Leukaemia in Children

Essentially, there are three main types of leukaemia that are categorised based on how speedily they develop and by which kind of white blood cell is involved. Most types of leukaemia in children are:

Acute lymphoblastic leukaemia (ALL): This affects lymphocytes

Acute myeloid leukaemia (AML): This affects blast cells, which are immature white blood cells

The less common types of childhood leukaemia are:

Chronic myelogenous leukaemia (CML): This starts in certain blood-forming cells of the bone marrow.

Juvenile myelomonocytic leukaemia (JMML): This happens when blasts make too many myelocytes and monocytes (two types of white blood cells)

In leukaemia, the bone marrow makes many abnormal white blood cells that crowd the bone marrow and enter the bloodstream. However, unlike healthy white blood cells, they cannot protect the body from infections. Although leukaemia in children is the most common type of cancer, most kids and teens who are treated for the illness are cured. Now that we have understood the types of leukaemia in children, let’s understand how the condition is diagnosed.

In addition to seeking a complete medical history and doing a comprehensive physical examination, here are some additional steps for diagnosing childhood leukaemia:

Bone marrow aspiration and/or biopsy: For this procedure, a small amount of bone marrow fluid called aspiration and/or solid bone marrow tissue called a core biopsy are examined for size, number, and maturity of blood cells and/or abnormal cells

Complete blood count (CBC): In this a specific volume of blood is examined for the number, size, and maturity of different blood cells

Additional blood tests: These might include evaluation of liver and kidney functions, blood chemistries, and genetic studies

CT scan: This is a noninvasive imaging procedure for producing axial, or horizontal images (usually called slices) of the body

MRI: This diagnostic procedure produces detailed images of structures and organs within the body

X-Ray: Through this diagnostic test, images of internal tissues, bones, and organs are produced

Sonography: Through this imaging technique, internal organs can be examined as they function. It also helps to assess blood flow through various vessels.

Lymph node biopsy: For this procedure, a tissue sample is removed from the lymph node and examined

Spinal tap/lumbar puncture: This procedure measures the pressure in the spinal canal and brain. Using a special hollow needle, a small amount of cerebrospinal fluid (CSF) is extracted and sent for testing to determine whether there are leukaemia cells, an infection, or other problems.

With the onset of leukaemia, abnormal cells (blasts) reproduce rapidly and start to compete for nutrients and space with the other healthy cells. Here are the most common symptoms of childhood leukaemia, but it is important to note that each child may experience symptoms differently:

Night sweats and fever

Bruising and bleeding that is unexplained, with small red spots appearing under the skin

Lumps in the underarms, neck, groin or stomach, or around the eyes

Pale skin

Dry skin rash

Aside from the above, here are a few other symptoms of childhood cancer leukaemia:

Aches in the bones or joints or under the ribs

Tiredness or weakness

Loss of appetite

A feeling of fullness or swelling in the abdomen

It can be observed that the aforementioned symptoms have a similarity to other common health conditions. So, if parents or guardians notice these it does not necessarily mean that your child has leukaemia; however, it is a good idea to visit the doctor for clarification.

Although the precise causes of leukaemia in children are unknown, several factors can play a role. Here are certain factors that might put certain children at higher risk of leukaemia:

Family history of leukaemia

Genetic conditions- certain conditions (like Down syndrome) can increase a child’s risk of developing leukaemia

Exposure to radiation- children who have been x-rayed before birth and those who have previously undergone radiation therapy for cancer treatment

Children who have undergone chemotherapy in the past

The treatments for childhood leukaemia will vary depending on the risk level, which relies on:

Age

Overall health and medical history

Genetics

The type of leukaemia

Tolerance of the treatments

Development of the disease

Expected progress of the disease

Personal preferences

Generally, the treatment begins with addressing the initial symptoms. These are often anaemia, bleeding, and/or infections. Childhood leukaemia is also treated with:**-

Chemotherapy:- Strong medicines are given either orally or through an IV to target the fast-growing cancer cells. Side effects are common because these medicines also harm normal cells.

Intrathecal medications:- Medicine is injected into the area around the spinal cord

Radiation therapy:- Targeted energy, such as X-rays, kills leukaemia cells. It can also help with aches owing to swollen liver, spleen, or lymph nodes. This can also relieve pain from bone marrow expansion.

Blood and bone marrow/stem cell transplantation:- First, the cancer cells in the bone marrow are destroyed. Then, a donor’s stem cells are given by IV to replace the bone marrow cells that have been killed. These stem cells make their way to the bone marrow via the bloodstream. These fresh stem cells then start making normal white blood cells, red blood cells, and platelets.

Biological/immunological therapy:- To help the body’s immune system find and kill the bad cells, antibodies against the cancer cells are given. They can also help guide radiation or drugs directly to the cancer cells.

Blood transfusions:- These may be required to replace red blood cells and/or platelets.

Medicines:- Medicines can be prescribed to treat side effects and to prevent or treat infections.

Follow-up care:**- To analyse how well the treatment is working, regular follow-ups are required. This can also help doctors identify whether the disease is relapsing and help them manage any late effects of treatment.

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