ON THIS PAGE: You will learn about the factors that doctors use to describe this type of cancer. This is called classification. Use the menu on the side of your screen.
There is no staging system for childhood acute lymphoblastic leukemia (ALL), unlike some other types of cancer. However, there are a number of factors that help doctors choose the best treatment plan and predict the chance that the disease will come back after treatment. Doctors plan each child’s treatment based on these and other factors:
Age. Infants younger than 12 months and children age 10 and older need more intensive treatments.
White blood cell counts. Children with very high white blood cell counts need more intensive treatments. Commonly, white blood cell counts are labeled as very high if they are more than 50,000 per microliter (ml).
Immunophenotyping. This test shows the types and amounts of proteins made or expressed by the leukemia cells. Knowing if the cancer cells express the proteins more like those of normal white blood cells called B-cells or T-cells will help doctors plan appropriate treatment. It is also useful to help predict how well treatment will work.
Genetic abnormalities in the leukemia cells. Abnormal numbers of chromosomes, abnormal structural changes in a chromosome, or certain molecular genetic changes in the chromosomes of leukemia cells may affect outcome and treatment. Note that the genetic changes referred to here are changes in the genes of the leukemia cells, not the child’s cells – most children with leukemia have completely normal genes.
Response to early treatment. How well treatment works in the first 1 to 4 weeks of treatment may predict the leukemia’s overall response to treatment. This will be determined by examining the child’s blood or bone marrow regularly. Recent studies have shown that some children may need more intense treatment to improve the chance of a cure. This includes children whose cancer is not responding well to early treatment or those who have high levels of residual leukemia cells (cells remaining after treatment) at the end of remission induction (see Types of Treatment).
Doctors also use the following terms to describe the state of ALL for each child:
Untreated ALL. The child has not yet received any treatment.
ALL in remission. There are normal levels of white cells and other blood cells after treatment. Physical examinations, blood counts, and bone marrow aspirations show no detectable leukemia. Remission is the absence of signs or symptoms of leukemia. However, it is very important to continue treatment, even when a child is in remission, to keep the leukemia from coming back.
Recurrent ALL. Recurrent ALL is leukemia that comes back after the child has had some period of remission. The leukemia may recur in the bone marrow, spinal fluid, testicles, or less commonly, in other areas of the body.
Refractory ALL. The leukemia did not go into remission, despite remission induction treatment (see more details in the next section on Types of Treatment.)
Information about the cancer’s classification will help the doctor recommend a specific treatment plan. The next section in this guide is Types of Treatment. You may use the menu to choose a different section to read in this guide.