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Leukemia in Children: 1 Rahul Dhaker, Asst. Professor, RCN

Leukemia is a cancer of the blood or bone marrow that commonly affects children. The two main types are acute lymphocytic leukemia (ALL) and acute myelogenous leukemia (AML). ALL accounts for about 3 out of 4 childhood leukemia cases. Symptoms include fatigue, pale skin, infections, easy bruising or bleeding, and organ swelling. Diagnosis involves medical history, physical exam, blood tests, bone marrow testing. Treatment primarily consists of chemotherapy, sometimes with radiation or bone marrow transplantation, and aims to cure the cancer or achieve long-term remission. Chemotherapy is usually given in induction, consolidation, and maintenance phases and has significant side effects.

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Rahul Dhaker
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947 views

Leukemia in Children: 1 Rahul Dhaker, Asst. Professor, RCN

Leukemia is a cancer of the blood or bone marrow that commonly affects children. The two main types are acute lymphocytic leukemia (ALL) and acute myelogenous leukemia (AML). ALL accounts for about 3 out of 4 childhood leukemia cases. Symptoms include fatigue, pale skin, infections, easy bruising or bleeding, and organ swelling. Diagnosis involves medical history, physical exam, blood tests, bone marrow testing. Treatment primarily consists of chemotherapy, sometimes with radiation or bone marrow transplantation, and aims to cure the cancer or achieve long-term remission. Chemotherapy is usually given in induction, consolidation, and maintenance phases and has significant side effects.

Uploaded by

Rahul Dhaker
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Leukemia in Children

Rahul Dhaker, Asst. Professor, RCN 1


Introduction
• Leukemia is a hematological malignancy or a
cancer of the blood.
• Blood cells and platelets are produced in the bone
marrow.
• In leukemia, some new white blood cells (WBCs)
fail to mature properly.
• These immature cells continue to reproduce at a
rapid rate, crowding out healthy cells and
producing a host of symptoms.
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Cont…Introduction

• Leukemia is the most common cancer in children


and teens, accounting for almost 1 out of 3 cancers.

• Most childhood leukemias are acute lymphocytic


leukemia (ALL).

• Most of the remaining cases are acute myeloid


leukemia (AML).

• Chronic leukemias are rare in children.


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Etiology
• The exact cause of most cases of childhood leukemia
is not known.
• Genetic risk factors
– Inherited syndromes
• Down syndrome (trisomy 21)
• Li-Fraumeni syndrome

– Inherited immune system problems


– Having a brother or sister with leukemia
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Rahul Dhaker, Asst. Professor, RCN
Cont… Etiology

• Lifestyle-related risk factors


– include smoking, being overweight, drinking too much
alcohol, and getting too much sun exposure

• Environmental risk factors


– Radiation exposure

– Exposure to chemotherapy and certain other chemicals

– Immune system suppression

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Cont… Etiology

• Risk factors
– Exposure to electromagnetic fields
– Living near a nuclear power plant
– Infections early in life
– Mother’s age
– Parent’s smoking history
– Fetal exposure to hormones or birth control pills
– Father’s workplace exposure to chemicals and
solvents
– Chemical contamination of ground water
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Rahul Dhaker, Asst. Professor, RCN
Classification
• Acute leukemias
– Acute lymphocytic (lymphoblastic) leukemia (ALL)
– Acute myelogenous (Myelocytic) leukemia (AML)
– Hybrid or mixed lineage leukemia

• Chronic leukemias
– Chronic myelogenous (Myelocytic) leukemia (CML)
– Chronic lymphocytic leukemia (CLL)
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Rahul Dhaker, Asst. Professor, RCN
Cont… Classification

• Juvenile myelomonocytic leukemia (JMML)


– This rare type of leukemia is neither chronic nor acute.
– t begins from myeloid cells, but it usually doesn’t
grow as fast as AML or as slow as CML.
– It occurs most often in young children (under age 4).
– Symptoms can include
• pale skin,
• fever, ,
• cough,
• easy bruising or bleeding,
• trouble breathing (from too many white blood cells in the
lungs), and an enlarged spleen and lymph nodes.
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Acute lymphocytic
(lymphoblastic) leukemia (ALL)
• One main type of acute leukemia is acute lymphocytic
leukemia (ALL),
• which accounts for about 3 out of 4 cases of leukemia in
children.
• ALL is a form of leukemia that affects the lymphocytes, a
type of white blood cells which fights infection.
• When a patient has ALL, the bone marrow makes too many
immature white blood cells and they do not mature
correctly.
• Therefore, the white blood cells over-produce, crowding the
other blood cells.
• The white blood cells also do not work correctly to fight
infection.
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Acute myelogenous leukemia(AML)
• This type of leukemia, also called
– acute myeloid leukemia,
– acute myelocytic leukemia, or
– acute non-lymphocytic leukemia, accounts for
most of the remaining cases.
• AML is cancer of the blood in which too many
myeloblasts, immature white blood cells, are
produced in the bone marrow.

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Clinical manifestation
• Fatigue or pale skin

• Infections and fever

• Easy bleeding or bruising

• Extreme fatigue or weakness

• Shortness of breath

• Coughing
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Cont… Clinical manifestation

• Other symptoms may include:-


• Bone or joint pain
• Swelling in the abdomen, face, arms, underarms,
sides of neck, or groin
• Swelling above the collarbone
• Loss of appetite or weight loss
• Headaches, seizures, balance problems, or abnormal
vision
• Vomiting
• Rashes
• Gum problems
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Rahul Dhaker, Asst. Professor, RCN
Diagnostic evaluation
• History taking
• Physical examination
• Hb level
• RBC count and hematocrit value
• Bone marrow aspiration and biopsy
• Chets X-ray
• CSF Study
• lymph-node biopsy
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Management
• Treatment for leukemia usually is carried out by a
team of specialists, including nurses, social
workers, psychologists, surgeons, and other health
care professionals.
• Chemotherapy is the main treatment for
childhood leukemia, although the dosages and
drug combinations may differ.
• Chemo can be given by mouth, into a vein, or into
the spinal fluid.
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• Radiation therapy

• Chemotherapy

• Bone marrow transplantation

• Supportive and symptomatic management to be


provided to prevent complication.

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Chemotherapy
• Chemotherapy medicines are given for
several reasons:
• To treat cancers that respond well to chemotherapy
• To decrease the size of tumors for easier and safer
removal by surgery
• To enhance the cancer-killing effectiveness of
other treatments, such as radiation therapy
• To control the cancer and enhance the patient’s
quality of life
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• chemotherapy, usually in 3 main phases:
– Induction(इन्डक्शन)
– Consolidation (also called intensification)(कन्सालडै शन / कन्साललडे शन)
– Maintenance
• Some of the drugs used to treat childhood leukemia include:
– Vincristine (Oncovin)
– Daunorubicin, also known as daunomycin (Cerubidine)
– Doxorubicin (Adriamycin)
– Cytarabine, also known as cytosine arabinoside or ara-C (Cytosar)
– L-asparaginase (Elspar), PEG-L-asparaginase (pegaspargase, Oncaspar)
– Etoposide (VePesid, others)
– Teniposide (Vumon)
– 6-mercaptopurine (Purinethol)
– 6-thioguanine
– Methotrexate
– Mitoxantrone
– Cyclophosphamide (Cytoxan)
– Prednisone
– Dexamethasone (Decadron, others)

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Treatment Side Effects
• Appetite Problems • Low Red Blood Cell
Count (Anemia)
• Constipation • Low White Blood
• Dehydration Cell Count
(Neutropenia)
• Diarrhea
• Mouth Sores and Dry
• Fatigue Mouth
• Fever • Nausea and Vomiting
• Hair Loss (Alopecia) • Pain
• Skin Changes
• Low Platelet Count
• Weight Gain or
(Thrombocytopenia) Weight Loss
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Complication
• Infection- ( Lungs, GI and Skin)

• Bleeding

• Arrhythmia

• Heart block

• There may be CNS and Skeletal involvement

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