Leukemia is derived from the Greek words leukos meaning white, and haima meaning blood. It is a type of cancer of the blood and/or bone marrow (blood generating organ within the long bones) and is characterized by an abnormal increase of white blood cells (TLC). Leukemia is a broad term covering a spectrum of diseases. It is part of the even broader group of diseases affecting the blood, bone marrow and lymphoid system, which are all known as hematological neoplasms.

 

Types Of Leukemia

Acute lymphoblastic leukemia (ALL):

  • It is the most common type of leukemia affecting young children.
  • Children can present at any age from newborns to adolescent.
  • Children between 2-6 years of age fare better in terms of final outcome.
  • Females fare better than males in prognosis.
  • The Etiology of leukemia is multifactorial:- Genetics, Infections, Environmental causes.
  • Investigations: Various Blood tests need to be done for making the diagnosis.
  • Standard treatments involve chemotherapy and radiotherapy.
  • The survival rates vary by age:

                            Minimum Risk Group survival rate is 80%.

                            In High Risk cancer Group survival rate is 50%.

Acute Myelogenous Leukemia (AML):

  • It is less common than ALL however does occur in children.
  • It is a more difficult tumor to treat than ALL.
  • ALL is more common than AML except in neonates with Down’s Syndrome.
  • AML is treated with chemotherapy.
  • The five-year survival rate is 40%.

Acute Myelogenous Leukemia (AML):

  • Usually occurs mainly in adults.
  • The five-year survival rate is 90%.

Chronic lymphocytic leukemia (CLL) :

  • Most often affects adults over the age of 55.
  • It sometimes occurs in younger adults, but it almost never affects children.
  • Two-thirds of affected people are men.
  • The five-year survival rate is 75%.
  • It is incurable, but there are many effective treatments to improve the quality of life of the child.

Symptoms (Noticed by the parents/ teachers)

  • Fever
  • Night Sweats
  • Weight Loss
  • Paleness
  • Refusal to play
  • Lethargy

Sign (Noted by Physician)

  • Fever
  • Bone pains(Pain in legs/arms)
  • Lymphadenopthy(Swellings in neck,axilla,groin)
  • Hepatpmegaly(Increased liver size)
  • Splenomegaly(Increase in the size of spleen)
  • Pallor
  • Petechiae(Small round red spots on the skin anywhere on the body due to intradermal bleed)
  • Gum Hypertrophy(enlarged gums)
  • Bleeding gums
  • Intra-oral hematomas(Bleeding in the mucosa of the mouth)

Diagnosis

Diagnosis is based on the clinical findings and various blood tests needed to categorize the type of cancer and the prognosos;whether good or bad.

Investigation that need to be done and/or repeated are:

  • Complete blood counts

           Usually show anemia,thrombocytipenia

           Leucocyte counts maybe low or high 

          The predominant population of leucocytes will be blasts- depending on the type of cancer       lymphoblasts or myeloblasts.

          Sometimes interpretation of the CBC report maybe difficult due to low counts.In that case close follow up is essential.

  • Bone marrow aspiration or biopsy

         Is the test required for diagnosis and typing of leukemia

         The blast population is indentified (>20% is leukemia according to WHO guidelines)

         Flow-cytometry and cytogenetics are sent. This is the most important investigation to prognosticate the leukemia.

         If blast population is less than 20% and clinical suspicion is present then the child must be closely followed up and bone marrow aspiration repeated at a later date.

Investigations done during the follow up of the patient:

  • Complete blood counts 1. Regular Complete Blood Tests are required to follow up on the response of chemotherapy and the susceptbillity of the child towards infections(febrille neutropenia).
  • Liver function tests and renal (kidney) function tests are done to assess the effect of the chemotherapy drugs on the liver and the kidney.
  • Radiological investigations like X-ray, ultrasound, and/or MRI may also be needed

Treatment

Treatment of leukemia is based on chemotherapy i.e. use of drugs given via oral, intravenous, subcutaneous and intra-thecal (into the back) route to avoid leukemia spreading to the brain and to other organ of the body and/or treat it if it has already spread.

Treatment is usually given over a period of 2 years in ALL and around 6 months in AML. Some patients may require bone marrow transplant for complete cure.

Some children may require radiotherapy as well. The need for radiotherapy and bone marrow transplant depends on the type of leukemia the child is suffering from and the results of various tests that have been performed.

The common protocols used in various centers around the globe in pediatric cancer hospitals are:

  • MCP 841 protocol
  • BFM (Berlin Frankfurt Münster) protocol.
  • Modified BFM protocol
  • HSK (Hong Kong Singapore) protocol

 Complications of the chemotherapy

There are various side effects of treatment as chemotherapy is strong medication. The child can have:

  • Nausea
  • Vomiting
  • Decreased appetite
  • Hair fall
  • Diarrhea
  • Oral ulcers
  • Fever
  • There is constant need for blood transfusions and platelet transfusions as the chemotherapy is eradicating the disease process form the body the bone marrow stops producing these cells and have to be replaced.

Special Instructions to the parents

  • Measure fever twice a day with a clean thermometer and report to hospital immediately if fever is more than or equal to 100f
  • Report to hospital in case of fever, vomiting, bleeding, or anything unusual in the child’s daily activity.
  • No vaccinations should be administered during the chemotherapy
  • No uncooked food items to the given to the child like salads, fruits.
  • Use boiled (cooled) and/or filtered water only.
  • Maintain personal and dental hygiene.Brush teeth with finger.
  • Child should not be isolated but avoid contact with sick family members and friends.
  • Toys should be cleaned regularly and stuffed toys should be avoided.