OVERVIEW

What is acute lymphoblastic leukemia?

Acute lymphoblastic leukemia (ALL) is a malignant tumor of the hematopoietic system caused by abnormal and excessive proliferation of lymphocytes. Patients may present with anemia, bleeding, infections, as well as enlargement of the liver, spleen, and lymph nodes.

ALL is common in children but can also occur in other age groups, with peak incidence ages being 2–10 years, 15–24 years, and over 80 years.

ALL is a common type of leukemia, accounting for 70% of childhood leukemia cases and 20% of adult leukemia cases.

SYMPTOMS

What are the clinical manifestations of acute lymphoblastic leukemia?

• Susceptibility to infections: Infections can occur in various parts of the body, such as the mouth, throat, lungs, gastrointestinal tract, perianal area, skin, and blood. Symptoms include fever, chills, rigors, mouth ulcers, sore throat, chest pain, cough, sputum production, abdominal pain, diarrhea, and painful perianal lumps.
• Bleeding: Symptoms include skin petechiae or bruising, gum bleeding, nosebleeds, and heavy menstrual bleeding. Intracranial bleeding may cause headaches, nausea, vomiting, or even death.
• Anemia: Symptoms include pale complexion, dizziness, shortness of breath, and rapid heartbeat.
• Bone pain: Pain in the joints or bones, tenderness in the lower sternum. Young children may limp or refuse to bear weight.
• Lymphadenopathy: Enlarged lymph nodes may be felt in the neck, supraclavicular area, antecubital fossa, or groin. They are firm and painless.
• Hepatosplenomegaly and gum swelling: Gum hyperplasia and swelling may occur. Enlarged liver and spleen can be detected during physical examination.
• Other less common symptoms include headaches, vomiting, drowsiness, unilateral testicular enlargement, chest pain, difficulty swallowing, and difficulty breathing.

What other diseases can acute lymphoblastic leukemia cause?

• Various infections, such as stomatitis, gingivitis, tonsillitis, pneumonia, perianal inflammation, perianal abscess, herpes simplex virus infection, shingles, and sepsis.
• Intracranial hemorrhage.
• Seizures, etc.

Can acute lymphoblastic leukemia cause sequelae?

Acute lymphoblastic leukemia is a malignant disease of the blood system. Some patients may lose their lives in a short time, while others may survive after chemotherapy, radiotherapy, or hematopoietic stem cell transplantation. However, the long-term and complex treatment process may lead to various possible sequelae, which are difficult to predict. Each case must be managed individually.

CAUSES

What are the causes of acute lymphoblastic leukemia?

The exact cause is currently unknown, but it may be related to factors such as genetics, living environment, physical radiation, chemical toxins, etc. A small portion of acute lymphoblastic leukemia patients have chromosomal and genetic abnormalities.

Is acute lymphoblastic leukemia hereditary?

It is generally not hereditary. Although there have been reports of multiple leukemia cases occurring successively in certain families, it remains unclear whether this is related to genetics or shared living environments among family members.

Is acute lymphoblastic leukemia contagious?

No.

DIAGNOSIS

What tests may be needed for the diagnosis of acute lymphoblastic leukemia?

Main tests include complete blood count, coagulation function, bone marrow aspiration, chromosome and genetic testing, which are used to confirm the diagnosis.

Other tests include blood uric acid levels, electrolytes, liver function, kidney function, blood culture, etc., which assist in diagnosis and guide further treatment.

Which diseases have similar manifestations to acute lymphoblastic leukemia?

Juvenile idiopathic arthritis, osteomyelitis, infectious mononucleosis, immune thrombocytopenia, pertussis, parapertussis, aplastic anemia, other malignancies (such as neuroblastoma, retinoblastoma, rhabdomyosarcoma, and Ewing sarcoma), eosinophilia, etc.

Tests like complete blood count, bone marrow aspiration, and blood culture can help differentiate these diseases.

TREATMENT

Which department should I visit for acute lymphoblastic leukemia?

Hematology department.

How is acute lymphoblastic leukemia treated? How long does the treatment take?

Acute lymphoblastic leukemia (ALL) can be classified into many types based on genetic testing results, and different types require different treatment methods. Doctors will develop personalized treatment plans according to each patient's specific condition.

ALL treatment is divided into several stages: induction therapy, consolidation therapy, and maintenance therapy. Treatment methods include chemotherapy, targeted drug therapy, radiation therapy, hematopoietic stem cell transplantation, etc.

The total treatment duration depends on the patient's physical condition and disease progression. Most treatment plans take 2–3 years to complete.

What are the common risks and complications during acute lymphoblastic leukemia?

Tumor lysis syndrome:

• Tumor lysis syndrome is a toxic reaction caused by the massive breakdown of leukemia cells after chemotherapy. It manifests as hyperphosphatemia, hypocalcemic seizures, hyperuricemia, arrhythmia, and acute kidney failure. Patients aged >10 years, with splenomegaly, mediastinal masses, or white blood cell counts >20,000/μL are prone to tumor lysis syndrome.
• Doctors will take measures to prevent tumor lysis syndrome.

Thrombosis:

• Includes intracranial dural sinus thrombosis with hemorrhage, deep vein thrombosis, and pulmonary embolism. Patients treated with asparaginase, concurrent glucocorticoid therapy, older age, or central venous catheters are at higher risk of thrombosis.

Bleeding:

• Bleeding is usually caused by low platelet counts. Mild cases involve skin or mucosal bleeding, while severe cases may lead to life-threatening intracranial hemorrhage.
• Doctors will administer platelet transfusions as needed to prevent fatal bleeding.

Infection:

• Leukemia patients already lack normal white blood cells, and chemotherapy-induced bone marrow suppression further reduces white blood cell counts, increasing infection risks. Severe infections can be life-threatening.
• Doctors may prescribe white blood cell boosters and antibiotics to prevent or treat infections.

Neuropathy:

• Nearly all patients treated with vincristine develop neuropathy, which may manifest as paresthesia, muscle weakness, or vocal cord paralysis.
• Doctors may adjust vincristine dosage based on the condition. Vincristine-induced neuropathy is usually reversible but may take months to resolve.

Systemic allergic reactions:

• Several drugs can cause severe allergic reactions. Doctors will prepare anti-allergy medications before treatment.

Adrenal suppression:

• This is a side effect of glucocorticoids. After stopping glucocorticoids, patients may experience weakness, loss of appetite, rapid weight loss, hypoglycemia, and hypotension.

Most patients recover within weeks. Doctors may prescribe low-dose glucocorticoids to help patients through the recovery period.

Is follow-up necessary after acute lymphoblastic leukemia treatment? How often should follow-ups occur?

Lifelong follow-up is required to monitor for leukemia recurrence and long-term drug side effects.

In the first year after treatment, monthly follow-ups are needed. If the condition remains stable, follow-ups can be scheduled every 3–6 months for the next 2–4 years. After that, annual follow-ups are required for life.

Follow-up tests typically include complete blood counts, liver and kidney function tests, and electrolyte checks. Additionally, doctors may perform bone marrow aspiration, minimal residual disease (MRD) testing, or lumbar punctures (cerebrospinal fluid tests) as needed.

Can acute lymphoblastic leukemia be completely cured? Can it recur? How can recurrence be prevented?

Current medical technology enables nearly 90% of pediatric patients and 40% of adult patients to achieve long-term survival or even complete cure. The remaining patients may have short survival periods and eventually succumb to the disease.

Acute lymphoblastic leukemia can recur, typically during treatment or within 1–2 years after treatment. Signs of recurrence include anemia, elevated white blood cell counts, low platelet counts, hepatosplenomegaly, bone pain, fever, or sudden intolerance to chemotherapy.

There is no effective way to prevent recurrence. Regular follow-ups are essential for early detection, and timely treatment may still be effective. Recurrence symptoms resemble initial onset symptoms, such as fever, fatigue, bleeding, and bone pain. If these symptoms occur, seek medical attention immediately.

What is the likelihood of death from acute lymphoblastic leukemia?

Approximately 10% of pediatric patients and 60% of adult patients may die. Causes of death include disease recurrence, progression, or severe complications during treatment.

DIET & LIFESTYLE

What should patients with acute lymphoblastic leukemia pay attention to during hospitalization?

During hospitalization, especially during chemotherapy, the following should be noted:

• Diet: Chemotherapy consumes a lot of energy, so patients should eat a high-energy, high-protein, and low-fat diet, but choose easily digestible foods.
• Drink plenty of water: This can help prevent tumor lysis syndrome.
• Hygiene: Chemotherapy weakens immunity, making patients prone to bacterial and viral infections, so hygiene must be strictly maintained.
• Keep the room clean, ventilate frequently, and ensure regular air disinfection (performed by medical staff).
• Wash hands before meals and after using the toilet. Food should be fresh and clean, and rinse the mouth after eating.
• Clean the perianal area after bowel movements if possible.
• Wear a mask and stay warm when white blood cell counts are low.
• Caregivers with colds or other illnesses should also wear masks to avoid infecting the patient.

What should patients with acute lymphoblastic leukemia pay attention to in daily life?

• Hygiene: Same as the precautions mentioned for hospitalization.
• Avoid bumps: Move carefully and slowly to prevent injuries and excessive bleeding. Brush teeth gently.
• Be mindful of anemia: Stand up slowly to avoid dizziness or fainting. Avoid strenuous exercise.
• Watch for relapse: Even without symptoms, follow-up examinations should be done as advised. Seek immediate medical attention if signs of relapse (e.g., fever, fatigue, bleeding, or bone pain) occur.

What should patients with acute lymphoblastic leukemia pay attention to in their diet?

• Hygiene: Wash hands before meals, rinse the mouth after eating, and ensure food is fresh and clean.
• Ensure sufficient energy intake: Eat enough staple foods and choose easily digestible options (avoid sticky rice products like rice cakes, dumplings, or zongzi). Eat smaller, frequent meals if appetite is poor.
• Ensure protein and nutrient intake: Consume lean meat, poultry, fish, eggs, and dairy, along with leafy greens and fruits to improve immunity and anemia. If kidney function is impaired, consult a dietitian for low-protein, high-quality food choices.

Does acute lymphoblastic leukemia affect fertility?

Unless the disease affects the reproductive system, it does not directly impact fertility. However, chemotherapy and radiation therapy may affect fertility, so patients should wait for a considerable period after treatment before considering pregnancy.

Individual cases vary, so patients with fertility plans should discuss them in detail with their doctors.

Will daily activities, such as exercise or high-altitude travel, be affected for patients with acute lymphoblastic leukemia?

Yes.

Patients with acute lymphoblastic leukemia often experience anemia, weakened immunity, and bleeding tendencies. Strenuous exercise or high-altitude travel should be avoided to prevent hypoxia, severe bleeding, or infections, which can be life-threatening.

PREVENTION

Is there any way to prevent acute lymphoblastic leukemia?

Try to avoid risk factors that may trigger leukemia, such as improving immunity to prevent viral infections, minimizing radiation exposure, and avoiding contact with toxic chemical agents (such as formaldehyde).