Tests for acute lymphoblastic leukaemia (ALL)

You usually have a number of tests to check for acute lymphoblastic leukaemia (ALL). Your doctor may suspect or sometimes diagnose ALL from a blood test. You then have more tests to confirm your diagnosis and find out more about the leukaemia.

ALL is a type of blood cancer. It starts from white blood cells called lymphocytes in the bone marrow. The bone marrow is the soft inner part of the bones where new blood cells are made.

ALL is most often diagnosed in young children aged 0 to 4 years, but it can also affect adults. This page is about the tests used to diagnose ALL in adults. We have separate information about the tests for childhood ALL. 

Tests your GP might do

Most people with symptoms that could be due to cancer start by contacting their GP surgery. Your first appointment may be a telephone appointment. Your GP surgery then might arrange for you to go in and see a doctor or other healthcare professional.

Some people are also diagnosed after they become unwell and go to accident and emergency (A&E). 

Your GP can do some tests to help them decide if you need to see a specialist. This usually includes:

• a physical examination

• blood tests

Depending on your symptoms and the results of your blood tests, your GP may also arrange for you to have other tests such as an x-ray or ultrasound scan. You usually have these tests at your local hospital.

Physical examination

Your doctor usually asks you to lie or sit down. They look and feel your skin to check for any abnormalities or areas that are swollen. Things they look for include signs of bleeding, bruising and infection.

They may also listen to your chest and tummy (abdomen) to find out if they sound normal.

You can ask for someone else to be in the room with you if you want, to act as a chaperone. A chaperone is a trained healthcare professional such as a nurse. A friend or relative can also stay with you for support. They can be with you during the examination. 

Blood tests

Blood tests can check your general health including:

• how well your liver and kidneys are working
• the number of blood cells in your blood such as platelets and red blood cells

Tests your specialist might do

Depending on your symptoms and the results of your blood tests, your GP might arrange for you to go to the hospital. Sometimes this is quite quick, and you might have to go there straight away. This can happen if your GP suspects that you have leukaemia.

The specialist you see at the hospital is called a haematologist. This is a doctor who specialises in diseases of the blood such as leukaemia.

Your specialist usually repeats the blood tests done by your GP. You also have more tests such as:

• a bone marrow test

• tests on your leukaemia cells

• a lumbar puncture

• scans such as chest x-ray, CT scan or MRI scan

• tests to check for infection

• tests to look at substances on the surface of cells and tissues. These are called tissue typing tests

Bone marrow test

A bone marrow test is often the first test you have at the hospital. This test can confirm if you have ALL. It can also help to find out more information about the type of ALL you have. 

You usually have this test under local anaesthetic. This means that you are awake but the area is numb.

During a bone marrow test, your doctor uses a needle to take a sample of bone marrow. They may then use a second needle to take out a piece of more solid bone marrow tissue. This is usually from the back of your hip bone.

A specialist doctor called a pathologist looks at the tissue under a microscope.

Tests on the leukaemia cells

Your doctor usually does a number of checks on the leukaemia cells. They use the blood and bone marrow samples you have given. The tests check for changes:

• on the surface of the leukaemia cells. These are immunophenotyping tests
• in the genes and chromosomes of the leukaemia cells. These are sometimes called cytogenetic or molecular studies

Immunophenotyping

Immunophenotyping are tests to look for certain proteins on the surface of leukaemia cells. These tests can help to find out:

• the type of leukaemia you have. For example, if you have ALL or another type of leukaemia such as acute myeloid leukaemia (AML)

• the subtype of ALL you have such as B cell or T cell ALL

A specialist laboratory does immunophenotyping tests. Sometimes doctors use a technique called flow cytometry to do immunophenotyping.

Flow cytometry tests can be done on blood samples if leukaemia cells are present. But they are usually done on bone marrow samples.

These tests can also help to find out how well treatment is working and if your leukaemia has gone away after treatment.

Tests to look for changes in the genes and chromosomes

There are different tests that look for changes in the genes and chromosomes of your leukaemia cells.

Fluorescence in situ hybridisation (FISH)

FISH is a test that looks for chromosome changes in cells. It can help your doctor work out which treatment you need.

Philadelphia positive ALL is the main subtype of ALL that can be picked up by this test. But there are also many other chromosome changes that are important in helping your doctor understand more about your leukaemia.

We also have a 2 minute video that explains what Philadelphia positive leukaemia is.

Polymerare chain reaction (PCR)

PCR are tests that can pick up changes in genes and chromosomes to help diagnose cancer. It helps your doctor work out the treatment you need. In leukaemia, it can also monitor how well your treatment is working.

Other genetic tests

New types of genetic testing are becoming available on the NHS. Doctors use these tests to understand more about the gene changes that happen in leukaemia. These tests are done at specialist laboratories around the UK. They are called genomic laboratory hubs.

Lumbar puncture

A lumbar puncture is a test to check the fluid that circulates around the brain and spinal cord. This is called the cerebrospinal fluid or CSF.

Your doctor uses a thin needle to take a sample of the CSF from your lower back. They then check the fluid for cancer or infection. You usually have a lumbar puncture under local anaesthetic.

Scans

You usually have a number of scans to check for ALL or infection. 

Chest x-ray

An x-ray is a test that uses small amounts of radiation to take pictures of the inside of your body. They are a good way to show changes in organs such as the lungs.

You might have a chest x-ray to check for signs of infection if you have any symptoms.

CT scan

A CT scan uses x-rays and a computer to create detailed pictures of the inside of your body. You usually have a CT scan of your neck, chest, abdomen and pelvis .

You might have a CT scan to:

• check if the leukaemia has caused any of your lymph nodes , spleen or liver to enlarge
• check how well your treatment is working if you had any swollen areas before the treatment
• look for infections

MRI scan

MRI stands for magnetic resonance imaging. It uses magnetism and radio waves to take pictures of the inside of your body.

You don’t often have an MRI scan for ALL. But there might be situations where your doctor might want you to have one. For example, if you have symptoms that suggest that you might have:

• leukaemia that has spread to the central nervous system (CNS)
• bleeding in your brain

Ultrasound scan

Ultrasound scans use sound waves to create a picture of a part of the body. You might have an ultrasound scan to look for changes in your lymph nodes, liver or spleen.

You may also have it to help find a vein to put a central line. A central line is a long tube that goes into a large vein near the heart. They are used for taking blood samples and giving drugs.

PET-CT scan

A PET-CT scan combines a CT scan with a PET scan. The CT scan takes a series of x-rays from all around your body and puts them together to create a 3 dimensional (3D) picture. The PET scan uses a mildly radioactive drug to show areas of your body where cells are more active than others.

There are different reasons why you might have a PET-CT scan for ALL. For example, you may have a PET-CT scan after you are first diagnosed with T cell ALL. You usually have a PET-CT scan of your neck, chest, abdomen and pelvis.

Tests to check for infections

ALL and its treatment can weaken your immune system . This is because it stops your bone marrow from making blood cells that help fight infection. This increases your risk of getting an infection.

You have blood tests to check for specific viruses before you start treatment. This helps your doctor know your risk of developing these viruses during treatment or the risk of them flaring up.

Your doctor usually tests for:

• human immunodeficiency virus (HIV)

• hepatitis B virus (HBV)

• hepatitis C virus (HCV)

• herpes simplex virus (HSV)

• Epstein-Barr virus (EBV)

• cytomegalovirus (CMV)

Tissue typing

Tissue typing is a set of tests that you have using a sample of your blood and saliva. You might have it if your doctors think that you need treatment with a stem cell transplant using a donor’s stem cell. This is called an allogeneic transplant.

Tissue typing tests can show how closely a possible stem cells donor’s tissue matches your own.

Treatment

The tests you have help your doctor find out if you have leukaemia and the type of leukaemia you have.

This is important because doctors use this information to recommend the best treatment for you.

Coping

Coping with a diagnosis of ALL can be difficult. There is help and support available for you and your family.