Acute lymphoblastic leukemia (ALL)

Acute lymphoblastic leukemia (ALL) is a cancer of the lymphoid line of blood cells characterized by the development of large numbers of immature lymphocytes. ALL progresses rapidly and is typically fatal within weeks or months if left untreated. ALL is typically treated initially with chemotherapy aimed at bringing about remission but can be further treated with chemotherapy over a longer period of time. Treatment usually also includes intrathecal chemotherapy since systemic chemotherapy can have limited penetration into the central nervous system and the central nervous system is a common site for relapse of acute lymphoblastic leukemia.

Treatment can also include either radiation therapy or stem cell transplantation if spread to the brain has occurred. Stem cell transplantation may be used if the disease recurs following standard treatment. ALL affected about 876,000 people globally in 2015 and resulted in about 111,000 deaths. It occurs most commonly in children, particularly those between the ages of two and five. In the United States it is the most common cause of cancer and death from cancer among children. Survival for children increased from under 10% in the 1960s to 90% in 2015.

Prior to the development of chemotherapy regimens and hematopoietic stem cell transplant, children
were surviving a median length of 3 months, largely due to either infection or bleeding. Since the
advent of chemotherapy, the prognosis for childhood leukemia has improved greatly and children
with ALL in developed countries have a greater than 80% five-year survival rate. It is estimated that
60–80% of adults undergoing induction chemotherapy achieve complete remission after 4 weeks,
and those over the age of 70 have a cure rate of 5%.

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