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Leukemia Treatment in Children
As part of one of the world's most active cancer centers, Children's Cancer Hospital has remarkable experience and skill with treating leukemia in children. This can make a difference in your child's outcome.
A team of specially trained doctors follow your child throughout their leukemia treatment, all the way to survivorship. They communicate closely with each other, and with you, to ensure comprehensive, personalized care plan for leukemia. They are supported by full complement of health care professionals dedicated to your child's treatment, including nurses, physician assistants, therapists and others.
Children's Cancer Hospital offers leukemia clinical trials for innovative new treatments for leukemia. Behind the scenes we are working on groundbreaking research to change the future of pediatric cancer.
Treating the Whole Child
Children's Cancer Hospital is designed just for children, with a full range of services and amenities that help make the child and family's experience as comfortable as possible. We go beyond medical care to deliver a comprehensive experience that treats the whole child.
And, at Children's Cancer Hospital, your child benefits from the resources and expertise of one of the nation's top cancer centers.
Leukemia is the most common childhood cancer, making up about 1/3 of all pediatric cancers. In the United States, about 3,500 children get a leukemia diagnosis each year.
The disease starts in the bone marrow, where new blood cells are made. In a healthy person, blood stem cells in the marrow develop into the different types of healthy blood cells. When a child develops leukemia, some of these cells become abnormal and cancerous. They don’t do their job well and they multiply quickly, crowding out healthy cells in the marrow and in the bloodstream.
There two main types of leukemia, depending on the type of blood stem cell that causes the cancer. Lymphoid stem cells should make different types of healthy white blood cells, which are used to fight off infection. In lymphocytic (or lymphoblastic) leukemia, too many of these cells are made. These cancerous cells are poor at fighting infection.
Myeloid stem cells produce different types of blood cells, including red and white blood cells. Myeloid (or myelogenous) leukemia occurs when an immature type of white blood cell, called a myeloblast, becomes cancerous. Just like in lymphotic leukemia, these cells multiply rapidly and crowd out healthy cells.
Both types of leukemia are classified as either acute or chronic. Acute is fast moving, while chronic develops at a much slower rate. Children almost never have chronic leukemia. About 75% of childhood cases are acute lymphoblastic leukemia (ALL), with most of the rest being acute myeloid leukemia (AML).
Childhood leukemia risk factors
There’s no know way to prevent leukemia, but there are several risk factors that may increase a person’s chance of developing the disease. These include having one of several genetic disorders, including:
- Bloom syndrome
- Diamond-Blackfan anemia
- Down syndrome
- Fanconi anemia
- Klinefelter syndrome
- Li-Fraumeni syndrome
- Schwachman-Diamond syndrome
- Trisomy 8
- Severe congenital neutropenia (also called Kostmann syndrome)
Other possible risk factors include having a sibling with the disease or exposure to high levels or radiation or certain chemicals, including benzene, which is used in oil refineries, chemical plants and other industries.
In addition, people who are treated for another cancer with certain chemotherapy drugs are at a higher risk of developing the leukemia. Every cancer survivorship program should screen for this type of leukemia.
Most cases of leukemia are not inherited. The rare hereditary forms of the disease are caused by a mutation in the patient’s DNA that can be passed down from one generation to another. Sometimes the patient gets this mutation from a parent. Sometimes it is an entirely new mutation that the patient did not inherit, but that can be passed down to his or her children.
MD Anderson’s Childhood Cancer Survivorship Clinic can screen for chemotherapy-related leukemia for anyone who was diagnosed with cancer before age 21, as well as provide care for all pediatric cancer survivors.
In rare cases, childhood leukemia can be passed down from one generation to the next. Genetic counseling may be right for you. Learn more about the risk to you and your family on our genetic testing page.
Did You Know?
Many times, leukemia does not have symptoms in the early stages. When it does, they can vary from child to child, depending on the type of leukemia. If there are symptoms, they may include:
- Fever/infection. This occurs because the body doesn’t have enough healthy white blood cells to fight an infection.
- Frequent and serious nose bleeds and bleeding gums. These can happen because the blood doesn’t have enough platelets, which are used in blood clotting.
- Pain or a feeling of fullness below the ribs. This can be caused by leukemia cells forming a mass in the abdomen.
- Easy bruising and bleeding
- Weakness and fatigue
- Headaches, light-headedness, dizziness, or shortness of breath
- Loss of appetite
- Bone or joint pain
- Petechiae, pinpoint red spots caused by bleeding under the skin
- Lumps under the skin in the groin, underarm or neck. They may be blue or purple, or may not be discolored at all. Painless lumps may also form around the eyes and be blue-green.
Most of the time, these symptoms are not caused by leukemia. However, it is important to discuss any symptoms with your doctor, since they may signal other health problems.
A childhood leukemia diagnosis usually starts with symptoms that lead to a doctor's visit. The doctor should then perform a simple blood test. If the test shows abnormal levels of red or white blood cells or the presence of leukemia cells, a bone marrow biopsy is ordered. This requires taking a sample of bone marrow from the hip with a needle, and then looking for the presence of disease.
A lumbar puncture is also performed to determine whether leukemia has affected the central nervous system. During this procedure, health care professionals use a needle to remove cerebrospinal fluid from the spine.
At the Children's Cancer Hospital, these procedures are performed under anesthesia for minimal discomfort to your child. Special doctors called hematopathologists use a full battery of laboratory tests to identify the leukemia type.
While many cancers are defined by their stages, there is no widely used staging system for childhood leukemia. Instead, patients are placed in risk groups depending on their condition and how far the disease has progressed. Doctors use these risk groups to help plan a patient's treatment.
(Source: National Cancer Institute)
Acute Lymphoblastic Leukemia (ALL)
Risk groups for childhood acute lymphoblastic leukemia are described as:
Standard (low) risk: Includes children aged 1 to 9 years who have a white blood cell count of less than 50,000/µL (or millionths of a liter) at diagnosis.
High risk: Includes children younger than 1 year or older than 9 years and children who have a white blood cell count of 50,000/µL or more at diagnosis.
Other factors that affect the risk group include the following:
- Whether the leukemia cells formed from B lymphocytes or T lymphocytes
- Whether there are certain changes in the chromosomes of the lymphocytes
- How quickly the leukemia responds to initial therapy
It is important to know the risk group in order to plan treatment. Children with high risk ALL usually receive more aggressive treatment than children with standard risk ALL.
Acute Myeloid Leukemia (AML)
Childhood AML is described as newly diagnosed, in remission, or recurrent.
Newly diagnosed childhood AML: The disease has not been treated except to relieve symptoms such as fever, bleeding, or pain, and one of the following is true:
- More than 20% of the cells in the bone marrow are blasts (leukemia cells), or
- Less than 20% of the cells in the bone marrow are blasts and there is a specific change in the chromosome
Childhood AML in remission: The disease has been treated and the following are true:
- The complete blood count is almost normal.
- Less than 5% of the cells in the bone marrow are blasts (leukemia cells).
- There are no signs or symptoms of leukemia in the brain, spinal cord or other parts of the body.
Recurrent childhood AML has recurred (come back) after it has been treated. The cancer may come back in the blood and bone marrow or in other parts of the body.
The Children's Cancer Hospital's leukemia treatment team includes experts in all forms of cancer therapy. They collaborate on each case to decide the best possible treatment for every child.
Chemotherapy uses drugs to kill cancer cells. It is the most common treatment for pediatric leukemia. There are three stages of chemotherapy for pediatric leukemia patients. ALL patients get all three, while AML need just the first two.
- The remission induction stage is designed to kill most of the disease cells in the blood and bone marrow, putting the disease into remission, when the signs and symptoms of the disease have mostly or completely disappeared. Treatment during this stage is intense, and often requires long hospital stays. It’s also effective: More than 95% of children enter remission after one month of care.
- Consolidation is designed to kill any remaining cancer cells. This stage is also called intensification, since it is usually more intense than remission induction
- Maintenance, or continuation therapy, is designed to kill any final remaining cells and to prevent relapse. Children in the high-risk group may get a more intense therapy during this stage.
A stem cell transplant may be required for children whose leukemia has returned or has not responded to standard treatments. Blood stem cells are taken from the bone marrow of the patient before cancer treatment (autologous), or from a donor whose marrow most closely matches the patient (allogeneic). Stem cells may also be collected from a newborn's umbilical cord and placenta and used for a cord blood transplant. These cells are used to replace diseased stem cells destroyed by cancer treatment, creating a new "blood factory" that will hopefully produce healthy, mature white blood cells.
Radiation therapy may be used when leukemia has affected the brain and central nervous system or is likely to spread to these areas. Beams of radiation are precisely aimed at the treatment area from outside the body.
Find the latest news and information about childhood leukemia in our
Knowledge Center, including blog posts, articles, videos, news
releases and more.
Before I was diagnosed with cancer in June 1998, I wanted to be a princess, a teacher or a veterinarian.
Instead, I became a registered nurse at MD Anderson Children’s Cancer Hospital — the place that saved my life. And it’s all because of the outstanding care I received here as a child.
Dual diagnosis: granulocytic sarcoma and acute myeloid leukemia
My cancer story began the summer after first grade. At the time, my life seemed idyllic: I was learning golf with my dad, earning badges as a Brownie Girl Scout and playing soccer. Little did I know what life had in store for me.
One day I was watching TV with my mom, and I mentioned that I could see two television sets. Concerned, she called over a neighbor who was an optometrist and another who was a nurse. They noticed my left eye was crossed inward and told her to get me to a doctor right away.
After examining me, my ophthalmologist promptly referred us to a neurologist. Later, he told us he could actually see a tumor pressing against my optic nerve, but the scans ordered by the neurologist confirmed it: I had granulocytic sarcoma — a very rare type of tumor — in my head, as well as acute myeloid leukemia (AML).
A unique childhood cancer treatment plan
Granulocytic sarcoma is usually found in the abdominal area of adults after they’ve been diagnosed with acute myelogenous leukemia, so it was unusual for me to have both at age 7 — and for the tumor to be in my brain.
A few days after my diagnosis, I had surgery to remove the tumor at a hospital near Galveston, Texas. The procedure went well, but after three different people told my parents I should see pediatric oncologist David G. Tubergen, M.D. (now retired) at MD Anderson, they decided to bring me here for the rest of my treatment.
Because my diagnosis was so unique, Dr. Tubergen put together a new combination of chemotherapy drugs for me. Some were normally used to treat brain tumors, and some were normally used to treat AML. The first round went fine. But after the second round, I developed a 103-degree fever that kept rising, and I had to be readmitted to the hospital.