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Pediatric Acute Lymphoblastic Leukemia

Acute lymphoblastic leukemia (ALL) is the most common form of leukemia found in children, accounting for about 30 percent of all pediatric cancers.  Around 3,000 children in the United States are affected by ALL each year.  ALL has one of the highest cure rates of all childhood malignancies, with 85-90% of all children diagnosed with this disease ultimately becoming long-term survivors.  At Ochsner for Children, our Pediatric Hematologists and Oncologists work with a multidisciplinary team to provide state of the art care to children and young adults diagnosed with ALL.  We are very active in research and clinical trials designed to increase cure rates, decrease treatment-related side effects and improve care for long-term survivors.

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What is acute lymphoblastic leukemia?

Acute lymphoblastic leukemia (ALL) is a cancer that affects the white blood cells. These cells fight infection and help protect the body against disease.  Patients with ALL have too many immature white blood cells in their bone marrow. These cells crowd out normal white blood cells. Without enough normal white blood cells, the body has a harder time fighting infections. ALL affects a type of white blood cell called lymphocytes, causing them to build up in the liver, spleen and lymph nodes.  There are several different types of ALL, the most common of which is “Pre-B cell” ALL.  Other types of ALL, such as T-cell and B-cell, can also occur, however they are less common in children.

What are the symptoms of acute lymphoblastic leukemia?

Symptoms of ALL include:

  • Fever
  • Easy bruising or bleeding that is hard to stop
  • Flat, dark-red skin spots (petechiae) due to bleeding under the skin
  • Pain in the bones or joints
  • Lumps in the neck, underarm, stomach or groin
  • Weakness, fatigue, paleness or loss of appetite
  • Shortness of breath

How common is acute lymphoblastic leukemia?

ALL is the most common type of childhood cancer.  It affects about 1 in 28,500 people, and about 3,000 children younger than age 20 are found to have ALL each year in the United States. Siblings of children with leukemia have a slightly higher risk of developing ALL, but the rate is still quite low: no more than 1 in 500.  It occurs most commonly in children 2 to 4 years of age.

What are the survival rates for acute lymphoblastic leukemia?

  • About 98 percent of children with ALL go into remission within 4 weeks of starting treatment.
  • Around 90 percent of children with ALL can be cured.  Patients are considered cured after 5 years in remission. 
  • Certain types of ALL may have slightly higher or lower cure rates.

The diagnosis of acute lymphoblastic leukemia in children is based on a complete medical history and physical examination and on the following diagnostic tests:

  • Complete blood count (CBC). Blood drawn is used to look at the white blood cell number, as well as platelets. Blood tests may be done to evaluate the liver and kidneys and how the blood is clotting. 
  • Bone marrow aspirate and biopsy. Bone marrow aspirates and biopsies involve inserting a needle into a bone in the pelvis and removing about 2 teaspoons of marrow for examination. Bone marrow studies usually require sedation or general anesthesia.
  • Lumbar puncture (spinal tap). Spinal taps involve inserting a needle into the lower back, between the bones of the spinal column or backbone, to remove the fluid that surrounds the brain and spinal cord. The same needle can be used to insert medicines to prevent or treat leukemia in the brain or spinal cord (intrathecal chemotherapy).  Lumbar punctures are often done under sedation.
  • Chest X-ray. Chest X-rays are taken to see if there is a mass of cells in the thymus that may affect breathing.

How is acute lymphoblastic leukemia treated?

ALL treatment includes three phases:

  • Induction — The purpose of this phase, which often occurs in the hospital, is to kill the leukemia cells in the blood and bone marrow and put the disease into remission (a return to normal blood cell counts)
  • Consolidation/intensification — The purpose of this phase is to rid the body of any remaining cells that could begin to grow and cause the leukemia to relapse
  • Maintenance — to destroy any cancer cells that might have survived the first two phases

Four types of treatment may be used during any of these treatment phases:

  • Chemotherapy (“chemo”)—uses powerful medicines to kill cancer cells or stop them from growing (dividing) and making more cancer cells.
  • Stem cell transplant — This involves destroying the blood forming cells in the bone marrow with high-dose chemotherapy and radiation, then replacing them with cells from a donor
    • A stem cell transplant gives the patient new blood cells and a new immune system from a donor’s blood or bone marrow.
    • Some types of stem cell transplants may be called “bone marrow transplants” because the cells come from the donor’s bone marrow. 
  • Radiation therapy — While infrequently used, high-energy X-rays or other types of radiation can kill cancer cells or stop them from growing.
  • Targeted therapy — Newer medicines are now available that target and attack specific cancer cells without harming normal cells.  Many of these medicines are still considered experimental.

What clinical trials does Ochsner Hospital for Children offer for leukemia treatment?

  • As part of the Children’s Oncology Group, Ochsner Hospital for Children is an active participant in children’s cancer research.  We currently have multiple clinical trials available to treat children and young adults with leukemia.