Leukemia

The term leukemia refers to cancers of the white blood cells (also called leukocytes or WBCs). Leukemias, as a group, make up about a quarter of all pediatric cancers. Luckily, with treatment, most children with leukemia will be free of the disease without it coming back.

Leukemias start in the bone marrow — the soft tissue found inside bones that produces blood cells. When a child is diagnosed with leukemia, it’s because the white blood cells in the body are producing abnormally. These cells (also known as blasts) start to crowd out the healthy cells in the bone marrow. Eventually, the healthy cells have no place to go, so they stop producing. When a child's body no longer produces enough healthy white blood cells it can cause anemia, swollen lymph nodes, and other symptoms of leukemia in children.

Leukemia is classified as being either acute (meaning it’s rapidly developing) or chronic (meaning it’s slowly developing). About 98% of pediatric leukemias are acute.

 
Types of Pediatric Leukemia
Types of leukemia in children include:
  • Acute lymphoblastic leukemia (ALL): This happens when too many lymphoblasts (a certain type of white blood cell) are produced.
    This is the most common type of leukemia, affecting nearly 60% of kids with leukemia.
  • Acute myelogenous leukemia (AML): This occurs when too many immature white blood cells (called myeloid blasts) are made.
    These leukemia cells are abnormal and can’t mature into normal white blood cells.
  • Chronic myelogenous leukemia (CML): This rare form of pediatric leukemia happens because there are too many mature white blood cells.

 
Signs and Symptoms of Leukemia in Children

Although the symptoms of leukemia in each individual child can vary, common symptoms of leukemia in children include:

  • anemia  (when the level of healthy red blood cells in the body becomes
    too low)
  • bleeding and/or bruising
  • frequent or reoccurring infections
  • bone and joint pain
  • abdominal pain
  • swollen lymph nodes (also called “swollen glands”)
  • difficulty breathing
  • excessive fatigue (more tired than usual)
  • poor appetite

IMPORTANT NOTE: Instances of the symptoms of leukemia in children listed above, either together or on their own, do not automatically mean that a child has leukemia or any other kind of cancer. Any or all of these symptoms could be a sign of something else.

 
Diagnosing Leukemia in Children

One of our Nemours pediatric hematologists-oncologists (doctors who treat blood disorders and cancers) will conduct a physical examination on your child to check for symptoms of leukemia in children such as signs of infection, anemia, abnormal bleeding, and swollen lymph nodes.

The doctor will also feel your child's abdomen to see if the liver or spleen is enlarged. We’ll also take a complete medical history by asking about your child’s symptoms, past health, your family's health history, any medications your child is taking, allergies, etc.

After this exam, the doctor will order a CBC (complete blood count) to measure the numbers of white cells, red cells, and platelets in your child's blood. Your child’s blood chemistries will also be checked.

Then, depending on what we find in the exam and blood tests, your child also may need a:

  • bone marrow biopsy and aspiration (when marrow samples are taken for testing, usually from the back of the hip)
  • lymph node biopsy (when lymph nodes are removed and examined under a microscope to look for abnormal cells)
  • lumbar puncture (also called a spinal tap, when a sample of spinal fluid is taken from the lower back and examined for evidence of abnormal cells. This test will show if the leukemia has spread to the brain and spinal cord.)

We know that tests can be scary – for you and your child. Whatever kind of tests your child might need, know that your Nemours pediatric leukemia care team will do everything we can to make the experience as comfortable as possible – physically and emotionally. We’ll give sedation or anesthesia as needed and offer support and guidance at every step.

Learn more about what to expect with certain medical tests »

 
Treating Leukemia in Children

Depending on your child’s age, overall health, extent of the disease, and other factors, treatment may include one or a combination of the following:

  • chemotherapy
  • radiation therapy   
  • blood or bone marrow transplant (also sometimes called a BMT, BBMT, stem cell transplant, or cord blood transplant)
  • medications/antibiotics
  • blood transfusions

At Nemours, we know that getting a cancer diagnosis can be very frightening and overwhelming for your whole family. That’s why Nemours’ board-certified pediatric hematologists-oncologists, specialty nurses, cancer researchers, and other cancer experts are focused on helping not only your child, but your family, as well.

From diagnosis to treatment (and beyond) we’ll be here to help guide your family through your pediatric leukemia journey – and to strive and hope, with you, for a better tomorrow.

Acute Myeloid Leukemia (AML)

About Leukemia

Leukemia is a type of cancer that affects the body's white blood cells (WBCs).

Normally, WBCs help fight infection and protect the body against disease. But in leukemia, WBCs turn cancerous and multiply when they shouldn't, resulting in too many abnormal WBCs, which then interfere with the body's ability to function normally.

In acute myeloid leukemia (AML), too many immature white blood cells (called myeloid blasts) are made. These leukemia cells are abnormal and cannot mature into normal white blood cells. This type of leukemia affects 20% of kids with this cancer of the blood cells.

Thanks to advances in therapy and clinical trials, the outlook for kids with AML is promising. With treatment, most are cured.

Causes

The cause of AML is unknown, though doctors know that certain medical conditions can increase a child's risk of getting AML. However, just because a child has a risk factor does not mean that he or she will get AML.

Risks include inherited genetic problems such as Down syndrome, neurofibromatosis type 1, Fanconi anemia, Noonan syndrome, and other inherited bone marrow failure syndromes (IBMFS). In addition, other non-inherited conditions such as preleukemia (also called myelodysplastic syndrome or MDS) and aplastic anemia can increase the risk of AML.

AML is also more common in kids who've been treated with chemotherapy or radiation. In fact, AML is the most common type of secondary cancer in children who have previously undergone cancer treatment.

In addition, a child with an identical twin who was diagnosed with leukemia before age 6 has a 20% to 25% chance of developing AML. Fraternal twins and other siblings of kids with leukemia have two to four times the average risk of developing it, too.

Certain environmental factors can predispose a child to leukemia. For example, exposure to radiation (such as X-rays) prior to birth may trigger the disease in a developing fetus.

Signs and Symptoms

AML is called "acute" because it tends to worsen quickly if left untreated. Chronic blood cancers, like chronic myelogenous leukemia (CML), tend to progress more slowly. However, the symptoms of all types of leukemia are generally the same and include:

  • fatigue and weakness
  • swollen lymph nodes
  • recurrent infections (like bronchitis or tonsillitis)
  • fever
  • easy bruising or petechiae (tiny red spots on the skin caused by easy bleeding)
  • bone and joint pain
  • abdominal pain (caused by abnormal blood cells accumulating in organs like the kidneys, liver, and spleen)

Sometimes a child might have painless lumps that can be felt in the lymph nodes of the neck, underarm, or groin area. These lumps of leukemia cells (called chloromas) can develop anywhere in the body.

Diagnosis

The subtypes of AML are classified according to the way the cells look under a microscope. If a doctor suspects leukemia, a child may undergo tests that include:

  • Blood tests. Tests such as a complete blood count, liver and kidney function panels, and blood chemistries can give important information about the number of normal blood cells in the body and how well the organs are functioning. The blood cells will also be examined under a microscope to check for abnormal shapes or sizes, and determine which subtype of AML a child has.
  • Bone marrow aspiration and biopsy. In this procedure, the doctor inserts a needle into a large bone, usually the hip, and removes a small amount of bone marrow to examine it for abnormal cells.
  • Imaging studies. These may include an X-ray, CT scan, MRI, or ultrasound to check for an enlarged spleen or liver, and also to rule out any other possible causes of a child's symptoms.
  • Lumbar puncture. Also called a spinal tap, this procedure uses a hollow needle to remove a small amount of cerebrospinal fluid (the fluid surrounding the brain and spinal cord) for examination in a lab.
  • Flow cytometry tests. By analyzing the properties of the cancer cells, doctors can determine the type of leukemia a child has. This is important because treatment varies among different types of leukemia.
  • Chromosomal tests. By analyzing DNA from blood or bone marrow, doctors can check for the specific genetic changes that identify the various subtypes of AML. This is important because treatments may vary according to subtype.
  • Tissue typing or HLA (human leukocyte antigen) typing. If a child needs a stem cell transplant (also called a bone marrow transplant), this test helps doctors find a suitable stem cell donor. It works by comparing the proteins on the surface of a child's blood cells with the proteins on a potential donor's cells. The more "HLA markers" a child and donor share, the greater the chance that a transplant will be successful.

Treatment

Because it can progress so quickly, there is no staging system for AML. Doctors generally characterize the disease as newly diagnosed or in remission.

Treatment is divided into two phases. The goal of the first phase, called induction, is to kill as many cancer cells as possible and achieve remission (a state where there is no evidence of disease in the body). The second phase (called post-remission, consolidation, or continuation therapy) is designed to eliminate any undetectable leukemia cells.

Phases I and II of treatment may include the following therapies alone or in combination:

  • Chemotherapy. This is the use of special drugs to kill the cancer cells. Several chemotherapy drugs are often combined to attack the cancer cells in different ways.
  • Chemotherapy through lumbar puncture. This procedure, known as intrathecal (IT) chemotherapy, delivers chemotherapy drugs directly to the cerebrospinal fluid, where cancerous cells can collect.
  • All-trans retinoic acid (ATRA). This vitamin A treatment is sometimes given alongside chemotherapy to kids with acute promyelocytic leukemia (APL), a subtype of AML.
  • Arsenic trioxide. This substance (an inorganic compound) is also used to treat kids with APL.
  • Stem cell transplant (also called bone marrow transplant). This procedure involves destroying cancer cells and normal bone marrow and immune system cells with high-dose chemotherapy and then reintroducing healthy donor stem cells into the body. These new stem cells can rebuild a healthy blood supply and immune system.
  • Clinical trials. These are research studies that offer promising new treatments that are not yet available to the general public. A child's doctor will decide if a child is a good candidate for a clinical trial.

Coping

Being told that a child has cancer can be a terrifying experience, and the stress of cancer treatment can be overwhelming for any family.

Although you might feel like it at times, you're not alone. To find out about support that may be helpful to you or your child, talk to your doctor or a hospital social worker. Many resources are available to help you get through this difficult time.

Reviewed by: Emi H. Caywood, MD
Date reviewed: March 2012