Acute Leukemia

What is Leukemia?

Leukemia is a type of blood cancer that begins in the bone marrow. The bone marrow is the soft inner part of the bone that produces the blood cells, including white blood cells that are used by the body to fight infection, red blood cells to carry oxygen and platelets that help with blood clotting and stop bleeding.

For more information regarding acute leukemia services in St. Louis or to schedule an appointment at St. Louis Children's Hospital, please call 314.454.5437 or 800.678.5437 or email us.

When a child has leukemia, the bone marrow produces white blood cells that don’t mature correctly and the immature cells, or blast cells, continue to reproduce themselves and crowd out the normal healthy cells. When this happens a child experiences symptoms of leukemia.

There are three main types of leukemia in children – acute lymphocytic leukemia (ALL), acute myelogenous leukemia (AML) and chronic myelogenous leukemia (CML).

Learn more about leukemia.

What is Acute Leukemia?

Acute leukemia differs from chronic leukemia in how it develops and worsens. In acute leukemia, the number of abnormal blood cells (blasts) increases much more rapidly than in chronic leukemia. Also, in acute leukemia the blasts remain immature and cannot carry out their normal functions, but in chronic leukemia some of the blasts mature and can function normally.

The two types of acute leukemia are defined by the type of white blood cell that is affected.

Acute lymphocytic leukemia

(ALL) affects lymphoid cells, while acute myelogenous leukemia (AML) affects myeloid cells.

Acute lymphocytic leukemia (ALL), also known as lymphoblastic and lymphoid, is the most common type of leukemia seen in young children. In this type of leukemia, the lymphocytes, the cells that normally fight infection, don’t mature and overproduce. The overproduction of the lymphocytes crowds out the other healthy blood cells. The cause of acute lymphocytic leukemia is unknown; however, it most likely occurs because of a gene mutation and is not inherited.

Acute myelogenous leukemia (AML), also known as granulocytic, myelocytic, myeloblastic and myeloid, occurs in both adults and children. In this type of leukemia, the white blood cells called granulocytes don’t mature correctly and the blast cells crowd out the other healthy blood cells. The cause of AML is unknown.

Symptoms of Acute Leukemia

Each child may experience symptoms of ALL and AML differently, but in acute leukemia symptoms may occur suddenly and in a matter of days or weeks. The most common signs and symptoms associated with acute leukemia are:

• Anemia
  With anemia, your child may appear tired, pale and may have increased respiration to compensate for the decrease in oxygen carrying capacity. A blood test will show that the number of red blood cells will be below normal.

• Bleeding and/or bruising
  When platelets are unable to be produced because of the blasts crowding the bone marrow, bleeding can occur and your child may bruise more easily. A blood test will show that the number of platelets will be below normal (thrombocytopenia).

• Bone and joint pain
  Pain in the bones and joints is usually a result of the bone marrow being overcrowded by the blasts.

• Recurrent fevers and infections
  In a child with leukemia, the white blood cells are immature and unable to fight infection. The poorly functioning white blood cells leads to a great risk of viral and bacterial infections.

• Frequent or severe nosebleeds and bleeding gums

• Swollen lymph nodes
  Lymph nodes are responsible for filtering the blood and leukemia cells may collect in the lymph nodes, causing swelling. Swollen lymph nodes may be seen or palpated in the neck, chest and groin or under the arms.

• Abdominal pain
  Leukemia cells can collect in the kidney, liver and spleen, causing enlargement of these organs located in the abdomen. The enlarged organs may cause pain and the pain may cause a loss of appetite and weight loss.

• Difficulty breathing
  Leukemia cells can clump together in the thymus, a gland under the breastbone and in the throat. This mass of cells can cause difficulty breathing. Any wheezing, coughing and/or labored or painful breathing requires immediate medical attention.

• Weakness, fatigue, decreased energy

Diagnosing Acute Leukemia

In addition to a complete medical history and a physical examination, diagnostic procedures and tests used to diagnose acute leukemia may include:

• Blood tests
  A measurement of the size, number and maturity of different blood cells is taken for a specific volume of blood. Tests may also include the analysis of blood chemistries and evaluation of liver and kidney function.

• Genetic testing
  One of the causes of acute lymphocytic leukemia is an uninherited genetic mutation.

• Bone marrow aspiration and/or biopsy
  This procedure involves taking a small amount of bone marrow fluid (aspiration) and/or solid bone marrow tissue (biopsy), usually from the hip bones, to be examined for the number, size and maturity of blood cells and/or abnormal blood cells.

• MRI, X-ray, CAT scan and ultrasound
  These procedures provide images of organs and structures within the body, allowing doctors to determine if there are enlarged organs or other abnormalities.

• Spinal tap/lumbar puncture
  A special needle is placed in the lower back, into the spinal canal. The pressure in the spinal canal and brain is measured and a small amount of cerebral spinal fluid may be removed for testing.

• Lymph node biopsy
  A sample of tissue is removed from a lymph node and examined under a microscope to determine if unhealthy blood cells have accumulated in the node.

Treatment of Acute Leukemia

Your child’s treatment plan will be determined by a pediatric oncologist and will be based on your child’s age and medical history, the extent of the disease, your child’s tolerance for certain medications and other factors.

Treatment usually begins by addressing some of the symptoms of the leukemia, such as anemia, bleeding and/or infection. In addition, treatment for leukemia may include one or more of the following:

• Chemotherapy
  Chemotherapy are medications that helps fight cancer. They are given by mouth, in the vein, in the muscle or under the skin.

• Targeted drug therapy
  In recent years, new drugs that target specific parts of cancer cells have been developed. These drugs work differently than standard chemotherapy drugs and often have less severe side effects.

• Radiation therapy
  Radiation therapy uses high-energy waves such as x-rays to kill or shrink cancer cells. It is rarely used to treat leukemia in the central nervous system or other places such as the eyes or testes.

• Bone marrow transplant
  A bone marrow transplant involves taking cells found in the bone marrow (stem cells), filtering those cells and giving them back to the patient they came from or to another person. The goal of bone marrow transplantation is to replace the diseased, non-functioning bone marrow with healthy bone marrow.

• Blood transfusion
  Almost all patients with leukemia require a blood transfusion during their treatment. Blood transfusions use healthy blood cells from donors and help to replace red blood cells, platelets and other blood components. Leukemia often interferes with the production of red blood cells, white blood cells and platelets. A blood transfusion helps to offset this effect of the disease.

• Surgery
  Surgery has a very limited role in treating childhood leukemia because leukemia cells spread throughout the bone marrow and to many other organs through the blood. Aside from a possible lymph node biopsy, surgery rarely has any role in the diagnosis or treatment of acute leukemia.

There are various treatment stages in the treatment of acute leukemia.

• Induction therapy
  A combination of chemotherapy and/or radiation therapy and medications given to stop the process of abnormal cells being made in the bone marrow. Remission is the goal in this stage of treatment. Remission means the leukemia cells are no longer being made. This phase may last approximately one month and can be repeated if the goal is not achieved.

• Intensification/Consolidation therapy
  Continued treatment even though leukemia cells may not be visible. The leukemia cells may not be visible in a blood test or bone marrow examination, but it is possible that the cells are still present in the body.

• Maintenance therapy
  This stage maintains leukemia-free bone marrow by continuing less intense chemotherapy for a longer duration. This phase is used for acute lymphocytic leukemia but not for acute myelogenous leukemia. It can last months to several years. Regular visits to your child’s physician are required in order to determine response to treatment, detect any recurrent disease and manage any side effects of the treatment.

For more information on acute leukemia in children or to schedule an appointment with a pediatric oncologist call 314.454.5437 or 800.678.5437 or email us.