What is the treatment for children with leukemia?

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What are the symptoms of childhood leukaemia?
What causes leukaemia?
How is childhood leukaemia diagnosed?
Tests to find leukaemia
Staging and further tests
How is childhood leukaemia treated?
Living with childhood leukaemia
Resources and support
What causes leukemia in children?
What can I do to prevent leukemia in my child?
Key points about leukemia in children

Leukaemia is cancer that affects the white blood cells (lymphocytes). It affects the blood and bone marrow, where blood cells are made. Leukaemia may be acute, appearing fast and growing quickly, or chronic, appearing gradually and growing slowly. Most childhood leukaemias are acute.

Children with leukaemia usually need treatment for 2 to 3 years, as well as ongoing regular check-ups to monitor and treat any late effects.

There are several types of leukaemia seen in children, including:

acute lymphoblastic leukaemia (ALL), also called acute lymphocytic leukaemia — this is the most common type in children
acute myeloid leukaemia (AML), also called acute myeloblastic leukaemia
chronic lymphocytic leukaemia (CLL), the most common type of leukaemia in adults but rare in children
chronic myeloid leukaemia (CML), which is very rare in children but more common in teenagers

Types of leukaemia differ in the type of cell they originate from, as well as in the way they are treated and their chance of successful treatment.

Watch this video from Cancer Australia about what it can be like to have cancer as a child:

What are the symptoms of childhood leukaemia?

For acute types of childhood leukaemia — ALL and AML — symptoms include:

anaemia, causing paleness, weakness, breathlessness and tiredness
repeated infections, for example mouth sores, infected cuts and scratches
unexplained bruising and bleeding
bone or joint pain
other symptoms — such as enlarged lymph nodes (glands), chest pain and abdominal discomfort due to a swollen spleen or liver

The symptoms of leukaemia are similar to that of some other common conditions. If you notice any of these symptoms, it doesn't mean your child has leukaemia, but it's a good idea to see your doctor.

What causes leukaemia?

The exact causes of leukaemia in children are not known, but it is likely that several factors are involved. Factors that may put some children at higher risk of genetic damage that can lead to leukaemia include:

infections: delayed exposure to common childhood infections or an abnormal response by the child’s immune system to these infections
radiation: exposure to large doses of ionising radiation (energy from x-rays and radioactive materials) before birth or in the early years
chemicals: exposure to high levels of certain chemicals, such as benzene
congenital disorders: like Down syndrome and Fanconi anaemia

How is childhood leukaemia diagnosed?

Many symptoms of childhood leukaemia are general and can be caused by a range of illnesses. To make a definite diagnosis of leukaemia, a number of tests need to be done.

Your doctor will most likely give your child a physical examination and take a sample of their blood so it can be examined under a microscope. If the blood test shows large numbers of abnormal white blood cells, and low numbers of healthy blood cells, more tests will be done to confirm the diagnosis.

Tests to find leukaemia

There are several tests that can be done to confirm a diagnosis of leukaemia, and to work out which type it is:

Bone marrow biopsy — a syringe is used to take a sample of bone marrow, usually from the hip bone, for examination under the microscope and genetic testing.
Lumbar puncture — sometimes called a spinal tap. A needle is put into the space between the bones of the lower back and fluid from around the spinal cord is removed for examination under the microscope to look for abnormal white blood cells.

Staging and further tests

The 'stage' of leukaemia describes how far the cancer has spread. Doctors conduct staging with tests including a chest x-ray, CT scan or lumbar puncture. They may also look for chromosomal changes in your child’s blood.

How is childhood leukaemia treated?

The main treatment given to children with leukaemia is chemotherapy (a combination of medicines), usually as tablets or injections. Radiotherapy may also be used to kill cancer cells in the brain, and in some cases, a stem cell or bone marrow transplant may also be necessary.

Other treatments include:

antibiotics to prevent infections
immunotherapy to use the body's own immune system to fight cancer cells
targeted therapy, medicine that targets cancer cells but with fewer side effects than chemotherapy
blood products to restore the normal contents of the blood

Treatments for leukaemia in children, as with adults, can cause a range of short-term side effects, such as nausea and loss of hair. Longer-term effects, called 'late effects', can also develop any time after treatment, so ongoing check-ups are needed.

Living with childhood leukaemia

Children with leukaemia can need treatment for up to 3 years. During this time, it's important they have the opportunity to live as normal a life as possible. Whenever feeling well enough, they should be encouraged to do their usual activities, like having playtime, and going to school or day care.

Caring for a child with leukaemia can be very challenging and stressful. Many support services exist to help families, including Cancer Councils in each state and territory (call 13 11 20), and the Leukaemia Foundation.

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Last reviewed: March 2021

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ABOUT CAUSES DIAGNOSIS TREATMENT NEXT STEPS

Leukemia is cancer of the blood. It’s the most common form of cancer in childhood. The cancer cells grow in bone marrow and go into the blood. The bone marrow is the soft, spongy center of some bones. It makes blood cells. When a child has leukemia, the bone marrow makes abnormal blood cells that don’t mature. The abnormal cells are usually white blood cells (leukocytes). The bone marrow also makes fewer healthy cells. The abnormal cells reproduce very quickly. They don’t work the same as healthy cells.

The types of blood cells include:

Red blood cells (erythrocytes). Red blood cells carry oxygen. When a child has a low level of healthy red blood cells, this is called anemia. A child may feel tired, weak, and short of breath.
Platelets (thrombocytes). Platelets help with blood clotting and stop bleeding. When a child has low levels of platelets, he or she bruises and bleeds more easily.
White blood cells (leukocytes). These fight infection and other disease. When a child has low levels of white blood cells, he or she is more likely to have infections.

There are different types of leukemia in children. Most leukemias in children are acute, which means they tend to grow quickly. Some of the types of leukemia that occur in children include:

Acute lymphocytic (lymphoblastic) leukemia (ALL). This is the most common type of leukemia in children.
Acute myelogenous (myeloid, myelocytic, non-lymphocytic) leukemia (AML). This is the second most common type of leukemia in children.
Hybrid or mixed lineage leukemia. This type is rare. It is a mix of ALL and AML.
Chronic myelogenous leukemia (CML). This type is also rare in children.
Chronic lymphocytic leukemia (CLL). This type is extremely rare in children.
Juvenile myelomonocytic leukemia (JMML). This is a rare type of cancer that doesn’t grow quickly (acute) or slowly (chronic).

What causes leukemia in children?

The exact cause of leukemia in children is not known. There are certain conditions passed on from parents to children (inherited) that increase the risk for childhood leukemia. But, most childhood leukemia is not inherited. Researchers have found changes (mutations) in genes of the bone marrow cells. These changes may occur early in a child's life or even before birth. But they may occur by chance (sporadic).

The risk factors for childhood leukemia include:

Exposure to high levels of radiation
Having certain inherited syndromes, such as Down syndrome and Li-Fraumeni syndrome
Having an inherited condition that affects the body's immune system
Having a brother or sister with leukemia

The symptoms depend on many factors. The cancer may be in the bone marrow, blood, and other tissue and organs. These may include the lymph nodes, liver, spleen, thymus, brain, spinal cord, gums, and skin.

Symptoms can occur a bit differently in each child. They can include:

Pale skin
Feeling tired, weak, or cold
Dizziness
Headaches
Shortness of breath, trouble breathing
Frequent or long-term infections
Fever
Easy bruising or bleeding, such as nosebleeds or bleeding gums
Bone or joint pain
Belly (abdominal) swelling
Poor appetite
Weight loss
Swollen lymph glands (nodes)

The symptoms of leukemia can be like other health conditions. Make sure your child sees a healthcare provider for a diagnosis.

Your child's healthcare provider will ask many questions about your child's symptoms. He or she will examine your child. Your child's healthcare provider may recommend blood tests and other tests. A complete blood count (CBC) provides the number of red blood cells, different types of white blood cells, and platelets. If the results are abnormal, your child's healthcare provider may recommend that your child see a pediatric cancer specialist (pediatric oncologist). The oncologist may want your child to have additional tests including:

Bone marrow aspiration or biopsy. Bone marrow is found in the center of some bones. It’s where blood cells are made. A small amount of bone marrow fluid may be taken. This is called aspiration. Or solid bone marrow tissue may be taken. This is called a core biopsy. Bone marrow is usually taken from the hip bone. This test is done to see if cancer (leukemia) cells are in the bone marrow.
Lab tests of blood and bone marrow samples. Tests like flow cytometry and immunohistochemistry. These tests determine the exact type of leukemia. DNA and chromosome tests may also be done.
X-ray. An X-ray uses a small amount of radiation to take pictures of bones and other body tissues.
Ultrasound (sonography). This test uses sound waves and a computer to create images.
Lymph node biopsy. A sample of tissue is taken from the lymph nodes. It’s checked with a microscope for cancer cells.
Lumbar puncture. A special needle is placed into the lower back, into the spinal canal. This is the area around the spinal cord. This is done to check the brain and spinal cord for cancer cells. A small amount of cerebral spinal fluid (CSF) is removed and sent for testing. CSF is the fluid around the brain and spinal cord.

When leukemia is diagnosed, the doctor will find out the exact type of leukemia it is. Leukemia is not assigned a stage number like most other cancers. Instead, it's classified into groups, sub-types, or both.

ALL (acute lymphocytic leukemia) is the most common leukemia in children. It's separated into 2 groups based on the type of lymphocyte the leukemia started in. That would be B cells or T cells. About 8 out of 10 cases of ALL in children are B-cell ALLs. These can be further classified into sub-types. The other 2 out of 10 cases are T-cell ALLs.

AML (acute myelogenous leukemia) is the other kind of leukemia that's common in children. Doctors use 2 different systems to classify AML. The French-American-British (FAB) system divides AML into 8 sub-types based on how the cells look under the microscope. The World Health Organization (WHO) classification system is newer. It groups AML into many groups based on things like the details of the gene changes in the cancer cells as well as the FAB sub-types.

Classifying leukemia is very complex. But it's an important part of making treatment plans and predicting treatment outcomes. Be sure to ask your child's healthcare provider to explain the stage of your child's leukemia to you in a way you can understand.

Your child may first need to be treated for low blood counts, bleeding, or infections. Your child may receive:

Blood transfusion with red blood cells for low blood counts
Blood transfusion with platelets to help stop bleeding
Antibiotic medicine to treat any infections

Treatment will depend on the type of leukemia and other factors. Leukemia can be treated with any of the below:

Chemotherapy. These are medicines that kill cancer cells or stop them from growing. They may be given into the vein (IV) or spinal canal, injected into a muscle, or taken by mouth. Chemotherapy is the main treatment for most leukemias in children. Several medicines are often given at different times. It’s usually done in cycles, with rest periods in between. This gives your child time to recover from the side effects.
Radiation therapy. These are high-energy X-rays or other types of radiation. They are used to kill cancer cells or stop them from growing. Radiation may be used in certain cases.
High-dose chemotherapy with a stem cell transplant. Young blood cells (stem cells) are taken from the child or from someone else. This is followed by a large amount of chemotherapy medicine. This causes damage to the bone marrow. After the chemotherapy, the stem cells are replaced.
Targeted therapy. These medicines may work when chemotherapy doesn’t. For example, it may be used to treat children with chronic myeloid leukemia (CML). Targeted therapy often has less severe side effects.
Immunotherapy. This is treatment that helps the body's own immune system attack the cancer cells.
Supportive care. Treatment can cause side effects. Medicines and other treatments can be used for pain, fever, infection, and nausea and vomiting.
Clinical trials. Ask your child's healthcare provider if there are any treatments being tested that may work well for your child.

With any cancer, how well a child is expected to recover (prognosis) varies. Keep in mind:

Getting medical treatment right away is important for the best prognosis.
Ongoing follow-up care during and after treatment is needed.
New treatments are being tested to improve outcome and to lessen side effects.

A child may have complications from the tumor or from treatment. They may also be short-term or long-term.

Treatment may have many side effects. Some side effects may be minor. Some may be serious and even life-threatening. Your child may take medicines to help prevent or lessen side effects. You’ll be given instructions about what you can do at home.

Possible complications of leukemia can include:

Serious infections
Severe bleeding (hemorrhage)
Thickened blood from large numbers of leukemia cells

Possible long-term complications from the leukemia or the treatment can include:

Return of the leukemia
Growth of other cancers
Heart and lung problems
Learning problems
Slowed growth and development
Problems with the ability to have children in the future
Bone problems such as thinning of bones (osteoporosis)

What can I do to prevent leukemia in my child?

Most childhood cancers, including leukemia, can’t be prevented. The risk from X-rays and CT scans is very small. But healthcare providers advise against them in pregnant women and children unless absolutely needed.

A child with leukemia needs ongoing care. Your child will be seen by oncologists and other healthcare providers to treat any late effects of treatment and to watch for signs or symptoms of the cancer returning. Your child will be checked with imaging tests and other tests. And your child may see other healthcare providers for problems from the cancer or from treatment.

You can help your child manage his or her treatment in many ways. For example:

Your child may have trouble eating. A dietitian may be able to help.
Your child may be very tired. He or she will need to balance rest and activity. Encourage your child to get some exercise. This is good for overall health. And it may help to lessen tiredness.
Get emotional support for your child. Find a counselor or child support group can help.
Make sure your child attends all follow-up appointments.

Call the healthcare provider if your child has:

Fever
Symptoms that get worse
New symptoms
Side effects from treatment

Key points about leukemia in children

Leukemia is cancer of the blood. The cancer cells develop in the bone marrow and go into the blood. Other tissue and organs that may be affected include the lymph nodes, liver, spleen, thymus, brain, spinal cord, gums, and skin.
When a child has leukemia, the bone marrow makes abnormal blood cells that do not mature. The abnormal cells are usually white blood cells (leukocytes). And with leukemia, the bone marrow makes fewer healthy cells.
Common symptoms of leukemia in children include feeling tired and weak, easy bruising or bleeding, and frequent or long-term infections.
Leukemia is diagnosed with blood and bone marrow tests. Imaging may be done to look for signs of leukemia in different parts of the body.
Chemotherapy is the main treatment for most leukemias in children.
A child with leukemia may have complications from the leukemia and from the treatment.
Ongoing follow-up care is needed during and after treatment.

Tips to help you get the most from a visit to your child’s healthcare provider:

Know the reason for the visit and what you want to happen.
Before your visit, write down questions you want answered.
At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
Ask if your child’s condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if your child does not take the medicine or have the test or procedure.
If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.