Description
Leukemia is a type of cancer that affects the blood and bone marrow, and it is the most common form of cancer in children. The goal of treatment is to achieve remission, which means that there are no longer any signs of leukemia in the body. The management of leukemia in children usually involves a combination of chemotherapy, radiation therapy, and stem cell transplantation. Chemotherapy is the main treatment for leukemia in children, and it involves the use of drugs to kill cancer cells. Radiation therapy may be used to target leukemia cells that have spread to the brain or spinal cord. Stem cell transplantation may be necessary in some cases, particularly if the leukemia has relapsed or is not responding to other treatments. Supportive care is also an important part of leukemia management in children, and may include pain management, nutrition support, and psychological support.
Summary Listen
- Pediatric leukemia, particularly acute lymphoblastic leukemia (ALL), is the most common childhood malignancy, affecting a significant number of children annually. Unlike adult cancers, childhood cancers respond well to therapy, showing distinct biological and therapeutic characteristics. The incidence of ALL is higher in children aged two to five years and slightly more common in boys.
- Several risk factors are associated with ALL, including prenatal X-ray exposure, previous chemotherapy treatment, and genetic conditions such as Down syndrome and Fanconi anemia. Presenting features of ALL are diverse, ranging from fever and bleeding to bone pain and lymphadenopathy. Diagnosis requires a high index of suspicion and thorough evaluation.
- Diagnosis of ALL involves a complete blood count with peripheral smear examination, blood chemistries, and bone marrow aspiration with morphology, flow cytometry, and cytogenetic analysis. Treatment is divided into supportive care and definitive therapy. Supportive care addresses complications like cytopenias, infections, and tumor lysis syndrome.
- Definitive treatment of ALL is risk-based and involves four phases: remission induction, consolidation, central nervous system-directed therapy, and maintenance. Remission induction aims to eliminate blasts from the bone marrow. Consolidation eradicates residual microscopic disease. The drugs used in each phase differ, for example, commonly used drugs in remission induction are vinristine, steroids and asparagenes. CNS-directed therapy targets sanctuary sites like the brain and testicles to prevent relapse.
- Risk stratification factors include patient-based factors (age, WBC count), disease-based factors (immunophenotype, cytogenetics), and response to treatment (minimal residual disease - MRD, steroid response). Good-risk cytogenetics include hyperdiploidy and ETV6-RUNX1 mutations, while poor-risk cytogenetics include Philadelphia chromosome and KMT2A rearrangement. Long-term maintenance therapy with oral medications like mercaptopurine and methotrexate is crucial for lowering relapse risk.
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About the Speakers
Dr Vasudha Nandagudi Rao
MBBS, MD (PAED), FMTI RCPCH Clinical fellowship in Paediatric Oncology, Consultant Pediatric Oncology, Bengaluru
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