Childhood Acute Lymphoblastic Leukemia

Acute lymphoblastic leukemia (ALL), also known as acute lymphocytic leukemia, is a quickly progressing disease in which too many abnormal white blood cells are found in the bone marrow (the soft, spongy center of long bones). Acute lymphoblastic leukemia accounts for about 75 to 80 percent of childhood leukemias and 85 percent of newly diagnosed patients go on to become event-free survivors. In some cases, children who are treated for ALL and achieve an initial complete remission will have the disease return; this is known as relapsed acute lymphoblastic leukemia.

Children and teens with acute lymphoblastic leukemia are treated at Dana-Farber/Boston Children's Cancer and Blood Disorders Center through the Childhood Leukemia Program.

Dana-Farber/Boston Children's offers a wide array of support services and programs for pediatric patients and their families during and after cancer treatment.

Symptoms of Childhood ALL

Because leukemia is a cancer of the bone marrow, the initial symptoms often are related to abnormal bone marrow function. Bone marrow is responsible for producing the body's blood cells, including the red blood cells, white blood cells, and platelets. While your child may experience symptoms differently, some of the most common ALL symptoms include:

• Anemia: Leukemia frequently causes anemia (low red blood cell count) because the bone marrow becomes too crowded with leukemia cells to produce normal red blood cells. Your child may appear tired and pale, and she may breathe faster to compensate for the decrease in her cells' ability to carry oxygen.
• Bone and joint pain: Your child may experience pain in his bones and joints. This pain is usually a result of the bone marrow being overcrowded and "full." Many children experience lower back pain or develop a limp.
• Bruising or petechiae: When the marrow is too crowded to allow platelets to be produced, your child may bruise more easily. You might notice petechiae, or tiny red dots, on the skin if your child has a low number of platelets. These are very small blood vessels that have "leaked" or bled. While these symptoms pose no immediate risk, they do indicate the possibility of a more serious underlying problem. A blood count will show an abnormally low number of platelets.
• 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.
• Recurrent infections: Although there may be an unusually high number of white blood cells on your child's blood count, these white blood cells aren't mature and don't fight infection. Your child may have had several viral or bacterial infections over the past few weeks and may show symptoms of an infection, such as a fever, runny nose, and cough.
• Abdominal pain: Stomach aches also may be a symptom of leukemia. Leukemia cells can collect in your child's kidney, liver, and spleen, causing these organs to become enlarged. Pain in the abdomen may cause your child to lose her appetite and lose weight.
• Swollen lymph nodes: Your child also may have swelling in the lymph nodes under the arms, or in the groin, chest, and neck. Leukemia cells may collect in the nodes, causing swelling.
• 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. 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. Keep in mind that the symptoms of ALL may resemble other more common conditions or medical problems. Always consult your child's physician for a diagnosis.