Leukemia
There are several typeas of leukemia:- Acute lymphoblastic leukaemia (ALL) - the most common form of childhood leukaemia
- Acute myeloid leukaemia (AML) - the less common form of childhood leukaemia - the less common form of childhood leukaemia
- Chronic Myeloid Leukaemia and Juvenile Chronic Myeloid Leukaemia (sometimes called chronic myelomonocytic leukaemia) are very rare subtypes of childhood leukaemia whose cause is unknown. They require specific treatment, which will usually include stem cell transplantation if a suitable donor is identified.
Acute lymphoblastic leukaemia (ALL)
What is ALL?
Acute lymphoblastic leukaemia (ALL) is the most common form of childhood cancer. The cause of the disease is unknown. It presents with an excessive growth of abnormal, immature white blood cells called lymphoblasts. This initially occurs in the bone marrow, which is the site of all normal blood cell production, (red blood cells, platelets and various types of white blood cells). The acute prefix means that the disease can progress rapidly, while a chronic type of disease develops slowly. The uncontrolled growth of leukaemic lymphoblasts can replace the normal marrow cells in the bone marrow, and from there they can spread into the blood stream. Lymphoblasts have the potential to spread to other organs of the body such as the liver, spleen, lymph glands, and the cerebro-spinal fluid (CSF).Signs & Symptoms
Children with leukaemia can present with a variety of symptoms, most commonly pallor, lethargy, fever, easy bruising, pain in the bones or joints, swollen glands and/or weight loss.Diagnosis
A full blood examination suggests the diagnosis of ALL but a bone marrow aspirate is necessary to confirm the diagnosis. Other blood tests, a lumbar puncture and a chest X-ray will also be done.Treatment
Chemotherapy is the primary mode of treatment for ALL. Almost all children with ALL are elegible to participate in clinical research trials. These are either international trials originating from the Children's Oncology Group (COG) in the USA or European trials of infant or relapsed leukaemia. If your child is eligible to participate in a clinical research trial, then you will be asked to consent for the clinical and laboratory information to be collected and collated with that of other patients at the trials centre. Some trials are randomised clinical trials where two or more different treatments are compared. Treatment allocation is determined randomly by computer in order to eliminate bias. Intensity of treatment is determined by prognostic features at diagnosis, rate of response to treatment and DNA studies during early treatment.Treatment is divided into a number of phases. The initial phase is induction lasting for 28 to 35 days, with the aim to achieve remission. After the initial hospital stay following the diagnosis, the child is required to attend the Outpatient clinic, often weekly for further chemotherapy and monitoring. Chemotherapy is given orally, intravenously, intramuscularly, subcutaneously and intrathecally. Further hospital admissions will depend on the particular treatment required and whether any side effects of treatment develop. During some phases of therapy your child may require blood and/or platelet infusions and/or intravenous antibiotics if a fever or infections develops.
Therapy is most intensive for the first 5-10 months depending on the protocol. Thereafter continuation (maintenance) therapy is given with monthly intravenous injections, 8 to12 weekly intrathecal therapy and daily and weekly oral chemotherapy to be taken at home. Chemotherapy for ALL continues for just over two years for girls and three years for boys. Throughout treatment children are encouraged to participate as much as possible in normal activities and attend school. ALL is now curable in 75-80% of children.
Follow up care
Once therapy is completed there is a regular schedule of follow up care to monitor initially for disease recurrence, and later the continued growth and development of the child.Acute myeloid leukaemia (AML)
What is AML?
Acute myeloid leukaemia (AML) is the less common form of childhood leukaemia. It is also known as Acute Non-Lymphoblastic Leukaemia (ANLL). It presents with an excessive growth of abnormal, immature white blood cells called myeloblasts. This occurs in the bone marrow, which is the site of all normal blood cell production (red blood cells, platelets and various types of white blood cells). The acute prefix means that the disease can progress rapidly, while a chronic type of disease develops slowly. The uncontrolled growth of leukaemic myeloblasts can replace the normal blood cells in the bone marrow and from there they can spread into the bloodstream. Myeloblasts have the potential to spread to other organs of the body such as the liver, spleen and lymph glands.Signs & Symptoms
Children with AML can present with a variety of symptoms namely pallor, lethargy, fever, easy bruising, pain in the bones or joints, swollen glands and/or weight loss.Diagnosis
A full blood examination suggests the diagnosis of AML but a bone marrow aspirate is necessary to confirm the diagnosis. Other blood tests, a lumbar puncture and chest Xray will also be done.Treatment
Chemotherapy is the primary mode of treatment for AML. As for ALL parental consent will be sought for your child to be entered on the appropriate clinical trial. Treatment lasts about six months and is divided into a number of phases. Two courses of induction therapy are followed by 2-3 courses of intensive therapy. Chemotherapy is given orally, intravenously, intramuscularly, subcutaneously and intrathecally. All courses of therapy are given as an inpatient. As the therapy is more intensive to that of therapy for ALL, there is an increased incidence of hospital admissions and requirements for blood and platelet infusions and antibiotics for fever and infections.Depending upon certain clinical, laboratory and molecular features present at diagnosis and on early response to therapy, stem cell transplantation may be necessary if a suitable donor is available. This is usually only performed if remission is achieved.
AML is now curable in 60% of children. With limitations the children are encouraged to participate as much as possible in normal activities and when able to return to school.