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Tests and diagnosis
By Mayo Clinic staff
Tests and procedures used to diagnose acute lymphocytic leukemia include:
- Blood tests. A blood test may reveal too many white blood cells, not enough red blood cells and not enough platelets. A blood test may also show the presence of blast cells — immature cells normally found in the bone marrow but not circulating in the blood.
- Bone marrow test. During bone marrow aspiration, a needle is used to remove a sample of bone marrow from the hipbone to look for leukemia cells. The sample is sent to a lab for testing. Doctors in the lab will classify blood cells into specific types based on their size, shape and other features. They also look for certain changes in the cancer cells and find out whether the leukemia cells began from the B lymphocytes or T lymphocytes. This information helps your doctor develop a treatment plan.
- Imaging tests. Imaging tests such as a chest X-ray, computerized tomography (CT) scan or an ultrasound examination may help determine whether cancer has spread to the brain and spinal cord or other parts of the body.
- Spinal fluid test. A lumbar puncture test, also called a spinal tap, may be used to collect a sample of spinal fluid. The sample is tested to see whether cancer cells have spread to the spinal fluid.
Determining a risk group in children with ALL
Doctors use several factors to determine a risk group for children with acute lymphocytic leukemia. The risk refers to the chance that cancer will recur after treatment. Risk groups include standard, high-risk or very high-risk categories. Your child's risk group helps determine his or her treatment. Factors used to determine risk group include:
- Age. Infants and children older than 10 are generally placed in a high-risk category.
- White blood cell count. The higher the white blood cell count at the time of diagnosis, the higher the risk group.
- Where cancer began. Immunophenotype testing determines whether the cancer began in the B lymphocytes (B-cell ALL) or the T lymphocytes (T-cell ALL). About 85 percent of cases are B cell, and about 15 percent are T cell. In general, children with B-cell ALL do better than those with T-cell ALL. So children with B-cell ALL are usually in a lower risk group, while those with T-cell ALL are in a higher risk group.
- Specific changes within the cancer cells. Cytogenic testing looks for changes to the chromosomes in the lymphocytes. The presence of certain kinds of hard-to-treat mutations also places children in a higher risk group.
