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Tag Archives: Childhood Leukemia

Childhood Leukemia: Long-Term Prognosis and Survival Rates

i-4BrMB6x (1)When discussing long-term survival rates for childhood leukemia and other types of childhood cancer, oncologists rarely use the term “cure”. Instead, to discuss short-term outlook and response to treatment, doctors will discussion remission, minimal residual disease, and relapse. For longer term outlook, physicians use a number called the 5-year survival rate. Thanks to advances in treatment options, both remission rates and 5-year survival rates for childhood leukemia have significantly improved over the past several decades, and children who remain free of leukemia after five years are generally considered “cured”.

In the short term, the goal of chemotherapy is to achieve remission. Remission is defined by a lack of leukemia cells after the initial induction phase of chemotherapy. A child is considered to have achieved remission if the bone marrow contains less than 5% of blast cells, blood cell counts are within normal limits, and the child shows no symptoms of disease. Further chemotherapy after remission is designed to destroy any remaining leukemia cells, as well as prevent the growth of new cancer cells.

If the leukemia does not respond to initial treatment, it is classified in one of two ways. Minimal residual disease means that cancer cells in the bone marrow can be detected with more sensitive tests than a standard microscope scan. MRD usually involves a higher risk of relapse (growth of new cancer cells). Active disease means that cancer cells are still easily detectable in the bone marrow, indicating either that the leukemia has not responded to treatment or that there has been a relapse of the disease. In both of these cases, oncologists will likely pursue more intensive chemotherapy in order to achieve remission.

The 5-year survival rates for both Acute lymphocytic leukemia (ALL) and Acute myelogenous leukemia (AML) have greatly improved over the past few decades. For ALL, the 5-year survival rate is now more than 85%. For AML, the 5-year survival rate is 60-70%; however, these rates vary greatly depending upon the subtype of AML as well as other factors.

Prognosis Factors for Childhood Leukemia

When discussing 5-year survival rates for childhood leukemia (as with any form of childhood cancer), it is important to remember that the specific numbers given above are only an average compiled from all treated cases of childhood leukemia across the Unites States, and do not provide a specific prognosis for your child. Your child’s oncology team will help you understand your child’s prognosis and potential for long-term survival, based on your child’s unique diagnosis, response to treatment, and general health.

There are several key prognosis factors that will help your child’s oncology team understand the degree of risk presented by your child’s leukemia, as well as the intensity of the requirement treatment.

Prognosis factors relative to ALL: During the diagnostic process, childhood leukemia is generally categorized into three “risk groups”: standard-risk, high-risk, or very high-risk. These risk groups will help determine the intensity of the required treatment and may impact the child’s long-term prognosis. Generally speaking, children in the standard-risk group have a better outlook than children in the very high-risk grouping; however, thanks to advances in treatment options, even children with very high-risk leukemia still have an excellence chance of achieving remission and long-term cure. Other prognosis factors include:

  • Age at diagnosis: Children between the ages of 1 and 9 tend to have a more positive prognosis than children under the age of 1 or over the age of 10. This applies only to B-cell ALL; age does not seem to be a prognosis factor in T-cell ALL.
  • Initial white blood cell count: Children with very high WBC counts at diagnosis are generally placed in the high or very high risk group and will require more intensive treatment.
  • Subtype of ALL: Children who are diagnosed with pre-B, common, or early pre-B-cell ALL have a more positive prognosis outlook than children with mature B-cell leukemia; this is also true of B-cell ALL with intensive treatment.
  • Gender: Girls have a slighter better prognosis outlook than boys, although this gap has shrunk in recent years than to more advanced treatment options.
  • Race/ethnicity: African-American and Hispanic children seem to have a slighter worse outlook than other ethnicities.
  • Spread to other organs: The spread of the leukemia into specific organs such as the fluid around the brain and spinal cord, as well as the testicles in boys, usually classifies the leukemia as high or very high risk with a less favorable outlook.
  • Number of chromosomes and chromosome translocations: Studies have linked some prognosis factors to the number of chromosomes within the leukemia cells, as well as translocations (or the swapping of genetic material) between specific chromosomes.
  • Response to treatment: The initial reduction of cancer cells in the bone marrow during the first 1 to 2 weeks of chemotherapy helps determine long-term outlook; however, if the leukemia does not respond as expected in this time frame, doctors will generally initiate a more intensive treatment protocol.

Prognosis factors for AML: The prognosis factors for AML are similar to those listed above for ALL but with some minor differences; however, prognosis factors in general do not seem to be quite as important in either guiding treatment or predicting short- or long-term outcomes.

About American Childhood Cancer Organization

American Childhood Cancer Organization (ACCO) is a non-profit charity dedicated to helping kids with cancer and their families navigate the difficult journey from cancer diagnosis through survivorship. Internationally, ACCO is the sole U.S. member of Childhood Cancer International (CCI), the largest patient-support organization for childhood cancer in the world. Here in the United States, ACCO promotes the critical importance of ensuring continued funding into new and better treatment protocols for childhood cancer.  And most importantly, ACCO is focused on the children: developing and providing educational tools for children fighting cancer and their families, empowering them in their understanding of childhood cancer and the medical decisions they must make during this difficult journey. All of ACCO’s resources are available free of charge for families coping with childhood cancer.

For additional information about childhood cancer or on the ACCO, or to order resources for you or your child, please visit our website at www.acco.org , call 855.858.2226 or visit:

What is the Treatment for Childhood Leukemia?

The majority of children diagnosed with childhood leukemia will be treated with chemotherapy. Chemotherapy (often simply called “chemo” for short) involves targeting cancerous cells with specific drugs. The specific type of drugs, their dosages, and the duration of the treatment will be unique to each patient, depending on the type and classification of leukemia, the cancer’s classification of risk, and the specific needs of each child. Surgery and radiation are not commonly utilized in the treatment of childhood leukemia, although they may be required to address specific health issues in certain cases. Because chemotherapy can have significant short- and long-term health effects on childhood leukemia survivors, researchers are continuing to investigate new and less toxic treatments such as immunotherapy and targeted chemotherapy; however, these treatments are still in the research phase.

Because AML and ALL are the two most common types of childhood leukemia, this discussion will focus specifically on their treatment.

Chemotherapy for ALL

pediatric ChemotherapyTreatment for children with Acute lymphocytic leukemia (ALL) usually involves smaller dosages of chemotherapy but spread over a period of two-to-three years (boys often receive treatment for longer than girls, due to a higher risk of recurrence). For most children with ALL, chemotherapy will involve three distinct phases:

  • Induction: The goal of induction is to kill 99% of existing cancer cells and achieve “remission”, in which no cancer cells are found in the bone marrow and blood counts return to normal (this is not, however, the same as a “cure”). Induction usually lasts about one month and is extremely intense, requiring prolonged hospital stays and frequent visits to the doctor. Induction almost always includes intrathecal chemotherapy, in which the chemotherapy is targeted at the cerebrospinal fluid to kill any cancer cells that may have spread to the brain and/or spinal column.
  • Consolidation (intensification): This phase usually lasts for 1-2 months and is designed to reduce the number of cancer cells remaining in the body, as well as fight the potential for drug resistance among those cancer cells. This phase is also highly intense (often more so than induction).
  • Maintenance: About 95% of children with ALL will achieve remission after induction and consolidation. For these children, an additional 2 years of so-called maintenance chemotherapy will help prevent the disease from recurring. Maintenance is much less intensive, and usually involves the administration of chemotherapy for brief periods every 4-8 weeks. The early part of maintenance may involve 1-2 months of intensified treatments called re-induction or delayed intensification.

Chemotherapy for AML

Chemotherapy for AML is more intensive, involving higher dosages of treatment drugs but over a shorter duration. Chemotherapy for AML includes an induction phase and a consolidation (intensification) phase, but usually lacks a maintenance phase.

  • Induction: Induction for AML usually involves the administration of drugs for several days in a row, with treatments scheduled every 10-14 days. Less time between treatments is generally more effective but can lead to more severe side effects. Each treatment plan will depend on the child’s unique disease progression and their reaction to the chemotherapy. Treatment will continue until the bone marrow is clear of leukemia cells, usually after 2-3 treatment cycles. As with ALL, treatment usually involves intrathecal chemotherapy as well.
  • Consolidation (intensification): Between 85-90% of children with AML will achieve remission after the induction phase. Consolidation usually involves several more months of intensive chemotherapy, as well as intrathecal chemotherapy. In some cases, a stem cell transplant from a sibling may be appropriate as well, especially for children with high risk AML.

Although the duration of treatment is shorter for AML, it requires extensive supportive care and attention to ancillary issues such as nutrition, medication, and blood transfusions to cope with the more severe side effects, including (but not limited to) damage to the bone marrow responsible for creating new blood cells.

About American Childhood Cancer Organization

American Childhood Cancer Organization (ACCO) is a non-profit charity dedicated to helping kids with cancer and their families navigate the difficult journey from cancer diagnosis through survivorship. Internationally, ACCO is the sole U.S. member of Childhood Cancer International (CCI), the largest patient-support organization for childhood cancer in the world. Here in the United States, ACCO promotes the critical importance of ensuring continued funding into new and better treatment protocols for childhood cancer.  And most importantly, ACCO is focused on the children: developing and providing educational tools for children fighting cancer and their families, empowering them in their understanding of childhood cancer and the medical decisions they must make during this difficult journey. All of ACCO’s resources are available free of charge for families coping with childhood cancer.

 

For additional information about childhood cancer or on the ACCO, or to order resources for you or your child, please visit our website at www.acco.org , call 855.858.2226 or visit:

About Childhood Leukemia (ALL & AML)

leukemiaChildhood leukemia—a blood-based cancer in which abnormal cancer cells grow in the bone marrow—is the most common type of childhood cancer, accounting for almost one-third of all childhood cancer diagnoses. There are three different types of childhood leukemia. The most common type—Acute lymphocytic (lymphoblastic) leukemia, or ALL, accounts for approximately 3 out of 4 cases of childhood leukemia. ALL stems from abnormal cells growth in immature lymphocytes, the white blood cells that help the body fight infection. Acute myelogenous leukemia (AML) accounts for about one out of four cases of childhood leukemia. AML begins with abnormal growth of myeloid cells, which are responsible for the development of non-lymphocytic white blood cells, red blood cells, and platelets. A third type of childhood leukemiaJuvenile myelomonocytic leukemia (JMML)—is extremely rare. Like AML, it develops in the myeloid cells. It is acute (quickly growing) but it does not develop and spread as quickly as AML or ALL.

Symptoms of Childhood Leukemia

Childhood leukemia begins in the bone marrow (the soft core within the bone responsible for the development of blood cells, including red blood cells, white blood cells, and platelets), quickly spreading into the blood stream and potentially crowding out healthy cells our body needs to properly function. Once in the blood stream, cancer cells begin to travel throughout the body and can impact the health of other organs. The symptoms of leukemia often depend on the type of blood cell impacted by the cancer, and whether the cancer has begun to impact other organs.

Red blood cells: Red blood cells are responsible for carrying oxygen from the lungs to every cell in the body. If childhood leukemia has caused a shortage of healthy red blood cells, symptoms can include:

  • Unusually pale skin
  • Fatigue
  • Weakness
  • Shortness of breath
  • Headaches
  • An unusual sensation of cold
  • Feeling lightheaded or dizzy

White blood cells: White blood cells help the body fight off illness caused by viruses and/or bacteria. If childhood leukemia has caused a shortage of white blood cells, or prevents the white blood cells from functioning properly, your child may not be able to fight infection properly. Recurring infections or infections that won’t go away even with medical intervention may indicate the presence of leukemia. Fever is usually the main indicator of an infection.

Platelets: Platelets are responsible for helping create blood clots in order to control and stop bleeding. If childhood leukemia has caused a shortage of platelets, symptoms can include:

  • Easy and frequent bruising
  • Easy bleeding
  • Frequent and/or severe nosebleeds
  • Bleeding gums

As childhood leukemia spreads from the blood stream into various other organs of the body, it can cause symptoms relating to specific organs, including:

  • Bone or joint pain
  • Swollen lymph nodes
  • Swelling in the abdomen caused by the build-up of cancer cells in the liver and/or spleen
  • Weight loss/loss of appetite caused by swelling abdominal organs pressing on the stomach
  • Coughing or trouble breathing caused by the build-up of cancer cells near or in the lungs
  • Headaches, seizures, vomiting, loss of balance, and blurred vision could be indications that leukemia cells have begun to accumulate in the brain and spinal cord
  • Swelling of the face and arms—SVC syndrome—a potentially very serious symptom caused by the build-up of cancer cells in the thymus, leading to pressure on the blood vessel moving blood between the head and arms
  • Symptoms more common in children with AML include skin rashes, gum problems (swelling, pain, and bleeding), extreme weakness, extreme tiredness, and slurring of speech

With the exception of serious symptoms such as SVC syndrome and the extreme fatigue and weakness sometimes (although rarely) seen in patients with AML, the most common symptoms of childhood leukemia are also symptoms of many routine childhood illness. Childhood leukemia is a very rare disease, and the presence of one or more of these symptoms does not mean that your child has leukemia. However, it is important to have your child examined by a pediatrician, who will suggest additional diagnostic testing if he or she suspects that the symptoms may be related to childhood leukemia.

About American Childhood Cancer Organization

American Childhood Cancer Organization (ACCO) is a non-profit charity dedicated to helping kids with cancer and their families navigate the difficult journey from cancer diagnosis through survivorship. Internationally, ACCO is the sole U.S. member of Childhood Cancer International (CCI), the largest patient-support organization for childhood cancer in the world. Here in the United States, ACCO promotes the critical importance of ensuring continued funding into new and better treatment protocols for childhood cancer.  And most importantly, ACCO is focused on the children: developing and providing educational tools for children fighting cancer and their families, empowering them in their understanding of childhood cancer and the medical decisions they must make during this difficult journey. All of ACCO’s resources are available free of charge for families coping with childhood cancer.

For additional information about childhood cancer or on the ACCO, or to order resources for you or your child, please visit our website at www.acco.org , call 855.858.2226 or visit:

Childhood Leukemia: Are Prevention and Early Detection Possible?

Learning that your child has leukemia is devastating, and of course many parents want to know if there is anything that they could have done to prevent the cancer or detect it sooner. The simple and honest answer to both these questions is: NO. Unlike many types of adult cancers, childhood leukemia is not linked to lifestyle or environmental factors. Therefore, there is no known way to prevent the development of childhood leukemia. Likewise, unlike with many adult cancers, there are no routine screenings or testing procedures used for “early detection” of childhood cancers such as leukemia.

What Causes Childhood Leukemia?

If childhood cancer is not linked to lifestyle or environmental factors, then what cases it? Unfortunately, the answer to that very basic question is not yet known. Cancer, generally speaking, is caused when normal cells begin to grow and function abnormally. They replicate more quickly than normal and do not die when they are supposed to. Gradually, if left untreated, the cancer cells will crowd out normal cells and negatively impact the body’s ability to functional normally. In most cases of childhood leukemia, scientists do not know what triggers certain cells in the bone marrow to begin growing and functioning abnormally.

dna illustrationGenerally speaking, scientists believe that specific changes in the DNA inside normal bone marrow cells may trigger that cell to become a leukemia cell. Those DNA changes may be inherited from a parent or they may simply be random. One type of DNA mutation connected with leukemia and other cancers can impact oncogenes and/or tumor suppressor genes. Oncogenes help cells grow and divide properly; tumor suppressor genes slow down cell replication and control cell death. If a DNA mutation turns on too many oncogenes and/or turns off tumor suppressor genes, the result may result in the development of childhood leukemia or other cancers. Another genetic mutation linked to leukemia is known as chromosome translocation, in which DNA from one chromosome breaks off and attaches itself to a different chromosome. When translocation impacts oncogenes and/or tumor suppressor genes, it can lead to the development of childhood cancer. In most cases, these mutations are random and not linked to inherited mutations.

Are there risk factors for childhood leukemia?

There are a few known risk factors for childhood leukemia.

  • Inherited syndromes: children with Down syndrome (trisomy 21) and Li-Fraumeni syndrome have a significantly higher chance of developing childhood leukemia than the general population; children with Li-Fraumeni syndrome also have a higher risk of developing other forms of cancer including bone or soft tissue sarcomas and brain tumors.
  • Inherited immune system problems: children with certain conditions such as Ataxia-telangiectasia, Wiskott-Aldrich syndrome, Bloom syndrome, and Schwachman-Diamond syndrome have an increased risk of serious infection due to the body’s inability to fight infection correctly; however, they also have an increased risk of developing childhood leukemia.
  • Having a sibling with leukemia: while the overall risk is still very low, siblings of children with leukemia do have a slightly increased chance of developing leukemia themselves. The risk increases for identical twins, and greatly increases if the leukemia develops in twins under the age of one.

It is important to note, however, that while inherited conditions may result in a higher risk factor for childhood leukemia, most cases of childhood leukemia are not linked to any known or inherited risk. Moreover, childhood leukemia does not seem to be conclusively linked to any known lifestyle or environmental risk factors, with the one exception of exposure to extremely high levels of radiation (for instance, Japanese survivors of the 1945 atomic bombings had a greatly increased risk of developing AML within 6-8 years of exposure). Scientists continue to research potential links between childhood leukemia and smaller dosages of radiation, as well as chemotherapy and toxic chemicals.

About American Childhood Cancer Organization

American Childhood Cancer Organization (ACCO) is a non-profit charity dedicated to helping kids with cancer and their families navigate the difficult journey from cancer diagnosis through survivorship. Internationally, ACCO is the sole U.S. member of Childhood Cancer International (CCI), the largest patient-support organization for childhood cancer in the world. Here in the United States, ACCO promotes the critical importance of ensuring continued funding into new and better treatment protocols for childhood cancer.  And most importantly, ACCO is focused on the children: developing and providing educational tools for children fighting cancer and their families, empowering them in their understanding of childhood cancer and the medical decisions they must make during this difficult journey. All of ACCO’s resources are available free of charge for families coping with childhood cancer.

 

For additional information about childhood cancer or on the ACCO, or to order resources for you or your child, please visit our website at www.acco.org , call 855.858.2226 or visit:

Childhood Leukemia Cancer

Symptoms_of_leukemiaLeukemia is a blood-based cancer that begins in the bone marrow, the soft inner part of the bone responsible for the growth of new blood cells. As leukemia cells accumulate in the bone marrow, by replicating more quickly than normal cells and not dying when they should, they begin to crowd out healthy cells and then quickly spread into the blood stream. Once in the blood stream, the leukemia cells move to different areas of the body and begin to impact the ability of other organs to function normally. Leukemia is the most common type of cancer in children, accounting for nearly one-third of all childhood cancers, and should not be confused with other types of cancers that begin in other organs and then spread to the bone marrow.

In children, there are two main types of leukemia, both of which are acute (quickly growing):

  • Acute lymphocytic (lymphoblastic) leukemia (ALL): ALL develops in immature lymphocytes, the white blood cells responsible for helping the body fight infections and bacteria. In general, ALL is the most common type of childhood leukemia: about three out of four cases. Most cases of ALL start in so-called B cells, the lymphocytes responsible for making antibodies for fighting viruses; however, some cases of ALL can begin in the T cells, which help fight infection themselves.
  • Acute myelogenous leukemia (AML): Approximately one out of four cases of childhood leukemia are designated as AML, also known as acute myeloid leukemia, acute myelocytic leukemia, or acute non-lymphocytic leukemia. AML begins in the myeloid cells responsible for creating non-lymphocytic white blood cells, red blood cells, and platelets.

 

Juvenile myelomonocytic leukemia (JMML) is a very rare type of childhood leukemia that usually occurs in children under the age of 4. Like AML, it begins in the myeloid cells, but it does not grow as quickly as traditional AML (yet grows more quickly than chronic leukemia common in adults). Chronic (slow-growing) leukemias such as chronic myelogenous leukemia (CML) and chronic lymphocytic leukemia (CLL) are extremely rare in children.

 

Childhood Leukemia: Detection and Diagnosis

 

The most common symptoms of childhood leukemia, such as fatigue, headaches, paleness, fever and infection, and easy bruising and bleeding are very similar to the symptoms of many routine childhood illnesses. However, should these symptoms persist, reoccur frequently, and/or gradually worsen over time, your pediatrician may recommend that your child undergo testing with a pediatric oncologist to detect the potential presence of leukemia.

The first step in detecting and diagnosing childhood leukemia is a simple blood test. A complete blood count (CBC) will determine how many cells of each type (red blood cells, white blood cells, and platelets) are present in the blood; high numbers of white blood cells and low numbers of red blood cells and platelets may indicate the presence of leukemia. The blood sample will also be examined under a microscope to look for abnormalities in the blood cells themselves.

A blood test can indicate the potential presence of leukemia, but is not sufficient for diagnosis. In order to diagnose leukemia, bone marrow aspiration and biopsy are required. These two procedures are usually performed at the same time. During an aspiration, a thin, hollow needle is inserted in to the bone while a small amount of bone marrow is removed through a syringe. Then, a small piece of bone and marrow is removed with a slighter larger needle in order to perform a bone marrow biopsy.

Once leukemia has been diagnosed through a bone marrow aspiration and biopsy, the pediatric oncologist may require several additional tests in order to look for leukemia cells in other parts of the body. These tests can help classify and stage the leukemia, as well as determine the appropriate course of treatment. Additional tests may include:

  • Lumbar puncture (spinal tap): to detect leukemia cells in the cerebrospinal fluid
  • Chest x-ray: to detect enlarged thymus or lymph nodes, as well as pneumonia and lung infection
  • CT scan or MRI: to detect the presence of leukemia in lymph nodes, spleen, liver, brain, and/or spinal cord
  • PET scan: helpful for determining the extent to which leukemia cells have spread throughout the body

If these tests reveal the presence of childhood leukemia, your child’s oncologist will work with you to develop an appropriate course of treatment.

About American Childhood Cancer Organization

American Childhood Cancer Organization (ACCO) is a non-profit charity dedicated to helping kids with cancer and their families navigate the difficult journey from cancer diagnosis through survivorship. Internationally, ACCO is the sole U.S. member of Childhood Cancer International (CCI), the largest patient-support organization for childhood cancer in the world. Here in the United States, ACCO promotes the critical importance of ensuring continued funding into new and better treatment protocols for childhood cancer.  And most importantly, ACCO is focused on the children: developing and providing educational tools for children fighting cancer and their families, empowering them in their understanding of childhood cancer and the medical decisions they must make during this difficult journey. All of ACCO’s resources are available free of charge for families coping with childhood cancer.

For additional information about childhood cancer or on the ACCO, or to order resources for you or your child, please visit our website at www.acco.org , call 855.858.2226 or visit:

 

 

Illustration by By Mikael Häggström (All used images are in public domain.) [Public domain], via Wikimedia Commons

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