Childhood leukemia is the most common type of tumor in the underage population. The abnormal white blood cells come from the bone marrow, and they can spread rapidly through the body’s bloodstream, crowding out normal cells and increasing the risk of infection and other health problems in affected children.
While tumors in children are tricky, most childhood leukemias can be successfully cured.
What can cause childhood leukemia?
Clinicians do not yet know the exact cause of childhood leukemia, but certain factors increase the risk of the disease. It is important to note that children with risk factors will not always develop leukemia. In fact, most children with leukemia do not have any known risk factors.
The following factors are generally considered to increase the risk of childhood leukemia:
- Having congenital inherited Li-Fermini syndrome, Down syndrome, or Creutzfeldt-Jakob syndrome;
- Having an inherited immune system disorder such as ataxia capillaris;
- Has a sibling with leukemia, especially in identical twins;
- Has been exposed to high doses of radiation, chemotherapy drugs, or organic solvents such as benzene;
- Treatment with immunosuppressive drugs, such as organ transplants.
Despite the low level of risk, clinicians nevertheless recommend that children with the above leukemia risk factors should ideally have regular medical checkups for early detection of abnormalities.
What types of childhood leukemia are there?
Almost all childhood leukemias are acute leukemias, which means that the disease progresses very rapidly. Only a very small percentage of children have chronic leukemia, which progresses slowly.
The classification of childhood leukemia includes:
- Acute lymphoblastic leukemia (ALL), which accounts for about 3/4 of all childhood leukemias.
- Acute lymphoblastic leukemia (ALL), which accounts for about 3/4 of all childhood leukemias.
- Acute myeloblastic leukemia (AML), the second most common clinical type of childhood leukemia.
- Mixed spectrum leukemia, a rarer type with features of both ALL and AML.
- Chronic myelogenous leukemia (CML), rare in children.
- Chronic lymphocytic leukemia (CLL), which is rare in children.
- juvenile myelomonocytic leukemia (JMML), a rarer type of leukemia that is neither chronic nor acute, often occurs in children younger than 4 years of age.
What are the common symptoms of childhood leukemia?
Symptoms of leukemia are usually the same as those of acute leukemia.
Leukemia symptoms are often the cause of visits to the doctor, and early diagnosis can make an eventual cure more likely.
Many of the signs and symptoms of childhood leukemia occur when leukemia cells crowd out normal cells to survive.
Common symptoms include:
- Lack of energy or pale skin;
- Infection and fever;
- Easy bleeding or bruising;
- extreme fatigue or weakness;
- Shortness of breath;
- Cough.
Other symptoms include:
- Bone pain or joint pain;
- swelling in the abdomen, face, arms, armpits, side of the neck, and groin;
- swelling above the clavicle;
- loss of appetite or weight loss;
- Headache, epilepsy, balance disorders, or visual abnormalities;
- Vomiting;
- Rash;
- Gum lesions.
How is childhood leukemia diagnosed?
To diagnose childhood leukemia, the doctor needs to take a complete medical history of the child and perform a detailed physical examination. The physical examination is done to confirm the diagnosis and staging of leukemia, and the initial examination includes:
- Hematology, blood count, and observation of blood cell morphology;
- Bone marrow aspiration biopsy, usually from the hip bone, to obtain a sample of bone marrow to confirm the diagnosis of leukemia;
- Lumbar puncture or spinal tap to check for the spread of leukemia cells into the cerebrospinal fluid.
The pathologist examines the child’s blood cells under a microscope and also examines a bone marrow sample to assess the number of hematopoietic cells and adipocytes.
The child also undergoes other tests to determine the type of leukemia, and the doctor uses the results of these tests to predict the effectiveness of treatment options for the child with leukemia.
Some tests need to be repeated.
Some tests need to be repeated to evaluate how well the child is responding to the treatment.
How is childhood leukemia treated?
The child’s family needs to have a full conversation with the treating physician to develop the optimal treatment plan based on the leukemia staging and a combination of other factors.
There is a significant improvement in survival rates for most types of childhood leukemia, and pediatric medical centers have the advantage of more specialized treatment and care.
Before oncology treatment can begin, the child needs to address complications of the disease. For example, changes in blood cells can lead to infection or risk of severe bleeding, which can affect the amount of oxygen supplied to body tissues. Treatment options may include the application of antibiotics, blood transfusions, and other anti-infective measures.
- Chemotherapy: Chemotherapy is the primary treatment for childhood leukemia. Children can receive antineoplastic agents orally, intravenously, or intrathecally (injected into the spinal cord). To avoid leukemia relapse, patients also need to be treated with a cyclic maintenance regimen over a 2- to 3-year period.
- Targeted therapy: Sometimes, targeted therapy is also used to treat leukemia. This therapy targets specific sites of tumor cells and works in a different way than standard chemotherapy regimens. Targeted therapy is effective for specific types of childhood leukemia with fewer serious side effects.
- Radiotherapy: Radiotherapy kills tumor cells through high-energy radiation, causing the tumor to shrink. It can also help prevent or treat leukemia that has spread to other parts of the body. Childhood leukemia is rarely treated with surgery.
- Stem cell transplantation: If standard treatment options do not work well, stem cell transplantation may be the best option. The process involves systemic radiation therapy combined with high-dose chemotherapy to destroy the child’s existing bone marrow tissue, followed by transplantation of new hematopoietic stem cells.
- Gene therapy: The FDA has approved a gene therapy, CAR-T cell therapy, for B-cell acute lymphoblastic leukemia under age 25 that has failed to respond to other regimens. Scientists are also exploring the efficacy of this therapy for patients with tumors over the age of 25.
CAR-T cell therapy, which involves harvesting a patient’s own immune cells – T cells – for the treatment of tumors. Clinicians isolate T cells from a patient’s blood and modify the cells by loading them with new genes, and the new, improved T cells are better able to recognize and destroy tumor cells.