Childhood Leukemia

Leukemia is one of the most common forms of cancer in children and teenagers. Like adult leukemia, childhood leukemia is often categorized by how fast the leukemia grows, acute (fast growing) or chronic (slow growing), and by the type of white blood cell, lymphocytic or myeloid. Most children with leukemia have acute leukemia, which progresses quickly.

The majority of childhood leukemia is acute lymphocytic leukemia (ALL). Most of the remaining cases of childhood leukemia are acute myeloid leukemia (AML). Although chronic leukemia is rare in children, it can occur.

Diagnosing Childhood Leukemia

Childhood leukemia often causes general symptoms such as fatigue, fever, bone pain, easy bruising and frequent infections. Physical examination often reveals bruising and pinpoint red dots (petechiae), enlarged lymph nodes, and enlarged liver and spleen. In addition to physical exam findings, the following tests can be used.

  • Complete blood count (CBC) measures the levels of white blood cells (cells that fight infection), red blood cells (cells that carry oxygen throughout the body) and platelets (cells that stop bleeding) in the blood. A child with acute leukemia may have an elevated white blood cell count and usually has low levels of red blood cells and platelets.
  • Bone marrow aspiration and biopsy involve removing a liquid sample of marrow (aspiration) and bone chip (biopsy) from within the bone. Both samples are used to visualize the type of leukemia cells, as well as to perform additional diagnostic studies for confirming the type of leukemia.
  • Cytogenetic testing analyzes chromosomes (genetic strands) in the leukemia cells. Cytogenetic testing with fluorescence in situ hybridization (FISH) is a technique that uses fluorescent dyes to detect changes in the leukemia chromosomes. This “genetic imprint” is used to classify the leukemia and determine the extent of therapy needed to treat it.
  • Flow cytometry is a specialized test that classifies the subtype of leukemia by analyzing the type of proteins on the surface and inside the leukemia cell. These proteins function much like a name badge and help to identify the types of cells in the bone marrow and blood stream.
  • Lumbar puncture (spinal tap) is a test that samples the fluid around the brain and spinal cord (cerebrospinal fluid) to determine if leukemia cells are present.

Imaging tests, such as computed tomography (CT), magnetic resonance imaging (MRI), ultrasound and X-ray, 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 risk classification (low vs. high risk) help your child’s doctor to choose the best treatment. Most types of cancer are assigned a stage to indicate the extent of the disease, based on the size of the tumor and how far the cancer has spread.

Leukemia does not form solid tumors (except when part of a leukemia/lymphoma combined diagnosis) and spreads to the blood quickly, so it is not staged like a solid tumor or cancer. Instead, doctors use a risk classification system for leukemia that incorporates the type of leukemia cells, the age and gender of the patient, the genetic profile of the leukemia cells, and the response of the disease to treatment.

Treating Childhood Leukemia

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

Chemotherapy is typically the main treatment for childhood leukemia. For some children with certain high-risk leukemia, high-dose chemotherapy may be combined with hematopoietic (blood-forming) stem cell transplantation. Targeted therapy, immunotherapy and radiation therapy may also be used.

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 (intravenous or IV) or as an oral pill, but may also be given as an injection into a muscle (intramuscular injection) or into the spinal fluid (intrathecal). Chemotherapy is given in cycles, and children with leukemia usually receive a combination of different types of chemotherapy drugs. The goal of chemotherapy for leukemia is complete remission of the disease, which occurs when all signs and symptoms of leukemia are gone and only normal cells are found in the blood and bone marrow.

Some of the common side effects of chemotherapy for leukemia include hair loss, appetite loss, nausea, vomiting, fatigue, and diarrhea. In addition, children will often require red blood cell and platelet transfusions, particularly when receiving more high-powered chemotherapy. Your health care team can offer helpful suggestions and medications to prevent and manage side effects, an important part of therapy called supportive care.

Hematopoietic stem cell transplantation may be recommended. Stem cells used for this purpose can come from the blood, bone marrow or umbilical cord. Allogeneic stem cell transplantation uses stem cells from a family or volunteer donor whose tissue type matches that of the patient. People receiving any type of allogeneic transplantation may experience graft-versus-host disease (GvHD) as a side effect of treatment. GvHD can be treated with steroids or other drugs that suppress the immune system.

Therapy that targets specific parts of cancer cells to kill them or stop them from growing is available for some types of cancers and leukemia. This type of treatment may be appropriate for children with chronic myeloid leukemia, in which leukemia cells almost always have an abnormal chromosome called the Philadelphia chromosome. Chemotherapy that targets this chromosome is available.

Immunotherapy is a treatment that works with or stimulates a person’s own immune system to recognize and destroy cancer cells. One of the newest types, chimeric antigen receptor (CAR) T-cell therapy, allows physicians to modify a patient’s own T-cells by adding a new gene that enables them to recognize and kill cancer cells. This one-time therapy is uniquely designed for each patient and is currently approved for patients up to 25 years of age who have refractory or relapsed B-cell precursor acute lymphocytic leukemia. Monoclonal antibodies are another kind of immunotherapy treatment. They are laboratory-made versions of proteins made by the immune system to fight infection, and can be designed to attack specific parts of cancer cells.

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

Clinical trials may offer access to leading-edge treatments that aren’t yet widely available. Talk to your doctor about the possibility of participating in a clinical trial.

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