What is acute lymphoblastic leukemia (ALL)?
ALL is a fast-growing blood cancer. It’s also called acute lymphocytic leukemia or acute lymphoid leukemia. In ALL, the body makes abnormal lymphocytes, a type of blood cell, in the bone marrow. 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. They also grow quickly and crowd out the bone marrow. This prevents it from making normal cells your body needs.
How does blood or marrow transplant (BMT) work for ALL?
BMT, also known as a bone marrow transplant or blood stem cell transplant, can treat patients who have ALL, including older patients. It replaces the unhealthy blood-forming cells (stem cells) with healthy ones. For some people, transplant can cure their disease.
The most common type of transplant for ALL is an allogeneic transplant. This type uses healthy blood-forming cells donated by someone else to replace the unhealthy blood-forming cells. These healthy cells can come from a family member, unrelated donor or umbilical cord blood. First, you get chemotherapy (chemo), with or without radiation, to kill the unhealthy cells. Then, the healthy donated cells are given to you through an intravenous (IV) catheter. The new cells travel to the inside of your bones and begin to make healthy blood cells.
The entire transplant process, from when you start of chemo or radiation, until hospital discharge, can last weeks to months. This is followed by many months of recovery near the transplant center and at home. Your transplant team will closely watch you to prevent and treat any side effects or complications.
When should I see a transplant doctor?
You or your child should see a transplant doctor early after diagnosis if:
- The initial chemo doesn’t lead to remission within 28 days of starting treatment
- The ALL has a high risk of relapse (coming back)
- The disease comes back 1 or more times after chemo
- Your child is diagnosed as an infant
Your first appointment with a transplant doctor
Even if you don’t need 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 your first appointment, the transplant doctor will:
- Review your medical history
- Talk with you about your treatment options
- Discuss the risks and benefits of transplant
- Recommend the best time for you to get a transplant and prepare for treatment
- Start a donor search even if you don’t need it right away. This can help you get a transplant faster if it’s needed later.
Learn about your risk for relapse
Doctors look at certain factors to see how likely it is that the ALL will come back (relapse) including:
- The number of white blood cells in your bloodstream when you were diagnosed
- Cytogenetic and molecular testing results
To do cytogenetic and molecular testing, doctors look at the chromosomes and genes in the leukemia cells. Chromosomes and genes 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. Others predict a higher risk. To do 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 seen. The results tell doctors if the ALL is likely to come back.
Ask your doctor for a copy of your test results and to explain what the results mean. Remember, if the ALL has a high risk of relapse and you’re healthy enough for transplant, it’s important to see a transplant doctor right away.
Questions to ask your doctor
Ask questions so you understand your treatment options and can make decisions that are best for you. Questions you may want to ask your doctor include:
- What are my chances of a cure or long-term remission if I get a transplant?
- If I don’t get a transplant?
- What are the risks of waiting or trying other treatments before a transplant?
- Does my current health or age affect how well transplant might work for me?
- What do my cytogenetic and molecular test results mean for my treatment?
- What are the possible side effects of transplant? How can they be reduced?
- How might my quality of life change over time, with or without transplant?
Most recent medical review completed March 2017.