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Information from PDQ for Patients
Childhood acute lymphoblastic leukemia
208/00026
** DESCRIPTION **
-- What is childhood acute lymphoblastic leukemia? --
Childhood acute lymphoblastic leukemia (also called acute lymphocytic leukemia
or ALL) is a disease in which too many underdeveloped infection-fighting white
blood cells, called lymphocytes, are found in a child's blood and bone marrow.
ALL is the most common form of leukemia in children, and the most common kind
of childhood cancer.
Lymphocytes are made by the bone marrow and by other organs of the lymph
system. The bone marrow is the spongy tissue inside the large bones in the
body. The bone marrow makes red blood cells (which carry oxygen and other
materials to all tissues of the body), white blood cells (which fight
infection), and platelets (which make the blood clot). Normally, the bone
marrow makes cells called blasts that develop (mature) into several different
types of blood cells that have specific jobs to do in the body.
The lymph system is made up of thin tubes that branch, like blood vessels, into
all parts of the body. Lymph vessels carry lymph, a colorless, watery fluid
that contains lymphocytes. Along the network of vessels are groups of small,
bean-shaped organs called lymph nodes. Clusters of lymph nodes are found in
the underarm, pelvis, neck, and abdomen. The spleen (an organ in the upper
abdomen that makes lymphocytes and filters old blood cells from the blood), the
thymus (a small organ beneath the breastbone), and the tonsils (an organ in the
throat) are also part of the lymph system.
Lymphocytes fight infection by making substances called antibodies, which
attack germs and other harmful bacteria in the body. In ALL, the developing
lymphocytes become too numerous and do not mature. These immature lymphocytes
are then found in the blood and the bone marrow. They also collect in the
lymph tissues and make them swell. Lymphocytes may crowd out other blood cells
in the blood and bone marrow. If your child's bone marrow cannot make enough
red blood cells to carry oxygen, your child may have anemia. If your child's
bone marrow cannot make enough platelets to make the blood clot normally, your
child may bleed or bruise easily. The cancerous lymphocytes can also invade
other organs, the spinal cord, and the brain.
Leukemia can be acute (progressing quickly with many immature cancer cells) or
chronic (progressing slowly with more mature-looking leukemia cells). Acute
lymphoblastic leukemia progresses quickly, and can occur in both children and
adults. Treatment is different for adults than it is for children. Refer to
the PDQ patient information summary on Adult Acute Lymphocytic Leukemia
Treatment for more information. Refer to the PDQ summaries on Chronic
Lymphocytic Leukemia Treatment, Chronic Myelogenous Leukemia Treatment, Adult
or Childhood Acute Myeloid Leukemia Treatment, and Hairy Cell Leukemia
Treatment for more information.
Early signs of ALL may be similar to those of the flu or other common diseases,
such as a fever that won't go away, feeling weak or tired all the time, aching
bones or joints, or swollen lymph nodes. If your child has symptoms of
leukemia, his or her doctor may order blood tests to count the number of each
of the different kinds of blood cells. If the results of the blood tests are
not normal, a bone marrow biopsy may be performed. During this test, a needle
is inserted into a bone in the hip and a small amount of bone marrow is removed
and examined under the microscope, enabling the doctor to determine what kind
of leukemia your child has and plan the best treatment.
Your child's doctor may also do a spinal tap, in which a needle is inserted
through the back to remove a sample of the fluid that surrounds the brain and
spine. The fluid is then examined under a microscope to see if leukemia cells
are present.
Your child's chance of recovery (prognosis) depends on your child's age at
diagnosis, the number of white blood cells in the blood (the white blood cell
count) at diagnosis, how far the disease has spread, the biologic
characteristics of the leukemia cells, and how well the leukemia cells respond
to treatment.
** STAGE EXPLANATION **
-- Stages of childhood acute lymphoblastic leukemia --
There is no staging for childhood acute lymphoblastic leukemia. The treatment
depends on age, the results of laboratory tests, and whether or not the patient
has been previously treated for leukemia.
-- Untreated --
Untreated acute lymphoblastic leukemia (ALL) means that no treatment has been
given except to reduce symptoms. There are too many white blood cells in the
blood and bone marrow, and there may be other signs and symptoms of leukemia.
-- In remission --
Remission means that treatment has been given and the number of white blood
cells and other blood cells in the blood and bone marrow is normal. There are
no signs or symptoms of leukemia.
-- Recurrent/refractory --
Recurrent disease means that the leukemia has come back (recurred) after going
into remission. Refractory disease means that the leukemia failed to go into
remission following treatment.
** TREATMENT OPTION OVERVIEW **
-- How childhood acute lymphoblastic leukemia is treated --
There are treatments for all patients with childhood acute lymphoblastic
leukemia (ALL). The primary treatment for ALL is chemotherapy. Radiation
therapy may be used in certain cases. Bone marrow transplantation is being
studied in clinical trials.
Chemotherapy uses drugs to kill cancer cells. Chemotherapy drugs may be taken
by mouth, or may be put into the body by a needle in a vein or muscle.
Chemotherapy is called a systemic treatment because the drug enters the
bloodstream, travels through the body, and can kill cancer cells throughout the
body. For ALL, chemotherapy drugs may sometimes be injected (usually through
the spine) into the fluid that surrounds the brain and spinal cord; this is
known as intrathecal chemotherapy.
Radiation therapy uses x-rays or other high-energy rays to kill cancer cells
and shrink tumors. Radiation for ALL usually comes from a machine outside the
body (external beam radiation therapy).
Bone marrow transplantation is a newer type of treatment. First, high doses of
chemotherapy with or without radiation therapy are given to destroy all of the
bone marrow in the body. Healthy marrow is then taken from another person (a
donor) whose tissue is the same as or almost the same as the patient's. The
donor may be a twin (the best match), a brother or sister, or another person
not related to the patient. The healthy marrow from the donor is given to the
patient through a needle in a vein, and the marrow replaces the marrow that was
destroyed. A bone marrow transplant using marrow from a relative or person not
related to the patient is called an allogeneic bone marrow transplant.
An even newer type of bone marrow transplant, called autologous bone marrow
transplant, is being studied in clinical trials. During this procedure, bone
marrow is taken from the patient and may be treated with drugs to kill any
cancer cells. The marrow is frozen to save it. The patient is then given
high-dose chemotherapy with or without radiation therapy to destroy all of the
remaining marrow. The frozen marrow that was saved is thawed and given through
a needle in a vein to replace the marrow that was destroyed.
There are generally 4 phases of treatment for ALL. The first phase, remission
induction therapy, uses chemotherapy to kill as many of the leukemia cells as
possible to cause the cancer to go into remission.
The second phase, called central nervous system (CNS) prophylaxis, is
preventive therapy using intrathecal and/or high-dose systemic chemotherapy to
the CNS to kill any leukemia cells present there, or to prevent the spread of
cancer cells to the brain and spinal cord even if no cancer has been detected
there. Radiation therapy to the brain may also be given, in addition to
chemotherapy, for this purpose. CNS prophylaxis is often given in conjunction
with consolidation/intensification therapy.
Once a child goes into remission and there are no signs of leukemia, a third
phase of treatment called consolidation or intensification therapy, is given.
Consolidation therapy uses high-dose chemotherapy to attempt to kill any
remaining leukemia cells.
The fourth phase of treatment, called maintenance therapy, uses chemotherapy
for several years to maintain the remission.
-- Treatment by stage --
Treatment for childhood acute lymphoblastic leukemia depends on the prognostic
group to which your child is assigned based primarily on your child's age and
white blood cell count at diagnosis.
Your child may receive treatment that is considered standard based on its
effectiveness in a number of patients in past studies, or you may choose to
have your child take part in a clinical trial. Not all patients are cured with
standard therapy and some standard treatments may have more side effects than
are desired. For these reasons, clinical trials are designed to test new
treatments and to find better ways to treat cancer patients. Clinical trials
are ongoing in most parts of the country for most stages of childhood ALL. For
more information, call the Cancer Information Service at 1-800-4-CANCER
(1-800-422-6237); TTY at 1-800-332-8615.
** UNTREATED CHILDHOOD ACUTE LYMPHOBLASTIC LEUKEMIA **
Your child's treatment will probably be remission induction chemotherapy to
kill cancer cells and cause the leukemia to go into remission. Induction
chemotherapy is almost always successful in inducing remission. Intrathecal
and/or high-dose systemic chemotherapy, with or without radiation therapy to
the brain, may also be given to prevent the spread of cancer cells to the brain
and spinal cord. Clinical trials are testing new ways of inducing remission.
** CHILDHOOD ACUTE LYMPHOBLASTIC LEUKEMIA IN REMISSION **
Your child's treatment will probably be intensive chemotherapy to kill any
remaining cancer cells. Intrathecal and/or high doses of systemic
chemotherapy, with or without radiation therapy to the brain, may also be given
during this phase of treatment to prevent the spread of cancer cells to the
brain and spinal cord. Following intensification therapy, chemotherapy
generally continues until the child has been in continuous remission for
several years.
** RECURRENT CHILDHOOD ACUTE LYMPHOBLASTIC LEUKEMIA **
Treatment depends on the type of treatment your child received before, how soon
the cancer came back following treatment, and whether the leukemia cells are
found outside the bone marrow. Your child's treatment will probably be
systemic or intrathecal chemotherapy, radiation therapy, or bone marrow
transplantation. You may want to consider entering your child into a clinical
trial of new chemotherapy drugs or bone marrow transplantation.
** TO LEARN MORE **
Call
For more information, U.S. residents may call the National Cancer Institute's
(NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237)
Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing
callers with TTY equipment may call 1-800-332-8615. The call is free and a
trained Cancer Information Specialist is available to answer your questions.
Web sites and Organizations
The NCI's Cancer.gov Web site (http://cancer.gov) provides online access to
information on cancer, clinical trials, and other Web sites and organizations
that offer support and resources for cancer patients and their families. There
are also many other places where people can get materials and information about
cancer treatment and services. Local hospitals may have information on local
and regional agencies that offer information about finances, getting to and
from treatment, receiving care at home, and dealing with problems associated
with cancer treatment.
Publications
The NCI has booklets and other materials for patients, health professionals,
and the public. These publications discuss types of cancer, methods of cancer
treatment, coping with cancer, and clinical trials. Some publications provide
information on tests for cancer, cancer causes and prevention, cancer
statistics, and NCI research activities. NCI materials on these and other
topics may be ordered online or printed directly from the NCI Publications
Locator (https://cissecure.nci.nih.gov/ncipubs). These materials can also be
ordered by telephone from the Cancer Information Service toll-free at
1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.
LiveHelp
The NCI's LiveHelp service, a program available on several of the Institute's
Web sites, provides Internet users with the ability to chat online with an
Information Specialist. The service is available from 9:00 a.m. to 10:00 p.m.
Eastern time, Monday through Friday. Information Specialists can help Internet
users find information on NCI Web sites and answer questions about cancer.
Write
For more information from the NCI, please write to this address:
National Cancer Institute
Office of Communications
31 Center Drive, MSC 2580
Bethesda, MD 20892-2580
** ABOUT PDQ **
PDQ is a comprehensive cancer database available on Cancer.gov.
PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information
database. Most of the information contained in PDQ is available online at
Cancer.gov (http://cancer.gov), the NCI's Web site. PDQ is provided as a
service of the NCI. The NCI is part of the National Institutes of Health, the
federal government's focal point for biomedical research.
PDQ contains cancer information summaries.
The PDQ database contains summaries of the latest published information on
cancer prevention, detection, genetics, treatment, supportive care, and
complementary and alternative medicine. Most summaries are available in two
versions. The health professional versions provide detailed information
written in technical language. The patient versions are written in
easy-to-understand, non-technical language. Both versions provide current and
accurate cancer information.
The PDQ cancer information summaries are developed by cancer experts and
reviewed regularly.
Editorial Boards made up of experts in oncology and related specialties are
responsible for writing and maintaining the cancer information summaries. The
summaries are reviewed regularly and changes are made as new information
becomes available. The date on each summary ("Date Last Modified") indicates
the time of the most recent change.
PDQ also contains information on clinical trials.
In the United States, about two-thirds of children with cancer are treated in a
clinical trial at some point in their illness. A clinical trial is a study to
answer a scientific question, such as whether one treatment is better than
another. Trials are based on past studies and what has been learned in the
laboratory. Each trial answers certain scientific questions in order to find
new and better ways to help cancer patients. During treatment clinical trials,
information is collected about new treatments, the risks involved, and how well
they do or do not work. If a clinical trial shows that a new treatment is
better than one currently being used, the new treatment may become "standard."
Listings of clinical trials are included in PDQ and are available online at
Cancer.gov (http://cancer.gov/clinical_trials). Descriptions of the trials are
available in health professional and patient versions. For additional help in
locating a childhood cancer clinical trial, call the Cancer Information Service
at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.
The PDQ database contains listings of groups specializing in clinical trials.
The Children's Oncology Group (COG) is the major group that organizes clinical
trials for childhood cancers in the United States. Information about
contacting COG is available on Cancer.gov (http://cancer.gov) or from the
Cancer Information Service at 1-800-4-CANCER (1-800-422-6237), TTY at
1-800-332-8615.
The PDQ database contains listings of cancer health professionals and hospitals
with cancer programs.
Because cancer in children and adolescents is rare, the majority of children
with cancer are treated by health professionals specializing in childhood
cancers, at hospitals or cancer centers with special facilities to treat them.
The PDQ database contains listings of health professionals who specialize in
childhood cancer and listings of hospitals with cancer programs. For help
locating childhood cancer health professionals or a hospital with cancer
programs, call the Cancer Information Service at 1-800-4-CANCER
(1-800-422-6237), TTY at 1-800-332-8615.
Date Last Modified: 09/2002
******************************************************************************
* If you want to know more about cancer and how it is treated, or if you *
* if you wish to know about clinical trials for your type of cancer, you *
* can call the NCI's Cancer Information Service at 1-800-422-6237, toll *
* free. A trained information specialist can talk with you and answer *
* your questions. *
******************************************************************************
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This information has been brought to you by
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