About childhood acute lymphoblastic leukemia (all)
What is childhood acute lymphoblastic leukemia (all)?
Childhood acute lymphoblastic leukemia (ALL) is a type of cancer in which the bone marrow makes too many immature lymphocytes (a type of white blood cell).
Childhood acute lymphoblastic leukemia (also called acute lymphocytic leukemia or ALL) is a cancer of the blood and bone marrow. This type of cancer usually gets worse quickly if it is not treated. It is the most common type of cancer in children.
Normally, the bone marrow makes blood stem cells (immature cells) that develop into mature blood cells over time. A blood stem cell may become a myeloid stem cell or a lymphoid stem cell.
The myeloid stem cell develops into one of three types of mature blood cells:
- Red blood cells that carry oxygen and other materials to all tissues of the body.
- Platelets that help prevent bleeding by causing blood clots to form.
- Granulocytes (white blood cells) that fight infection and disease.
The lymphoid stem cell develops into a lymphoblast cell and then into one of three types of lymphocytes (white blood cells):
- B lymphocytes that make antibodies to help fight infection.
- T lymphocytes that help B lymphocytes make the antibodies that help fight infection.
- Natural killer cells that attack cancer cells and viruses.
Blood cell development. A blood stem cell goes through several steps to become a red blood cell, platelet, or white blood cell.
In ALL, too many stem cells develop into lymphoblasts and do not mature to become lymphocytes. These lymphoblasts are called leukemia cells. The leukemia cells do not work like normal lymphocytes and are not able to fight infection very well. Also, as the number of leukemia cells increases in the blood and bone marrow, there is less room for healthy white blood cells, red blood cells, and platelets. This may lead to infection, anemia, and easy bleeding.
There are subgroups of childhood ALL.
There are different subgroups of ALL based on the following:
- Whether the type of blood cell that is affected looks more like a B lymphocyte or a T lymphocyte.
- The age of the child at diagnosis. For example, whether the child is younger than one year, one year to 10 years old, or older than 10 years (teenager).
- Whether there are certain changes in the chromosomes. Philadelphia chromosome -positive ALL is one type of chromosome change that may occur.
Family history and exposure to radiation may affect the risk of developing childhood ALL.
Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. People who think they may be at risk should discuss this with their doctor. Possible risk factors for ALL include the following:
- Having a brother or sister with leukemia.
- Being white or Hispanic.
- Living in the United States.
- Being exposed to x-rays before birth.
- Being exposed to radiation.
- Past treatment with chemotherapy or other drugs that weaken the immune system.
- Having certain changes in genes or genetic disorders, such as Down syndrome.
What are the symptoms for childhood acute lymphoblastic leukemia (all)?
Signs of childhood ALL include Fever and bruising.
These and other signs and symptoms may be caused by childhood ALL or by other conditions. Check with your child's doctor if your child has any of the following:
- Easy bruising or bleeding.
- Petechiae (flat, pinpoint, dark-Red spots under the skin caused by bleeding).
- Bone or joint pain.
- Painless lumps in the neck, underarm, stomach, or groin.
- Pain or feeling of fullness below the ribs.
- Weakness, feeling tired, or looking pale.
- Loss of appetite.
What are the causes for childhood acute lymphoblastic leukemia (all)?
Most of the time, doctors don't know what causes B-cell ALL in children.
Some things make this disease more likely, including exposure to high doses of X-rays and other forms of radiation, or cancer treatment with chemotherapy. Children with certain genetic diseases, such as Down syndrome, are also more likely to get ALL.
What are the treatments for childhood acute lymphoblastic leukemia (all)?
Treatment for ALL is completed in three main phases:
- Induction. The goal of the induction phase is to get to remission, or a point when no cancer cells are found in the blood or blood marrow. Your child may need to stay in the hospital for the first month or so of treatment as a pediatric oncologist carefully monitors their progress.
- Consolidation. The consolidation phase is often the most intense and may last several months. The goal here is to target any leftover leukemia cells in the body and prevent them from developing a resistance to the medications. Some children may also receive a stem cell transplant during this stage of treatment.
- Maintenance. This type of therapy begins only after a child’s leukemia is in remission after the first two stages. The goal of this stage is to prevent cancer cells from regrowing (relapsing). Medications in this phase are given at lower doses, but it’s important to take them as directed to prevent a relapse.
Specific therapy options may include:
- Chemotherapy. Chemotherapy is the primary course of treatment for kids with ALL. It involves delivering certain cancer-fighting medications through an IV, into the muscle, or into the cerebrospinal fluid. In some cases, chemo may be taken orally. No matter the route, the medications enter the blood to reach the whole body at once.
- Radiation. This treatment uses high-powered X-rays to kill cancer cells and keep them from spreading in the body. In particular, radiation may be used if ALL has spread or has the potential to spread to the brain, spinal cord, or testicles.
- Stem cell transplant. Chemo may be given in combination with a stem cell transplant (bone marrow transplant). Stem cells can help replace damaged blood cells and promote healthy blood cells. This therapy is given via infusion and may be used for an ALL relapse.
- Targeted therapy. There are also drugs that target specific cancer cells and their abnormalities. Targeted therapy kills cancer cells and may be used in combination with other therapies in any phase of treatment.
- New therapies. Beyond these standard treatments, doctors are working with new options, like immunotherapy. CAR T-cell therapy, for example, uses the body’s own immune system to kill off cancer cells. In this treatmenet, T-cells are created in a lab and then infused into the body to attack the ALL.
- Clinical trials. Doctors and researchers are working on creating new treatments for ALL and finding new ways to use current treatments. Your child may be eligible to take part in a clinical trial, but understand that these treatments are experimental. You can discuss both the benefits and risks with your child’s doctor.
The exact course of treatment will depend on whether the cancer cells originated from B or T lymphocytes. Your child’s doctor may prescribe a combination of various chemotherapy drugs as needed.
After each phase of treatment is completed, your child will be given a period of rest before progressing to another phase. In general, treatment with chemo for ALL takes between 2 and 3 yearsTrusted Source to complete.
What is the outlook for children with ALL?
Overall, researchers have found that the prognosis for children with ALL is good. According to the Leukemia and Lymphoma Society, survival rates from 2009 to 2015 were 91.9 percent for children younger than 15 years, and 94.1 percent for those younger than age 5.
Around 90 percent of kids with this form of cancer will be cured. “Cured” in this case means that the cancer will not relapse in the 10 years after treatment.
Some children, like those with Down Syndrome, may be more likely to have relapses than other children. And there is a chance that some kids may deal with effects or complications from ALL years after treatment.
Your child’s oncologist can give your more details on their individual prognosis.
What are the risk factors for childhood acute lymphoblastic leukemia (all)?
Factors that may increase the risk of acute lymphocytic leukemia include:
- Previous cancer treatment. Children and adults who've had certain types of chemotherapy and radiation therapy for other kinds of cancer may have an increased risk of developing acute lymphocytic leukemia.
- Exposure to radiation. People exposed to very high levels of radiation, such as survivors of a nuclear reactor accident, have an increased risk of developing acute lymphocytic leukemia.
- Genetic disorders. Certain genetic disorders, such as Down syndrome, are associated with an increased risk of acute lymphocytic leukemia.
Is there a cure/medications for childhood acute lymphoblastic leukemia (all)?
The most common type of pediatric cancer is childhood Acute Lymphoblastic Leukemia (ALL). It is a kind of blood and bone marrow cancer that spreads swiftly and can be lethal within a few months if left untreated.
1. Children experiencing acute lymphoblastic leukemia might receive a variety of treatments (ALL). Some therapies are mainstream (already used), while others are being investigated in clinical studies.
2. Because childhood cancer is uncommon, joining in a clinical study should be considered. Some clinical trials are only available to people who have not yet begun treatment.
The therapy of childhood ALL is divided into three stages:
1. Induction therapy: Induction therapy is the initial part of treatment. Its goal is to eradicate leukemia cells from the blood and bone marrow. This causes the leukemia to go into remission. This is often referred to as the remission induction period.
2. Consolidation/intensification therapy: Consolidation/intensification therapy is the second stage of treatment. It starts after the leukemia has gone into remission. Consolidation/intensification therapy aims to eliminate any leftover leukemia cells that might not be active but could regrow and trigger a relapse.
3. Maintenance therapy: The final part of treatment is maintenance therapy. Its goal is to eliminate any leftover leukemia cells that could repopulate and induce a recurrence. Cancer medicines are frequently administered at lower doses than those used for induction and consolidation/intensification therapy. This is also known as the phase of continuing therapy.
Fatigue,Weakness,Dizziness or lightheadedness,Shortness of breath,Pale skin,Frequent infections,Bruising,Fever,Bone pain,Loss of appetite
Bleeding: nosebleeds, bleeding gums, or heavy menstrual bleeding in women,Swollen lymph nodes (in and around the neck, underarm, abdomen, or groin)