Childhood Acute Lymphocytic Leukemia
Table of Contents
What is childhood acute lymphocytic leukemia?
- Stage Explanation
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Stages of childhood acute lymphocytic leukemia
- Treatment Option Overview
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How childhood acute lymphocytic leukemia is treated
- Treatment by stage
- Untreated Childhood Acute Lymphocytic Leukemia
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- Childhood Acute Lymphocytic Leukemia in Remission
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- Recurrent Childhood Acute Lymphocytic Leukemia
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- To Learn More
What is childhood acute lymphocytic leukemia?
Childhood acute lymphocytic leukemia (also called acute lymphoblastic leukemia or ALL)
is a disease in which too many underdeveloped infection-fighting white blood cells, called
lymphocytes, are found in a child's blood and bone marrow. ALL is the most common form of
leukemia in children, and the most common kind of childhood cancer.
Lymphocytes are made by the bone marrow and by other organs of the lymph system. The
bone marrow is the spongy tissue inside the large bones in the body. The bone marrow makes
red blood cells (which carry oxygen and other materials to all tissues of the body), white
blood cells (which fight infection), and platelets (which make the blood clot). Normally,
the bone marrow makes cells called blasts that develop (mature) into several different
types of blood cells that have specific jobs to do in the body.
The lymph system is made up of thin tubes that branch, like blood vessels, into all
parts of the body. Lymph vessels carry lymph, a colorless, watery fluid that contains
lymphocytes. Along the network of vessels are groups of small, bean-shaped organs called
lymph nodes. Clusters of lymph nodes are found in the underarm, pelvis, neck, and abdomen.
The spleen (an organ in the upper abdomen that makes lymphocytes and filters old blood
cells from the blood), the thymus (a small organ beneath the breastbone), and the tonsils
(an organ in the throat) are also part of the lymph system.
Lymphocytes fight infection by making substances called antibodies, which attack germs
and other harmful bacteria in the body. In ALL, the developing lymphocytes become too
numerous and do not mature. These immature lymphocytes are then found in the blood and the
bone marrow. They also collect in the lymph tissues and make them swell. Lymphocytes may
crowd out other blood cells in the blood and bone marrow. If your child's bone marrow
cannot make enough red blood cells to carry oxygen, your child may have anemia. If your
child's bone marrow cannot make enough platelets to make the blood clot normally, your
child may bleed or bruise easily. The cancerous lymphocytes can also invade other organs,
the spinal cord, and the brain.
Leukemia can be acute (progressing quickly with many immature cancer cells) or chronic
(progressing slowly with more mature-looking leukemia cells). Acute lymphocytic leukemia
progresses quickly, and can occur in both children and adults. Treatment is different for
adults than it is for children. For information on adult ALL, see the PDQ patient
information statement on adult acute lymphocytic leukemia. Separate PDQ patient
information statements are also available for chronic lymphocytic leukemia, chronic
myelogenous leukemia, adult or childhood acute myeloid leukemia, and hairy cell leukemia.
Early signs of ALL may be similar to those of the flu or other common diseases, such as
a fever that won't go away, feeling weak or tired all the time, aching bones or joints, or
swollen lymph nodes. If your child has symptoms of leukemia, his or her doctor may order
blood tests to count the number of each of the different kinds of blood cells. If the
results of the blood tests are not normal, a bone marrow biopsy may be performed. During
this test, a needle is inserted into a bone in the hip and a small amount of bone marrow
is removed and examined under the microscope, enabling the doctor to determine what kind
of leukemia your child has and plan the best treatment.
Your child's doctor may also do a spinal tap, in which a needle is inserted through the
back to remove a sample of the fluid that surrounds the brain and spine. The fluid is then
examined under a microscope to see if leukemia cells are present.
Your child's chance of recovery (prognosis) depends on your child's age at diagnosis,
the number of white blood cells in the blood (the white blood cell count) at diagnosis,
how far the disease has spread, the biologic characteristics of the leukemia cells, and
how well the leukemia cells respond to treatment.
Stages of childhood acute lymphocytic leukemia
There is no staging for childhood acute lymphocytic leukemia. The treatment depends on
whether or not the patient has been previously treated for leukemia.
Untreated
Untreated acute lymphocytic leukemia (ALL) means that no treatment has been given
except to alleviate symptoms. There are too many white blood cells in the blood and bone
marrow, and there may be other signs and symptoms of leukemia.
In remission
Remission means that treatment has been given and that the number of white blood cells
and other blood cells in the blood and bone marrow is normal. There are no signs or
symptoms of leukemia.
Recurrent/refractory
Recurrent disease means that the leukemia has come back (recurred) after going into
remission. Refractory disease means that the leukemia failed to go into remission
following treatment.
How childhood acute lymphocytic leukemia is treated
There are treatments for all patients with childhood acute lymphocytic leukemia (ALL).
The primary treatment for ALL is chemotherapy. Radiation therapy may be used in certain
cases. Bone marrow transplantation is being studied in clinical trials.
Chemotherapy uses drugs to kill cancer cells. Chemotherapy drugs may be taken by mouth,
or may be put into the body by a needle in a vein or muscle. Chemotherapy is called a
systemic treatment because the drug enters the bloodstream, travels through the body, and
can kill cancer cells throughout the body. For ALL, chemotherapy drugs may sometimes be
injected (usually through the spine) into the fluid that surrounds the brain and spinal
cord; this is known as intrathecal chemotherapy.
Radiation therapy uses x-rays or other high-energy rays to kill cancer cells and shrink
tumors. Radiation for ALL usually comes from a machine outside the body (external beam
radiation therapy).
Bone marrow transplantation is a newer type of treatment. First, high doses of
chemotherapy with or without radiation therapy are given to destroy all of the bone marrow
in the body. Healthy marrow is then taken from another person (a donor) whose tissue is
the same as or almost the same as the patient's. The donor may be a twin (the best match),
a brother or sister, or another person not related. The healthy marrow from the donor is
given to the patient through a needle in a vein, and the marrow replaces the marrow that
was destroyed. A bone marrow transplant using marrow from a relative or person not related
is called an allogeneic bone marrow transplant.
An even newer type of bone marrow transplant, called autologous bone marrow transplant,
is being studied in clinical trials. During this procedure, bone marrow is taken from the
patient and may be treated with drugs to kill any cancer cells. The marrow is frozen to
save it. The patient is then given high-dose chemotherapy with or without radiation
therapy to destroy all of the remaining marrow. The frozen marrow that was saved is thawed
and given through a needle in a vein to replace the marrow that was destroyed.
There are generally four phases of treatment for ALL. The first phase, remission
induction therapy, uses chemotherapy to kill as many of the leukemia cells as possible to
cause the cancer to go into remission. Once a child goes into remission and there are no
signs of leukemia, a second phase of treatment, called consolidation or intensification
therapy, is given. Consolidation therapy uses high-dose chemotherapy to attempt to kill
any remaining leukemia cells. The third phase, called central nervous system (CNS)
prophylaxis, is preventive therapy using intrathecal and/or high-dose systemic
chemotherapy to the central nervous system (CNS) to kill any leukemia cells present there,
or to prevent the spread of cancer cells to the brain and spinal cord even if no cancer
has been detected there. Radiation therapy to the brain may also be given, in addition to
chemotherapy, for this purpose. CNS prophylaxis is often given in conjunction with
consolidation/intensification therapy. The fourth phase of treatment, called maintenance
therapy, uses chemotherapy for several years to maintain the remission.
Treatment by stage
Treatment for childhood acute lymphocytic leukemia depends on the prognostic group to
which your child is assigned based primarily on your child's age and white blood cell
count at diagnosis.
Your child may receive treatment that is considered standard based on its effectiveness
in a number of patients in past studies, or you may choose to have your child take part in
a clinical trial. Not all patients are cured with standard therapy and some standard
treatments may have more side effects than are desired. For these reasons, clinical trials
are designed to test new treatments and to find better ways to treat cancer patients.
Clinical trials are ongoing in most parts of the country for most stages of childhood ALL.
For more information, call the Cancer Information Service at 1-800-4-CANCER
(1-800-422-6237); TTY at 1-800-332-8615.
Your child's treatment will probably be remission induction chemotherapy to kill cancer
cells and cause the leukemia to go into remission. Induction chemotherapy is almost always
successful in inducing remission. Intrathecal and/or high-dose systemic chemotherapy, with
or without radiation therapy to the brain, may also be given to prevent the spread of
cancer cells to the brain and spinal cord. Clinical trials are testing new ways of
inducing remission.
Your child's treatment will probably be intensive chemotherapy to kill any remaining
cancer cells. Intrathecal and/or high doses of systemic chemotherapy, with or without
radiation therapy to the brain, may also be given during this phase of treatment to
prevent the spread of cancer cells to the brain and spinal cord. Following intensification
therapy, chemotherapy generally continues until the child has been in continuous remission
for several years.
Treatment depends on the type of treatment your child received before, how soon the
cancer came back following treatment, and whether the leukemia cells are found outside the
bone marrow. Your child's treatment will probably be systemic chemotherapy or bone marrow
transplantation. You may want to consider entering your child into a clinical trial of new
chemotherapy drugs or bone marrow transplantation.
TO LEARN MORE..... CALL 1-800-4-CANCER
To learn more about childhood acute lymphocytic leukemia, call the National Cancer
Institute's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at
1-800-332-8615. By dialing this toll-free number, you can speak with someone who can
answer your questions.
The Cancer Information Service can also send you booklets. The following booklets about
leukemia may be helpful to you:
- What You Need To Know About Leukemia
Research Report: Bone Marrow Transplantation
The following booklets on childhood cancer may also be helpful to you:
- Young People with Cancer: A Handbook for Parents
Talking with Your Child About Cancer
When Someone in Your Family Has Cancer
Managing Your Child's Eating Problems During Cancer Treatment
The following general booklets related to questions on cancer may also be helpful:
- What You Need To Know About Cancer
Taking Time: Support for People with Cancer and the People Who Care About
- Them
What Are Clinical Trials All About?
Chemotherapy and You: A Guide to Self-Help During Treatment
Radiation Therapy and You: A Guide to Self-Help During Treatment
There are many other places you can get material about cancer treatment and services to
help you. You can check the social service office at your hospital for local and national
agencies that help with your finances, getting to and from treatment, care at home, and
dealing with your problems.
You can also write to the National Cancer Institute at this address:
- National Cancer Institute
Office of Cancer Communications
31 Center Drive, MSC 2580
Bethesda, MD 20892-2580
Date Last Modified: 04/98
If you want to know more about cancer and how it is treated, or if you wish to know
about clinical trials for your type of cancer, you can call the NCI's Cancer Information
Service at 1-800-422-6237, toll free. A trained information specialist can talk
with you and answer your questions.
Source: National Cancer Institute
National Institutes of Health
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