How We Diagnose Childhood Acute Lymphoblastic Leukemia (ALL)

Expert Care and Treatment for Childhood Blood Cancers

The Hematologic Malignancy Center at Dana-Farber/Boston Children's Cancer and Blood Disorders Center is one of the top pediatric leukemia and lymphoma treatment centers in the world. In addition to treating blood cancers, our Center also treats histiocytosis, a condition that shares some of the characteristics of cancer.

Childhood Hematologic Malignancy Center

Your child's physician may order different tests to determine whether your child has ALL and what type of ALL your child has. In addition to a physical examination and history, some of these tests may include:

  • Complete blood count (CBC): A CBC is a blood test that measures the number and type of blood cells in your child's blood.
  • Bone marrow aspiration and biopsy: Marrow may be removed by aspiration or a biopsy under local anesthesia. This test is performed by placing a needle through the bone (most often one or both of the hip bones) to the marrow space to get a sample. The sample is examined under the microscope to determine the type of cells seen in the marrow. This test is necessary to make the diagnosis of leukemia.
  • Spinal tap/lumbar puncture: A special needle is placed into the lower back between the back bones (vertebral bodies) into the spinal canal. A small amount of cerebral spinal fluid (called CSF — the fluid that surrounds a child's brain and spinal cord) will be removed and tested to see if leukemia cells are seen under the microscope. In cases of ALL, chemotherapy is given into the spinal fluid at the same time that a lumbar puncture is done.
  • X-ray: An x-ray is a way to get a picture of bones, lungs, and other organs. In ALL, this test is performed to look for a mass in the chest, which can sometimes occur and cause breathing problems.
  • Chromosome analysis: Samples of blood and bone marrow can be sent to a special laboratory to look for certain changes in the chromosomes of the leukemia cell. For example, in ALL, part of one chromosome may be moved to another chromosome, or there may be too many or too few chromosomes. The results of chromosome tests may help to determine the way the leukemia is treated.

After we complete all necessary tests, our experts meet to review and discuss what they have learned about your child's condition. We will meet with you and your family to discuss the results and outline the best treatment options for your child's leukemia.