Leukemia in Children

Leukemia in Children

Leukemia is a malignant disease of the blood cells, notable for the accumulation of abnormal young cells, known as blasts. These abnormal cells replace normal blood cells in the bone marrow and infiltrate other organs such as lymph nodes, spleen, liver, central nervous system, testicles, skin, and eyes.

Among children and adolescents, leukemia is the most common cancer, especially its acute forms. The estimated incidence is 3 to 4 cases per 100,000 children under the age of 15, peaking between 2 and 5 years of age.

Subtypes of Leukemia in Children

• Acute Lymphocytic Leukemia (ALL): Affects lymphocytes and, among all leukemias, it is the most common in childhood. If properly treated after diagnosis, it has a survival rate exceeding 80%, meaning it has a high likelihood of cure.
• Acute Myeloid Leukemia (AML): A rarer subtype in childhood. The cells involved in AML formation are the ones that form white blood cells, excluding lymphocytes, red blood cells, and platelets.
• Mixed-lineage leukemias (undifferentiated): May present cells from both lymphoid and myeloid lineages.
• Chronic leukemias: Rare in children, characterized by cell overproduction that can reach the mature stage of cells. Juvenile Myelomonocytic Leukemia (JMML): A rare type of leukemia in childhood. It is part of the group of proliferative and dysplastic diseases of the bone marrow and is characterized by an increased number of monocytes.

Symptoms and signs of leukemia in children

The main symptoms of leukemia in children include:

• Leg pain
• Joint pain
• Extreme fatigue
• Fever
• Paleness
• Bruises and/or red spots on the skin
• Bleeding
• Enlarged lymph nodes or glands
• Abdominal pain (caused by enlarged liver or spleen)
• Headache
• Vomiting
• Enlargement of the testicles
• Subcutaneous nodules
• Changes in kidney function (decreased urine volume, for example)
• Continuous lack of appetite
• Unexplained weight loss

Many symptoms of leukemia in children can be common to other diseases. Therefore, it is important to be attentive to the set of symptoms and seek medical help as soon as possible when they manifest.

Diagnosis of leukemia in children

The diagnosis of leukemia in children begins with an analysis of the patient’s medical history and a physical examination. During the medical consultation, lymph nodes, bleeding areas, bruises, and enlargement of the spleen or liver are investigated.

Subsequently, tests are requested. The first blood test requested is the complete blood count, which shows if there are suggestive blood abnormalities, such as the presence of blasts, low platelets, and/or anemia. Some details of it:

• Bone marrow biopsy: identifies the presence of increased blast cells in the bone marrow. It is also performed during treatment to assess the body’s response.
• Flow cytometry and immunohistochemistry: performed with a sample of bone marrow or other body fluids, it allows for both the classification of leukemia and monitoring of the response to treatment.
• Karyotype or cytogenetics (chromosome evaluation): chromosomal analysis is performed on a bone marrow sample to identify genetic alterations that determine the risk of disease relapse, as well as to determine specific treatments according to the genetic mutations found.
• Molecular biology: more sensitive than karyotype, it evaluates genetic mutations that occur in chromosomes.

If the result of the bone marrow biopsy is inconclusive or if the bone marrow aspiration does not provide a sufficient sample for examination, a bone biopsy may be necessary, in which a bone fragment is removed with a specific needle.

An examination of the cerebrospinal fluid (CSF) may also be necessary. For this procedure, a small needle is inserted into the space between the bones of the lower back to perform a lumbar puncture to aspirate the cerebrospinal fluid (CSF), which circulates around the brain and spinal cord. The aim of this test is to identify the presence of leukemia cells in the central nervous system.

Lumbar puncture is also performed to administer chemotherapy drugs into the spinal cord space to prevent or treat leukemia if it is present in the central nervous system.

Imaging tests are also requested for the diagnosis of leukemia in children. X-rays, ultrasounds, CT scans, and MRIs, among other tests, are performed to evaluate the extent of the disease and if there is any spread to other areas.

Treatment and Prevention

The treatment of leukemia follows a specific protocol according to the type of the disease. It is carried out through chemotherapy, radiotherapy, immunotherapy, and bone marrow transplant. Each method is discussed with the doctor, considering efficacy and side effects, to choose the best option for each patient.

There are no screening methods to prevent leukemia in children, but it is essential to be aware of the signs of the disease to seek immediate medical help.

Some genetic conditions may predispose to leukemia, such as Li-Fraumeni syndrome or Down syndrome, and children who have undergone previous treatments may also be at higher risk.

Is leukemia in children curable?

Many patients and their families wonder about a cure. Leukemia in children can be successfully treated in many cases, and most children diagnosed with leukemia have a good chance of being cured.

It is essential to emphasize that individual factors, such as prognosis, stage of the disease, and other conditions, should be taken into consideration.