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What is leukemia?

Leukemia is cancer of the blood and develops in the bone marrow. The bone marrow is the soft, spongy center of the long bones that produces the three major blood cells: white blood cells to fight infection; red blood cells that carry oxygen; and platelets that help with blood clotting and stop bleeding. When a child has leukemia, the bone marrow, for an unknown reason, begins to make white blood cells that do not mature correctly, but continue to reproduce themselves. Normal, healthy cells only reproduce when there is enough space for them to fit. The body can regulate the production of cells by sending signals when to stop. With leukemia, these cells do not respond to the signals to stop and reproduce, regardless of space available.

These abnormal cells reproduce very quickly and do not function as healthy white blood cells to help fight infection. When the immature white blood cells, called blasts, begin to crowd out other healthy cells in the bone marrow, the child experiences the symptoms of leukemia (i.e., infections, anemia, bleeding).

Who is affected by leukemia?

Leukemia is the most common form of cancer in childhood. It affects approximately 2,800 children each year in the US, accounting for about 30 percent of childhood cancers.

Leukemia can occur at any age, although it is most commonly seen in children between 2 and 6 years of age. The disease occurs slightly more frequently in males than in females, and is more commonly seen in Caucasian children than in African-American children, or children of other races.

What causes leukemia in children?

The majority of childhood leukemias are acquired genetic diseases. This means that gene mutations and chromosome abnormalities in cells occur sporadically (by chance).

The immune system plays an important role in protecting the body from diseases, and possibly cancer. An alteration or defect in the immune system may increase the risk for developing leukemia. Factors such as exposure to certain viruses, environmental factors, chemical exposures, and various infections have been associated with damage to the immune system.

With the exception of specific genetic syndromes, little is known about the causes of childhood leukemia.

What are the different types of leukemia?

There are three main types of leukemia, including the following:

The difference between lymphocytic and myelogenous is the stage of development on what is called the pluripotent stem cell. The pluripotent stem cell is the first stage of development of all of the blood cells (white blood cells, red blood cells, and platelets). This stem cell goes through stages of development until it matures into a functioning cell. The type of leukemia is determined by where the cell is in the stage of development when it becomes malignant, or cancerous.

The stem cell matures into either the lymphoid or myeloid cells. The lymphoid cells mature into either B-lymphocytes or T-lymphocytes. If the leukemia is among these cells, it is called acute lymphocytic leukemia (ALL). If the leukemia is found even further along this stage of development, it can be further classified as B-cell ALL or T-cell ALL. The more mature the cell, the more difficult it is to treat.

The myeloid cells develop into platelets, red blood cells, and specialized white blood cells called neutrophils and macrophages. There are many classifications of AML. The type of leukemia is determined by the stage of development when the normal cells become leukemia cells.

What are the symptoms of leukemia?

Because leukemia is cancer of the blood-forming tissue called the bone marrow, the initial symptoms are often related to irregular bone marrow function. The bone marrow is responsible for storing and producing about 95 percent of the body's blood cells, including the red blood cells, white blood cells, and platelets.

When leukemia occurs, the abnormal white blood cells (blasts) begin to reproduce very rapidly and begin crowding out and competing for nutrients and space with the other healthy cells. The following are the most common symptoms of leukemia. However, each child may experience symptoms differently. Symptoms may include:

With acute leukemia (ALL or AML), these symptoms may occur suddenly in a matter of days or weeks. With chronic leukemia (CML), these symptoms may develop slowly over months to years.

It is important to understand that the symptoms of leukemia may resemble other blood disorders or medical problems. These are common symptoms of the disease, but do not include all possible symptoms. Children may experience symptoms differently. Always consult your child's physician for a diagnosis.

How is leukemia diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for leukemia may include:

Treatment for leukemia:

Specific treatment for leukemia will be determined by your child's physician based on:

Treatment usually begins by addressing the presenting symptoms such as anemia, bleeding, and/or infection. In addition, treatment for leukemia may include (alone or in combination) the following:

What are the various stages of leukemia treatment?

There are various stages in the treatment of leukemia, including the following:

Long-term outlook for a child with leukemia:

Prognosis greatly depends on:

As with any cancer, prognosis and long-term survival can vary greatly from child to child. Prompt medical attention and aggressive therapy are important for the best prognosis. Continuous follow-up care is essential for the child diagnosed with leukemia.

Side effects of radiation and chemotherapy, as well as second malignancies, can occur in survivors of leukemia. New methods are continually being discovered to improve treatment and to decrease side effects of the treatment for the disease.

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