Leukaemia in Children

Leukaemia is a haematological malignancy or blood cancer. It develops in the bone marrow, the soft inner part of bones where new blood cells are made. The cure rate of leukaemia in children is much higher than that of adults, although some side-effects of treatment last till adulthood.

What is Leukaemia?

Leukaemia is cancer of the bone marrow, the spongy tissue in the centre of our bones that makes the three kinds of blood cells – red blood cell, white blood cell and platelet. One of the different types of white blood cell is called lymphocyte. The most common form of cancer in children is Acute Lymphoblastic Leukemia. Basically, when one lymphocyte goes bad, it starts to multiply fast, attacks the bone marrow and eventually takes over it.

What Are the Causes of Leukaemia in Kids

The exact cause of leukaemia in children is not really known. However, some suspected causes are as below:

• Both prenatal and post-natal exposure to ionizing radiation (particularly X-rays)
• Pesticide exposure in either parent
• Exposure to electromagnetic fields (EMFs)
• Certain immune-suppressing drugs which are given to a child after he has undergone an organ transplant
• Children who have an identical twin with the disease or a sibling with the disease
• Children already suffering from a genetic disorder like Li-Fraumeni Syndrome, Down Syndrome, Klinefelter Syndrome, Fanconi’s Anaemia, Bloom Syndrome, Kostmann Syndrome, Neurofibromatosis and Ataxia Telangiectasia

Types of Childhood Leukaemia

Acute leukaemia in a child is a disease which is prevalent mostly in the age group of 2 – 5 years. We may also find some chronic types of the disease in children, which are rare. Some of the common types of leukaemia in children are as below.

• Acute Lymphoblastic Leukaemia (ALL): This is a fast-growing form of the disease when the bone marrow makes too many immature lymphocytes (a type of white blood cell).

• Acute Myeloid Leukaemia (AML): In this type, the bone marrow makes a large number of abnormal blood cells.

• Juvenile Myelomonocytic Leukaemia (JML): In this type of leukaemia too many bone marrow stem cells become two types of white cells, some of which never become mature white cells.

• Chronic Myelogenous Leukaemia (CML): It is a type of leukaemia when too many bone marrow stem cells become a type of white blood cell called granulocytes. In this type of the disease, it is seen that some of these never become mature white cells.

Signs & Symptoms of Leukaemia

Some of the symptoms of leukaemia are described below.

1. Low Red Blood Cell Counts (Anaemia):

Red blood cells carry oxygen to all parts of the body. Therefore, shortage of these can result in:

• Tiredness
• Weakness
• Feeling cold
• Feeling dizzy or light-headed
• Headaches
• Shortness of breath
• Pale skin

2. Low White Blood Cell Count

• Infections can occur which do not seem to go away because of a shortage of normal white blood cells. They may have one infection after the other.
• Recurrent fever may be a sign of leukaemia since infection is one of the primary causes of fever.

3. Low Platelet Count:

Platelets help stop bleeding. Therefore a shortage of platelets can cause –

• Easy bruising and bleeding
• Frequent or severe nose bleeding
• Bleeding gums

4. Other Symptoms:

• Bone or joint pain: This is due to a build-up of leukaemia cells near the surface of the bone or inside the joint.

• Swelling of the abdomen: leukaemia cells can also collect in the Liver or the spleen making them bigger.

• Loss of appetite and weight loss: If the spleen or liver gets big enough to press upon other organs like the stomach, the child may feel full after eating only a little leading to loss of appetite and eventually, weight loss.

• Swollen lymph nodes: Some leukaemia cells may spread to Lymph Nodes. These swollen nodes may be seen or felt under the skin in certain parts of the body like the neck, underarm areas, above the collarbone or the groin.

• Coughing or trouble breathing: Some types of leukaemia which affects and enlarges the thymus (a small organ in front of the trachea, breathing tube that goes to the lungs) or the Lymph Nodes. This further goes on to press the Trachea which causes coughing or trouble breathing. However, trouble in breathing can also be caused due to high White Blood Cell count since in such circumstance, leukaemia cells build up in small blood vessels.

• Swelling of the face and arms: It is caused when an enlarged Thymus presses the Superior Vena Cava causing the blood to “back up” in the veins.

• Headaches, seizures and vomiting: When leukaemia spreads to the brain and spinal cord, these symptoms may be noticed in the child.

• Rashes and gum problem: When leukaemia cells spread to the gum, it causes swelling, pain and bleed of the gums and when it spreads to the skin, it causes rashes.

• Extreme weakness and fatigue: This symptom occurs when a very high count of leukaemia cells causes the blood to become very thick and slows the blood circulation through small blood vessels of the brain.

How is Leukaemia Diagnosed?

After thoroughly analysing the child’s medical history and any family history of cancer, all the symptoms and how long the child has had them, if a doctor suspects leukaemia, he will ask for certain tests to be done. The results of these tests will help doctors to determine the type of leukaemia.

1. Blood Tests

The blood samples are usually taken from a vein in the arm but in younger children and infants, they may be taken from other veins such as in the feet or scalp or from a “finger stick”.

2. Bone Marrow Aspiration and Biopsy

These two tests are done at the same time by obtaining bone marrow samples taken from the back of Pelvic (Hip) bones.A Bone marrow biopsy follows the aspiration. Here a small part of the marrow and the bone is removed using a slightly larger needle. The needle is pushed down into the bone for extraction.

3. Lumbar Puncture

This test also known as the Spinal tap is used to look for leukaemia cells in the cerebrospinal fluid (CSF). The test is done in the lower part of the back of the spinal cord.

Treatment for Leukaemia

The treatment depends on the type and stage of cancer. Some forms of cancer grow slowly and do not require immediate treatment. However, treatment for leukaemia usually consists of one or more of the following.

1. Chemotherapy

Drugs are used to kill the affected cells. The type of affliction determines the use of a single drug or a combination of different drugs.

2. Radiation therapy

High energy radiation is used to damage leukaemia cells and inhibit there growth

3. Stem Cell Transplant

It is a procedure to replace diseased bone marrow with healthy bone marrow, either your own or from a donor.

4. CAR T-Cell Therapy

A new form of cell therapy that uses specially altered T-cells to specifically target cancer cells. The treatment seeks to sharpen and strengthen the immune system’s inherent cancer-fighting powers through modified versions of the patient’s own immune system T-Cells.

5. Surgery

Surgery has a limited role in treatments the cancer cells are not clustered together in a single removable tumour but spread widely throughout the body.

6. Immunotherapy

It is a treatment that works by prompting the body’s own immune system to identify and destroy cancerous cells.

After Treatment

1. Follow Up Exams

Through these tests, doctors will watch for possible signs of leukaemia as well as short and long-term effects of the treatment.

2. Keeping Track of Medical Records

It is very important to keep a record of your child’s medical care and treatment so that in case the child changes the doctor, it will help the latter to understand his case and the type of treatment he has been on.

Social and Emotional Issues Occur During and After Treatment

Some survivors may have a hard time recovering and adjusting to life after cancer. Anxiety and emotional stress after the treatment can have an adverse effect on a young person’s growth. It can get in the way of relationships, school, work and other aspects of life. However, with support from family, friends, doctors and support groups, a cancer survivor can go a long way in the years to come.

Survival Rate of Children With Leukaemia

Most childhood leukaemia has a has very high remission rates with some up to 90%, which means there is no trace of cancer cells in the body. However, the survival rate differs from one type to the other. The survival rate of children with Acute Lymphoblastic leukaemia is much higher than that of Acute Myeloid Leukaemia.

Children suffering from leukaemia not only face health issues, but also psychological and social issues. Therefore, such children should be given a lot of empathy, love and care so that they can lead a normal life like the others.

Also Read: Cerebral Palsy in Children