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Childhood acute lymphocytic leukemia


Table of Contents

OVERVIEW OF PDQ
What is PDQ?
How to use PDQ
DESCRIPTION
What is childhood acute lymphocytic leukemia?
STAGE EXPLANATION
Stages of childhood acute lymphocytic leukemia
Untreated
In remission
Recurrent/refractory
TREATMENT OPTION OVERVIEW
How childhood acute lymphocytic leukemia is treated
Treatment by stage
UNTREATED CHILDHOOD ACUTE LYMPHOCYTIC LEUKEMIA
CHILDHOOD ACUTE LYMPHOCYTIC LEUKEMIA IN REMISSION
RECURRENT CHILDHOOD ACUTE LYMPHOCYTIC LEUKEMIA
TO LEARN MORE

OVERVIEW OF PDQ


What is PDQ?

PDQ is a computer system that provides up-to-date information on cancer and its prevention, detection, treatment, and supportive care. PDQ is a service of the National Cancer Institute (NCI) for people with cancer and their families and for doctors, nurses, and other health care professionals.

To ensure that it remains current, the information in PDQ is reviewed and updated each month by experts in the fields of cancer treatment, prevention, screening, and supportive care. PDQ also provides information about research on new treatments (clinical trials), doctors who treat cancer, and hospitals with cancer programs. The treatment information in this summary is based on information in the PDQ summary for health professionals on this cancer.


How to use PDQ

Cancer in children and adolescents is rare. The majority of children with cancer are treated at cancer centers with special facilities to treat childhood cancers. There are organized groups of doctors and other health care professionals who work together by doing clinical trials to improve treatments for children with cancer.

PDQ can be used to learn more about current treatment of different kinds of cancer. You may find it helpful to discuss this information with your child's doctor, who knows your child and has the facts about your child's disease. PDQ can also provide the names of additional health care professionals and hospitals that specialize in treating children who have cancer.

Before your child begins treatment, you may want to consider entering your child in a clinical trial. PDQ can be used to learn more about the trials. A clinical trial is a research study that attempts to improve current treatments or find new treatments for people with cancer. Clinical trials are based on past studies and information discovered in the laboratory. Each trial answers specific scientific questions in order to find new and better ways to help people with cancer. During clinical trials, information is collected about new treatments, their risks, and how well they do or do not work. When a clinical trial shows that a new treatment is better than the treatment currently used as "standard" treatment, the new treatment may become the "standard" treatment. Children who are treated in clinical trials have the advantage of getting the best available therapy. In the United States, about two thirds of children with cancer are treated in a clinical trial at some point in their illness.

Listings of current clinical trials are available on PDQ. In the United States, there are two major groups (called cooperative groups) that organize clinical trials for childhood cancers: the Childrens Cancer Group (CCG) and the Pediatric Oncology Group (POG). Doctors who belong to these groups or who take part in other clinical trials are listed in PDQ.

To learn more about cancer and how it is treated or to learn more about clinical trials for your child's kind of cancer, call the National Cancer Institute's Cancer Information Service. The number is 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. The call is free and a trained information specialist will be available to answer your cancer-related questions.

PDQ is updated whenever there is new information. Check with the Cancer Information Service to be sure that you have the most up-to-date information.


DESCRIPTION


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 summary on adult acute lymphocytic leukemia. Separate PDQ patient information summaries 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.


STAGE EXPLANATION


Stages of childhood acute lymphocytic leukemia

There is no staging for childhood acute lymphocytic leukemia. The treatment depends on age, the results of laboratory tests, and 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 reduce 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.


TREATMENT OPTION OVERVIEW


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 to the patient. 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 to the patient 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.

The second 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.

Once a child goes into remission and there are no signs of leukemia, a third 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 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.


UNTREATED CHILDHOOD ACUTE LYMPHOCYTIC LEUKEMIA

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.


CHILDHOOD ACUTE LYMPHOCYTIC LEUKEMIA IN 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.


RECURRENT CHILDHOOD ACUTE LYMPHOCYTIC LEUKEMIA

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 or intrathecal chemotherapy, radiation therapy, 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

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. The call is toll-free and a trained information specialist can answer your questions.

Booklets are available and may be ordered from The Cancer Information Service. The following booklets about leukemia may be helpful:

What You Need To Know About Leukemia
Bone Marrow Transplantation and Peripheral Blood Stem Cell Transplantation

The following booklets on childhood cancer may also be helpful:

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 where material about cancer treatment and information about services are available. Check the hospital social service office for the names of local and national agencies that help with finances, getting to and from treatment, care at home, and dealing with other problems.

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: 11/1999


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.


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