Diagnosis

Tests and procedures used to diagnose acute lymphocytic leukemia include:

• Blood tests. Blood tests may reveal too many or too few 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.

• Bone marrow test. During bone marrow aspiration and biopsy, a needle is used to remove a sample of bone marrow from the hipbone or breastbone. The sample is sent to a lab for testing to look for leukemia cells.

  Doctors in the lab will classify blood cells into specific types based on their size, shape, and other genetic or molecular features. They also look for certain changes in the cancer cells and determine whether the leukemia cells began from B lymphocytes or T lymphocytes. This information helps your doctor develop a treatment plan.

• Imaging tests. Imaging tests such as an X-ray, a computerized tomography (CT) scan or an ultrasound scan 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 fluid that surrounds the brain and spinal cord. The sample is tested to see whether cancer cells have spread to the spinal fluid.

Determining your prognosis

Your doctor uses information gathered from these tests and procedures to determine your prognosis and decide on your treatment options. Other types of cancer use numerical stages to indicate how far the cancer has spread, but there are no stages of acute lymphocytic leukemia.

Instead, the seriousness of your condition is determined by:

• The type of lymphocytes involved — B cells or T cells
• The specific genetic changes present in your leukemia cells
• Your age
• Results from lab tests, such as the number of white blood cells detected in a blood sample