment, highly sensitive MRD tests search for leukemia cells that are too few to see under the microscope. MRD is one of the strongest guides to further treatment, including the decision to transplant.

Treatment for adult ALL is given in phases and is tailored to age, general health and the genetic profile of the leukemia. A dedicated team follows each patient through every phase.

Treatment phases

1. Induction — intensive chemotherapy over about 4–6 weeks to bring the leukemia into remission.
2. Consolidation / intensification — further courses to destroy remaining leukemia cells.
3. Maintenance — lower-dose tablets and periodic injections, usually for about two years, to prevent relapse.
4. CNS prophylaxis — chemotherapy into the spinal fluid (and sometimes radiation) to protect the brain and spinal cord.

Chemotherapy

Combinations of drugs are given by vein, by mouth and into the spinal fluid. Doses and schedules are adjusted to the patient's age and fitness.

Targeted therapy

Tyrosine kinase inhibitors (such as imatinib, dasatinib or ponatinib) block the BCR-ABL1 signal in Philadelphia chromosome-positive ALL and are combined with chemotherapy or steroids.

Immunotherapy

Antibody-based medicines such as blinatumomab and inotuzumab ozogamicin help the immune system find and kill leukemia cells, especially when MRD remains or the disease returns.

Radiation therapy

Radiation may be used for leukemia in the brain or spinal cord, for a large chest mass, or as part of total body irradiation before a transplant.

Bone marrow / stem cell transplant

An allogeneic stem cell transplant may be recommended for high-risk ALL, MRD-positive disease or relapse. Stem cells from a matched sibling, an unrelated donor or a half-matched (haploidentical) family member replace the patient's marrow, and the new immune system helps control remaining leukemia.

CAR T-cell therapy

The patient's own T-cells are collected, modified in a laboratory to recognise leukemia (CD19) and infused back. CAR T-cell therapy is an option for relapsed or resistant B-cell ALL.

We care for the whole person

Nutrition advice, infection prevention, psychological support, physiotherapy and help for families are part of every treatment plan, from the first visit to long-term follow-up.

Adults with ALL are cared for by our hematologists, hemato-oncologists and transplant physicians working as one team. Choose a specialist below to read their profile or book a consultation.