What is the survival rate for Acute Lymphoblastic Leukaemia?

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%

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What causes Acute Lymphoblastic Leukaemia?

The leading cause of Acute Lymphoblastic Leukaemia is DNA mutation within the bone marrow stem cells. This mutation causes excess white blood cells to be produced and released before they mature and are ready to fight infections. The primary function of mature white blood cells is to fight infections within the body.

It remains unclear as to what triggers the mutations in the stem cells in ALL. However, there are some risk factors, including:

• Smoking
• Previous chemotherapy
• Weakened immune systems – such as patients with conditions such as HIV or patients on immunosuppressive therapy
• Genetic disorders – a small number of childhood ALL cases are believed to be related to genetic disorders such as Down’s syndrome.

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Does Acute Lymphoblastic Leukaemia have stages?

Unlike some other forms of cancer, Acute Lymphoblastic Leukaemia (ALL) has no standard staging system.

Instead, patients with Acute Lymphoblastic Leukaemia are usually classified by risk category. This is determined by factors including the age of the patient, white cell count at presentation, subtype of ALL, response to initial therapy, and any cytogenetic or molecular abnormalities on bone marrow assessment.

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How is Acute Lymphoblastic Leukaemia diagnosed?

Acute Lymphoblastic Leukaemia is usually diagnosed from a blood test and bone marrow assessment.

Specific tests, including flow cytometry, karyotyping, cytogenetics-FISH and molecular mutation analysis, will be performed to confirm the diagnosis of ALL, classify the subtype of ALL, and the prognostic risk group.

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Who normally gets Acute Lymphoblastic Leukaemia?

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

Amongst ALL cases in children, 85% occur in individuals under the age of 15.

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How long is the treatment for Acute Lymphoblastic Leukaemia?

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.

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What is high-risk Acute Lymphoblastic Leukaemia?

High-risk ALL is defined by features including the patient’s age (adults generally are more likely to have higher risk disease), subtype of ALL, and adverse cytogenetic or molecular features.

Patients with high-risk ALL are less likely to respond to standard therapy and have an increased risk of disease relapse even after successful initial treatment.

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How is Acute Lymphoblastic Leukaemia treated in the elderly?

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.

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Does Acute Lymphoblastic Leukaemia run in families?

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..

Is Acute Lymphoblastic Leukaemia rare?

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

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What happens if Acute Lymphoblastic Leukaemia is left untreated?

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.

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How quickly does Acute Lymphoblastic Leukaemia progress?

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..

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Does Acute Lymphoblastic Leukaemia show up in routine blood work?

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.

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What tests are done to diagnose Acute Lymphoblastic Leukaemia?

Acute Lymphoblastic Leukaemia is usually diagnosed through a blood test and bone marrow assessment.

Specific tests, including flow cytometry, karyotyping, cytogenetics-FISH and molecular mutation analysis, will be performed to confirm the diagnosis of ALL, and classify the subtype of ALL and the prognostic risk group.

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What is the difference between AML and ALL?

The primary difference between acute myeloid leukaemia and Acute Lymphoblastic Leukaemia is the type of white blood cell in which it originates. AML affects myeloid cells, while ALL affects lymphocytes.

AML occurs more in adults than children, whereas ALL is the most common cancer in children and young adults.

ALL is highly curable in children and young adults, whereas AML has a poorer response rate in this age group.

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How much does it cost to treat Acute Lymphoblastic Leukaemia in Singapore?

The cost of ALL varies depending on the age and risk group of the patient. Some patients may only require chemotherapy and targeted therapy, whereas other patients may benefit from an allogeneic haematopoietic stem cell transplantation. For patients with aggressive ALL, there are novel targeted therapies as well as cellular therapy such as CAR-T cell therapy.

Our haematologists at CFCH will carefully assess your medical condition and work with you to determine the appropriate treatment options.

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Is Acute Lymphoblastic Leukaemia aggressive?

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.

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Is lymphoblastic lymphoma the same as lymphoblastic leukaemia?

Both lymphoblastic lymphoma and Acute Lymphoblastic Leukaemia are aggressive forms of blood cancer arising from abnormal lymphocytes.

Lymphoblastic lymphoma generally involves lymph nodes and presents with swollen lymph glands or organ involvement.

Treatment for both forms of cancer often involves similar or overlapping regimens (with chemotherapy and targeted therapeutic agents) as the source of the initial abnormal cells are often alike.

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How soon do you start chemotherapy after your Acute Lymphoblastic Leukaemia diagnosis?

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.

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How is paediatric Acute Lymphoblastic Leukaemia treated?

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.

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What is pre-B ALL leukaemia?

Pre-B ALL is a form of leukaemia where too many B-cell lymphoblasts (immature white blood cells) are found in the blood and bone marrow. This is the most common form of ALL, accounting for approximately 75% of all ALL cases.

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How would you rule out ALL if AML is suspected?

Patients with acute leukaemia will usually undergo a bone marrow assessment. The specific tests performed during this assessment, including flow cytometry, cytogenetics, and molecular analysis, will usually be able to distinguish ALL from AML.

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How successful is chemotherapy for Acute Lymphoblastic Leukaemia?

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.

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What are the signs of an ALL relapse?

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.

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What are the chances of ALL returning?

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%.

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When does an ALL patient need a bone marrow transplantation?

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.

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When do we use CAR-T cell therapy in ALL?

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.

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How do we stage ALL?

Unlike some other forms of cancer, Acute Lymphoblastic Leukaemia (ALL) has no standard staging system.

Instead, patients with Acute Lymphoblastic Leukaemia are usually classified by risk category. This is determined by factors including the age of the patient, white cell count at presentation, subtype of ALL, response to initial therapy, and any cytogenetic or molecular abnormalities on bone marrow assessment.

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What are the chances of a cure for ALL?

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.

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What new treatments are available for patients with ALL?

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.

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Disclaimer:
The information on the Centre For Clinical Haematology website is intended for educational use.  It should not be considered or used as a substitute for medical advice, diagnosis or treatment from a qualified health professional.
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