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Acute Lymphoblastic Leukemia: Treatment & Diagnosis

Home> Acute Lymphoblastic Leukemia> Diagnosis and Treatment

An early diagnosis of acute lymphoblastic leukemia goes a long way toward designing an appropriate treatment for this condition. It is important for patients not to ignore the different signs and symptoms of acute lymphoblastic leukemia.

The diagnosis of acute lymphoblastic leukemia is made using various tests. These tests help doctors arrive at a definitive diagnosis, determine the extent of the disease, and devise a treatment plan that is most suitable for the patient.

At HCG, acute lymphoblastic leukemia treatments are devised by a multidisciplinary care team. This team comprises specialists coming from multiple disciplines to thoroughly evaluate the case and then create a treatment plan that is tailor-made to the individual needs of the patient.

Tests for Diagnosis of Acute Lymphoblastic Leukemia

The following are commonly recommended tests for leukemia that can help in the accurate diagnosis of acute lymphoblastic leukemia.

Blood Tests

If an individual is suspected to have ALL, the doctor may recommend a complete blood count (CBC) initially. This blood test is performed to check for the levels of different cells in the blood, which include red blood cells, platelets, and white blood cells. Patients with ALL often have high levels of immature white blood cells and low levels of red blood cells and platelets.

Cytogenetic testing

Cytogenetic testing is recommended to look for chromosomal abnormalities. This particular test helps diagnose acute lymphoblastic leukemia and devise an effective plan for acute leukemia treatment.

Polymerase chain reaction (PCR)

Polymerase chain reaction (PCR) is a form of test done with the patient's DNA sample. This test can find even the slightest changes in the genes and chromosomes, which cannot be seen under the microscope. The test is used to determine the specific gene changes associated with ALL.

Bone marrow test

A bone marrow test is one of the common tests recommended for the diagnosis of acute lymphoblastic leukemia. The bone marrow test for acute lymphoblastic leukemia often involves bone marrow aspiration and a bone marrow biopsy.
During the bone marrow aspiration, the doctor inserts a thin, hollow needle into the bone to get a small amount of liquid bone marrow. On the other hand, during a bone marrow biopsy, the doctor removes a small part of the bone and marrow with the help of a bigger needle. The samples collected are examined for the presence of cancer cells.

Imaging Test

Imaging tests, namely MRI, X-rays, ultrasound, and PET-CT, are recommended to obtain clear pictures of the insides of the human body. These imaging tests are recommended to determine the extent of the disease's spread.

Lumbar Puncture Test

Acute lymphoblastic leukemia progresses rapidly and is often found to spread to the patient's brain and spinal cord. A lumbar puncture test is performed to check for the spreading of leukemia. During the test, a hollow, small needle is inserted between the lumbar bones of the spine to collect the spinal fluid. This fluid is examined for the presence of cancer cells.

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Treatment Stages of Acute Lymphoblastic Leukemia

The treatment of acute lymphoblastic leukemia is divided into different phases or stages. Each stage or phase may last from a few weeks to several months. ALL patients need to complete all phases of their treatment for better health outcomes.

Induction

Induction is the first phase of acute leukemia treatment. The main purpose of this treatment phase is to destroy and kill the maximum number of leukemia cells present in the blood and bone marrow.
Also, this ALL treatment is used to restore the production of normal blood cells. Doctors administer different chemotherapy drugs during this stage.

Consolidation

During this phase, the doctors see if the cancer is still present even after the first cycle of treatment. If the results are positive, the doctor will continue with the consolidation stage of treatment.
This phase of treatment aims at destroying any left-over leukemia cells to prevent the cancer from coming back.

Interim Maintenance

During this stage, the bone marrow is given time for recovery while maintaining remission.

Intensification

During this treatment phase, the doctor first evaluates the possibility of leukemia coming back and any genetic changes the patient may have. During this phase, the chemotherapy drugs are administered in higher doses as compared to other stages.

Maintenance

This last phase of treatment is designed to prevent any of the leukemia cells from regrowing. During this stage, acute lymphoblastic leukemia medication is given to the patient for many years, but in lower doses. This phase may last up to two years, and patients can carry on with their routine activities during this phase.

Acute lymphoblastic leukemia treatments

Here are the different acute leukemia treatments recommended to ALL patients based on the type of ALL, the extent of its spread, the patient’s age, and the patient’s overall health status. The following acute lymphoblastic leukemia treatments may be recommended alone or in combination based on the individual case parameters:

Chemotherapy

Chemotherapy uses drugs to kill and destroy cancerous cells. During the process, the drugs are either administered to the patient intravenously or orally.

Induction Chemotherapy

Induction chemotherapy is the first line of acute leukemia treatment. This phase of treatment is designed to destroy the maximum number of leukemia cells.
Also, during this phase of treatment, specific drugs are administered to restore the white blood cell count. Once the blood count becomes normal, a biopsy may be conducted to check whether the patient has achieved complete remission.

Consolidation Chemotherapy

Consolidation chemotherapy involves giving multiple intensive chemotherapy cycles to the patients for six to nine months. During this phase, the patient may be given platelet and red blood cell transfusions.

Maintenance Chemotherapy

Once the patients complete their cycles of chemotherapy, they are given oral chemotherapy medications for an extra period of 18 to 24 months. Also, the patients are required to go for multiple tests while on chemotherapy medicines.

Central Nervous System (CNS) Prophylaxis

As ALL is known to recur in the spinal fluid, chemotherapy is injected directly into the fluid of the spinal column. This is done through a process where a needle is inserted between the lower back's vertebrae, and then chemotherapy drugs are infused directly into the spinal fluid. This is known as Central Nervous System (CNS) Prophylaxis.

Intrathecal Medications/Chemotherapy

During intrathecal chemotherapy or medications, the chemotherapy drugs are inserted directly into the cerebrospinal fluid, which surrounds the spinal cord and brain.

Blood Transfusions

Blood transfusions are not part of the leukemia treatment plan, but they are sometimes used to reduce cancer symptoms such as anemia, bleeding, bruising, etc.

Antibiotics

Since ALL patients are often more susceptible to viral infections, they are often administered preventive medications such as Septra, Bactrim, and Acyclovir.

Placement of Permanent Line

During ALL treatment, a permanent central venous line is placed to administer acute lymphoblastic leukemia medication and draw blood samples for tests.

Radiation Therapy

Radiation therapy uses high-energy radiation beams, such as X-rays, to kill and destroy cancerous cells. Radiation therapy is often recommended by doctors if the cancer spreads to the central nervous system.

Blood and Marrow Transplantation

A bone marrow transplant is a consolidation therapy used to treat and manage recurrences. During this procedure, the patient gets leukemia-free bone marrow (stem cells) from a healthy individual (the donor).

Investigational Therapies

Investigational therapies can be defined as a new line of treatment or drug that doctors are investigating under a clinical trial or study. These therapies are recommended for patients who have exhausted all treatment options.

Targeted Therapy

Targeted therapies make use of drugs that specifically target the bio-components associated with cancer cells and cause cancer cells to grow. By specifically targeting cancer cells, targeted therapy minimizes damage to healthy tissues in the body.

Immunotherapy

Immunotherapy refers to the use of drugs to assist a patient's immune system in identifying cancerous cells and launching an attack against them in an effective manner.

Coping and Support for Acute Lymphocytic Leukemia

The acute lymphoblastic leukemia medical procedure can be tedious and daunting. Thus, the patient needs complete support not only from the medical staff but also from the people around them.

Here are some coping and support tips for acute lymphocytic leukemia patients:

Learn enough about leukemia to feel comfortable making treatment decisions


It is advised to get proper knowledge about cancer, its treatment, and the risks involved before moving forward with the procedure. The patient can always ask the doctor and can research different platforms for proper information. This helps the patient make informed health decisions.

Lean on your whole healthcare team


The healthcare team for cancer consists of psycho-oncologists, onco-dietitians, child-life workers, rehabilitation therapists, chaplains, and social workers. These professionals are exclusively trained to build a strong support system for cancer patients. The patients must get comfortable leaning on their healthcare team, as this also contributes to better health outcomes.

Explore programs for children with cancer


There are multiple organizations that come up with special programs for kids diagnosed with cancer. These activities include summer camps, wish-granting programs, and support groups. Exploring these groups can aid in getting the required help from both professionals and other volunteers who support pediatric cancer patients.

Help family and friends understand your situation


It is important for patients to keep their family and friends in the loop and keep communicating with them about their appointments, medications, any setbacks in the treatment, test results, etc. Patients must let their family and friends know they need them around and that they need their help. This helps the people around cancer patients understand the right way to be there for them.


Conclusion


Acute lymphoblastic leukemia spreads quite quickly and often demands immediate medical attention. In many cases, the patients may not experience any alarming symptoms either.

Thus, it is always better to see a doctor when something is not normal. This helps the doctor design an effective line of treatment for the same.

Frequently Asked Questions

What is the first-line treatment for ALL?

Chemotherapy is the first line of treatment for ALL. Chemotherapy is administered in different phases, such as induction, consolidation, and maintenance.

The treatment for acute lymphoblastic leukemia usually lasts between two and three years.

Acute lymphoblastic leukemia curable rates depend on multiple factors. The type of ALL, the extent of the disease's spread, the patient’s age, and their overall health status determine the success rates. Pediatric patients and those diagnosed and treated in the early stages have better survival rates.

The main diagnostic marker for acute leukemia is the presence of blasts, which are immature cells in the bone marrow that do not circulate in the blood.

Yes, it is possible to treat stage 4 leukemia. The treatment goal for these cases would be to delay the disease progression, manage the symptoms, and prolong patient survival.

Yes, ALL can be detected in a blood test. To confirm the findings from the blood test, additional tests, such as a bone marrow examination, immune phenotyping, etc., may be recommended.

Yes, for a few diseases, like ALL, you will have to receive chemotherapy even after achieving remission. The main goal of administering chemotherapy when you are in remission is to prevent cancer from coming back. It is called maintenance therapy, and it may go on for up to 2 years.