Types of Acute lymphocytic leukemia


Based on how the leukemia cells looked under the microscope after normal staining, a group of French, American, and British (FAB) leukemia researchers classified ALL into three subtypes (L1, L2, and L3) in the 1970s. The FAB categorization method has mostly been superseded by modern lab tests that allow clinicians to identify ALL more precisely. This is an older method that is used less frequently by doctors. It classifies ALL into three categories (L1, L2, and L3) based on the appearance of the leukemia cells under the microscope.

Some of these characteristics are included in the World Health Organization (WHO) classification system, which was most recently revised in 2016. ALL is divided into many categories under the WHO system: The World Health Organization (WHO) is a global health organization that works to improve people’s health. It is determined by the type of malignant lymphocyte (white blood cell) and its features. This method aids your doctors in treatment planning and forecasting. There are three subtypes to choose from:

  • This is the most frequent form in adults, pre (precursor) B cell ALL
  • Young adults are more likely to be affected by pre (precursor) T cell ALL, and men are more likely to be affected.

B cell (mature) this type is identified by specific genetic modifications. B cell (mature). Because ALL is related to Burkitt lymphoma, it is also referred to as Burkitt type ALL.

  • Acute leukaemia with the mixed phenotype (MPAL)
  • This is a rare form of leukaemia that has characteristics with acute lymphoblastic leukaemia (ALL) and acute myeloid leukaemia (AML) (AML). Acute biphenotypic or acute bilineal leukaemia are other names for this condition.

ALL, or acute lymphocytic leukemia, is a malignancy that affects the blood and bone marrow. According to the National Cancer Institute, B-cell acute lymphoblastic leukemia is the most prevalent form of ALL in both children and adults. When you are diagnosed with ALL, you will be given a subtype, such as B-cell or T-cell. Your therapy will be influenced by your subtype. The initial round of treatment will most likely include chemotherapy and medicines. The outcome of your other treatments will be determined by how your body reacts to the chemotherapy. B-cell acute lymphoblastic leukemia is a dangerous disease, but it may be treated and cured.

Acute Lymphoid Leukemia

ALL B-cells:

B-cell ALL with several genetic flaws (gene or chromosome changes). B-cell acute lymphoblastic leukemia (B-cell ALL) is a form of ALL that causes you to have a lot of immature white blood cells called B-cell lymphoblasts in your circulation and bone marrow. According to the Leukemia and Lymphoma Society, B-cell acute lymphoblastic leukemia is the most prevalent subtype of ALL, accounting for 75 percent of ALL occurrences in adults. It generally moves along rapidly.

When you have B-cell acute lymphoblastic leukemia, your body produces immature white blood cells rather than the mature white blood cells that the body requires. Immature cells are incapable of performing essential functions such as combating infections, T-cells attack and kill the infected cells directly. To fight infections, your body needs both T- and B-cells.

  • Hypodiploidy in B-cell ALL (the leukaemia cells have fewer than 44 chromosomes [normal cells have 46]) Hyperdiploidy in B-cell ALL (the leukaemia cells have more than 50 chromosomes)
  • B-cell ALL [t(9;22)] caused by a translocation between chromosomes 9 and 22. (the BCR-ABL1 fusion gene is produced by the Philadelphia chromosome)
  • B-cell ALL with chromosome 11 translocation to another chromosome
  • B-cell ALL [t(12;21)] having a translocation between chromosomes 12 and 21.
  • B-cell ALL with a chromosome 1–19 translocation [t(1;19]
  • B-cell ALL with chromosomes 5 and 14 translocation [t(5;14)]
  • Amplification of a region of chromosome 21 (too many copies) in B-cell ALL (iAMP21) 
  • B-cell ALL with tyrosine kinase or cytokine receptor translocations (sometimes called “BCR-ABL1–like ALL”)
B-cell Acute Lymphocytic Leukemia

Prevention and Risk factors:

B-cell acute lymphoblastic leukemia has no known cause, and there is no method to avoid it. Any hazardous risk factors that you can manage, such as smoking, should be avoided. However, there’s no assurance that you won’t have B-cell acute lymphoblastic.

What are some of the most frequent risk factors?

Even though the origin of the cellular DNA mutation that leads to B-cell acute lymphoblastic leukemia is unknown, several risk factors might enhance your chances of acquiring the illness.

  • Down syndrome and other genetic abnormalities are possible risk factors. A higher chance of developing B-cell acute lymphoblastic leukaemia is linked to the chromosomal variations that produce diseases like Down syndrome.
  • Chemotherapy and other cancer therapies are among the most common. Chemotherapy or radiation therapy for cancer patients increases the chance of acquiring B-cell acute lymphoblastic leukaemia.
  • Radiation at high doses. A person’s chance of getting B-cell acute lymphoblastic leukaemia is enhanced after being exposed to nuclear reactor accidents or other high amounts of radiation.
  • Smoking. Many cancers, including B-cell acute lymphoblastic leukaemia, have been related to smoking.


B-cell acute lymphoblastic leukemia can be treated in a variety of ways.

Induction therapy is the initial step of treatment, and it attempts to kill lymphoblasts and regulate your blood cell production. Once this happens, you’ll be in remission, but you’ll still require therapy. Following that, you’ll get post-remission therapy to eliminate any residual cancer cells in your body. After that, you’ll usually get maintenance therapy for a few years. The cancer cells are prevented from regrowing with maintenance treatment.

During these stages, you may receive the following treatments:

  • Chemotherapy. During the initial phase of treatment, you’ll get chemotherapy to kill cancer cells. In the post-remission and maintenance therapy periods, you may additionally get chemotherapy.
  • Radiation. X-ray-like beams are used in radiation treatment to kill cancer cells. If your cancer has spread, you could require radiation.
  • Therapy with a specific focus. Medication will be given to you to target the cancer cells’ “errors.” It’s possible that they’ll perish as a result. In most cases, targeted therapy is utilised in conjunction with chemotherapy in the early phase of treatment.
  • Transplants of stem cells Stem cell transplants replace diseased bone marrow with healthy fresh bone marrow.
  • Immunotherapy. Immunotherapy works by boosting your body’s natural immune system to aid in the battle against cancer. If you experience a relapse, you may be given this therapy.
  • CAR-T cell treatment is a kind of chimeric antigen receptor (CAR)-T cell therapy. CAR-T cell therapy is a treatment that manipulates your body’s T-cells to combat cancer cells. Children and young adults are the most often recipients of this therapy.

For B-cell acute lymphoblastic leukemia, there are additional experimental therapies and clinical trials available. Keep in mind that because these therapies are still in the early stages of development, they may pose a considerable risk.

T-Cell ALL

T-cell acute lymphoblastic leukemia (T-ALL) is an aggressive and rapidly progressing form of acute leukemia. It affects lymphoid-cell-producing stem cells, namely T lymphocytes, a kind of white blood cell, as opposed to B lymphocytes, which are usually affected by acute lymphoblastic leukemia (ALL).

Although there is no clear reason in the majority of T-ALL instances, it is crucial to remember that: It is not a disease that can be passed on from one person to another (contagious). It is not handed on from one generation to the next (inherited)

Risk factors:

Age – Most types of leukemia are more frequent in persons over the age of 50. The only exception is ALL, which has a peak occurrence in children between the ages of 2 and 5. T-ALL is most frequent in children who are a little older.

Being a man – T-ALL has a greater impact on men than on women of all ages. T-Everywhere is not staged since it is found all over the body when it is initially discovered. 

T-ALL is classified as high-risk, standard, or low-risk using a system. It’s crucial to emphasize that this relates to the likelihood of a positive response to conventional therapy. Many individuals with high-risk illnesses will perform well if therapy is tailored to their risk category. Unfortunately, a patient with a low-risk illness may not necessarily have a good outcome. The risk group is just one of the elements that influence treatment outcomes. The majority of T-ALL patients are classified as high-risk, which means that with the right therapy, they have a very strong chance of being cured.


T-ALL patients will almost all begin therapy right away. The only exception would be if a patient is gravely unwell and unable to obtain treatment due to other medical issues. In younger and/or fitter people, acute leukemia is typically curable with conventional therapy. Patients who are older or less fit typically respond well to therapy at first, but the problem will most likely return, which is known as a relapse. Leukemia is treated in a variety of methods.

  • Chemotherapy is a term that refers to the use of medicines that destroy cells. T-ALL is typically treated with steroids in addition to chemotherapy.
  • Radiation treatment — In T-ALL, it is usually only used in conjunction with a stem cell transplant.
  • A stem cell transplant may be administered to younger/fitter patients (bone marrow transplant). Healthy stem cells from a donor are used in this procedure. If chemotherapy does not cure T-ALL, this procedure is performed.
  • T-cell ALL lymphoblastic leukaemia with early T-cell precursors* * It’s unclear whether there’s sufficient proof that it’s a distinct group (meaning it’s still a “provisional entity”).

Acute leukemias of mixed phenotype

A few acute leukemias have both lymphocytic and myeloid characteristics. Myeloid and lymphocytic characteristics can coexist in leukemia cells. Other times, a person’s leukemia cells may have myeloid and lymphocytic characteristics. Mixed lineage leukemia, acute undifferentiated leukemia, or mixed phenotypic acute leukemia are all terms used to describe these kinds of leukemia (MPAL). According to most research, these leukemias are thought to have a worse prognosis than typical ALL or AML subtypes.


A person’s prognosis for B-cell acute lymphoblastic leukemia is determined by some factors. Children under the age of 15 are, for example, far more likely to have successful therapy and attain full remission. On the other hand, new cancer therapies are assisting more patients than ever before in achieving remission. According to the Leukemia and Lymphoma Society, all forms of leukemia had a five-year survival rate of about 14% decades ago.

In today’s world, the five-year survival rate for ALL is 71.7 percent. In children, the incidence is considerably greater. B-cell acute lymphoblastic leukemia usually goes into remission. Many patients, however, may relapse and require further therapy. If you’ve been in remission for 5 years or longer, you’re extremely likely to be cured of B-cell acute lymphoblastic leukemia.


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