Leukemia starts in bone marrow, the soft, spongy center of some bones that makes blood cells. Leukemia cells build up and crowd out healthy blood cells.
Bruising or bleeding easily (from tiny blood vessels that break). Anemia (low numbers of red blood cells).
Doctors treat childhood leukemia with chemotherapy drugs. These poisonous drugs kill cancer cells and the healthy cells they affect.
Diagnosis
The most common type of leukemia in children starts in the bone marrow, the soft, spongy center inside some bones where blood cells are made. The cancerous blood cells (leukemia cells) build up and crowd out normal blood cells, and they usually spill into the bloodstream and spread to other organs. There are many different types of leukemia, categorized by how fast they develop and the kind of white blood cell involved.
Doctors use lab tests to find out if your child has leukemia and what kind. They will check the levels of certain blood cells, such as red and white blood cells and platelets. They may also measure the activity of your child’s spleen and liver. These are important in detecting problems like infection, anemia and unusual bleeding or bruising.
Your child will probably have a chest X-ray and a magnetic resonance imaging (MRI) scan, which use a combination of sound waves and magnets to make detailed pictures of your child’s internal organs. These tests will show whether or not the spleen and liver are enlarged, which is sometimes a sign of leukemia. They can also show whether a type of chemotherapy, such as methotrexate, is working or not.
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To diagnose leukemia, doctors will often do a test that measures the number of cancerous and normal blood cells in your child’s bone marrow. They will also do a biopsy of a sample of solid bone marrow and liquid bone marrow to see if the cancer cells are present.
These samples will be tested with special lab tests, such as flow cytometry and immunohistochemistry, to identify the type of leukemia your child has. The results from these lab tests will help decide what treatment your child will receive.
Several other kinds of tests can give your child’s doctor information about the leukemia, such as chromosome studies and next generation sequencing tests. These are very sensitive, and they can find some chromosome or gene changes that were too small to be seen with a microscope. This can help improve a treatment plan.
Treatment
A child with leukemia will have many tests to find out the type of leukemia they have and how advanced it is. They will also have many treatments to help get rid of it and keep it away.
Treatment starts with induction therapy, which aims to use strong chemotherapy drugs to kill the leukaemia cells. Your child will stay in hospital on the children’s cancer ward while they have this treatment. During this time they will have blood tests to check how well the treatment is working. They may also have a bone marrow transplant at this point, if it is suitable for them.
As the leukemia cells grow, they crowd out healthy blood cells in the bone marrow. This can cause problems like anemia, which makes your child feel tired and pale because their blood can’t carry enough oxygen. They may also get recurrent infections because their white blood cells can’t fight them. And they might have bleeding problems like nosebleeds and easy bruising, because their platelets can’t stop them from clotting.
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Some treatments can also affect the normal cells in other parts of your child’s body, like the kidneys and liver. This can make them feel sick (nauseous) and cause other health problems, like mouth ulcers or heart damage. They might need other treatments to protect these organs.
Research is looking for better ways to treat childhood leukemia, including CAR T-cell therapy. At NewYork-Presbyterian Morgan Stanley Children’s Hospital, we are a leader in this exciting new type of treatment. It uses your child’s own T cells, which are removed, modified in the lab to recognise leukemia cells and multiplied. These then return to your child’s body to detect and destroy the leukemia cells.
Side effects
A child with leukemia can have many side effects of treatment. These can include fever, fatigue and nausea. In some cases, treatment can affect a child’s lungs or heart. A child can also develop bone and joint pain. This happens when leukemia cells enter the bones and damage bone tissue.
The most common way to treat childhood leukemia is with chemotherapy drugs. These are given in a specific dose and sequence, based on a patient’s risk group defined at diagnosis. There are three phases of treatment — induction, consolidation, and interim maintenance.
During induction therapy, children have high doses of chemotherapy and other cancer drugs. They might need to stay in the hospital for a short time and may have trouble eating.
Afterward, the medicine can kill the remaining leukemia cells. This is called consolidation or intensification therapy. During this phase, children might need to stay in the hospital for several days at a time. They will be given antibiotics to help prevent infection while they are sick.
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Once leukemia is in remission, doctors reduce the amount of medication and sometimes do regular blood tests to see how well they are working. They might also do a spinal tap (lumbar puncture). This involves inserting a needle into the spine at the area where the spinal cord ends to check the pressure and to remove a sample of cerebral spinal fluid (CSF).
CSF is a clear fluid that bathes the brain and spinal cord.
If the test shows that the bone marrow is not producing enough new blood cells, it is a sign of leukemia relapse. The outlook for relapse depends on how quickly the leukemia returns and whether it is seen in other parts of the body.
During treatment, a child can still be a kid, but it’s important to balance rest and activity. A dietitian can help a child get enough nutrition during treatment.
Survivors of childhood cancer are at increased risk of problems, such as heart failure, heart attacks and valve abnormalities, years after treatment ends. This is why it is important to get follow-up care and take all medicines as prescribed. Researchers are finding ways to make treatments better and reduce long-term side effects.
Prevention
There are a number of ways to help prevent childhood leukemia. The most common is to take medicine (chemotherapy) that kills cancer cells and keeps them from coming back. Children who get this treatment often feel better after they finish it.
The most common type of leukemia is acute lymphocytic leukemia or ALL, which happens when the bone marrow makes too many white blood cells. These abnormal cells crowd out healthy cells and make it hard for the blood to work properly. Other types of leukemia include acute myelogenous leukemia or AML, which happens when the bone marrow is making abnormal myeloblasts, a type of blood cell.
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Doctors don’t know exactly what causes most cases of leukemia. They do know that leukemia is a disease that starts in blood-forming stem cells called precursors. These cells usually develop into different types of blood and immune system cells. But in leukemia, a mutation occurs that makes the precursors grow and multiply without control. The mutations that cause leukemia can be caused by many things, including some medicines or viruses.
Almost all types of leukemia can affect the brain and nervous system. Some may even spread to other parts of the body. The disease is also very expensive to treat.
A diagnosis of leukemia is devastating for a child and family. It can impact mental as well as physical health and lead to depression, anxiety, and other mood problems. There are many resources available to help children and their families cope with the emotional and practical challenges of the disease.
Unlike most cancers, there is no way to prevent most kinds of leukemia at this time. However, researchers are working on ways to treat other diseases with radiation and chemotherapy without raising the risk of leukemia. They are also trying to find out how to use drugs to stop the body from rejecting transplanted organs. In some rare cases, leukemia develops as a side effect of life-saving treatments for other diseases, such as radiation or surgery to remove a tumor.
