Phone Numbers
Directory assistance
(203) 688-4242
Patient information
(203) 688-4177
Adult emergency
(203) 688-2222
Children's emergency
(203) 688-3333
Admitting
(203) 688-2221
Children's admitting
(203) 688-3331
Psychiatric admitting
(203) 688-9907
Leukemia
Leukemia is the most common type of cancer in children and adolescents. There are two basic types of leukemia—chronic leukemia, which progresses slowly and is very rare in children, and the more common acute form, which progresses much faster.
The blood is made up of three major types of cells: red blood cells that carry oxygen, platelets that help blood clot, and white blood cells that fight infection. Leukemia is a cancer of the white blood cells.
Leukemia starts in the bone marrow, which produces white blood cells (also called leukocytes). The cancer causes the bone marrow to produce many times the normal number of white blood cells. However, these cells are often misshapen and do not function like normal cells. Bone marrow is found in the flat bones of the body, such as the skull, the back and hip.
Types of leukemia
There are two types of acute leukemias—acute lymphocytic leukemia,
or ALL, and acute nonlymphocytic leukemia, ANL, which is also called myelogenous
leukemia. The outlook for children with leukemia depends on the type of
cancer and the stage at which it is diagnosed.
Acute lymphocytic leukemia (ALL)
More than two-thirds of all cases
of leukemia diagnosed in children are ALL, which is most common between
ages two and five. There are two types of ALL: B-cell and T-cell.
The B-cell subtype is much more common. Survival rates for ALL have
increased dramatically over the last 30 years. Today, about 80 percent
of children diagnosed with this disease survive.
Acute nonlymphocytic leukemia (ANL) (also called acute myelogenous leukemia or AML)
ANL is most common before age two
or during the teen years.
Risk factors
Most children and adults who develop leukemia have no known risk factors
for the disease, so it's not known why these cancers develop. However,
scientists studying the patterns of occurrence have noted certain risk
factors for leukemia, including:
- Deficiencies in the immune system at birth, Down syndrome or certain genetic disorders
- Having an identical twin who develops AML or ALL before age six
- Exposure to extremely high levels of radiation (Japanese survivors of the atomic bomb)
- Previous cancer treatment with radiation therapy or chemotherapy
- Taking medicine to suppress the immune system following an organ transplant
Symptoms
There are no screening tests available to detect leukemia, but children
with risk factors should be followed more closely. Children may be tired,
experience shortness of breath or appear pale; may bruise easily; experience
bone or joint pain; have little appetite; suffer from infections and high
fever; have an enlarged spleen or liver; or have swollen lymph nodes.
There may be a delay in diagnosis because some of these symptoms mimic
those caused by noncancerous conditions.
Questions to ask your child's doctor
Diagnosis
A medical history and physical exam can help determine if a child needs
further evaluation. Blood tests, bone marrow aspiration and/or biopsy,
lymph node biopsy and lumbar puncture are some of the tests used to determine
if cancer is present. Additional tests will be required to identify the
type of leukemia present. Classifying the type of leukemia helps doctors
select the best treatment strategy. Imaging studies, such as X-rays, MRI
and CT and bone scans are also used in diagnosing and evaluating leukemia.
Diagnosing cancer
Treatment
Before cancer is treated, it has to be staged. Staging involves finding
out where the cancer is located, the extent of the cancer and whether
it has spread.
Our cancer team includes the child's pediatrician as well as specialists (such as pediatric oncologists and hematologists) at the Yale Cancer Center. Once the cancer is staged, the cancer care team will suggest a treatment plan. This is an important decision and it is good to take time and think about all of the choices.
With leukemia, chemotherapy is the treatment of choice. A combination of chemotherapy drugs will be given in various ways, including by mouth, through a vein, into a muscle and into cerebrospinal fluid. Chemotherapy can cause side effects. Be sure to discuss side effects of treatment with the pediatric oncologist before your child begins therapy.
Stem cell transplant can be used to treat children with ALL or ANL who relapse. (For information on stem cell transplant, see the National Cancer Institute site.)
Clinical trials, protocols and research
Learn more
• YNHH Health Library: Leukemia
Last revised: Jan 8, 2008 (dh)
