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Pediatric Acute Lymphoblastic Leukemia (ALL)

Acute Lymphoblastic Leukemia in Children

Leukemia is the most common type of cancer found in children, and it’s a type of blood cancer. If a child has leukemia, their bone marrow makes a large amount of blood cells that don’t function in the same way that healthy blood cells do, and over time they become cancerous.

There are a couple of different forms of childhood leukemia, with the most common one being acute lymphoblastic leukemia or ALL for short. The word “acute” means that the disease spreads rapidly, while “lymphocytic” means it develops from a type of white blood cell by the name of lymphocytes.

ALL can be divided into two different groups, based on what type of lymphocyte the leukemia first appeared in. It can be B-cell ALL, which is more common, and T-cell ALL, which is less common.

Pediatric Acute Lymphoblastic Leukemia (ALL)

Causes and Risk Factors

A risk factor is something that increases a child’s chances of developing acute lymphoblastic leukemia. It’s important to note that a risk factor doesn’t necessarily mean someone will develop a disease, however, it can increase the chances. These are the currently known causes and risk factors for ALL:
  • Genetic syndromes: There are some genetic syndromes that increase the risk of developing ALL. These include Down syndrome, bloom syndrome, neurofibromatosis, and Fanconi anemia just to name a few.
  • High levels of radiation exposure: Longer exposures to radiation, like for example via radiotherapy or medical imaging tests, can increase a child’s chances of getting ALL.
  • Gender: Even though ALL can develop in both males and females, it’s more common among boys than girls, however, medical professionals don’t know the reason for this yet.
  • Having ALL in the family: If a child develops ALL, their sibling, especially an identical twin, has a high chance of developing the disease as well.
  • Race: Statistically, ALL develops in Caucasian children more than children of any other race; however, there is no known reason for this occurrence.
There are certain risk factors that are believed to increase the chances of developing ALL, however, they haven’t been confirmed to be risk factors as of yet. These include exposure to secondhand smoke, hair dyes, electromagnetic fields as well as chemicals such as gasoline, diesel and pesticides.

Signs and Symptoms

When a child develops ALL, it may seem like a regular cold in the beginning because the first symptom is often a high fever. However, it’s later followed by other symptoms.

A child who has acute lymphoblastic leukemia can have some or all of the following symptoms:

  • Heavy breathing or shortness of breath
  • A feeling of constant tiredness and weakness
  • Swollen lymph nodes that appear under the arms, in the neck, or in the groin
  • Getting bruises or bleeding easily
  • Frequent infections that appear seemingly out of nowhere
  • Constant and persistent headaches
  • Dark red spots that appear under the skin
  • Bone pain, especially below the ribs
  • An unexplained loss of appetite

These symptoms could indicate the presence of ALL, but not necessarily. If you notice your child displaying these symptoms, take them to the doctor because, without a proper diagnosis, you won’t be able to know for sure.


Once you take your child to the doctors and explain their symptoms, they will do a series of tests to see if they have this or any other disease.

The first test the doctor will do is a blood test. This could include:

  • A complete blood count with differentials: A CBC with differentials measures the number of red blood cells, white blood cells, and platelets inside the patient’s body. If your child has ALL, their white blood cell levels will be high, and the red blood cell and platelet levels will be low.
  • A peripheral blood smear: This blood test is used for the same purposes as a CBC test, however, instead of using a machine, a medical professional will examine the blood sample under a microscope.

If the blood test shows any irregularities, further tests will be ordered. The next stage in testing is a bone marrow test. Since ALL first appears in the bone marrow, if a doctor suspects the presence of acute lymphoblastic leukemia, they will perform a bone marrow aspiration and biopsy.

During this procedure, a hollow needle is inserted into the patient’s bone and a small piece of bone marrow is removed. After the extraction is complete, a pathologist will examine the marrow under a microscope and look for signs of leukemia.

After the blood test and bone marrow aspiration and biopsy are completed, the medical professional in charge of the case will be able to determine if ALL is present. However, the next step is to determine the type of ALL.

This is done by performing the following tests:

  • Lab tests such as cytochemistry, flow cytometry, and immunohistochemistry
  • Chromosome tests such as Cytogenetics, Fluorescent in situ hybridization (FISH), and Polymerase chain reaction (PCR)
  • Lumbar puncture, also known as a spinal tap
  • Lymph node biopsy
  • Imaging tests, such as an X-ray, MRI scan, and CT scan

Getting an ALL diagnosis is always a hard and challenging time, but as long as you get your child treatment in time and put your faith in the right medical institution, they can be cured.

Factors That Affect Prognosis and Treatment

When a child gets diagnosed with ALL, their doctor will be able to determine what their prognosis is and what treatment would be optimal for their condition. These factors include:
  • The age when the diagnosis was made: Children diagnosed with ALL between the ages of 1 and 9 usually have a better prognosis and higher cure rates than those who get diagnosed at 10 years old or older.
  • Gender: Just like girls are less likely to get ALL, they’re also more likely to be cured than boys.
  • The subtype of ALL: If a child gets diagnosed with the B-cell ALL subtype, their prognosis is much better if it’s early B-cell leukemia instead of mature B-cell leukemia.
  • The number of chromosomes: ALL can change the number of chromosomes in the patient’s body. While a healthy individual has 46 chromosomes, those who get diagnosed with ALL often have more or fewer. The prognosis is better if the patient’s leukemia cells have more than 50 chromosomes, but worse if they have fewer than 44.
  • Response to initial treatment: When a child gets diagnosed with ALL, they will go into remission, which is the first treatment step for ALL and other cancers. If there is a major reduction of leukemia cells in the first few weeks of remission, the prognosis will be better.
It’s important to understand that a good prognosis just means the patient will receive less aggressive treatment. ALL with a bad prognosis can still be cured, just with some more aggressive methods.

ALL in Children Risk Groups

Whenever a child gets diagnosed with acute lymphoblastic leukemia, they will be put into a risk group. These risk groups determine the patient’s prognosis and what kind of treatment they will receive.

The ALL risk groups include low-risk, standard-risk, high-risk and very high-risk. The factors that determine the patient’s risk group are nearly the same as the ones that affect prognosis and treatment, and the better the prognosis, the lower the risk rate.

Those with low-risk ALL have very minor symptoms and can often be cured with the simplest methods.

The difference between standard-risk and high-risk patients comes down to factors such as age, white blood cell count, and number of chromosomes.

As for very high-risk patients, the one thing that distinguishes them from high-risk patients is chromosome changes. There are certain changes that can happen to chromosomes inside leukemia cells which makes it harder to treat and requires special and more intense medication.

Children with ALL can be treated, regardless of their risk group, the treatment method will just differ for those with low-risk and those with high-risk acute lymphoblastic leukemia.



There are four different treatment options for acute lymphoblastic leukemia, and they include chemotherapy, radiotherapy, targeted therapy and a bone marrow transplant. The treatment option chosen as well as for how long it will be administered will depend on the patient’s prognosis and risk factors.

Chemotherapy is the most commonly used treatment option for most types of cancers, including ALL. Chemotherapy involves the use of special drugs and is given in three phases over the course of multiple months. These phases include induction, consolidation and maintenance.

The duration of chemotherapy and the specific drugs that are used is decided based on the patient’s risk level. For some patients, this treatment option is enough to cure their leukemia, while others will require further or alternative treatment options.

These include:

  • Radiation therapy: Radiation therapy uses a type of radiation, such as X-rays, to either destroy cancer cells or stop them from growing. This method is often used for patients whose ALL has spread to the brain and spinal cord.
  • Targeted therapy: This treatment uses drugs to identify specific cancer cells, target them and destroy them without causing harm to the healthy cells around them. This is a gentler and less harmful procedure than chemotherapy and radiotherapy.
  • Bone marrow transplant: This treatment option involves a procedure during which a surgeon will destroy the bone marrow that is infected with leukemia. Afterward, they will replace it with healthy and specialized stem cells, which will help the patient grow more healthy blood-forming cells. This will, in turn, help them fight off their disease more easily.

Going through treatment for acute lymphoblastic leukemia is a long and harrowing process, not just for the patient, but for their entire family. Health isn’t something to take lightly, and if you find yourself in a situation where your child or someone you love suffers from ALL, Sheba Medical Center is your best option.

Request a Consultation

Sheba Medical Center provides innovative, personalized medical care to patients from around the world. We are the largest, most comprehensive hospital in the Middle East and dedicated to providing advanced and compassionate medicine for everyone. We welcome all cases, including the rarest and the most challenging. Our medical teams collaborate to provide the best possible health outcomes. From your initial inquiry through long-term follow-up care, we are here for you.

Request a consultation

Sheba Medical Center provides innovative, personalized medical care to patients from around the world. We are the largest, most comprehensive hospital in the Middle East and dedicated to providing advanced and compassionate medicine for everyone. We welcome all cases, including the rarest and the most challenging. Our medical teams collaborate to provide the best possible health outcomes. From your initial inquiry through the long-term follow-up care, we are here for you.

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