Leukemia in Children
Leukemia is cancer that starts in
young (immature) blood cells. It’s the most common kind of cancer in children.
The leukemia cells grow in bone
marrow and then go out into the blood. The bone marrow is the soft, spongy center
of certain bones. Healthy blood cells are made in the bone marrow. When a child has
leukemia, the bone marrow makes abnormal blood cells that don’t mature and don't work
the way they should. The abnormal cells are usually white blood cells (leukocytes).
The abnormal cells reproduce very quickly. They build up in the bone marrow and crowd
out healthy blood cells. This keeps the bone marrow from making enough healthy
The types of blood cells
Red blood cells (erythrocytes) or RBCs. Red blood
cells carry oxygen from the lungs to the body and carry carbon dioxide back to the
lungs. A low level of RBCs is called anemia. It can make your child feel tired, weak,
and short of breath.
Platelets (thrombocytes). Platelets help with blood
clotting and stop bleeding. A child with low levels of platelets will bruise and
White blood cells (leukocytes) or WBCs. These cells fight
infection and other disease. A child with low levels of white blood cells is more
likely to have infections.
There are different types of
leukemia in children. Most leukemias in children are acute. This means they tend to
quickly. The most common types of leukemia in children are:
Acute lymphocytic (or lymphoblastic) leukemia
This is the most common type of leukemia in children. About 3 out of 4
kids with leukemia have ALL.
Acute myelogenous (or myeloid, myelocytic,
non-lymphocytic) leukemia (AML).
Most of the remaining cases of leukemia in
children are AML.
Rare leukemias that are sometimes diagnosed in children include:
Hybrid or mixed lineage leukemia. This is a mix of ALL
Chronic myelogenous (or myeloid) leukemia (CML)
Chronic lymphocytic leukemia (CLL)
Juvenile myelomonocytic leukemia (JMML). This is very
rare and is mostly found in very young children (toddlers).
The exact cause of leukemia in children is not known. There are
certain genetic and immune system conditions passed on from parents to children
(inherited) that increase the risk for childhood leukemia. Examples are Down syndrome
and Bloom syndrome. But most childhood leukemia is not inherited.
The risk factors for childhood
- Exposure to high levels of
- Having certain inherited syndromes,
such as Down syndrome and Li-Fraumeni syndrome
- Having an inherited condition that
affects the immune system
Symptoms of leukemia depend on many
factors. It might be in the bone marrow, blood, or other tissues and organs. These
include the lymph nodes, liver, spleen, thymus, brain, spinal cord, gums, and skin.
Symptoms can vary in each child,
and can include:
- Pale skin
- Feeling tired, weak, or cold
- Shortness of breath, trouble
- Frequent infections or infections that
don't go away
- Easy bruising or bleeding, many
nosebleeds, or bleeding gums
- Bone or joint pain
- Small, flat, red spots under the skin
- Belly (abdominal) swelling
- Not eating
- Weight loss
- Swollen lymph glands (nodes) that may
feel like firm bumps under the skin in the neck, armpits, or groin
These symptoms can be caused by
other, more common, health conditions. Make sure your child sees a healthcare provider
for a diagnosis.
Your child's healthcare provider
will ask a lot of questions about your child's symptoms. A physical exam will be done.
Blood tests and other tests may be needed. A complete blood count (CBC) shows the
of red blood cells, different types of white blood cells, and platelets in your child's
blood. If the results are abnormal, you may be referred to a pediatric cancer specialist
The oncologist may want to do more
tests to look for leukemia. If it's found, tests will be needed to learn more about
The tests used can include:
Bone marrow aspiration or biopsy. Bone marrow is in the
center of certain bones. It’s where blood cells are made. A small amount of bone
marrow may be taken out for testing. This is called aspiration. A solid piece of bone
marrow tissue may also be taken. This is called a biopsy. Bone marrow
is often taken from the back of the hip bone. Medicines will be used to help your
child sleep and not feel pain while this is done. This test can show if there are
leukemia cells in the bone marrow.
Lab tests of blood and bone marrow samples. Special tests
will be done on your child's blood and bone marrow. They're used to find out what
kind of leukemia it is and plan treatment. These tests include flow cytometry,
cytogenetic analysis, and immunohistochemistry. They look for things such as DNA and
chromosome changes in the leukemia cells.
X-ray. A chest X-ray might be done to look for infection,
swollen lymph nodes, or other changes inside your child's chest.
Ultrasound (sonography). This test uses sound waves and a
computer to create images of the inside of your child's body. It might be used to
look for swollen organs in the belly, such as the spleen, kidneys, and liver. It can
also be used to look at lymph nodes.
Lymph node biopsy. If swollen lymph nodes are found, a
tiny piece (sample) of the lymph node is taken out to be tested for cancer
Lumbar puncture. This is done to look for leukemia cells
in the brain and spinal cord. Medicine will be used to make your child sleep. Then
thin needle is put in between the bones of the lower back and into the spinal canal.
This is the area around the spinal cord. It contains cerebral spinal fluid (CSF),
fluid that flows around and cushions the brain and spinal cord. A small amount of
is removed and sent for testing.
When leukemia is diagnosed, tests
are done to find out the exact type of leukemia it is. Leukemia isn't given a stage
number like most other cancers. Instead it's classified into groups, subtypes, or
Classifying leukemia is very
complex. But it's an important part of making treatment plans and predicting treatment
outcomes. Be sure to ask your child's healthcare provider to explain the details of
child's leukemia in a way you can understand.
Before treatment starts, your child
may need to be treated for low blood counts or infections. This can be done by
- Red blood cell transfusions to bring
up low red blood cell levels
- Platelet transfusions to help stop
- Antibiotics to treat any
Leukemia treatment depends on
details about the type of leukemia, your child's age and overall health, your
preferences, and other factors. Treatment tends to be started soon after diagnosis.
You'll work with your child's treatment team to make the best plan. Sometimes more
1 kind of treatment is used. Leukemia can be treated with any of these:
Chemotherapy (chemo). This treatment uses strong medicines
to kill cancer cells or stop them from growing. Chemo is most often put into the
blood through a vein by an IV (intravenous) line. It can also be put right into the
spinal fluid (CSF), injected into a muscle, or taken by mouth. Chemo is the main
treatment for most leukemias in children. Several medicines are often given at
different times. It’s often done in cycles, with rest periods in between. This gives
your child time to recover between treatments.
Radiation therapy. This treatment uses high-energy X-rays
or other types of radiation beams to kill cancer cells or stop them from growing.
Radiation may be used in rare cases. But it's not used for most children with
High-dose chemotherapy with a stem cell transplant. Young
blood cells (stem cells) are taken from the child or from someone else. This is
followed by high doses of chemo. These doses kill the leukemia cells and the bone
marrow. Then the stem cells are given to rebuild healthy bone marrow. Transplant may
be needed if ALL comes back after treatment.
Targeted therapy. These medicines work in different ways
than chemo. They attack cancer cells that have certain changes in them. They might
used for certain subtypes of leukemia.
Immunotherapy. This treatment helps the body's own immune
system attack the cancer cells. It's mostly used in clinical trials at this
Supportive care. Cancer treatment can cause side effects.
Supportive care includes medicines and other treatments used to manage these side
effects. It can include treatments for pain, fever, infection, nausea, and vomiting.
Supportive care is used to treat the problems caused by the leukemia, not the disease
itself. It's a key part of good cancer care.
Clinical trials. Ask your child's healthcare provider if
there are any treatments being tested that may work well for your child. Most
children with cancer are treated as part of a clinical trial. This way a child gets
the best treatment available today, as well as treatment that's expected to be even
With any cancer, how well a child is expected to recover (their
prognosis) varies. Keep in mind:
- Getting medical treatment right away
is important for the best outcomes.
- Ongoing follow-up care during
and after treatment is needed.
- New treatments are being tested to
improve outcomes and to lessen side effects.
A child may have complications from
the leukemia or from treatment. These problems may be short-term or long-term.
Treatment can cause many side
effects. Some may be minor. Some may be serious and even life-threatening. Your child
may need medicines to help prevent or lessen side effects. You’ll also be given
instructions on what you can do at home.
Possible complications of leukemia
- Serious infections
- Severe bleeding (hemorrhage)
- Thickened blood from large numbers of
Possible long-term complications
from the leukemia or the treatment can include:
- Return of the leukemia
- Growth of other cancers later in
- Heart, lung, and thyroid problems
- Learning problems
- Slowed growth and development
- Hearing problems
- Problems with the ability to have
children in the future (infertility)
- Bone problems such as thinning of
Most childhood cancers, including leukemia, can’t be prevented.
A child with leukemia needs ongoing
care. Your child will be seen by oncologists and other healthcare providers to treat
late effects of treatment and to watch for signs or symptoms of the cancer returning.
Your child will be checked with imaging tests and other tests. And your child may
other healthcare providers for problems from the cancer or from treatment.
You can help your child manage
cancer treatment in many ways. For instance:
- Your child may have trouble eating. A
dietitian may be able to help.
- Your child may be very tired. They
will need to balance rest and activity. Encourage your child to get some exercise.
This is good for overall health. And it may help to lessen tiredness.
- Get emotional support for your child.
Find a counselor or child support group for help.
- Make sure your child goes to all
When to Call a Healthcare Provider
Talk with your child's healthcare provider about problems you should
watch for. Know how to get help after office hours and on weekends and holidays. Call
right away for any of the following:
- Fever of 100.4°F (38°C) or higher, or
as advised by your child's provider
- Symptoms or side effects that get
worse or don't get better with treatment
- New symptoms
- Leukemia is cancer of the blood. It's
the most common kind of cancer in children.
- The cancer cells grow in the bone
marrow and go into the blood.
- Common symptoms of leukemia in
children include feeling tired and weak, easy bruising or bleeding, and frequent or
- Leukemia is diagnosed with blood and
bone marrow tests. Imaging may be done to look for signs of leukemia in different
parts of the body.
- Chemotherapy is the main treatment for
most children with leukemia.
- Ongoing follow-up care is needed
during and after treatment.
Tips to help you get the most from
a visit to your child’s healthcare provider:
- Know the reason for the visit and what
you want to happen.
- Before your visit, write down
questions you want answered.
- At the visit, write down the name of a
new diagnosis, and any new medicines, treatments, or tests. Also write down any new
instructions your provider gives you for your child.
- Know why a new medicine or treatment
is prescribed and how it will help your child. Also know what the side effects
- Ask if your child’s condition can be
treated in other ways.
- Know why a test or procedure is
recommended and what the results could mean.
- Know what to expect if your child does
not take the medicine or have the test or procedure.
- If your child has a follow-up
appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your child’s
provider after office hours. This is important if your child becomes ill and you have
questions or need advice.