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In this Article

• What is childhood acute lymphoblastic leukemia (ALL)?
• What are causes and risk factors for childhood acute lymphoblastic leukemia (ALL)?
• What are symptoms and signs of childhood acute lymphoblastic leukemia (ALL)?
• How is childhood acute lymphoblastic leukemia (ALL) diagnosed?
• What is the prognosis for childhood acute lymphoblastic leukemia (ALL)?
• What are the stages of childhood acute lymphoblastic leukemia (ALL)?
• What is recurrent childhood acute lymphoblastic leukemia (ALL)?
• What is the treatment for childhood acute lymphoblastic leukemia (ALL)?
• What treatments are being tested in clinical trials?
• What is the treatment for recurrent childhood acute lymphoblastic leukemia (ALL)?
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• Childhood Acute Lymphoblastic Leukemia Index

The prognosis (chance of recovery) and treatment options may depend on:

• Age at diagnosis and race.
• How quickly and how low the leukemia cell count drops after initial treatment.
• Whether the leukemia cells began from B lymphocytes or T lymphocytes.
• Whether there are certain changes in the chromosomes of lymphocytes.
• Whether the leukemia has spread to the brain and spinal cord.
• Whether the child has Down syndrome.

If leukemia recurs (comes back) after initial treatment, the prognosis and treatment options may depend on:

• How long it is between the end of initial treatment and when the leukemia recurs.
• Whether the leukemia recurs in the bone marrow or outside the bone marrow.

Once childhood ALL has been diagnosed, tests are done to find out if the cancer has spread to the central nervous system (brain and spinal cord), testicles, or to other parts of the body.

The extent or spread of cancer is usually described as stages. For childhood acute lymphoblastic leukemia (ALL), risk groups are used instead of stages. The following tests and procedures may be used to determine the risk group:

• Lumbar puncture: A procedure used to collect cerebrospinal fluid from the spinal column. This is done by placing a needle into the spinal column. This procedure is also called an LP or spinal tap.
• Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body. The chest x-ray is done to see if leukemia cells are forming a mass in the middle of the chest.
• Testicular biopsy: The removal of cells or tissues from the testicles so they can be viewed under a microscope by a pathologist to check for signs of cancer. This procedure is done only if there seems to be anything unusual about the testicles during the physical exam.

There are three ways that cancer spreads in the body.

When cancer cells spread outside the blood, a solid tumor may form. This process is called metastasis. The three ways that cancer cells spread in the body are:

• Through the blood. Cancer cells travel through the blood, invade solid tissues in the body, such as the brain or heart, and form a solid tumor.
• Through the lymph system. Cancer cells invade the lymph system, travel through the lymph vessels, and form a solid tumor in other parts of the body.
• Through solid tissue. Cancer cells that have formed a solid tumor spread to tissues in the surrounding area.

The new (metastatic) tumor is the same type of cancer as the primary cancer. For example, if leukemia cells spread to the brain, the cancer cells in the brain are actually leukemia cells. The disease is metastatic leukemia, not brain cancer.