Acute lymphoblastic leukemia (ALL) is sometimes found on blood tests performed for other reasons, so it’s important to tell your doctor about any symptoms you might have.

To test for acute lymphoblastic leukemia (ALL), your OSUCCC – James experts may conduct a variety of tests, including:

Blood Tests

A blood test measures and counts the different types of cells in the blood (patients with ALL have too many white blood cells).

Other blood tests may be done to measure the amount of certain chemicals and antibodies in the blood. A peripheral blood smear is used to analyze how blood cells look under a microscope.

Bone Marrow Aspiration and Biopsy

During a bone marrow aspiration, your OSUCCC – James specialist will insert a hollow needle into the hip bone or breastbone to remove a small sample of liquid bone marrow (called aspirate).

For a bone marrow biopsy, a hollow needle is inserted into a piece of hip bone to collect a small sample of bone and marrow.

Medical Diagnostic Imaging

A patient may have medical imaging exams as part of ALL diagnosis or treatment. The OSUCCC – James specialists often use imaging to guide them to a precise area of the body for biopsy. If the experts suspect that the disease has spread to other organs, they may order X-rays or CT (computed tomography) exams to determine whether the ALL has spread and, if so, where.

Cellular and Molecular Tests

Your OSUCCC – James specialists and subspecialists may also use additional tests to detect specific proteins on the cell surface and to understand other specific features of the cells they have biopsied. Physical changes in the structure of your DNA (called chromosomal rearrangements) can help the experts determine the most effective, targeted treatment for your specific cancer.

Cytogenetic Analysis

Cytogenetic analysis identifies abnormal chromosomes (where genes are) that contribute to developing leukemia. In some ALL cases, certain pieces of DNA may be missing or may have moved. These missing or moved pieces can be detected under the microscope. For example, sometimes in ALL, part of one chromosome has moved to another chromosome. Identifying these abnormalities can help the OSUCCC – James specialists and subspecialists decide the very best kind of personalized treatment for an ALL patient.


This process identifies cells based on the kind of specific markers (genetic and molecular identifiers) on the surface of the cells. The test can identify the subtype of ALL by comparing the cancer cells to the normal cells. By staining cells with special dyes, color changes occur in one kind of leukemia cell but not in another kind, which indicates the ALL subtype.

RT-PCR Test (Reverse Transcription Polymerase Chain Reaction Test)

This test analyzes how a tissue sample reacts to certain chemicals, which enables the experts to look for changes in gene structure or function.

Fluorescent in Situ Hybridization (FISH)

The FISH analysis is a laboratory test for a patient’s chromosomes. It uses fluorescent dyes to identify tiny parts of the chromosomes that are abnormal. The fluorescent dyes are designed to attach only to certain genes.

Genomic Testing

Genomic tests analyze genes to determine if specific genetic changes (mutations) of cancer cells may exist.

Classifying Acute Lymphoblastic Leukemia

There is no such thing as routine acute lymphoblastic leukemia (ALL), as it behaves differently in each person. ALL is not classified in stages (i.e. there is no ALL stage I, II, III or IV).

Instead, the OSUCCC – James experts use advanced laboratory tests such as cytogenetic analysis to classify ALL in groups according to each individual leukemia’s cell characteristics (called immunophenotype), such as whether the leukemia developed from B cells or T cells.

By identifying cell characteristics, the OSUCCC – James ALL experts can plan the most targeted, accurate way to treat your specific disease. This in turn means improved outcomes, faster responses and fewer side effects.

Adult ALL is classified into these cell subtypes:

  • B-cell lineage
  • T-cell lineage

Then the experts can identify your ALL as either untreated or in remission.

  • Untreated ALL: In untreated ALL, the disease is newly diagnosed. The patient has signs and symptoms of ALL but has not yet been treated
  • ALL in Remission: ALL in remission means the patient has been treated for the disease and has no signs or symptoms of ALL. Their laboratory tests also indicate that their blood cells are within normal ranges

(Source: National Cancer Institute)

If you’ve been diagnosed with leukemia, would like a second opinion or would like to speak with a leukemia specialist, please call The James Line at 800-293-5066 or 614-293-5066 to make an appointment.

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The James Cancer Hospital and Solove Research Institute

460 West 10th Avenue

Columbus, Ohio 43210