Leukemia is the most common type of childhood cancer.
Thankfully, the survival rates for childhood leukemia have increased dramatically over the past several decades. Most cases of childhood leukemia are acute and spread very quickly.
The most common type of leukemia in children is acute lymphocytic leukemia (ALL).
Leukemia is a blood cancer. Most leukemia begins with cells that would usually become white blood cells. Normally, your body makes the correct amount of white blood cells needed to fight infections and carry out other important body functions.
Children with leukemia produce too many white blood cells, and these cells don’t function properly. The cells grow too quickly, crowding out red blood cells and platelets.
Most children with leukemia have an acute form of it. Acute leukemia progresses very quickly in the body and needs immediate treatment. The two types of leukemia most common in children are:
- Acute lymphocytic leukemia (ALL). ALL is the most common type of childhood leukemia and accounts for about 75 percent of all cases. ALL starts in immature white blood cells, called lymphoblasts. These cells create antibodies to fight things like bacteria and viruses in your body.
- Acute myeloid leukemia (AML). AML is the second most common type of childhood leukemia. AML begins in the bone marrow and then spreads through the blood. AML prevents immature blood cells found in bone marrow (called myeloblasts or monoblasts) from maturing into white blood cells that help fight infection and disease.
While ALL and AML account for almost all cases of childhood leukemia, children can sometimes develop other leukemia types. Rare types of leukemia in children include:
- Mixed lineage leukemia (MPAL). MPAL is a type of leukemia that has features of both AML and ALL. When it occurs in children, doctors generally follow the same treatment plan as ALL.
- Chronic myeloid leukemia (CML). Chronic leukemia is extremely rare in children. CML is a type of chronic leukemia that begins in the bone marrow. It develops and spreads slowly.
- Chronic lymphocytic leukemia (CLL). Just like CML, CLL spreads very slowly and is rarely found in children. CLL also begins in the bone marrow.
- Juvenile myelomonocytic leukemia (JMML). JMML is a rare type of leukemia that most often occurs in very young children. In JMML leukemia grows faster than CML but slower than AML.
The symptoms of leukemia in children can be hard to spot at first. Many symptoms are commonly seen in other, less serious, conditions. However, since childhood leukemia spreads quickly, getting medical attention as soon as possible is very important.
If your child has any of the symptoms below, especially if they’ve had them for more than 2 weeks, it’s time to make an appointment.
Symptoms that of leukemia in children include:
- loss of appetite
- weight loss
- joint pain
- pale skin
- trouble breathing
- cough that doesn’t go away
- lightheadedness or dizziness
- infections that don’t go away
- easy bruising
- trouble stopping bleeding after small cuts or scrapes
- frequent nosebleeds
- bleeding gums
- swollen stomach
- swollen lymph nodes
- swelling in the arms or face
Keep in mind that not all children will display all — or even most — of these symptoms. Additionally, most, if not all, of these symptoms are more often caused by other conditions.
So if a child has any of these symptoms, it doesn’t automatically mean they definitely have leukemia. But it does mean they should see a medical provider.
Your child might have several medical appointments and tests done if a doctor suspects leukemia.
At a first appointment, a doctor will ask you more about your child’s symptoms and about how long they’ve had them. The doctor will also want to know about any important family medical history, such as a family member who’s had or has cancer.
The doctor will also do a physical exam to look for signs of leukemia like paleness, bruises, swollen lymph nodes, or a swollen stomach.
If your child’s medical history or physical exam suggests leukemia, the doctor may then order tests to see if leukemia is causing your child’s symptoms.
Tests your child might have include:
Complete blood count (CBC)
A CBC is a lab test done with a standard blood draw. The test looks at the ratio of red blood cells, white blood cells, and platelets in the blood. This is important because children with leukemia normally have too many white blood cells.
A blood smear is a lab test that allows doctors to look at blood under a microscope. They’ll examine the blood for cells that look abnormal.
Bone marrow biopsy and aspiration
A biopsy and aspiration is done by inserting a long needle into a bone to extract liquid bone marrow cells and a small piece of bone.
The area will be numbed, and children are generally given medicine to help them relax or even sleep during the test. This allows doctors to analyze cancerous white blood cells produced in the bone marrow.
Also called a spinal tap, this test will be done if the doctor suspects there are leukemia cells in the fluid around the spinal cord and brain.
This test involves a needle being inserted in between the spinal bones to extra fluid. Children are often given medicine that allows them to sleep through this test.
In some cases, a doctor might order imaging tests, like x-rays and ultrasounds. These tests can help doctors get a closer look at a child’s lymph nodes or at organs that might be affected by cancer like the liver, spleen, kidney, or lungs.
Researchers aren’t sure what causes leukemia in children. In many cases, children diagnosed with leukemia have no risk factors and the cause of their leukemia is unknown.
Researchers do know that changes to the DNA inside bone marrow cells cause the disruption that leads to leukemia. Multiple chromosomal abnormalities can lead to this DNA change.
Chromosomal abnormalities can be inherited, but most often occur during the child’s lifetime.
More research is still being done to determine if there are more exact causes of leukemia in children. Some researchers think a combination of inherited genetics and risk factors might be the cause in at least some cases. But this hasn’t been proven.
Currently, there’s no known cause of most cases of leukemia in children.
Since scientists aren’t sure what causes leukemia in children, there’s no way to prevent it.
Some researchers are looking into ways to improve immune-suppressing medicines or chemotherapy treatments so that they don’t increase the risk of leukemia. But at the moment they’re the safest and most effective treatments available.
Some research suggests reducing exposure to things that might cause an increased risk of leukemia. This might include:
- avoiding unnecessary X-rays or CT scans
- keeping children away from pesticides and other strong chemicals
- both parents quitting smoking
- trying to limit or reduce exposure to polluted air
Childhood leukemia is treated by doctors who specialize in cancer in children, called pediatric oncologists. The oncologist will develop a treatment plan based on the type of cancer your child has and on how far it’s progressed.
In some cases, children might need treatment for symptoms before cancer treatment can begin. For example, a child with a bacterial infection will likely need antibiotic treatment before beginning their leukemia treatment.
The primary treatment for all types of childhood leukemia is chemotherapy. In some cases, children might also need radiation, surgery, or medication. The exact course of treatment depends on the type of leukemia your child has.
Treatment of children with acute lymphocytic leukemia (ALL)
Children with ALL receive chemotherapy treatment in three phases:
- Induction. This is the first phase of chemotherapy. Children will receive chemotherapy and take medicines aimed at achieving remission and might have multiple hospital stays. This phase usually lasts 1 to 3 months.
- Consolidation. Once their leukemia is in remission, children will start the consolidation phase. Children will receive several months of chemotherapy aimed at keeping ALL in remission during this phase. Some children might also receive a stem cell transplant during this phase.
- Maintenance. Children who remain in remission can enter the maintenance phase. During this phase, children can take prescription medicine to help keep their cancer in remission. The length of this phase will depend on the individual child and their progress.
Treatment of children with acute myeloid leukemia (AML)
Children with AML needed to be treated through an inpatient program at a hospital or cancer treatment center. They’ll receive chemotherapy in two phases:
- Induction. Children will receive intensive chemotherapy during the induction phase. The induction phase lasts until remission is achieved.
- Consolidation. Ducting consultation chemotherapy is used to destroy any remaining cancer cells. Some children might also have a stem cell transplant during this phase.
There’s no maintenance phase for children with AML.
The type of leukemia a child has also has an impact on the outlook. Both major types of childhood leukemia have seen a huge increase in survival rates over the past several decades as doctors have gotten better at treating leukemia.
However, even though both types now have much higher survival rates, there’s a difference in the outlook.
Based on the most recent research (2009-2015), the overall 5-year survival rate for ALL in children is 91.9 percent. The overall 5-year survival rate for AML in children is 68.7 percent.
While cancer is rare in childhood, leukemia is the most common type of cancer that affects children. Most children develop acute leukemias.
The exact treatment and outlook depend on the type of leukemia and on how far it’s progressed. The outlook for all types of leukemia today is much better than in the past.