Pediatric Leukemia

Leukemia is the most common type of cancer in both children and teens. It makes up about one-third of all childhood cancers, but it’s still a rare disease.

Leukemia is a cancer of the blood cells. Most leukemia starts with white blood cells, but it can begin in other blood cells. Blood cells grow and mature in the bone marrow before they are pushed out into the bloodstream to circulate throughout the body. When someone has leukemia, their bone marrow produces abnormal blood cells that begin circulating. These abnormal cells are the leukemia cells. When leukemia cells are first made, they function almost normally. But over time, they can crowd out normal blood cells, making it hard for the normal cells to do their job. Leukemia cells can also make their way throughout the body, to the lymph nodes, organs, or central nervous system. All cases of leukemia require treatment – usually in a children’s hospital under the supervision of a children’s cancer specialist (pediatric oncologist).

About 75% of children with leukemia have acute lymphocytic leukemia (ALL), and acute myelogenous leukemia (AML) makes up most of the rest of the cases. Chronic and hybrid forms of leukemia are extremely rare in children.

ALL tends to happen in early childhood – between the ages of 2 and 4. AML can happen at any time during childhood, but it is more common before the age of 2 and during the teen years. Both boys and girls can get leukemia. ALL is more common in boys, but AML occurs equally across genders.

There are four main types of leukemia, which can be classified as acute or chronic. Acute leukemia, when the leukemia cells grow quickly, is the most common childhood leukemia. In fact, almost all childhood leukemia is acute. Chronic leukemia is slow-growing. This type is rare in children.

The four main types are:

There are hybrid types of leukemia as well, but these only rarely occur in children. These leukemias have characteristics of both ALL and AML.

Juvenile myelomonocytic leukemia (JMML) is a rare form of leukemia. It is not characterized as either chronic or acute. It starts in the myeloid cells, but it doesn’t fit into the growth pattern of either acute or chronic leukemia – it grows slower than AML and faster than CML. JMML, when it occurs, tends to affect children under the age of 4.

Early symptoms of leukemia tend to be related to bone marrow malfunction. The symptoms below are the most common symptoms of leukemia, but not all children will experience all symptoms.

• Anemia – When red blood cells can’t be produced or are low in number, children may have several symptoms, including:
  • Feeling tired
  • Looking pale
  • Breathing rapidly or having an increased breathing rate
  • Low red blood cell and hemoglobin numbers
• Decreased platelet count (thrombocytopenia) and related symptoms, like:
  • Bleeding or bruising
  • Tiny red dots on the skin (called petechiae)
• Recurrent infections because infection-fighting white blood cells aren’t working; signs of infections may include:
  • Fever
  • Runny nose
  • Cough
• Bone and joint pain from cells overcrowding the bone marrow
• Abdominal pain or discomfort from cells collecting in the internal organs; abdominal pain may lead to:
  • Appetite loss
  • Weight loss
• Swollen lymph nodes in the neck, underarms, chest, and groin
• Difficulty breathing (dyspnea) or chest pain due to cell buildup around the thymus (which occurs in T-cell ALL)

Wheezing, coughing, or painful breathing is an emergency. If your child experiences any of those symptoms, call 911 or bring them to the emergency room.

If your child has acute leukemia, symptoms can occur suddenly, in weeks or even days. With chronic leukemia, symptoms tend to develop slowly over months or years.

If your child has symptoms of leukemia, call the doctor for an appointment. To diagnose leukemia, your child’s pediatrician will take a medical history, perform a physical exam, and order some diagnostic tests or procedures.

Tests and procedures for leukemia may include:

• Bone marrow aspiration – This procedure involves removing bone marrow fluid to test the cells for abnormalities.
• Bone marrow biopsy – Biopsy of the bone marrow involves taking a small sample of bone marrow tissue to examine it for abnormal cells.
• Complete blood count (CBC) – This test looks at different blood cells to check their size, number, maturity, and volume of total blood cells.
• Additional blood tests – Your child’s doctor may want to check blood chemistries, do genetic studies, or check kidney and liver function. These can all be done with blood tests.
• X-rays – Your child may need to have X-rays taken to check for signs of cancer.
• CT scans – A CT scan may help with the diagnosis of leukemia. It provides detailed images of the body, including bones, muscles, organs, and fat. The scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs.
• MRI scans – MRI scans may also be used. They provide detailed images of the body without radiation.
• Ultrasound – Using ultrasound, doctors can see the function of organs and how the blood is flowing through the blood vessels.
• Lymph node biopsy – This procedure may be done to check for cancer cells in the lymph nodes.
• Lumbar puncture – This test, also known as a spinal tap, can check pressures in the spine and brain and can remove spinal fluid so it can be tested for infection or other abnormalities.

If your child has leukemia, he or she will need treatment. You and your child’s doctor will work together to find a treatment that’s best for your child’s type of leukemia.

Corewell Health Children's pediatric oncology and hematology specialists offer comprehensive diagnosis and treatment for infants, children, adolescents, and early young adults with nearly every type of childhood cancer or blood disorder. Our specialists have decades of collective experience and offer the most advanced approaches to the treatment of these conditions, including at the Skandalaris Family Center for Children with Cancer & Blood Disorders at Corewell Health William Beaumont University Hospital.

For a referral to a doctor for your child, call 855.480.KIDS (5437).