Acute lymphoblastic leukemia (ALL)

Acute lymphoblastic leukemia (ALL), or acute lymphoid leukemia, is a fast-growing blood cancer in which the bone marrow produces abnormal lymphocytes. Bone marrow is the soft, spongy tissue inside bones. It makes red blood cells, white blood cells and platelets. A lymphocyte is a type of white blood cell and part of the immune system. Abnormal lymphocytes don’t fight infections very well, grow quickly, and crowd out the bone marrow. This prevents it from making the normal cells your body needs to function properly.

A blood or marrow transplant (BMT), also called a bone marrow transplant or blood stem cell transplant, replaces unhealthy bone marrow with healthy blood-forming cells from a donor. For some people, a successful transplant can cure ALL.

For ALL, doctors use an allogeneic transplant, meaning the donated cells come from someone else. These healthy blood-forming cells can come from:

• A family member
• An unrelated donor
• Umbilical cord blood

In addition to an allogeneic transplant, one emerging form of treatment for ALL called Chimeric antigen receptor T-cell (CAT-T) therapy, can help the immune system find and destroy cancer cells.

Although each person’s journey is unique, bone marrow transplantation for acute lymphoblastic leukemia typically follows a series of distinct phases. From the initial therapy to the infusion of donor cells and ongoing recovery, here’s how the transplant process generally works.

• Preparation: You’ll begin with chemotherapy (and sometimes radiation) to destroy the unhealthy marrow. This step, called conditioning therapy, makes room for new, healthy blood-forming cells.
• Transplant: Next, healthy donor cells are delivered through an intravenous (IV) catheter, often referred to as a stem cell infusion. These cells travel to the inside of your bones and begin producing new blood cells.
• Recovery: Full recovery can take several months to a year. From the start of conditioning to leaving the hospital can take weeks to months. You’ll then spend additional time recovering near the transplant center and at home. During this period, your transplant team carefully monitors you, helping prevent and manage any side effects or complications.

If you or your child are diagnosed with ALL, you should see a transplant doctor right away, especially if:

• Initial chemo doesn’t lead to remission within 28 days of starting treatment
• Your ALL has a high risk of relapse (coming back)
• The disease comes more than once after chemo
• Your child is diagnosed as an infant

Everyone’s body is different, and there are many contributing factors that impact how your body may handle an ALL diagnosis. We recommend always consulting with a doctor for the best advice on how to safely and effectively treat this disease.

Scheduling an appointment with a doctor to discuss your ALL diagnosis is the first step to finding a cure. Even if you don’t need a transplant right away, it’s important to see a transplant doctor early. Most patients have a better chance of a cure if they get a transplant sooner.

At the first appointment, the transplant doctor will:

• Review your or your child’s medical history
• Talk with you about ALL treatment options
• Discuss the risks and benefits of BMT transplant
• Recommend the best time for you or your child to get a transplant and prepare for treatment
• Start a donor search

Patients that come from ethnically diverse backgrounds will often have a harder time finding a matching bone marrow donor. This is because of genes called human leukocyte antigens (HLAs), which are the codes inside your body doctors use to help find a match. HLAs are inherited, which means it will be easier to find a match using a patient and donor that share the same ancestry.

Unfortunately, not all ethnicities are equally represented on the registry.

Learn more about the importance of diversity

Doctors look at certain factors to see how likely it is that ALL will relapse, including:

• The number of white blood cells in your bloodstream when you were diagnosed
• Cytogenetic and molecular testing results

For cytogenetic and molecular testing, doctors analyze the chromosomes and genes in the leukemia cells, which tell your body how to make everything it needs to work properly. Certain changes in the ALL chromosomes and genes predict a lower risk of relapse, while others predict a higher risk. To complete this testing, doctors study your blood and your bone marrow.

Your doctor may also test for minimal residual disease (MRD) if you, or your child, have no more signs of ALL. This test looks for chromosomes and genes from the ALL that may still be present, which are indicators of whether or not the ALL is likely to come back.

Always ask your doctor for a copy of your test results and to explain what the results mean. If the ALL has a high risk of relapse and you’re healthy enough for transplant, it’s important to see a transplant doctor as soon as possible.

Ask questions so you can best understand the treatment options available for your acute lymphoblastic leukemia. Questions you may want to ask include:

• What are my chances of curing ALL or entering long-term remission with a transplant? Without a transplant?
• What are the risks of waiting or trying other ALL treatments before a transplant?
• Does my or my child’s health or age affect the risks of transplant?
• What do the cytogenetic and molecular test results mean for treatment?
• What are the possible side effects of a bone marrow or blood stem cell transplant? How can they be reduced?
• How might my or my child’s quality of life change over time due to ALL, with or without transplant?

By asking these questions, you can better understand your options and plan the next steps in your treatment journey.

Learn more about planning for transplant