Rocky Mountain Cancer Centers

Possible signs of adult ALL include fever, feeling tired, shortness of breath during physical activity and easy bruising or bleeding. Most patients feel a loss of well-being, may tire easily or have a pale complexion from anemia. Discomfort in the bones and joints may be present. A doctor should be consulted if any of the following problems occur: fever, shortness of breath, easy bruising or bleeding, petechiae (flat, pinpoint spots under the skin caused by bleeding), weakness or feeling tired, loss of appetite or weight loss.

Doctors use tests that examine the blood and bone marrow to detect and diagnose adult ALL, including:

• physical examination and history
• complete blood count
• number of red blood cells, white blood cells, and platelets
• Immunophenotyping (identifying cells based on the types of antigens or markers on the surface of the cell to diagnose the subtype of ALL):
  • cytogenetic examination of tissue to analyze the number and shape of the chromosomes of cells
  • peripheral blood smear (checking for the presence of blast cells, number and kinds of white blood cells, number of platelets and changes in the shape of blood cells)
  • bone marrow aspiration and biopsy (looking for abnormal cells)

Once ALL has been diagnosed, tests may be conducted to see if the cancer has spread to other parts of the body. The spread of most cancers is usually described as stages. This is not true for acute leukemia. A doctor may use chest x-rays, lumbar puncture (spinal tap), ultrasound or a CT (CAT) scan to determine if the cancer has spread.

There is no standard staging system for adult ALL; instead the disease is described as untreated, in remission or recurrent. The subtype of the disease is important. Different therapies may be used, and the likely course of the disease and the prognosis may be different.

In untreated adult ALL, the disease is newly diagnosed and has not yet been treated. In adult ALL in remission, the complete blood count is normal, less than five percent of the cells in the bone marrow are blasts, and there are no signs or symptoms of leukemia in the brain, spinal cord, or elsewhere in the body. In recurrent adult ALL, the cancer has come back after it has been treated. ALL may recur in the blood, bone marrow or, rarely, other parts of the body (like spinal fluid).

The prognosis (chance of recovery) and treatment options depend on the age of the patient, subtype of ALL, a test to look for certain DNA changes in the ALL cells (the “karyotype” or “chromosome” test) used to determine whether the patient received chemotherapy in the past to treat a different cancer, history of a blood disorder, whether the cancer has spread to the central nervous system and whether the cancer has been treated before.

ALL can develop from lymphocytes that are in different stages of development. The principle subtypes of ALL are determined by special tests called immunophenotyping. The subclassification of cell types is important because it helps to determine the best treatment for each type of leukemia. The principle subtypes are B lymphocyte and T lymphocyte. B lymphocytic subtypes are identified by finding cell surface markers on the leukemic blasts that are identical to those on normal B lymphocytes. About 85 percent of ALL cases are the precursor B or B cell subtype. T lymphocytic subtypes are identified by finding cell surface markers on the leukemic blasts that are identical to those on normal T lymphocytes. About 15 percent of ALL cases are of the T cell subtype.

Physicians may also use chromosome abnormalities to assist in subclassifying ALL. For example, a change in chromosome number 22 occurs in a small percentage of children and a larger percentage of adults with placing the patient in a higher-risk category ALL. Examples of higher-risk types of ALL may be t4:11 or t9:22 (Philadelphia Chromosome).