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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.

Chronic Myelogenous Leukemia (CML)

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.

If too many mature WBCs are made, a child will develop chronic myelogenous leukemia (CML). While this type of leukemia is more common in adults, it can affect children, too.

Thanks to advances in therapy and clinical trials, the outlook for kids with CML is promising.

Causes

CML is caused by a chromosomal problem. The 23 pairs of chromosomes in the body each contain segments of DNA called genes. Genes are essentially the body's blueprints.

CML occurs when a piece of chromosome 22 breaks off and switches places with a piece of chromosome 9. (This piece, containing parts of both chromosome 9 and chromosome 22, is known as the Philadelphia chromosome.) The combination results in the cancer gene known as BCR-ABL. This is the gene that instructs the body to make too many mature WBCs.

Although researchers know what genes are involved in the development of CML, they do not yet know why some people get it and others do not.

Signs and Symptoms

CML tends to progress slowly, so at first a child may have few if any symptoms. In fact, symptoms can take months or even years to develop. 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
  • bone and joint pain
  • abdominal pain (caused by abnormal blood cells accumulating in organs like the kidneys, liver, and spleen)

Diagnosis

Often no symptoms appear for quite a while with CML, so it's commonly discovered when a child has a routine blood test for other reasons. A doctor who suspects a child has leukemia might order these tests:

  • 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.
  • 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. Cancerous WBCs can collect in this area.
  • 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 a child's blood or bone marrow, doctors can tell whether the Philadelphia chromosome is present. They also can tell how many cancer cells are in the blood at any given time.
  • 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

Treatment of CML takes into account things like the phase of the leukemia (whether it's in the early or later stages of the disease), the amount of cancerous cells in the body, and how well the other organs of the body are working. This information, in addition to a child's age and overall heath, helps doctors develop treatment plans that may include these options:

  • Targeted therapy. This treatment uses drugs to identify and attack the cancer cells without hurting the normal cells. These drugs, called tyrosine kinase inhibitors, target the cancer cells in CML and may be used as the first treatment for patients with an early phase CML.
  • Chemotherapy. This is the use of special drugs to kill cancer cells. Sometimes drugs are used in combination to attack the cells in different ways.
  • Stem cell transplant. This procedure involves destroying cancer cells and normal bone marrow and immune system cells with high-dose chemotherapy and then re-introducing healthy donor stem cells into the body. The new stem cells can rebuild a healthy blood supply and immune system.

After treatment begins, the goal is remission (when there is no longer evidence of cancer cells in the body). Once remission has occurred, maintenance chemotherapy is usually given to keep a child in remission and to keep killing cancer cells. The effect of treatment is assessed regularly by measuring how many BCR-ABL genes are in the blood.

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 available to you or your child, talk to your doctor or a hospital social worker. Many resources are available that can help you get through this difficult time.

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