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The disease starts in the bone marrow, where new blood cells are made. In a healthy person, blood stem cells in the bone 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 crowd out healthy cells in the bone marrow and in the bloodstream.
Most leukemia cases fall into one of two categories, chronic and acute. Chronic leukemia involves mature or partially mature cells and is slow growing. It is also rare in children. Acute leukemia impacts immature cells. It is more aggressive and makes up the vast majority of childhood leukemia cases.
Childhood acute lymphoblastic leukemia
Acute lymphoblastic leukemia (ALL) is the most common type of childhood leukemia, making up about 75% of all childhood leukemia cases. It’s also the most treatable type of childhood leukemia, with a five-year survival rate of around 90%.
ALL impacts lymphoid stem cells. In healthy bone marrow lymphoid stem cells make lymphoblasts. These lymphoblasts then turn into different types of healthy white blood cells, which are used to fight off infection.
In ALL, lymphoid stem cells make large numbers of diseased lymphoblasts and diseased white blood cells. These cancerous cells are poor at fighting infection and crowd out healthy cells.
Childhood ALL can be classified into two main subtypes, based on the kind of cell that’s the source of the cancer. B-cell ALL accounts for 80-85% of childhood ALL cases. The remaining 15-20% are T-cell ALL cases. This subtype is more common in boys than girls.
Childhood acute myeloid leukemia
Acute myeloid leukemia (AML) is the second most common type of childhood leukemia. The disease’s five-year survival rate for pediatric patients is about 65%, though that figure differs from subtype to subtype. Many of these subtypes are based on chromosome changes in the cancerous cells.
AML affects myeloid stem cells. These stem cells make three blood components:
- Red blood cells, which deliver oxygen throughout the body
- White blood cells, which help fight infection
- Platelets, which help blood form clots.
AML occurs when an immature type of white blood cell, called a myeloblast, becomes cancerous. In some cases, the myeloid stem cells produce too many diseased red blood cells and platelets. These cells don’t do their job well and multiply so rapidly that they crowd out healthy cells.
Childhood chronic myeloid leukemia
Chronic myeloid leukemia (CML) is rare in children. In the United States, fewer than 200 people under age 20 are diagnosed with CML each year. Most cases are in teenage patients.
Like AML, CML starts with myeloid stem cells in the bone marrow. These cells make several blood components, including certain types of white blood cells.
In CML, one kind of white blood cell, called a granulocyte or a blast, becomes diseased. These cells are not good at fighting infection. They are also long-lived and eventually start crowding out healthy white blood cells. This makes CML a slow-growing disease. Patients can live for years with few symptoms.
The treatment of pediatric CML is similar to the treatment for adults with the disease and include targeted therapies and stem cell transplantations.
Juvenile myelomonocytic leukemia
Juvenile myelomonocytic leukemia (JMML) is a rare type of leukemia, mostly found in children age four and younger. In JMML, the diseased cells are monocytes, a type of white blood cell. JMML is faster growing than chronic leukemia and slower growing than acute. It shares many symptoms with other types of leukemia, including a pale complexion, fever and infections. Since JMML cells gather in certain organs, symptoms can also include an enlarged spleen and difficulty breathing caused by cancer cells accumulating in the lungs. A stem cell transplant is the recommended treatment for JMML, though about half of patients who undergo a successful transplant relapse.
Childhood leukemia risk factors
There’s no known 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;
- exposure to x-rays, alcohol or cigarette smoke before birth
- exposure to high levels of radiation or certain chemicals, including benzene, which is used in oil refineries, chemical plants and other industries.
In addition, children who are treated for another cancer with certain chemotherapy drugs are at a higher risk of developing leukemia. Every cancer survivorship program should screen for leukemia because of this.
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 can pass 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.
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. When symptoms do occur, they’re often caused by too few healthy blood cells and too many diseased cells. Symptoms 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
- Night sweats
- 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 a simple blood test. A doctor may order this blood test after evaluating the patient’s symptoms. Other times, the test is part of a routine doctor’s appointment.
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 may also be 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 specific leukemia type and subtype.
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.
At MD Anderson's Children's Cancer Hospital, we know your child's health and well-being are your number one concern. Our renowned experts customize your child's care for leukemia utilizing the most advanced treatments and techniques with the least impact on your child's growing body. As part of one of the world's most active cancer centers, the Children's Cancer Hospital has remarkable experience and skill in these types of cancer. This can make a difference in your child's outcome.
Customized leukemia care plans
A team of specially trained physicians follows your child throughout treatment, all the way to survivorship. They communicate closely with each other, and with you, to ensure comprehensive, personalized care. They are supported by full complement of health care professionals dedicated to your child's treatment, including nurses, physician assistants, therapists and others.
The Children's Cancer Hospital offers clinical trials for innovative new treatments for leukemia. Behind the scenes, we are working on groundbreaking basic science research to change the future of pediatric cancer.
Treating the whole child
The Children's Cancer Hospital is designed just for children, with a full range of services and amenities that help make the child’s 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 the Children's Cancer Hospital, your child benefits from the resources and expertise of one of the nation's top cancer centers.
Chemotherapy for childhood leukemia
Chemotherapy uses drugs to kill cancer cells. It is the most common treatment for pediatric leukemia.
For acute leukemia patients, chemotherapy is given in two or three stages. Patients with ALL get all three, while AML patients 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 considered high-risk group may get a more intense therapy during this stage.
Stem cell transplants for childhood leukemia
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 (called an autologous transplant). They can also be from a donor whose bone marrow most closely matches the patient (an allogeneic transplant). 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 blood cells.
CAR T-cell therapy for childhood leukemia
CAR T-cell therapy is a type of immunotherapy that engineers a patient’s own T cells to recognize and attack cancer. For leukemia, it is only available to patients under age 25 with B-cell ALL. Only patients who have been treated unsuccessfully with at least two other cancer therapies are eligible.
Targeted therapy for childhood leukemia
Targeted therapy does not kill cancer cells directly. Instead, this treatment is designed to stop or slow the growth of cancer by interfering with, or targeting, molecules or genes in cancer cells that help the disease survive, grow and spread.
Radiation therapy for childhood leukemia
Radiation therapy uses high energy beams to kill cancer cells. Though it’s not a primary treatment for leukemia, it may be used when the disease has affected the brain and central nervous system or is likely to spread to these areas. It can also be used to kill masses of leukemia cells that have gathered together in places like the abdomen or spleen.
Why choose MD Anderson for childhood leukemia treatment?
Selecting a hospital is the first big choice a family makes after a cancer diagnosis. MD Anderson’s Children’s Cancer Hospital offers childhood leukemia patients the most advanced treatments from an expert team, along with support services designed to help the entire family through their cancer journey.
This journey starts with a diagnosis of each patient’s leukemia that is far more detailed and accurate than most hospitals. Through the skills of our leading pathologists, MD Anderson is able to quickly pinpoint alterations in the cancer cells. This information can be used to develop treatment plans tailored to each individual patient.
These treatment plans are created by our multidisciplinary team of physicians working together to benefit each patient. Among these physicians are leading medical oncologists who focus exclusively on treating childhood leukemia and related conditions and specialists from one of the largest stem cell transplantation services in the country. Their expertise includes caring for the newly diagnosed, as well as patients whose leukemia has relapsed or not responded to treatment.
While here, pediatric leukemia patients have access to clinical trials for children, teens and even adults. We’re also home to advanced treatments such as CAR T-cell therapy, which is only available at a few hospitals in the United States.
In addition, the Children’s Cancer Hospital offers supportive care services designed to improve your child’s quality of life, such as counseling and symptom management services. Patients also have access to programs like our arts in medicine activities, summer camps and support groups. We even have an accredited, in-hospital school that helps patients meet their academic goals while still in treatment.
If it weren’t for MD Anderson, we never would have seen our child soar and become the outstanding young woman she is today.
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