Pediatric Leukemia

According to The Children’s Hospital of Philadelphia (CHOP), pediatric leukemia is the most common type of cancer in children. Leukemia affects the bone marrow and blood cells. Normally blood cells mature and provide essential functions, such as fighting infections, blood clotting and carrying oxygen throughout the body. In pediatric leukemia, blood cells do not mature normally. Instead, immature blood cells are present and prevent healthy, mature blood cells from forming.

Types Of Leukemia In Children

There are two main types of leukemia in children: acute lymphoblastic and myelogenous leukemia. Both types of leukemia are considered acute and classified by the type of cell that is affected. According to CHOP, acute lymphoblastic leukemia (ALL) is the most common type of leukemia diagnosed in childhood. About 80 percent of leukemia diagnosed in children is ALL. In children with ALL, the white blood cells known as lymphocytes do not mature as they should. Without mature white blood cells, children are unable to fight off infections.

The other main type of pediatric leukemia is myelogenous leukemia (AML), which has several subtypes depending on what type of cells are involved. White or red blood cells along with platelets could be affected in children with AML.

There are a few other types of leukemia, which may occasionally occur in children, but they are considered rare and more commonly seen in adults. Rare types of leukemia in children include juvenile myelomonocytic leukemia, chronic myeloid leukemia and myelodysplastic syndromes.

Symptoms

Children may not have noticeable symptoms in the early stages of leukemia, according to MD Anderson Cancer Center. When symptoms do appear, fatigue is one of most common complaints. Other symptoms may include decreased appetite, weight loss, recurrent infections and bone pain. Some children also develop anemia and swollen lymph nodes.

Often, parents will notice their child looks pale or is bruising easily. Bruising may be due to a decrease in platelets, which helps blood clot. Small red spots under the skin known as petechiae may also develop due to low platelets.

Symptoms of pediatric leukemia may vary, and the above symptoms can also be caused by other conditions. When pediatric leukemia is suspected or needs to be ruled out, specific diagnostic tests will be performed. Blood tests, a bone marrow biopsy and a spinal puncture are common ways to confirm a diagnosis of leukemia in children.

Treatment

Treatment for pediatric leukemia may vary depending on the type of leukemia and is often a lengthy protocol, which involves months of treatment. Treatment will often include the following:

• Remission induction: With both ALL and AML chemotherapy is given to destroy the cancer cells and put the patient into remission. Although it may vary, induction chemotherapy often lasts about a month.

• Consolidation treatment: During consolidation treatment, children are given chemotherapy directly into the spinal fluid. Consolation therapy is intended to kill remaining cancer cells that may be in the central nervous system.

• Maintenance chemotherapy: The next part of treatment involves administering chemotherapy to prevent the disease from reoccurring. This stage of treatment will vary depending on the type of leukemia. For example, children with AML may have about six months of maintenance chemotherapy, while the protocol for ALL involves about two or three years of maintenance chemotherapy.

• Bone marrow transplant: In some cases, if chemotherapy does not get rid of the leukemia or if a child gets a reoccurrence, a bone marrow transplant may be recommended. A child going through a bone marrow transplant will usually undergo strong chemotherapy and radiation to destroy leukemia cells. Healthy marrow is taken from a donor and transfused into the patient.

Late Effects

Although treatment for childhood leukemia can be lifesaving, it often has side effects. In addition to side effects during treatment, children can also suffer from late effects, which occur months to years after treatment is completed. Several factors affect whether children will have late term effects of treatment and what they will be. The type of treatment and dosage of chemotherapy, as well as the child’s age during treatment all play a role in whether late effects develop.

According to the American Cancer Society, late effects may include learning difficulties, especially if radiation to the brain was given. Growth may also be affected, causing children to be shorter than average for their age. Additional late term effects include bone and vision problems, hearing loss and disorders of the thyroid.

A leukemia diagnosis and treatment is difficult for anyone to deal with and this holds true for children. Even after treatment has ended, emotional issues may develop in some kids. Long-term monitoring and support for children after treatment has ended can help treat late term effects and help children deal with both physical and psychological issues that develop.

A great deal of progress has been made in treating pediatric leukemia. In the 1960s, the survival rate for children with leukemia was only about 10 percent. That percentage has increased greatly over time. Currently children with the most common type of childhood leukemia have about a 90 percent survival rate according to the American Cancer Society. Continued research is also being done to work toward a definitive cure for childhood leukemia.

Sources:

• CHOP
• MD Anderson Cancer Center
• American Cancer Society
• American Cancer Society