Acute lymphoblastic leukaemia (ALL): symptoms, tests and treatment

Cancer Research UK explains that the bone marrow makes all blood cells, and in ALL abnormal lymphocyte-type cells build up in the marrow and stop healthy blood cells developing. They also spill into the blood and can spread to the lymph nodes, liver, spleen, brain and spinal cord, and rarely the testicles. The word acute means the leukaemia can develop quickly, unlike chronic leukaemias, which usually develop slowly.

There are several types and subgroups. In adults, B cell ALL is the most common type, at around 75% of cases, and T cell ALL accounts for around 25% and is more likely to affect young adults and men, according to Cancer Research UK. Knowing the type helps doctors choose treatment. Some cases are Philadelphia positive, meaning a particular chromosome change in the leukaemia cells.

The NHS says symptoms are not always obvious at first and can be similar to other conditions. The main ones are:

• feeling tired or weak

• bleeding or bruising easily or for no reason

• looking paler than usual

• getting ill a lot or taking longer to recover from illnesses

• a high temperature

• swollen glands, usually in the neck, armpits and groin

• pain in the bones or joints

• loss of appetite or losing weight without trying

• shortness of breath

• a swollen tummy that may feel painful, uncomfortable or full

Less common symptoms listed by the NHS include a headache, being sick, blurred vision, fits, a cough, a swollen and red face, neck, arms or hands, and swollen veins in the neck or chest. The NHS says to call 999 or go to A&E if a swollen, red face, neck, arms or hands, or swollen veins in the neck or chest, come on suddenly. Ask for an urgent GP appointment or call NHS 111 if a child is bleeding or bruising easily or for no reason.

These symptoms are very common and usually caused by other things, but the NHS says it is important to get them checked because finding cancer early may mean it is easier to treat. At the GP the doctor may examine swollen areas, listen to the chest and arrange an urgent blood test, and may refer you for more tests or to hospital.

It is not always clear what causes ALL. The NHS lists factors that raise the chance: being a child or young adult, a genetic condition such as Down's syndrome, certain types of chemotherapy in the past, a lot of radiation exposure or past radiotherapy especially in childhood, high exposure to benzene, and a weakened immune system such as with HIV.

The NHS says tests may include blood tests and a small sample taken from the bone marrow with a needle (biopsy). You may not have both. A bone marrow biopsy is usually done under local anaesthetic, with medicine to help you relax (sedation); young children may have a general anaesthetic. It can take a few weeks to get results. Specialists then usually do further tests, such as a lumbar puncture to sample spinal fluid, scans (X-ray, CT, MRI or ultrasound), more blood tests and sometimes a saliva sample, to plan treatment. A clinical nurse specialist is usually the main contact during and after treatment.

The NHS says ALL is often treatable and treatment usually needs to start quickly. What you have depends on the type of ALL, your age and your general health. It will usually include steroids, usually taken for up to a week before chemotherapy to start getting rid of leukaemia cells, and chemotherapy, the main treatment, usually a combination of medicines. Targeted medicines or immunotherapy may be used for certain types, if the cancer has come back or other treatment is not working. A stem cell or bone marrow transplant may be considered if the cancer has come back or is likely to.

Supportive treatments are offered alongside: antibiotics to prevent or treat infections, blood transfusions, growth factor medicines to help the marrow make blood cells, and vaccines such as flu and COVID-19. You will have regular check-ups during and after treatment, and the NHS says not to wait for the next check-up if you are worried about symptoms or side effects.

Sometimes ALL is very hard to treat and cannot be cured. The NHS says the aim is then to limit the cancer and its symptoms and help you live longer, with a palliative care or symptom control team supporting you and your family.