Acute Lymphoblastic Leukemia (ALL)


Acute lymphoblastic leukemia (ALL) is the commonest childhood cancer. It constitutes one fourth to one third of all pediatric malignancies and 75% of all leukemias.In India, each year over 6000 children < 15 years of age will develop ALL.

Signs and Symptoms

Persistent fever, fatigue, pallor, malaise, bleeding, bone and joint pain, enlargement of lymph node, spleen, liver

Cause and Risk Factors

Childhood ALL, as with most other cancers remains a disease with few proven etiologic factors. Genetic and immunologic factors , Environmental factors believed to be linked to leukemogenesis include exposure to radiation (atomic bomb), benzene, pesticides and herbicides, and chemotherapeutic drugs particularly alkylating agents and epipodophyllotoxins.  Certain viral infections have

also been implicated in the pathogenesis of human leukemia. Examples include Epstein-Barr virus (ALL-L3).

Screening and Diagnosis

Definitive diagnosis of specific leukemia subtype is made primarily by examination of bone marrow aspirate smear and should only be done at an Oncology Centre. .  Hb, total and differential WBC count, Chest X-ray (mediastinal mass), Uric acid and electrolytes : Na, K, Ca, PO4, LDH / KFT / LFT, Diagnostic spinal tap.


Treatment of ALL is the success story of Oncology, and has been the torch-bearer for developing curative treatments for other causes of cancer too. 


The aim of ALL therapy is induction of remission. The drug combinations most frequently used include Vincristine, Prednisolone, L-asparaginase with or without Daunorubicin. This is the most critical period of treatment as the patient has very low counts and is susceptible to complications. A bone marrow is done at the end of induction to establish remission status. Complete remission (CR) = less than 5% blasts in marrow.


This is a period of intensified treatment administered shortly after remission induction. Some

new chemotherapeutic agents are administered to tackle the problem of drug resistance. There is enough

evidence to suggest that intensification of treatment has improved the long term survival in all patients and

it has become a common practice in many treatment protocols particularly for high-risk patients.


  1. During this period, it is important to monitor the WBC count and maintainthe absolute neutrophil count (ANC) in the range (usually 1000 to 1500/ul)
  1. It is important to always monitor for clinical signs of relapse like persistent unexplained fever,  hepatosplenomegaly, lymphadenopathy, testicular enlargement or new CNS deficits as well as suspicious peripheral blood values.
  1. Consult your pediatric oncologist as soon as possiblein case of suspicion of relapse, persistent abnormal high or low WBC count, viral exanthem like herpes or chicken pox or febrile neutropenia (temperature of 101 F or more with ANC of < 500).

Patient & Family

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