This map explains acute lymphoblastic leukaemia (ALL) step by step: what it is, the types, the tests, the stages, the treatment and its side effects.
Tap any topic on the map to read about it. Topics with an arrow open more topics.
Tap a type on the map.
Why this matters: the type and genetic changes decide the treatment intensity and which targeted medicines are added.
The most common type (about 85 in 100).
Often presents with a mass in the chest and high white count. Treated with intensive chemotherapy.
Has the BCR-ABL mutation. A TKI tablet (imatinib, dasatinib or ponatinib) is added to treatment. More common in adults.
Tap a test on the map to see why it is done.
Treatment starts within days. Which results we wait for
A complete blood count and a look at the blood under the microscope (peripheral smear). Often the first sign of the disease.
Confirms ALL and whether it is B-cell or T-cell.
BCR-ABL (Philadelphia), KMT2A and other changes that decide the risk group.
A sample of spinal fluid from the lower back, to check for leukaemia in the brain and spinal fluid. Chemotherapy is also given this way (intrathecal).
Minimal residual disease: a very sensitive test on the marrow after treatment, which can find 1 leukaemia cell in 10,000 or more. It is the most important guide to further treatment.
Tissue typing of the patient and siblings, in case a transplant is needed.
Before starting chemotherapy, immunotherapy or targeted therapy, these tests check that you are fit for treatment, and give a starting point to compare with later.
| Test | Why it is done |
|---|---|
| CBC (complete blood count) | Haemoglobin, white cells and platelets. Treatment can lower them. |
| RFT (kidney function) | Many medicines are cleared by the kidneys; the dose may need to change. |
| LFT (liver function) | Many medicines are processed by the liver. |
| Viral markers: HBsAg, anti-HCV, HIV | Hepatitis B can flare up during treatment. If positive, a tablet is given to prevent this. |
| Blood sugar (and HbA1c if diabetic) | Steroids given with chemotherapy can raise blood sugar. |
| ECG and 2D Echo | Check the heart rhythm and pumping before treatment, as some medicines affect the heart. |
Before immunotherapy, also:
| Test | Why it is done |
|---|---|
| Serum TSH (thyroid) | Immunotherapy can affect the thyroid gland. |
| Serum cortisol (morning sample) | Immunotherapy can affect the adrenal and pituitary glands. |
Sometimes needed, depending on your treatment:
Your doctor will choose the tests that apply to you. Some of them are repeated during treatment.
ALL is grouped by risk, using age, white count, genetic changes and, most importantly, the MRD response. Tap a group on the map.
Favourable features and MRD negative after induction. Less intensive treatment.
High-risk genetic changes, or MRD still positive. More intensive treatment; transplant considered.
Treatment is given in phases over about 2 to 3 years. Tap a topic on the map.
Side effects: chemotherapy
Side effects: blinatumomab and CAR-T · transplant
Side effects: blinatumomab and CAR-T
Tap a treatment on the map.
Tap a topic on the map.
Fever of 38°C or more, bleeding, severe tummy pain, severe headache, fits, confusion, or leg swelling need urgent care.
This information is general. Your own treatment plan may be different. Please discuss it with your doctor.
Written and medically reviewed by Dr Prathyusha Eaga, MD, DM (Medical Oncology). Last reviewed: 12 October 2026. Based on NCCN and ESMO guidelines.
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