Acute Lymphoblastic Leukemia (ALL)

Acute lymphoblastic leukemia (ALL) is a hematologic malignancy of the bone marrow characterized by the rapid proliferation and accumulation of immature lymphocytes.  These malignant lymphocytes (blasts) grow quickly and prevent the bone marrow from making normal red blood cells, white blood cells and platelets.

ALL is the most common malignancy in children less than 15 years of age, but it can occur in people of any age.  Significant progress has been made in the treatment of childhood ALL such that more than 70% of children with ALL are cured with chemotherapy alone.  Chemotherapy outcomes in adults with ALL are inferior to that achieved in children.  Some patients have a more aggressive disease characterized by various high-risk features where chemotherapy alone may not be enough.  For these patients, referral to a transplant physician early in the disease course may offer the best route to cure and long-term remission.    

Most transplants for ALL are allogeneic and may utilize a matched sibling donor, an unrelated donor or umbilical cord blood.  Whether a transplant is right for an individual depends on how likely the leukemia is to return (relapse).  This is based on assessment of specific features of the leukemia called risk factors.  These risk factors include cytogenetic evaluation results from the bone marrow and other characteristics of the leukemia (T-cell or B-cell), patient age and treatment response. 

There are medical guidelines for when an individual should be referred for a transplantation consultation.  Talking to a transplant physician is recommended when:

Adults:

  • initial chemotherapy does not lead to remission within 28 days of starting treatment.
  • molecular or cytogenetic testing shows high-risk disease.
  • you repalse one or more times after chemotherapy.

Children:

  • the child is an infant at diagnosis
  • molecular or cytogenetic testing shows high-risk disease.
  • initial chemotherapy does not lead to remission within 28 days of starting treatment.