Childhood leukemia

Leukemia is the most common cancer in children. Like adult leukemia, childhood leukemia is often categorized as acute (fast growing) or chronic (slow growing) and lymphocytic or myeloid. Almost all children with leukemia have acute leukemia, which progresses quickly. About 75 percent of childhood leukemias are acute lymphocytic leukemia (ALL). Most of the remaining cases of leukemia are acute myeloid leukemia (AML). Chronic leukemias are rare in children, but when they do occur, most are chronic myeloid leukemia (CML). Juvenile myelomonocytic leukemia (JMML) is another rare type of childhood leukemia.

Diagnosing Childhood Leukemia

Childhood leukemia often causes general symptoms such as fatigue, fever and frequent infections and is often suspected during a physician examination because of these symptoms. In addition to a physical exam, blood, bone marrow and genetic tests may be used to diagnose childhood leukemia. These diagnostic tests can include:

  • Complete blood count (CBC) measures the number of white blood cells, red blood cells and platelets in the blood.
  • Bone marrow aspiration and biopsy are often done at the same time. During these procedures, bone marrow tissue samples are removed for examination. A bone marrow biopsy involves removing a sample of marrow from within the bone (usually the pelvic bone). For bone marrow aspiration, liquid bone marrow is removed, usually from the back of the pelvic bone.
  • Flow cytometry is a specialized test to count blood cells and helps classify the kind of leukemia.
  • Genetic tests can help the doctor find chromosome and other changes in specific genes in leukemia cells.

Imaging tests, such as computed tomography (CT), magnetic resonance imaging (MRI), ultrasound and X-ray are not necessary to diagnose leukemia in children but may be done to help determine the extent of the disease or to look for infections or other problems.

Classifying Childhood Leukemia

Knowing the type of leukemia and its extent helps your child’s doctor choose the best treatment for your child. Most types of cancer are assigned a stage to indicate the extent of the cancer, based on the size of the tumor and how far the cancer has spread. Leukemia does not form tumors (except when part of a leukemia/lymphoma combined diagnosis) and spreads to the blood quickly, so it is not staged this way. Instead, doctors use different systems to describe the extent of leukemia. These systems vary by the type of leukemia.

Treating Childhood Leukemia

After your child’s leukemia has been diagnosed, the treatment team will work with you and your family to choose the best treatment option.

Treatment options for childhood leukemia vary by leukemia type, but chemotherapy is the main treatment. For some children with certain high-risk leukemias, high-dose chemotherapy may be combined with a stem cell transplant. Targeted therapy, immunotherapy and radiation therapy may be used in some cases. Participating in a clinical trial is something that should definitely be considered by you and your physician.

Some children with leukemia are critically ill when their leukemia is diagnosed. For example, they may have a serious infection as a result of a shortage of normal white blood cells. If this happens, the critical condition may need to be treated before the leukemia itself.

Chemotherapy drugs stop the growth of cancer either by killing cancer cells or by preventing them from dividing and growing. They are usually given by injection into a vein (IV) or as an oral pill. One commonly used leukemia drug is given by intramuscular injection. Chemotherapy is given in cycles, and children with leukemia usually receive a combination of chemotherapy drugs. In most cases, chemotherapy for AML involves the use of higher doses of drugs over a shorter time (usually less than a year), whereas chemotherapy for ALL, which has phases that are intensive, mostly involves the use of lower doses over a longer time (usually two or three years). Chemotherapy drugs used for childhood leukemia include cyclophosphamide (Cytoxan), cytarabine (Cytosar-U), daunorubicin (Cerubidine), doxorubicin (Adriamycin), L-asparaginase (Elspar), mercaptopurine (Purinethol), methotrexate (Trexall), pegaspargase (Oncaspar), thioguanine (Tabloid), teniposide (Vumon) and vincristine (Oncovin).

A stem cell transplant with high-dose chemotherapy may be used for children with ALL, AML, CML or JMML. Stem cells used for transplant can come from the blood, bone marrow or umbilical cord. For childhood leukemia, stem cells from another person can be used, which is called an allogeneic transplant.

Targeted therapy drugs target specific parts of cancer cells to kill them or stop them from growing. Targeted therapy may be appropriate for children with CML, in whom leukemia cells almost always have an abnormal chromosome called the Philadelphia chromosome. Imatinib (Gleevec) is a targeted therapy drug that stops CML cells from growing by targeting the Philadelphia chromosome. Imatinib in combination with chemotherapy may help the small number of children who have ALL with the Philadelphia chromosome.

Immunotherapy is an innovative treatment that activates the immune system to fight cancer as it would fight bacteria or other foreign substances. One type of immunotherapy that may be useful for treating childhood ALL is monoclonal antibody therapy. Monoclonal antibodies are laboratory-made versions of proteins made by the immune system to fight infection. They can be designed to attack specific parts of cancer cells. Blinatumomab (Blincyto) is a monoclonal antibody that may be used to treat childhood ALL.

Radiation therapy uses high-energy radiation to kill cancer cells. It is not often used to treat childhood leukemia but may be used to prevent or treat metastasis (cancer spread) to the brain or testicles. Whole-body radiation therapy may be given before a stem cell transplant.

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