For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the latest information. They are conducting clinical trials in many countries for most stages of ALL.

Untreated
The treatment will probably be systemic chemotherapy. This could involve intrathecal chemotherapy alone or combined with either radiotherapy to the brain or high doses of systemic chemotherapy to treat or prevent the onset of leukemia in the brain.

Treatment also may include blood transfusions, antibiotics and instructions to keep body and teeth especially clean. New drugs are being evaluated in clinical trials.

In remission
The patient may be one of the following treatments:
- Clinical trials of high dose chemotherapy in the short term, low dose followed by long-term chemotherapy .- Clinical trials of allogeneic bone marrow transplantation.
- Clinical trials of autologous bone marrow transplantation.
- Intrathecal chemotherapy alone or combined with radiation to the brain or systemic chemotherapy in high doses, to prevent the growth of leukemia cells in the brain (CNS prophylaxis).

Appellant
The patient may receive radiation therapy to relieve symptoms or could choose to take part in a clinical trial of bone marrow transplantation.

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There is no staging for acute lymphoblastic leukemia (ALL) in adults. The type of treatment selected depends on whether the patient has received treatment before.

- Not treated
Untreated ALL means that it has been given no treatment except to relieve symptoms. There are too many white blood cells in the blood and bone marrow, and there may be other signs and symptoms of leukemia.

- In remission
Remission means that treatment has been given and that the number of white blood cells and other cells in the blood and bone marrow is normal. No signs or symptoms of leukemia.

- Appellant
Recurrent disease means the leukemia has come back after having gone into remission. Refractory disease means the leukemia has not gone into remission after treatment.

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• Acute Lymphoblastic Leukemia Stages
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Adult acute lymphoblastic leukemia (also called acute lymphocytic leukemia or ALL) is a disease in which there are too many white blood cells and bone marrow. White blood cells, also known as lymphocytes, are responsible for fighting infections.

Lymphocytes derived from bone marrow, the spongy tissue inside large bones of the body, and other organs of the lymphatic system. The bone marrow makes red blood cells (which carry oxygen and other materials to all tissues of the body), white blood cells (which fight infection) and platelets (which cause blood to clot).

Normally, the bone marrow makes cells called blasts, which are converted (at maturity) in several cell types that in turn have specific functions in the body. The substance that carries lymphocytes is lymph, a colorless, watery fluid found in lymphatic vessels. These, in turn, are part of the lymphatic system, which is made up of thin tubes that branch, like blood vessels to all body parts.

Along the network of vessels are groups of small organs called bean-shaped lymph nodes. Clusters of lymph nodes in the underarm, pelvis, neck and abdomen. The spleen (an organ located in the upper abdomen that produces lymphocytes and filters old blood cells from the blood), thymus (a small organ beneath the breastbone) and tonsils (located in the throat) are also part of the system node.

Lymphocytes fight infection by making substances called antibodies that attack germs and other harmful bacteria in the body. In ALL cases, the developing lymphocytes do not mature and become too numerous.

These immature lymphocytes are then found in the blood and bone marrow and accumulate in the lymphoid tissues causing them to swell. Lymphocytes may crowd out other cells in the blood and bone marrow. If the bone marrow can not produce enough red blood cells to carry oxygen, the patient may have anemia.

If you can not produce enough platelets for blood to clot normally, the patient may have bleeding or bruising easily. The cancerous lymphocytes can also invade other organs, spinal cord and brain.

Leukemia can be acute (progressing quickly with many immature cancer cells) or chronic (progressing slowly with leukemia cells more mature-looking). ALL progresses rapidly and can occur in both children and adults. Treatment given to children and adults is different.

It is often difficult to diagnose ALL. The first signs may be similar to the flu or other common diseases. You should see your doctor if you have the following signs or symptoms and they are not relieved: fever, feel weak or tired all the time, have pain in bones or joints, or will swell the lymph nodes.

If you have symptoms, your doctor may recommend that you do blood tests to count the number of cells of each type you have. If the results of blood tests are abnormal, the doctor may perform a bone marrow biopsy. During this test, a needle is inserted into a bone and removes a small amount of bone marrow, which is seen through a microscope.

The doctor may also do a spinal tap, in which a needle is inserted through the back to take a sample of fluid surrounding the brain and spine. The fluid is then examined under a microscope for the presence of leukemia cells. The doctor can then determine what kind of leukemia you have, and plan the best treatment.

Your chance of recovery (prognosis) depends on the leukemia cells look under a microscope, how far it has spread leukemia and their age and overall health.

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