What is acute lymphocytic leukemia?
Acute lymphocytic leukemia (ALL), also called acute lymphoblastic leukemia, is a cancer that starts from white blood cells called lymphocytes in the bone marrow (the soft inner part of the bones, where new blood cells are made).
In most cases, the leukemia invades the blood fairly quickly. It can then spread to other parts of the body, including the lymph nodes, liver, spleen, central nervous system (brain and spinal cord), and testicles (in males). Other types of cancer can start in these organs and then spread to the bone marrow, but these cancers are not leukemia.
The term "acute" means that the leukemia can progress quickly, and if not treated, would probably be fatal within a few months. "Lymphocytic" means it develops from early forms of lymphocytes, a type of white blood cell. This is different from acute myeloid leukemia (AML), which develops in other blood cell types found in the bone marrow. For more information on AML, see our document, Leukemia--Acute Myeloid.
Other types of cancer that start in lymphocytes are known as lymphomas (non-Hodgkin lymphoma or Hodgkin disease). The main difference between these types of cancers is that ALL starts in the bone marrow and may spread to other places, while lymphomas start in lymph nodes or other organs and then may spread to the bone marrow. Sometimes cancerous lymphocytes are found in both the bone marrow and lymph nodes when the cancer is first diagnosed, which can make it hard to tell if the cancer is leukemia or lymphoma. If more than 25% of the bone marrow is replaced by cancerous lymphocytes, the disease is usually considered leukemia. The size of lymph nodes is also important. The bigger they are, the more likely the disease is a lymphoma. For more information on lymphomas, see our documents, Non-Hodgkin Lymphoma and Hodgkin Disease.
There are actually many types of leukemia. They differ based on what types of cells they start in, how quickly they grow, which people they affect, and how they are treated. To understand leukemia, it helps to know about the blood and lymph systems.
Normal bone marrow, blood, and lymphoid tissue
Bone marrow is the soft inner part of some bones, such as the skull, shoulder blades, ribs, pelvis, and bones in the spine. The bone marrow is made up of a small number of blood stem cells, more mature blood-forming cells, fat cells, and supporting tissues that help cells grow.
Blood stem cells go through a series of changes to make new blood cells. During this process, the cells develop into 1 of the 3 main types of blood cell components:
- Red blood cells
- White blood cells (which include lymphocytes, granulocytes, and monocytes)
Red blood cells
Red blood cells carry oxygen from the lungs to all other tissues in the body, and take carbon dioxide back to the lungs to be removed.
Platelets are actually cell fragments made by a type of bone marrow cell called a megakaryocyte. Platelets are important in plugging up holes in blood vessels caused by cuts or bruises.
White blood cells
White blood cells help the body fight infections.
These are the main cells that make up lymphoid tissue, a major part of the immune system. Lymphoid tissue is found in lymph nodes, the thymus, the spleen, the tonsils and adenoids, and is scattered throughout the digestive and respiratory systems and the bone marrow.
Lymphocytes develop from cells called lymphoblasts to become mature, infection-fighting cells. The 2 main types of lymphocytes are B lymphocytes (B cells) and T lymphocytes (T cells).
- B lymphocytes: B lymphocytes protect the body from invading germs by maturing into plasma cells, which make proteins called antibodies. The antibodies attach to the germs (bacteria, viruses, and fungi), which helps the immune system destroy them.
- T lymphocytes: There are several types of T cells, each with a special job. Some T cells can destroy germs directly, while others play a role in either boosting or slowing the activity of other immune system cells.
Acute lymphocytic leukemia develops from early forms of lymphocytes. It can start in either early B cells or T cells at different stages of maturity. This is discussed in the section, "How is acute lymphocytic leukemia classified?"
These are white blood cells that have granules in them, which are spots that can be seen under the microscope. These granules contain enzymes and other substances that can destroy germs, such as bacteria. The 3 types of granulocytes – neutrophils, basophils, and eosinophils – are distinguished by the size and color of their granules.
These white blood cells, which are related to granulocytes, also help protect the body against bacteria. After circulating in the bloodstream for about a day, monocytes enter body tissues to become macrophages, which can destroy some germs by surrounding and digesting them.
Development of leukemia
Any of the cells from the bone marrow can turn into a leukemia cell. Once this change takes place, the leukemia cells fail to go through their normal maturing process. Leukemia cells may reproduce quickly, and may not die when they should. They survive and build up in the bone marrow. Over time, these cells spill into the bloodstream and spread to other organs, where they can keep other cells in the body from functioning normally.
Types of leukemia
Not all leukemias are the same. Leukemias are divided into 4 main types. Knowing the specific type of leukemia helps doctors better predict each patient's prognosis (outlook) and select the best treatment.
Acute leukemia versus chronic leukemia
The first factor in classifying a patient's leukemia is whether most of the abnormal cells are mature (look like normal white blood cells) or immature (look more like stem cells).
Acute leukemia: In acute leukemia, the bone marrow cells cannot mature properly. Immature leukemia cells continue to reproduce and build up. Without treatment, most patients with acute leukemia would live only a few months. Some types of acute leukemia respond well to treatment, and many patients can be cured. Other types of acute leukemia have a less favorable outlook.
Chronic leukemia: In chronic leukemia, the cells can mature partly but not completely. These cells may look fairly normal, but they generally do not fight infection as well as normal white blood cells do. And they survive longer, build up, and crowd out normal cells. Chronic leukemias tend to progress over a longer period of time, and most patients can live for many years. But chronic leukemias are generally harder to cure than acute leukemias.
Myeloid leukemia versus lymphocytic leukemia
The second factor in classifying leukemia is the type of bone marrow cells that are affected.
Myeloid leukemia: Leukemias that start in early forms of myeloid cells – white blood cells (other than lymphocytes), red blood cells, or platelet-making cells (megakaryocytes) – are myeloid leukemias (also known as myelocytic, myelogenous, or non-lymphocytic leukemias).
Lymphocytic leukemia: If the leukemia starts in early forms of lymphocytes, it is called lymphocytic leukemia (also known as lymphoid or lymphoblastic leukemia).
Leukemias can be divided into 4 main types based on whether they are acute or chronic, and whether they are myeloid or lymphocytic. The 4 main types are:
- Acute myeloid (or myelogenous) leukemia (AML)
- Chronic myeloid (or myelogenous) leukemia (CML)
- Acute lymphocytic (or lymphoblastic) leukemia (ALL)
- Chronic lymphocytic leukemia (CLL)
ALL is the most common of the 4 major types of leukemia among children, but it is actually the least common type among adults.
The rest of this document focuses on acute lymphocytic leukemia (ALL) in adults. For information on ALL in children, please see our document, Childhood Leukemia. Chronic leukemias and acute myeloid leukemia of adults are discussed in other American Cancer Society documents.
Last Medical Review: 01/23/2012
Last Revised: 01/18/2013
- What Is Leukemia - Acute Lymphocytic (ALL) in Adults?
- Causes, Risk Factors, and Prevention
- Early Detection, Diagnosis, and Staging
- Treating Leukemia - Acute Lymphocytic (ALL) in Adults
- Talking With Your Doctor
- After Treatment
- What`s New in Leukemia - Acute Lymphocytic (ALL) in Adults Research?
- Other Resources and References