Which molecular anomaly with acute lymphoblastic leukemia carries the worst prognosis

Interactive Information about ALL 

The Leukemia & Lymphoma Society has partnered with Medicine X to create
Acute Lymphoblastic Leukemia (ALL) Xplained, which uses storytelling to provide patients with a greater understanding of living with adult ALL.

To learn more about the diagnosis, treatment options, monitoring, and quality of life issues associated with adult ALL, please click here.

Available in English and Spanish.

• Is a cancer of the bone marrow and blood
• Progresses rapidly without treatment
• Does not have a clear cause

Click here to access ALL statistics. 

Click here to access information about ALL in children and teens. 

What You Should Know

• It's important to start treatment soon after diagnosis.
• ALL is also called acute lymphocytic leukemia and acute lymphoid leukemia.
• ALL affects the blood cells and immune system.
• There are several ALL subtypes.
• The type of treatment you receive and your treatment outcome depend on your ALL subtype and individual risk factors.
• Most children with ALL are cured of their disease after treatment.
• The numbers of adults and their remission lengths have grown significantly over the past 30 years.

What You Should Do

• Choose a doctor who specializes in treating ALL. This type of specialist is called a hematologist-oncologist. Or, your local cancer specialist can work with a leukemia specialist.
• Talk with your doctor about your diagnostic tests and what the results mean.
• Talk with your doctor about all your treatment options and the results you can expect from treatment. 
• Obtain and keep records of your test results and the treatment you receive as this information is useful for long-term follow-up of your condition.

How Does ALL Develop?

ALL results from either an acquired or a genetic injury to the  DNA (genetic material) of a developing stem cell in the bone marrow.

• Stem cells form blood cells (white cells, red cells and platelets).
• Although ALL starts in a stem cell in the bone marrow, it can spread to other areas such as the central nervous system, the lymph nodes and, more rarely, the testes.

This damaged cell becomes a leukemic cell and multiplies uncontrollably into billions of cells called leukemic lymphoblasts.

• Leukemic lymphoblasts
  • Do not function normally
  • Block the production of normal cells
  • Grow and survive better than normal cells

As a result, the number of healthy blood cells (red cells, white cells and platelets) is usually lower than normal.

• Anemia is a condition when there is a low number of red cells in the blood which can cause fatigue and shortness of breath.
• Neutropenia is a condition when there is a low number of white cells so that the immune system can't effectively guard against infection due to a lack of neutrophils (a type of white cell).
• Thrombocytopenia is a condition when there is a low number of platelets which can cause bleeding and easy bruising with no apparent cause.
• Low numbers of all three blood cell counts is called pancytopenia.

Risk Factors

Doctors don't know why some cells become leukemic cells and others don't. Usually DNA mutations associated with ALL occur during a person's lifetime rather than being inherited from a parent. For most people who have acute lymphoblastic leukemia (ALL), there are no obvious reasons why they developed the disease.

Risk factors associated with the disease include: 

•  Previous exposure to chemotherapy and radiation therapy
• Genetic disorders including: Down syndrome, neurofibromatosis, Klinefelter syndrome, Fanconi anemia, Schwachman-Diamond syndrome, Bloom syndrome and ataxia telangiectasia have been associated with an increased risk of developing ALL.
• Age. Children, adolescents or adults older than 70 years are at greater risk of developing ALL.
• Sex. Males are more likely to develop ALL than females.
• Race/ethnicity. In the United States, ALL is more common in Hispanics and whites.

Currently, there's no way to prevent the disease. You can't catch ALL from someone else.

Source: Acute Lymphoblastic Leukemia (ALL) in Adults. Reviewed by Ryan D. Cassaday, MD