Acute Lymphoblastic Leukemia (ALL)

Published Date : Jan 2024
Category : Oncology
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Breaking Stereotypes: Advancement and Barriers in the Fight Against Acute Lymphoblastic Leukemia (ALL) with DiseaseLandscape Insights

Acute Lymphocytic Leukemia (ALL) is a poignant thread that knits people's lives across continents in the complex network of global health concerns. This hematologic malignancy, which is demonstrated by the fast growth of immature lymphocytes, puts the health of individuals who are directly impacted in danger as well as placing a significant strain on global healthcare systems. ALL, the most prevalent kind of leukemia in children, affects families, doctors, and researchers equally and necessitates a team effort to understand its complexity.

An estimated 6,540 new cases of ALL are estimated by the American Cancer Society (3,660 in men and 2,880 in females). In the United States, there will be about 1,390 ALL-related deaths in 2023 (700 in men and 690 in women) due to acute lymphocytic leukemia.

About 25% of cancer diagnoses in children under the age of 15 are for ALL, the most frequent type of cancer in children, according to the NIH. The annual incidence of ALL in the United States is roughly 40 cases per million individuals between the ages of 0 and 14 and 21 cases per million individuals between the ages of 15 and 19. In the United States, every year about 3,100 children and teenagers under the age of 20 receive an ALL diagnosis.

Acute lymphocytic leukemia is a type of acute leukemia. It is also known as acute lymphoblastic leukemia or ALL. "Acute" refers to the tendency for it to worsen rapidly in the absence of treatment. The most prevalent kind of cancer in youngsters is called ALL. Adults are affected as well.

A type of white blood cell called a lymphocyte is produced in excess by the bone marrow in ALL. Normally, these cells aid the body in warding off infections. However, they are aberrant in ALL and are not very good at fending off infection. Additionally, they push away good cells, which increases the risk of bleeding easily, infection, and anemia. The brain and spinal cord were among the other areas of the body where these aberrant cells metastasized.

There are 2 types of ALL: B-cell acute lymphoblastic leukemia (B cell ALL) and T-cell acute lymphoblastic leukemia (T cell ALL).

B-cells produce proteins known as antibodies that combat infection to combat bacteria and viruses, or invaders. They adhere to the surface of an invasive pathogen. Because of this, the infection becomes a target for destruction by other immune cells.

There are several subgroups of B cell ALL, including:

  • Precursor B cell ALL
  • Mature B cell ALL (also known as Burkitt type ALL)
  • Common ALL
  • Pro B cell ALL

B cell precursor in adults, ALL is the most prevalent subtype of ALL. Approximately 75% of individuals with ALL are of this type, or 75 out of every 100.

T-cells directly target bacteria, viruses, and cancer cells in addition to assisting B-cells in producing antibodies. This is more frequent in men and more likely to harm young adults. This kind affects about 25 out of every 100 people with ALL (about 25%).

Another kind is known as mixed phenotype ALL, or mixed lineage ALL. Individuals with this kind exhibit characteristics of acute myeloid leukemia as well as ALL.


A precise reason for ALL is usually unknown. Cells frequently experience mutations in their genes. Robust cells possess ingenious mechanisms that prevent them from posing a threat to the body. However, the longer we live, the greater the likelihood that experiences mutations that evade these defenses. Because of this, ALL is more prevalent in the elderly. Numerous chromosomal and gene alterations are connected to ALL. Philadelphia chromosome-positive ALL is the most prevalent subtype of ALL in adults. Approximately 25% of adults belong to this category. Another name for it is Ph-positive ALL, or Ph+ ALL. The Philadelphia chromosome is a gene altered in leukemic cells found in people with Ph+ ALL.

Sign & Symptoms

An excess of mutant white blood cells and a deficiency of regular white blood cells, red blood cells, and platelets are the causes of the symptoms.

A person with ALL experience one or more of the following symptoms:

  • feeling worn down or feeble
  • symptoms like the flu
  • a fever or high temperature
  • catching or failing to recover from illnesses like colds and coughs.
  • Easily bruised and bleeding
  • Loss of weight
  • enlargement of your lymph glands
  • ache in the joints or bones
  • Lack of breath
  • feeling content in your abdomen
  • seeming pallid or faded

Diagnostic Analysis

Diagnostic and DNA testing of chromosomes has grown in significance in recent years to give physicians the data they need to determine the best course of treatment for each patient. The patient requires several types of tests to identify and categorize the ALL.

Physical Examination and Medical History

The doctor first obtains a thorough medical history and discusses current and previous illnesses, ailments, infections, and bleeding. Doctors also require information on any current and past prescription and over-the-counter medications that are regularly taken.

The doctor performs a physical examination to assess overall health and look for any indications of ALL, such as enlarged lymph nodes.

Full Blood Count

Full Blood Count (FBC) or complete blood count (CBC) is the first step in the diagnosing process. To investigate, a blood sample from an arm vein was sent to the lab. The presence of aberrant leukemic blast cells, which make up a large portion of white blood cells, indicates ALL. Bone marrow cells must be examined to confirm an ALL diagnosis.

Bone Marrow Biopsy

To confirm the diagnosis, a bone marrow biopsy is necessary. During a bone marrow biopsy, a sample of bone marrow is typically taken from the back of the hip bone. It is then submitted to a laboratory to be examined under a microscope to ascertain the kind and quantity of cells present as well as the level of hemopoiesis (blood-forming) activity occurring there. The presence of an excessive amount of blast cells in the bone marrow confirms the ALL diagnosis.

Lumbar Puncture

A portion of the brain and spinal cord is occasionally affected by ALL. The brain and spinal cord are surrounded and shielded by cerebrospinal fluid, or CSF. A procedure to remove some CSF is required if the symptoms point to leukemic cells in the CSF. This method is identified as a spinal tap or lumbar puncture.

Molecular Genetic Test

Molecular genetic techniques, such next-generation sequencing (NGS) and polymerase chain reaction (PCR), examine the genetic sequence/code directly and assist hematopathologists in determining the form of MPN. The findings of these tests take a1-2 weeks. 

Other Tests

  • Cytogenetic Testing: For cytogenetic testing, bone marrow aspirates are used. It provides details about the genetic composition of your cells. They examine the chromosomal aberrations and the structure of the cell. FISH, also known as fluorescent in-situ hybridization, is a cytogenetic test that is performed on bone marrow or blood samples.
  • Flow Cytometry: Flow cytometry uses dyes that attach to proteins to search for proteins on a cell's surface. The surface of leukemia blasts frequently has unusual protein combinations. We refer to this aberrant combination of 22 Acute Lymphoblastic Leukemia as a leukemia related immunophenotype. Applying dye to hundreds of cells allows flow cytometry to identify even minute quantities of leukemia that remain after chemotherapy.
  • Imaging Tests: It is possible to ascertain whether cancer has progressed to the brain, spinal cord, or other regions of the body by performing imaging tests like an X-ray, CT scan, or ultrasound scan.

Diagnostic Market Players:

Diagnostic Market Players

Diagnostic Product

Abbott Laboratories

PixCell HemoScreen CBC Test Kit

Roche Diagnostics

D-DIMER Quanti Card

Siemens Healthineers

BD Trek™

Bio-Rad Laboratories


Sysmex Corporation

PROCURE® Bone Marrow Aspiration Biopsy Needle Kit

Beckman Coulte

RETRIEVE® Bone Marrow Aspirate (BMA) Kit

Thermo Fisher Scientific

Arrow® OnControl® Powered Bone Access System

Becton, Dickinson, and Company

Molecular Probes™ CellROX™


Optima™ CT


Discovery™ MI

Sight OLO

SIGNA™ Architect

J & J MedTech



Treatment Analysis

There are typically three primary stages to the treatment of ALL.

Induction phase: chemotherapy and other medications are administered to eradicate leukemia cells from your bone marrow and blood.

consolidation (or intensification): treatment is meant to eradicate any leukemia cells that still present in parts of the body like the brain or spinal cord.

Maintenance phase: to lower the chance of recurrent leukemia. Another name for this is maintenance therapy.

The genetic composition of the leukemic cells, age, general health, and the ALL subtype will all influence the type of treatment that is given.


The primary treatment for ALL is chemotherapy. There are numerous methods for administering chemotherapy to treat ALL. This includes taking them as tablets, intravenously (into a vein), and intramuscularly (into a muscle). Chemotherapy is administered intrathecally, or directly into the fluid surrounding the brain and spinal cord (CNS), to prevent and treat disease in these structures. Chemotherapy destroys cancer cells with anti-cancer (cytotoxic) medications.

Chemotherapy side effects vary throughout patients. Chemotherapy destroys rapidly proliferating cells, such as leukemia cells.

It also harms normal cells that proliferate quickly. These comprise the cells found in the mouth, stomach, and bone marrow in addition to hair cells.

Bone Marrow Transplant

Bone marrow transplant. Also referred to as a stem cell transplant, a bone marrow transplant is used as consolidation therapy or to treat relapses. By substituting leukemia-free bone marrow from a healthy individual for leukemia-ridden bone marrow, this treatment enables a leukemia patient to regain healthy bone marrow.

To eliminate any bone marrow that causes leukemia, severe doses of radiation or chemotherapy are administered prior to a bone marrow transplant. After that, bone marrow from a matching donor is used to replace the marrow which is called as allogeneic transplant.

Targeted Drug Therapy

Treatments with targeted drugs concentrate on defects found in cancer cells. Tyrosine kinase inhibitors (TKI), a type of targeted therapy medication, will be used in treatment if testing reveals Philadelphia positive ALL (Ph+ ALL). (TKI). The most often prescribed TKI medication for ALL is imatinib.

Immunotherapy medications work by identifying and eliminating leukemia cells through the body's immune system. In certain cases, B-cell ALL patients is treated with rituximab if testing reveals that the leukemia cells have the protein CD20 on their surface.

Treatment Market Players

Treatment Market Players

Treatment Product

Novartis AG


Pfizer Inc


Roche Holding AG


Bristol Myers Squibb


Amgen Inc.


Gilead Sciences, Inc.

Vincasar PES®

Takeda Pharmaceutical Company Limited


Merck & Co., Inc.


Seattle Genetics, Inc


BioMarin Pharmaceutical Inc.


Incyte Corporation





Recent Development

  • In December 2023, Bristol-Myers Squibb announced that it received manufacturing and marketing authorization of the supplementary New Drug Application for a further indication for Abecma (idecabtagene vicleucel), a B-cell maturation antigen (BCMA)-directed chimeric antigen receptor (CAR) T cell immunotherapy, for patients with relapsed or refractory multiple myeloma (RRMM) who have received at least two prior therapies, comprising an anti-CD38 antibody, a proteasome inhibitor, and an immune-modulating substance.
  • Selecta Biosciences, Inc. announced its merger with Cartesian Therapeutics, Inc. in November 2023. The combined company is anticipated to have over $110 million on hand to support the development of the Cartesian pipeline through the Phase 3 study of lead product candidate, Descartes-08, a possible first-in-class RNA-engineered recombinant antigen receptor T-cell therapy (rCAR-T) for the treatment of MG, as well as the advancement of further RNA cell therapy initiatives, with the cash from both companies at close and the proceeds of the concurrent private financing.

Clinical Trial Assessment

The DiseaseLandscape Insights consultancy firm provides valuable support in future market trends on the development of new pharmaceutical products. This support helps to streamline the planning and execution of clinical trials of novel medications and treatments, implement effective patient recruitment strategies, ensure regulatory compliance, and increase the likelihood of successful trial outcomes.

The below table gives information about some currently ongoing clinical trials, including their study titles and respective stages:

Phase 1

Phase 2

Phase 3

Phase 4

Donor-Derived CD5 CAR T Cells in Subjects With Relapsed or Refractory T-Cell Acute Lymphoblastic Leukemia

Pediatric-Inspired Chemotherapy Plus Tyrosine Kinase Inhibitor in Adult Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia

A French Protocol for the Treatment of Acute Lymphoblastic Leukemia (ALL) in Children and Adolescents

Feasibility Study to Evaluate Outpatient Blinatumomab in Subjects with Minimal Residual Disease (MRD) of B-precursor Acute Lymphoblastic Leukemia (ALL)

CalPeg for Newly Diagnosed Acute Lymphoblastic Leukemia (ALL)

Intrathecal Chemoprophylaxis to Prevent Neurotoxicity Associated with Blinatumomab Therapy for Acute Lymphoblastic Leukemia

Treatment Protocol for Children and Adolescents with Acute Lymphoblastic Leukemia - AIEOP-BFM ALL 2017

ALL SCTped FORUM - Pharmacogenomic Study (add-on Study)

CD19-Car T Cell Therapy for the Treatment of Older Adults with Acute Lymphoblastic Leukemia in First Remission

Inotuzumab Ozogamicin for Children with MRD Positive CD22+ Lymphoblastic Leukemia

Study Comparing Blinatumomab Alternating with Low-intensity Chemotherapy Versus Standard of Care Chemotherapy for Older Adults with Newly Diagnosed Philadelphia-negative B-cell Precursor Acute Lymphoblastic Leukemia

South China Children Cancer Group - Relapsed-Acute Lymphoblastic Leukemia 2022 Protocol

Donor-Derived CD5 CAR T (CT125B) Cells for Relapsed or Refractory T- Cell Acute Lymphoblastic Leukemia/Lymphoma

A Second Infusion (Early Reinfusion) of Tisagenlecleucel in Children and Young Adults With B-Cell Acute Lymphoblastic Leukemia(B-ALL)

Testing the Use of Steroids and Tyrosine Kinase Inhibitors with Blinatumomab or Chemotherapy for Newly Diagnosed BCR-ABL-Positive Acute Lymphoblastic Leukemia in Adults

Comparative Study of BFC and BuCy Conditioning Regimen for Allo-PBSCT in Acute B-cell ALL

Phase 1/2 Study of UCART22 in Patients with Relapsed or Refractory CD22+ B-cell Acute Lymphoblastic Leukemia (BALLI-01)

Study of Chemotherapy-Free Induction Regimen for Ph+ Acute Lymphoblastic Leukemia with Inotuzumab Ozogamicin (InO)

Imatinib Mesylate and Combination Chemotherapy in Treating Patients with Newly Diagnosed Philadelphia Chromosome Positive Acute Lymphoblastic Leukemia

Flumatinib Versus Imatinib Combined with Chemotherapy for de Novo Ph+ ALL



DiseaseLandscape Insights (DLI) helps companies build and run effective strategies to prevent and control ALLepidemics. Furthermore, as awareness and anticipated epidemics grow, there is a growing demand for diagnostic tools, clinical evaluations, and novel therapeutics.

Major players involved in the production of medicinal items benefits from the information and experience provided by DiseaseLandscape Insights. The assistance provided by DLI facilitates patient recruitment strategies, regulatory compliance, and the planning and execution of clinical trials for novel medications and pharmaceuticals.

This ultimately motivates the leaders to conduct qualitative research, investigate manufacturing companies, and find out about raw material sources. All industry participants gain a stronger foothold Acute Lymphocytic Leukemia (ALL) and keep one step ahead with the help of DiseaseLandscape Insights.

Vishal SawantBusiness Development

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