Can Infants Get Leukemia?

Leukemia is a type of cancer that affects the blood cells made by the body. Typically, infants are able to make the right amount of white blood cells to fight off illness and infection.

Infants with leukemia make too many white blood cells. The cells grow rapidly and make it impossible for the body to have the right amount of other blood cells, including red blood cells and platelets.

There are several types of leukemia, but the term “infant leukemias” generally refers to two types when they occur in children younger than a year old:

• Acute lymphocytic leukemia (ALL). This type of leukemia begins in the immune system. It affects a type of immature white blood cells called lymphocytes. About 90 cases of infant ALL are diagnosed every year, according to a 2016 review of studies.
• Acute myeloid leukemia (AML). This type of leukemia begins in the bone marrow. As it grows, it spreads through the bloodstream and the body. About 70 cases of infant AML are diagnosed each year.

Symptoms of leukemia in older children can be mild at first. They may be similar to symptoms of the flu or other less serious conditions.

This is generally not the case with infants. Infants with leukemia tend to get sicker much faster and have more severe symptoms.

Infants are more likely to have signs and symptoms such as:

• High white blood cell counts. This can cause symptoms like:
  • fever
  • fatigue
  • swollen lymph nodes
  • trouble gaining weight
  • weight loss
  • trouble breathing
• Swelling of the liver and spleen. This can cause a yellowing of the skin and eyes called jaundice, as well as vomiting and easy bruising.
• Leukemia cells that spread into the skin. This causes a rash known as leukemia cutis. Infants with the rash have raised bumps that are generally purple, brown, red, or skin-colored. The rash is often found on the face, neck, and upper body.
• Nervous system problems. When leukemia affects an infant’s nervous system, it can cause the infant to have strange limb movements and trouble staying awake.

Infants with leukemia will likely also experience pain, muscle aches, and other discomforts. This will likely cause the baby to show signs of distress, like crying and screaming. The infant might have trouble eating and may sleep more than a typical infant.

It’s always a good idea to take an infant to a healthcare professional if they’re having any health symptoms or seem unusually distressed. Even if the cause isn’t something as serious as infant leukemia, it’s important to seek care as soon as possible.

The American Academy of Pediatrics recommends that infants have several well-child visits throughout their first year of life.

However, if your child has symptoms of leukemia or if you’re concerned, see your pediatrician immediately rather than waiting for the next scheduled well visit.

Your doctor will ask several questions if your infant has symptoms of leukemia. They’ll want to know the exact symptoms your baby has and how long these symptoms have been present. They’ll likely ask you if you have a family history of cancers or other conditions.

The doctor might then examine your infant for:

• signs of bruises
• swollen lymph nodes
• leukemia cutis skin rash

Your infant will need tests to confirm a diagnosis. They’ll need to have their blood drawn for lab work.

In infants, especially infants younger than 6 months old, blood is often drawn from the baby’s heel. This is called a dermal puncture, and it’s performed by poking the heel with a small needle and then collecting the drops of blood.

Infants might also have standard blood drawn by inserting a needle into a vein. Your child might be able to sit on your lap while this is being performed.

Blood draws allow a lab to test the blood to determine how many white blood cells, red blood cells, and platelets your infant has.

Drawing blood will also allow them to examine the cells under a microscope and look for any abnormal cells. Infants with leukemia will have a high number of white blood cells and abnormal cells.

Your child might also need a test to check their bone marrow. They’ll be put under anesthesia for this procedure, called a bone marrow biopsy.

During this procedure, a needle will be inserted into the spine so that a sample of bone marrow cells and a small piece of bone can be collected. This helps determine if there are cancer cells in the bone marrow.

Scientists and researchers aren’t sure what causes leukemia in infants. The condition is very rare, and conclusions are difficult to draw from such a small sample size. However, it is theorized that genetics may play a large role in infant leukemia.

Researchers think that some children inherit genes or genetic mutations that make them more likely to develop leukemia as infants.

Researchers also suspect environmental exposures and other factors during pregnancy may increase the risk that an infant will develop leukemia, but this is still being investigated.

Since there is no known cause for leukemia in infants, it’s difficult to pinpoint exact risk factors.

Infant leukemia is also very rare. With so few cases each year, it’s harder for researchers to study the condition and learn what the risk factors might be. However, there are things that make it more likely an infant will develop leukemia. These include having:

• certain genetic conditions, including Down syndrome and Li-Fraumeni syndrome
• a condition that affects the immune system
• a sibling with leukemia

Treatment for infants with leukemia often looks different from treatment for older children with leukemia. Infants are more likely to have trouble tolerating standard leukemia treatments and medications. Treatment depends on how the infant first responds and the type of leukemia they have.

Infants with leukemia will be treated by pediatric oncologists who specialize in cancer in children.

You might need to take your child to a specialty hospital or cancer center for treatment. Infants with leukemia will generally have chemotherapy at the center.

Chemotherapy

Infants with AML are treated with chemotherapy. There are two phases of treatment, induction and consolidation.

During the induction phase, the infant will receive intensive chemotherapy until the AML goes into remission.

Once the AML is in remission, infants will receive smaller doses of chemotherapy to kill any remaining cancer cells. This is called consolidation.

Infants with ALL will also receive chemotherapy. Some studies have found that chemotherapy protocols for AML are more effective in infants with ALL than the chemotherapy normally used for ALL in older children. The exact course of treatment will depend on how the infant first responds to treatment.

Stem cell therapy

Because up to 50 percent of infants with leukemia relapse, infants with leukemia may undergo stem cell transplants, also called bone marrow transplants, along with chemotherapy.

Stem cell transplant generally comes after consolidation, which is strong chemotherapy with the goals of:

• Decreasing older bone marrow cells. This makes room for the new marrow.
• Killing remaining cancer cells. This helps stop cancer from growing and spreading.
• Stopping or slowing the immune system. This helps prevent the rejection of the implanted stem cells.

After consolidation, stem cells are injected into a central line, which is a small tube inserted into a vein near the heart. The infant will need to stay in the hospital while the new stem cells begin to grow to help prevent infection.

Your child’s oncologist will determine the best treatment option for them.

Leukemia in infants spreads fast and is harder to treat than leukemia in older children. This leads to a worse outlook for infants with leukemia.

In a 25-year study that included over 15 thousand children with leukemia, researchers found that a child’s age at diagnosis is a predictor for recovery, with infants less than a year old having the lowest survival rates of children with ALL or AML.

Another factor is white blood cell count at the time of diagnosis. Infants with a very high white blood count at diagnosis have a less-promising outlook than infants with lower white blood cell counts.

Research is currently being done to help find treatments and methods that overcome the challenges of treating infants. Though survival rates are lower for infants, the outlook for children with childhood leukemia is generally good with 5-year survival rates of nearly 90 percent for ALL and 60 to 70 percent for AML. The 5-year survival rate for infants less than 1-year-old is 46 percent for ALL and slightly better for AML.

Infant leukemia is a very rare but very serious cancer. Infants with leukemia might have more severe symptoms than older children, and it might be harder for doctors to treat them.

Research is ongoing to find causes and treatments for infant leukemia and to improve future outcomes.