Acute lymphoblastic leukemia is a type of malignancy that most commonly affects children. The cancerous cells can either be found in the bone marrow itself, thus disrupting the process of blood cell production and maturation, or in other extramedullary organs.

The immature white blood cells that are produced by the diseased bone marrow initially replace the organ; as a result, it fails to produce the rest of the cellular lines, such as erythrocytes and platelets. Due to the pancytopenia that exists, patients can present with a multitude of symptoms. Specifically, a diminished erythrocyte count leads to anemia, pallor, weakness and fatigue, reduced platelets induce hemorrhagic events such as petechiae or active hemorrhage and the immature white blood cells cause an inadequate immune response to any infection. Although the patient is vulnerable to various microorganisms, they rarely exhibit septic phenomena. Many times, patients report a history of skeletal pain, arthritis and limping as the sole symptoms; as a result, diagnosis may be delayed [8]. Hepatosplenomegaly, fever and lymphadenopathy are also frequently observed.

In addition to the aforementioned symptoms, some types of ALL may lead to the development of masses outside of the borders of the bone marrow. The central nervous system, head and neck are the most common locations for these growths. The infiltration of the central nervous system may lead to papilledema, palsies of the cranial nerves, lethargy or nuchal rigidity; these symptoms rarely constitute the clinical manifestations at the time that ALL is originally diagnosed [9]. Another symptom that may raise suspicion of ALL is testicular edema in male patients that is not accompanied by pain.

Lastly, stridor is an alarming symptom that should indicate a possible mediastinal mass, which, in turn, may threaten the respiratory function. Corticosteroids should promptly be administered in order to prevent respiratory failure and close monitoring is also considered mandatory.

• Splenomegaly

  Splenomegaly and thrombocytopenia were frequently observed more in CD200 + patients. Increased frequency of CD34 + was associated with CD200 + and CD56 + patients. [ncbi.nlm.nih.gov]

  Five features were present in >50% of children: hepatomegaly (64%), splenomegaly (61%), pallor (54%), fever (53%) and bruising (52%). [adc.bmj.com]

  […] myeloblasts Small lymphocytes Entire myeloid series Anemia Severe in > 90% Severe in > 90% Mild in about 50% Mild in 80% Platelets Low in > 80% Low in > 90% Low in 20 to 30% High in 60% Low in 10% Lymphadenopathy Common Occasional Common Infrequent Splenomegaly [merckmanuals.com]

  CT, MRI, or abdominal ultrasonography may help assess splenomegaly or leukemic infiltration of other organs. Prognosis Cure is a realistic goal for both ALL and AML, especially in younger patients. [web.archive.org]

• Easy Bruising

  Symptoms of ALL include: Weakness or feeling tired Fever Easy bruising or bleeding Bleeding under the skin Shortness of breath Weight loss or loss of appetite Pain in the bones or stomach Pain or a feeling of fullness below the ribs Painless lumps in [medlineplus.gov]

  Symptoms of ALL include: Frequent infections Fever Easy bruising Bleeding that is hard to stop Flat, dark-red skin spots (petechiae) due to bleeding under the skin Pain in the bones or joints Lumps in the neck, underarm, stomach or groin Pain or fullness [stjude.org]

  Disrupted hematopoiesis leads to the most common presenting symptoms (anemia, infection, easy bruising and bleeding). [web.archive.org]

  Signs and symptoms Possible signs of adult ALL include fever, feeling tired and easy bruising or bleeding. [sppirx.com]

• Fever

  Fever — Many children with ALL have fevers that are not related to a specific infection, though sometimes fever at the time of diagnosis can be a sign of infection. [danafarberbostonchildrens.org]

  Normally, these cells are relatively rare, but in ALL, they continuously multiply and are overproduced by the bone marrow, causing fatigue, anemia, fever, and bone pain due to the spread of these cells into the bone and joint surfaces. [medcell.med.yale.edu]

  Here, a 16-year-old male presented with complaints of pain abdomen, on and off fever, joint pain, and hepatosplenomegaly for 2 months. Bone marrow examination was suggestive of acute leukemia with numerous leukoblasts on aspiration. [ncbi.nlm.nih.gov]

• Anemia

  Learn about this topic in these articles: blood disease In blood disease: Leukemia In acute lymphocytic anemia (ALL), most frequently seen in children, the cells are immature forms of the lymphatic series of cells. [britannica.com]

  The most common signs and symptoms of acute lymphoblastic leukemia in children are: Anemia. Anemia occurs when normal red blood cells can't be produced because the bone marrow is overcrowded by leukemia cells. [chop.edu]

  Although rarely observed in children affected by acute lymphoblastic leukemia, TTP is a potentially fatal illness that should be considered in the differential diagnosis of thrombocytopenia with hemolytic anemia. [ncbi.nlm.nih.gov]

  Normally, these cells are relatively rare, but in ALL, they continuously multiply and are overproduced by the bone marrow, causing fatigue, anemia, fever, and bone pain due to the spread of these cells into the bone and joint surfaces. [medcell.med.yale.edu]

• Fatigue

  Normally, these cells are relatively rare, but in ALL, they continuously multiply and are overproduced by the bone marrow, causing fatigue, anemia, fever, and bone pain due to the spread of these cells into the bone and joint surfaces. [medcell.med.yale.edu]

  A 21-year-old woman who presented fatigue had a new diagnosis of acute lymphoblastic leukemia underwent FDG PET/CT. The images demonstrated extramedullary infiltration in multiple organs, including the liver, pancreas, kidney and the bone. [ncbi.nlm.nih.gov]

  Medical Definition of acute lymphoblastic leukemia : lymphocytic leukemia that is marked by an abnormal increase in the number of lymphoblasts, that is characterized by rapid onset and progression of symptoms which include fever, anemia, pallor, fatigue [merriam-webster.com]

  Low levels of other blood cells can cause a variety of symptoms such as bleeding problems, fatigue and shortness of breath. White Blood Cells Copyright © Nucleus Medical Media, Inc. Causes The cause of ALL is unknown. [web.archive.org]

• Weakness

  She developed VCR toxicity that included tubulopathy, high blood pressure, neuropathic pain, difficulty walking, diffuse muscular weakness, constipation, abdominal pain. There are limited data in children with ALL for posaconazole prophylaxis. [ncbi.nlm.nih.gov]

  Symptoms of ALL include: Weakness or feeling tired Fever Easy bruising or bleeding Bleeding under the skin Shortness of breath Weight loss or loss of appetite Pain in the bones or stomach Pain or a feeling of fullness below the ribs Painless lumps in [medlineplus.gov]

• Weight Loss

  Symptoms include: Bone and joint pain Easy bruising and bleeding (such as bleeding gums, skin bleeding, nosebleeds, abnormal periods) Feeling weak or tired Fever Loss of appetite and weight loss Paleness Pain or feeling of fullness below the ribs from [medlineplus.gov]

• Dyspnea

  CASE REPORT We report the case of a 58-year-old male patient who presented with severe chest pain, dyspnea, systemic symptoms, leukopenia, normocytic anemia, and severe lactic acidosis. [ncbi.nlm.nih.gov]

  Clinical Evaluation As many as 75% of patients with T-cell lymphoblastic lymphoma will present with an anterior mediastinal mass, which may manifest as dyspnea, wheezing, stridor, dysphagia, or swelling of the head and neck. [9] B-cell subtypes usually [emedicine.medscape.com]

  Dyspnea (difficulty breathing) — In some cases of ALL, leukemia cells tend to clump together and form a mass in the middle of the chest. This chest mass can cause pain and difficulty breathing in your child. [danafarberbostonchildrens.org]

• Cough

  Following hospital admission, the patient initially presented with headache-caused nocturnal awakenings, evening fever, and cough, and he also lost approximately 7 kg in weight in a month not associated with sweating or itching. [ncbi.nlm.nih.gov]

  Wheezing, coughing and/or painful breathing requires immediate medical attention. ALL can cause a variety of symptoms in children based on their age and their disease type. [danafarberbostonchildrens.org]

  Any wheezing, coughing and/or labored or painful breathing requires immediate medical attention. [chop.edu]

• Loss of Appetite

  Symptoms of ALL include: Weakness or feeling tired Fever Easy bruising or bleeding Bleeding under the skin Shortness of breath Weight loss or loss of appetite Pain in the bones or stomach Pain or a feeling of fullness below the ribs Painless lumps in [medlineplus.gov]

  […] or loss of appetite Enlarged lymph nodes The signs and symptoms of ALL can be the same as more common children’s illnesses and some children are treated for those other illnesses before leukemia is diagnosed. [curesearch.org]

• Vomiting

  We report a case of a 3 years old boy who presented with prolonged fever, nausea, vomiting and increasing lower limbs pain. Skeletal X-rays and CT scan showed severe osteolytic lesions of the skull and extremities. [ncbi.nlm.nih.gov]

  Acute lymphocytic leukemia symptoms ALL symptoms are often similar to those of the flu and can include the following: Fever Weakness Fatigue Headaches Loss of appetite Pale skin Vomiting Body aches Other potential signs and symptoms of ALL may include [cancercenter.com]

  They include: nausea vomiting swelling in the face and lower legs muscle cramps rash diarrhoea Depending on how well you respond to treatment, the induction phase can last from two weeks to several months. [hse.ie]

  If this happens, the patient may have neurological symptoms, such as dizziness, vomiting, blurred vision, fits (seizures), and headaches. Causes and risk factors The causes of ALL are mostly not yet known, but there are some common risk factors. [medicalnewstoday.com]

• Bleeding Gums

  Symptoms include: Bone and joint pain Easy bruising and bleeding (such as bleeding gums, skin bleeding, nosebleeds, abnormal periods) Feeling weak or tired Fever Loss of appetite and weight loss Paleness Pain or feeling of fullness below the ribs from [medlineplus.gov]

  gums Frequent infections Nosebleeds Easy bruising Swollen lymph nodes around the neck, underarm, stomach or groin Shortness of breath Weight loss Acute lymphocytic leukemia treatment options Treatment for ALL may include chemotherapy, chemotherapy with [cancercenter.com]

• Palpitations

  Anaemia – due to lack of red blood cells Weakness, tiredness, shortness of breath, light-headedness, palpitations Infections – due to lack of normal white blood cells Infections are more frequent, more severe and last longer Fever, malaise (general feeling [leukaemiacare.org.uk]

  Symptoms Fatigue, dizziness and palpitations. Severe and unusual bone and joint pain. Recurrent and severe infections (oral, throat, skin, perianal infections commonly). Fever without obvious infection (but infection should be assumed). [patient.info]

  Symptoms of anemia are common and include fatigue, dizziness, palpitations, and dyspnea upon even mild exertion. Other patients present with signs of bleeding. Bleeding can be the result of thrombocytopenia due to marrow replacement. [emedicine.medscape.com]

  Signs and symptoms Signs and symptoms of ALL include the following: Fever Signs and symptoms of anemia, such as pallor, fatigue, dizziness, palpitations, cardiac flow murmur, and dyspnea with even mild exertion Bleeding Blood clots Palpable lymphadenopathy [emedicine.com]

• Chest Pain

  CASE REPORT We report the case of a 58-year-old male patient who presented with severe chest pain, dyspnea, systemic symptoms, leukopenia, normocytic anemia, and severe lactic acidosis. [ncbi.nlm.nih.gov]

  Other symptoms may include swollen lymph nodes (glands), chest pain and abdominal discomfort due to a swollen spleen or liver. Occasionally people have no symptoms and ALL is diagnosed during a routine blood test. [leukaemia.org.au]

  Other presenting symptoms and signs are usually nonspecific (eg, pallor, fatigue, fever, malaise, weight loss, tachycardia, chest pain) and are attributable to anemia and a hypermetabolic state. [web.archive.org]

  The most common presenting symptoms are due to disrupted hematopoiesis with ensuing Anemia Thrombocytopenia Granulocytopenia Anemia can manifest with fatigue, weakness, pallor, malaise, dyspnea on exertion, tachycardia, and exertional chest pain. [msdmanuals.com]

• Tachycardia

  The pallor, shortness of breath, tachycardia, and fatigue are due to anemia. Image : “Immature Large Blast Cells in Acute Lymphoblastic Leukemia.” by VashiDonsk. [lecturio.com]

  Other presenting symptoms and signs are usually nonspecific (eg, pallor, fatigue, fever, malaise, weight loss, tachycardia, chest pain) and are attributable to anemia and a hypermetabolic state. [web.archive.org]

  The most common presenting symptoms are due to disrupted hematopoiesis with ensuing Anemia Thrombocytopenia Granulocytopenia Anemia can manifest with fatigue, weakness, pallor, malaise, dyspnea on exertion, tachycardia, and exertional chest pain. [msdmanuals.com]

  Tachycardia and a flow murmur. Nonspecific signs of infection. Petechiae (due to thrombocytopenia), may progress into purpura or ecchymoses. Abdominal distention due to hepatomegaly and splenomegaly. Lymphadenopathy. Testicular enlargement. [patient.info]

  The initial presentation includes manifestations of the underlying anemia – pallor, fatigue, exercise intolerance, tachycardia, dyspnea, and sometimes congestive heart failure; thrombocytopenia – petechiae, purpura, easy bruising, bleeding from mucous [intechopen.com]

• Heart Failure

  failure more frequently in older patients than in young adults. [hematologyandoncology.net]

  The anthracycline-induced cardiomyopathy is a progressive disorder that manifests with signs of congestive heart failure. Rapid progression of symptoms may occur with pregnancy, anesthesia, or exercise [ 177, 178 ]. [intechopen.com]

• Hepatosplenomegaly

  Massive hepatosplenomegaly as a presentation of ALL has not been described previously in any patient population. [ncbi.nlm.nih.gov]

  The most frequent signs are lymphadenopathies, hepatosplenomegaly, fever, signs of haemorrhage, and bone pain. [orpha.net]

  Lymphadenopathy and hepatosplenomegaly, although rarely symptomatic, are noted in approximately 20% of patients ( 9 ). [accessmedicine.mhmedical.com]

• Hepatomegaly

  We emphasize the importance of being aware of this condition when a patient with ALL in complete remission presents with unexplained hepatomegaly, cytopenia, and fever. Early diagnosis and treatment may be lifesaving. [ncbi.nlm.nih.gov]

  Magnetic resonance imaging of the liver with intravenous contrast enhancement done at our hospital revealed hepatomegaly. [jmedicalcasereports.biomedcentral.com]

  Five features were present in >50% of children: hepatomegaly (64%), splenomegaly (61%), pallor (54%), fever (53%) and bruising (52%). [adc.bmj.com]

  Bone pain/tenderness, hepatomegaly, and splenomegaly may be present. About 7% of children have CNS involvement at the time of diagnosis. [lecturio.com]

• Petechiae

  Where considered clinically appropriate, features that the authors considered similar were aggregated (eg, ‘petechiae’, ‘purpura’ and ‘petechiae/purpura’ were combined into a single category, ‘petechiae/purpura’). [adc.bmj.com]

  Symptoms of ALL include: Frequent infections Fever Easy bruising Bleeding that is hard to stop Flat, dark-red skin spots (petechiae) due to bleeding under the skin Pain in the bones or joints Lumps in the neck, underarm, stomach or groin Pain or fullness [stjude.org]

  […] bleeding (such as bleeding gums, skin bleeding, nosebleeds, abnormal periods) Feeling weak or tired Fever Loss of appetite and weight loss Paleness Pain or feeling of fullness below the ribs from an enlarged liver or spleen Pinpoint red spots on the skin (petechiae [medlineplus.gov]

  Symptoms of ALL include: Fever Easy bruising or bleeding that is hard to stop Flat, dark-red skin spots (petechiae) due to bleeding under the skin Pain in the bones or joints Lumps in the neck, underarm, stomach or groin Weakness, fatigue, paleness or [ochsner.org]

• Night Sweats

  ALL symptoms include: Weakness or feeling tired Fever or night sweats Shortness of breath Unusual bleeding or bruising Unexplained loss of appetite or weight loss Night sweats Bone or stomach pain Frequent infections Tiny, dark red spots under the skin [cancer.osu.edu]

  The B symptoms, such as fever, night sweats, and weight loss, are frequent. White blood cell (WBC) count at presentation varies widely, and circulating blasts are generally noted. [accessmedicine.mhmedical.com]

  sweats These symptoms can occur with other conditions. [medlineplus.gov]

  sweats Easy bruising or bleeding Petechiae (flat, pinpoint spots under the skin caused by bleeding) Shortness of breath Weight loss Loss of appetite Bone or joint pain Stomach pain Pain or a feeling of fullness below the ribs Painless lumps in the neck [uvahealth.com]

• Purpura

  Thrombotic thrombocytopenic purpura (TTP) is a thrombotic microangiopathy caused by deficiency of von Willebrand factor-cleaving protease ADAMTS13. [ncbi.nlm.nih.gov]

  Where considered clinically appropriate, features that the authors considered similar were aggregated (eg, ‘petechiae’, ‘purpura’ and ‘petechiae/purpura’ were combined into a single category, ‘petechiae/purpura’). [adc.bmj.com]

  […] blood cells Weakness, tiredness, shortness of breath, light-headedness, palpitations Infections – due to lack of normal white blood cells Infections are more frequent, more severe and last longer Fever, malaise (general feeling of illness) and sweats Purpura [leukaemiacare.org.uk]

  […] bleeding gums or nosebleeds high temperature (fever) of 38C (100.4F) or above night sweats bone and joint pain easily bruised skin swollen lymph nodes (glands) abdominal pain – caused by a swollen liver or spleen unexplained weight loss a purple skin rash (purpura [nhs.uk]

• Bone Pain

  Normally, these cells are relatively rare, but in ALL, they continuously multiply and are overproduced by the bone marrow, causing fatigue, anemia, fever, and bone pain due to the spread of these cells into the bone and joint surfaces. [medcell.med.yale.edu]

  pale color, fever, easy bleeding or bruising, bone pain, enlarged lymph nodes[1] complications infection, tumor lysis syndrome[2][3] usual onset 2–5 years old[4] types b-cell all, t-cell all[2] causes usually unknown[5] risk factors identical twin with [know.cf]

  Although ALL primarily affects the bone marrow and peripheral blood, any organ or tissue may be infiltrated by the abnormal cells. The most frequent signs are lymphadenopathies, hepatosplenomegaly, fever, signs of haemorrhage, and bone pain. [orpha.net]

  Abstract A 47-year-old man presented with abdominal pain, vomiting, and bone pain. Laboratory findings revealed severe hypercalcemia, anemia, and renal insufficiency with decreased serum parathyroid hormone. [ncbi.nlm.nih.gov]

• Myalgia

  Her fever was of unknown origin but was suspected to be due to the cytokine-release syndrome ( Figure 1B ); she also had myalgias and 2 days of confusion (grade 3), all of which spontaneously resolved. [doi.org]

• Arthralgia

  Bone pain, arthralgia, and/or arthritis may manifest as decreased activity, general fussiness, irritability, or refusal to walk. [clinicaladvisor.com]

• Epistaxis

  A 30-year-old pregnant woman presented at 16 weeks' gestation with epistaxis, jaundice, diffuse abdominal pain and distension, massive hepatosplenomegaly and peripheral oedema. [ncbi.nlm.nih.gov]

  Epistaxis, menorrhagia and gingival bleeding may also occur. The pallor, shortness of breath, tachycardia, and fatigue are due to anemia. Image : “Immature Large Blast Cells in Acute Lymphoblastic Leukemia.” by VashiDonsk. [lecturio.com]

  Bleeding is usually manifested by petechiae, easy bruising, epistaxis, bleeding gums, or menstrual irregularity. Hematuria and GI bleeding are uncommon. [web.archive.org]

  Thrombocytopenia can cause mucosal bleeding, easy bruising, petechiae/purpura, epistaxis, bleeding gums, and heavy menstrual bleeding. Hematuria and GI bleeding are uncommon. [msdmanuals.com]

• Headache

  Following hospital admission, the patient initially presented with headache-caused nocturnal awakenings, evening fever, and cough, and he also lost approximately 7 kg in weight in a month not associated with sweating or itching. [ncbi.nlm.nih.gov]

  […] do their jobs cause the symptoms that people have as the leukemic cells invade: fatigue, significant bruising (not just a few bumps and bruises on the shins), fever, significant swollen lymph nodes throughout the body, and less commonly bone pain or headache [hollywoodlife.com]

  You should see your pediatrician if your child has any of the following: Unexplained fever and headaches Enlarged lymph nodes in the neck, arm pits, or groin Pain in the arms, legs, or back Easy bruising and bleeding Tiny red spots in the skin Fatigue [childrensnational.org]

  Acute lymphocytic leukemia symptoms ALL symptoms are often similar to those of the flu and can include the following: Fever Weakness Fatigue Headaches Loss of appetite Pale skin Vomiting Body aches Other potential signs and symptoms of ALL may include [cancercenter.com]

  Symptoms include fatigue, pallor, infection, bone pain, CNS symptoms (eg, headache), easy bruising, and bleeding. Examination of peripheral blood smear and bone marrow is usually diagnostic. [msdmanuals.com]

• Confusion

  Some patients present with leukostasis and clinical symptoms of impaired circulation such as a headache, confusion and respiratory distress. [lecturio.com]

  Children often have a more aggressive and dramatic presentation that may result in extreme pain in the extremities and joints and can be confused with arthritis. [cancertherapyadvisor.com]

  Tremor, headache, and other mental status changes (eg, confusion) have been reported. [bloodjournal.org]

  Her fever was of unknown origin but was suspected to be due to the cytokine-release syndrome ( Figure 1B ); she also had myalgias and 2 days of confusion (grade 3), all of which spontaneously resolved. [doi.org]

• Intracranial Hemorrhage

  Terson syndrome, in which intraocular hemorrhage is associated with intracranial hemorrhage, is more commonly reported in adults, although ocular manifestations of leukemia have been reported at presentation and are typically asymptomatic. [ncbi.nlm.nih.gov]

The first step towards diagnosing acute lymphocytic leukemia includes blood tests. Laboratory tests are expected to reveal anemia and thrombocytopenia, alongside leukocytosis. Lymphoblasts may also be present. A bone marrow biopsy is also required in order for the diagnosis of ALL to be definitive: the bone marrow is aspirated and biopsized, in order to detect an infiltration by precursor cells and to differentiate between a T or B type leukemia.

Furthermore, imaging modalities can illustrate the extent of the malignancy. Plain radiographs or a computerized tomography scan can be used to eliminate or confirm suspicion that the disease has disseminated to the brain or spinal cord. Finally, a lumbar puncture can also detect cancerous precursor cells within the cerebrospinal fluid.

As soon as the diagnosis of ALL is established, HLA-typing is promptly carried out [10] [11].

• Mediastinal Mass

  Radiation may also be required for palliation of symptomatic masses, such as a mediastinal mass with compression. Note that radiation is never the sole treatment modality. [emedicine.medscape.com]

  A chest radiograph shows normal results with no mediastinal mass or pulmonary infiltrate. [pedsinreview.aappublications.org]

  In T-cell ALL, a chest X-ray may sometimes show mediastinal widening or mediastinal mass. [lecturio.com]

  Lastly, stridor is an alarming symptom that should indicate a possible mediastinal mass, which, in turn, may threaten the respiratory function. [symptoma.com]

• Decreased Platelet Count

  After 16 months, the results of routine blood tests showed reduced hemoglobin levels and decreased platelet counts. In addition, blast-like cells were found in a peripheral blood smear. [ncbi.nlm.nih.gov]

  The decreased normal blood cells are responsible for most of the clinical symptoms. The decreased platelets cause bleeding. [lecturio.com]

• Thrombocytosis

  Myelodysplastic/myeloproliferative neoplasm with ring sideroblasts and thrombocytosis The criteria for MDS/MPN with ring sideroblasts and thrombocytosis (MDS/MPN-RS-T; previously known as RARS-T) include thrombocytosis (≥450 × 10 9 /L) associated with [doi.org]

Acute lymphocytic leukemia is a type of malignancy that may affect various organs and is treated pharmacologically, by administrating chemotherapy.

Treatment is individualized depending on the type of all. In general, every therapeutic plan centers around three basic treatment stages:

• Remission-induction phase
• Intensification phase
• Continuation therapy, reserved for those patients who exhibit residual disease

T-cell acute lymphocytic leukemia is treated with the addition of asparaginase and cyclophosphamide and mature B-cell acute leukemia requires a brief but intensive period of chemotherapy with additional methotrexate, cytarabine and cyclophosphamide.

Acute lymphocytic leukemia is considered a curable malignancy, with survival rates being exceptionally high during the past years. Although it progresses rapidly and will threaten the life of the patient, if left untreated, proper therapeutic actions are promising and generally effective.

Specifically, prognosis depends on a number of factors. Pediatric patients exhibit a greater recovery rate in comparison to adult individuals; amongst the adult group, patients that are diagnosed with ALL before the age of 50 also display a better prognosis. Studies have delineated that the remission rate for patients below the age of 30 is 90%, for patients between the ages of 30 and 60 the rate decreases to 80% and reaches its lowest number, 52%, when referring to patients who are older than 60 years of age [7].

Furthermore, patients who have a white blood cell count greater than 50,000 at the time of diagnosis are expected to respond better to treatment. The extent of the disease, including infiltration of other organs, involvement of the central nervous system etc, also affects prognosis in a negative way.

The exact subtype of ALL also makes a difference in the prognosis: patients with a T-cell acute lymphocytic leukemia recover at a bigger rate, compared to individuals with B-cell ALL. Additionally, individuals whose cancer evinces complete remission during the first 5 weeks since the initiation of treatment are seen in a more positive light, in contradistinction to patients whose remission requires longer periods of time or is never achieved.

The exact etiologic mechanisms that underlie ALL have yet to be firmly established. There have been, however, observations that lead to the illustration of various factors that are believed to play a role in the causes.

A genetic background has been proposed, especially due to the 25% possibility of a monozygotic twin to develop the disease, once its sibling is diagnosed with it. ALL has been linked to various other pathologies, such as trisomy 21, Bloom syndrome, Klinefelter syndrome and others [1] [2] [3]. Furthermore, the exposure to radiation or energy from a nuclear explosion, the use of tobacco products and hair dyes, as well as jobs related to electricity are all believed to contribute to the onset of acute lymphocytic leukemia [4].

It is also believed that viruses can lead to the development of such a malignancy, even though this hypothesis has not been substantiated scientifically. Various polymorphisms in the metabolism of folate is another potential etiologic factor [5].

Although ALL can be diagnosed in patients of all ages, children between the age of 0 to 14 are the ones most commonly affected by it. In fact, this type of cancer has been estimated to display a yearly incidence of approximately 4 cases per 100,000 children in the aforementioned age group [6]. This particular incidence is considered to be an average worldwide estimation.

The disease exhibits a predilection for Caucasian male individuals and its frequency peak is between 2 and 5 years old.

Acute lymphocytic leukemia is a malignancy of the hematopoietic system, namely the bone marrow and, subsequently, of the blood. The bone marrow is a vital organ responsible for the production and maturation of all the lines of the blood's components: erythrocytes, white blood cells and platelets.

The bone marrow produces all three types of cells; after a differentiation process is completed within the organ, it releases mature cells in the circulation. In the case of ALL normal white blood cells fail to differentiate properly and immature precursor cells are released into the circulation. This developmental arrest in the life cycle of leukocytes implies that the immune system does not possess cells that are mature enough to fight infection and the patient is therefore severely immunocompromised. Furthermore, the precursor cells known as lymphoblasts infiltrate the bone marrow to such a degree that they replace the organ's elements and, as a result, it is incapable of producing red cells and platelets as well.

The exact etiologic factors that underlie acute lymphocytic leukemia have not yet been clarified; it is therefore not possible to provide any strategic plan concerning its avoidance.

Acute lymphocytic leukemia (ALL) is a malignancy of the bone marrow. It affects the leukocytes, which are produced from the precursor cells, but fail to differentiate into mature white cells, because of an early arrest in their development.

The malignancy is defined as acute, due to the fact that it progresses quickly and, if left without the administration of the proper chemotherapeutic agents, it may threaten the life of the patient. Children are more commonly affected by this type of cancer than adults: a young age is amongst the positive prognostic factors with regard to the efficacy of the treatment.

The causes of acute lymphocytic leukemia are still not definitively established, although a certain genetic substrate has been proposed. Other factors that potentially contribute to the onset of the disease include exposure to chemicals, smoking and folate metabolism disruption.

ALL is diagnosed via a complete blood count and a bone marrow biopsy to definitively confirm the diagnosis. A plain radiograph or magnetic resonance imaging scan can be used to detect sites of potential dissemination, which are usually found in the brain or spinal cord. It is treated with chemotherapy and prognosis is generally positive.

Acute lymphocytic leukemia (ALL) is a type of cancer that affects the bone marrow, and, subsequently, the blood. It can occur at any age, but children are most commonly affected by it.

The bone marrow is a vital organ, that is responsible for the production and maturation of all of the cellular components of the blood: red blood cells, white blood cells and platelets. In cases of ALL, the white blood cells do not develop properly and experience a very early arrest in their maturation process. As a result, they are released into the circulation at an earlier developmental stage and are too immature to fight infections and diseases. Moreover, these immature cells, called lymphoblasts, progressively replace the material that the bone marrow is made of and lead to a decreased production of red blood cells and platelets as well.

Patients with ALL present with a variety of symptoms. Decreased concentrations of red blood cells lead to anemia, fatigue and weakness; less platelets imply a tendency towards hemorrhaging and the presence of immature white blood cells leads to the inability of the organism to protect itself against infections.

Acute lymphocytic leukemia is diagnosed with a complete blood count and a bone marrow biopsy. Radiologic evaluation is necessary to find out whether the malignant cells have infiltrated the brain or spinal cord. The condition is treated with chemotherapy.

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