Childhood Leukemia

Childhood Leukemia Explained

ByNanette Roser, RN

If your child has been diagnosed with leukemia or you are worried about it, you likely have a lot of questions. Learning some basics is a good place to start. In children, leukemia is the most common form of cancer, making up about one-third of all pediatric cancer cases.

What is Leukemia?

Leukemia is cancer of the body’s blood-forming tissues, including the bone marrow and the lymphatic system, and usually involves the white blood cells. Our bone marrow makes the cells that will develop into white blood cells, red blood cells, and platelets. Each type of cell has a different job:

  • White blood cells help your body fight infection.
  • Red blood cells deliver oxygen from your lungs to your tissues and organs.
  • Platelets help form clots to stop bleeding.

Your white blood cells fight infections, growing and dividing in an orderly way as your body needs them. However, in children with leukemia, the bone marrow produces excessive abnormal white blood cells that do not function properly.

When you have leukemia, your bone marrow makes many abnormal cells. This problem most often happens with white blood cells. These abnormal cells build up in your bone marrow and blood. They crowd out the healthy blood cells and make it hard for your cells and blood to do their job.

Causes

The cause of most types of leukemia is unknown. Scientists don’t understand the exact causes of leukemia. It seems to develop from a combination of genetic and environmental factors. Exposure to some types of chemotherapy or certain chemicals (such as benzene, some pesticides, and chemicals in tobacco smoke) increases the risk of developing some types of leukemia. However, this occurs in a minimal number of exposed people. Certain hereditary disorders may increase the risk as well. Two examples include Down syndrome and Fanconi anemia. In some people, leukemia is caused by certain abnormalities of the chromosomes.

Symptoms of Childhood Leukemia

Some common symptoms include:

  • Fatigue
  • Pale skin
  • Infections and fever
  • Easy bleeding or bruising
  • Extreme fatigue or weakness
  • Shortness of breath
  • Coughing

Other symptoms you may see or experience include:

  • Bone or joint pain
  • Loss of appetite or weight loss
  • Vomiting
  • Rashes
  • Swelling in the abdomen, face, arms, underarms, sides of neck, or groin
  • Headaches, seizures, balance problems, or abnormal vision

Diagnosis

Doctors may find chronic leukemia in a routine blood test before symptoms begin. If this happens, or if the child has signs or symptoms that suggest leukemia, they may undergo the following diagnostic exams:

  • Physical exam. Your doctor will look for physical signs of leukemia, such as pale skin from anemia, swelling of the lymph nodes, and enlargement of the liver and spleen.
  • Blood tests. By looking at a blood sample, your doctor can determine if there are abnormal levels of red or white blood cells or platelets — which may suggest leukemia. A blood test may also show the presence of leukemia cells, though not all types of leukemia cause the leukemia cells to circulate in the blood. Sometimes, the leukemia cells stay in the bone marrow.
  • Bone marrow test. Your doctor may recommend a procedure to remove a sample of bone marrow from the hipbone. The sample is sent to a laboratory to look for leukemia cells. Specialized tests of the leukemia cells may reveal specific characteristics that are used to determine treatment options.

A pathologist examines cells from blood tests under a microscope. This specialist also checks bone marrow samples for the number of blood-forming cells and fat cells.

Specific tests may be repeated later to see how your child responds to treatment.

Types of Leukemia

Knowing the specific type of leukemia a child has can help doctors better predict each child’s prognosis (outlook) and select the best treatment.

There are different types of leukemia, which are based on: 

  • If the leukemia is acute (fast-growing) or chronic (slow-growing) and
  • If the leukemia starts in myeloid cells or lymphoid cells

Acute leukemias

Most childhood leukemias are acute and typically need to be treated right away. These leukemias can cause bone and joint pain, fatigue, weakness, pale skin, bleeding or bruising, fever, weight loss, and other symptoms. Acute leukemias grow quickly, so they need to be treated (typically with chemotherapy) as soon as they are found.

The main types of acute leukemia are:

  • Acute lymphocytic (lymphoblastic) leukemia (ALL). About three out of four childhood leukemias are ALL. These leukemias start in early forms of white blood cells called lymphocytes.
  • Acute myeloid leukemia (AML). This type of childhood leukemia, also called acute myelogenous leukemia, acute myelocytic leukemia, or acute non-lymphocytic leukemia, accounts for most of the remaining cases of childhood leukemia. AML starts from the myeloid cells that normally form white blood cells (other than lymphocytes), red blood cells, or platelets.

Chronic leukemias

Chronic leukemias are rare in children. These leukemias tend to grow more slowly than acute leukemias but can be harder to cure. Chronic leukemias can be divided into two main types:

  • Leukemia starts in the bone marrow. The leukemia cells can build up there, crowding out normal cells. Most often, the leukemia cells spill into the bloodstream fairly quickly. Some types of leukemia can also spread to other parts of the body, such as the lymph nodes, spleen, liver, central nervous system (the brain and spinal cord), testicles, or other organs.
  • Some other childhood cancers, such as neuroblastoma or rhabdomyosarcoma, start in other organs and can spread to bone marrow. Notes: these cancers are not leukemia.

Treatment

Many leukemias can be treated effectively, and some can be cured. Treatment may consist of different types of drugs, such as:

  • Chemotherapy. Chemotherapy consists of drugs that attack cancer cells.
  • Immunotherapy. Immunotherapy is a cancer treatment that uses a person’s own immune system to kill cancer cells.
  • Targeted therapy. Targeted therapy consists of drugs directed at abnormal genes or proteins in cancer cells.

Doctors select a particular drug or combination of drugs based on the classification of leukemia. Sometimes, stem cell transplantation, radiation therapy, or surgery may be required.

The complications of leukemia may require treatment. These treatments may include:

  • Blood transfusions if leukemia causes severe anemia. 
  • Antibiotics if an infection develops. 
  • Platelet transfusions if bleeding occurs.

Cancerous white blood cells do not function like normal white blood cells so they cannot help the body fight off infections.

Remission occurs when leukemia is under control, and the number of abnormal cells in the bone marrow is very low. However, if the number of leukemia cells increases again, this is called a relapse.

Progress

According to the American Cancer Society, about 9,620 children in the United States under the age of 15 will be diagnosed with cancer in 2024. However, 80% of children and adolescents diagnosed with cancer survive their disease. The cancer death rate has declined by more than half from 1970 to 2021 in both children and adolescents, primarily due to improvements in treatment and high participation in clinical trials.

Considering this compelling progress, it’s heartening to note over 80% of children diagnosed with cancer now survive. This significant improvement, coupled with the steady decline in cancer death rates among children, underscores the advances in medical research and treatments. As we continue to support ongoing awareness, funding, and research, we can remain optimistic that even more children will survive and thrive, leading healthy, fulfilling lives.

References:

American Cancer Society. Cancer Facts & Figures 2024. Atlanta: American Cancer Society, 2024.

Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. WISQARS Leading Causes of Death Visualization Tool. Accessed at  https://wisqars.cdc.gov/lcd/ on May 22, 2024.

National Cancer Institute. Cancer in Children and Adolescents. 2023. Accessed at https://www.cancer.gov/types/childhood-cancers/child-adolescent-cancers-fact-sheet on May 23, 2024.

Merck Manual. Overview of Leukemia. By Ashkan Emadi, MD, PhD, West Virginia University School of Medicine, Robert C. Byrd Health Sciences Center; Jennie York Law, MD, University of Maryland, School of Medicine. Reviewed/Revised Oct 2023

Cleveland Clinic Children’s Hospital, Childhood Leukemia and Lymphoma Treatment. ChildhoodLeukemia and Lymphoma Treatment | Cleveland Clinic}}

Kliegman RM, et al. The leukemias. In: Nelson Textbook of Pediatrics. 21st ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed Oct. 16, 2020.

Leukemia. American Society of Hematology. https://www.hematology.org/education/patients/blood-cancers/leukemia. Accessed Oct. 16, 2020.

MedlinePlus [Internet]. Bethesda (MD): National Library of Medicine (US); [updated 2020 Jun 24]. Childhood Leukemia; updated 2023 Nov 28. Available from: Childhood Leukemia | MedlinePlus

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