From the Guidelines
There are no specific surveillance guidelines for individuals with a first-degree relative who has had acute lymphoblastic leukemia (ALL), and routine screening tests are not recommended for asymptomatic family members of ALL patients. The risk of developing ALL is slightly increased for family members, but the absolute risk remains very low, with only about 5% of ALL cases showing familial clustering 1. If you have a first-degree relative with ALL, you should inform your primary care physician about this family history during regular check-ups. Be vigilant about persistent symptoms such as unexplained fever, fatigue, easy bruising, frequent infections, bone pain, or enlarged lymph nodes, which warrant prompt medical evaluation.
Some key points to consider:
- Genetic counseling may be considered in families with multiple affected members or if ALL occurred at a very young age, as certain genetic syndromes (like Down syndrome, Li-Fraumeni syndrome, or Bloom syndrome) can increase ALL risk 1.
- Most cases of ALL are not hereditary, and routine genetic testing is not recommended unless there's a strong family history suggesting an inherited syndrome.
- The NCCN Guidelines for Pediatric Acute Lymphoblastic Leukemia, Version 2.2025, do not provide specific recommendations for surveillance of family members of ALL patients, but emphasize the importance of a thorough medical history and physical examination, as well as laboratory and imaging studies, for patients with suspected ALL 1.
- Prompt evaluation should be performed for patients showing signs and symptoms suggestive of leukemia and lymphoma, as recommended in the update on recommendations for cancer screening and surveillance in children with genomic instability disorders 1.
From the Research
Surveillance Guidelines for Patients with First Degree Relative History of Acute Lymphoblastic Leukemia
- There are no specific studies that provide surveillance guidelines for patients with a first degree relative history of acute lymphoblastic leukemia (ALL) 2, 3, 4, 5, 6.
- The available studies focus on the diagnosis, treatment, and prognosis of ALL, as well as the role of complete blood count (CBC) surveillance in detecting relapse 2, 4.
- One study found that regular blood count surveillance does not predict clinical outcomes or relapse in patients with ALL 2.
- Another study proposed a new threshold for white blood cell count at diagnosis for Philadelphia chromosome-positive ALL, which may contribute to better risk stratification 5.
- However, these findings do not directly address the question of surveillance guidelines for patients with a first degree relative history of ALL.
- Further research is needed to determine the appropriate surveillance strategies for this population.
- The provided studies do not offer any information on the surveillance of patients with a family history of ALL, only the treatment and diagnosis of the disease itself 3, 6.