Often patients initially present to the doctor with non-specific symptoms such as tiredness, bruising, recurrent fevers or swelling over the neck, groin or armpit. On other occasions, patients may be referred for investigations after having an abnormal blood test.

Blood Tests
Your doctor will most likely order a blood test called a Full blood Count (FBC), which will raise the suspicion of leukaemia. The FBC may show a high white blood cell count, a low haemoglobin level and low platelet count. An urgent referral to a Haematologist for further evaluation and treatment is required.

Bone Marrow Test
A bone marrow test is an important investigation to establish the diagnosis of acute leukaemia. Bone marrow is the soft tissue inside your bone which is responsible for making your blood cells.  The bone marrow test involves inserting a small needle into your hip bone and withdrawing a sample of bone marrow.  This is normally done under local anaesthetic. The sample is sent to the laboratory for various tests which help to determine the diagnosis and help the doctor develop the most suitable treatment regime.

Radiology Tests
X-rays, ultrasound or CT scans may be done to determine if other areas of the body are affected.

Lumbar Puncture
As ALL may affect the nervous system, a lumbar puncture may be performed to determine if there are any leukaemia cells in the nervous system.  This is done by passing a fine needle into the spine to withdraw a small amount of the cerebral spinal fluid (CSF) which surrounds the spine and brain.

Results from a routine blood test can indicate to your doctors that you may have Acute Lymphoblastic Leukaemia if you have a raised (or sometimes lowered white cell count) or other abnormal blood tests. In the early stages of ALL, the standard full blood counts may be normal.

If your doctor suspects that you may have ALL, they will likely refer you to a haematologist for further testing and to confirm the diagnosis.

Acute Lymphoblastic Leukaemia is a relatively rare condition amongst adults. However, it is the most common form of cancer in children and teenagers.

Acute Lymphoblastic Leukaemia is not typically hereditary. This means you do not have an increased risk of developing the condition if your family member is diagnosed with it.

However, your risk may increase if you have an identical twin diagnosed with ALL.

Acute Lymphoblastic Leukaemia is an aggressive form of leukaemia. The overproduction of the abnormal white blood cells responsible for Acute Lymphoblastic Leukaemia can occur over several days or weeks.

Patients with ALL usually need to commence some form of treatment soon after initial diagnosis so as to stabilise the disease and prevent the development of adverse effects. Once the diagnosis is firmly established, it is recommended that patients commence proper ALL treatment as soon as possible.

Acute Lymphoblastic Leukaemia typically develops relatively quickly. The overproduction of the abnormal white blood cells responsible for Acute Lymphoblastic Leukaemia can occur over several weeks to months.

ALL is an aggressive form of blood cancer that can progress rapidly without treatment. If left untreated, it is often rapidly fatal over a few months. This is due to the overproduction of abnormal blood cells, which suppress the production of healthy red blood cells, white blood cells, and platelets.

The survival rate for Acute Lymphoblastic Leukaemia is higher in children. However, more recent advances in treatment have extended adult survival rates. The current 5-year survival rate for patients over the age of 20 is 40%. On the other hand, the 5-year survival rate for patients under the age of 20 is 80-90%

While 80-90% of children and young adults will respond to initial ALL treatment, it is estimated that approximately 10-15% will experience disease relapse. For adults, the risk of disease relapse is even higher at 40-50%.

The signs and symptoms of an Acute Lymphoblastic Leukaemia relapse are the same as those experienced when you are first diagnosed. These signs may include swollen lymph nodes, bone and joint pain, anaemia, and difficulty breathing.

Patients with ALL usually need to commence some form of treatment soon after initial diagnosis so as to stabilise the disease and prevent the development of adverse effects. Once the diagnosis is firmly established, it is recommended that patients commence proper ALL treatment as soon as possible.

Modern-day treatments mean that 80-90% of children are alive and well at 5 years with current protocols. The 5-year overall survival is approximately 65% for adolescents, 40% for adults, and 15-20% for older patients.

Targeted therapy is able to attack specific abnormalities which are known to be found on the cancer cells.

CAR T-cell therapy is a form of immunotherapy that involves collecting a patient’s immune cells and modifying them in a laboratory to target specific cancer cells. These modified cells are then returned to the patient to strengthen their immune system against the cancer cells. It may be used in the treatment of Acute Lymphoblastic Leukaemia when two prior treatment options have proven unsuccessful

Patients who do not attain remission after induction or consolidation therapy are usually considered for an allogeneic haematopoietic stem cell transplantation. In addition, patients with poor prognostic markers on cytogenetics and molecular analysis are also considered for upfront transplantation.

In recent years with the advancement of cellular therapy and targeted immunotherapy, patients are being considered for treatment with these newer therapies before haematopoietic stem cell transplantation.

ALL can affect the Central Nervous System. If it does, CNS treatment will be needed by injecting drugs into the cerebrospinal fluid by lumbar puncture. This is called intrathecal (IT) chemotherapy.

The primary form of treatment for paediatric Acute Lymphoblastic Leukaemia is a combination of chemotherapy and targeted novel immunotherapy. Chemotherapy is typically administered over three stages – induction, consolidation, and maintenance.

There are several non-chemotherapy based options which are now available for patients with ALL. Targeted drugs like immunochemotherapy have been shown to be effective with less toxicity in older patients. In addition, with improvements in conditioning regimens and supportive care, selected older patients can still benefit from allogeneic haematopoietic stem cell transplantation.

Treatment for Acute Lymphoblastic Leukaemia typically lasts between two to three years. The first 3-6 months of treatment are often the most intense – known as the induction and consolidation phases of treatment which are given with the aim to clear the bone marrow of ALL.

Thereafter, patients are often on the maintenance phases of ALL for several years, intending to continue lower doses of therapy to prevent the relapse of the disease. During maintenance therapy, children and adults often are able to return to school and work.

While the majority of newly diagnosed ALL patients will receive a combination of chemotherapy with targeted therapy, there are now several newer treatment options available for patients with ALL who relapse after initial treatment. These include potent new targeted therapies, including a class of drugs known as bispecific antibodies. CAR-T cell therapy is also a new and exciting form of cellular therapy for patients with ALL.