Childhood Leukemia – What you need to know

• Acute leukemia is the most common cancer found in children.
• It accounts for about 25-30 percent of all pediatric cancers.
• It is caused by abnormalities in the blood-forming stem cells of the bone marrow.
• The cancer cells overproduce, crowding out and inhibiting the growth of cells that produce red blood cells, white blood cells and platelets.
• Symptoms such as paleness, fatigue or lack of energy, abnormal bleeding and bruising begin to appear within a short amount of time due to low platelet count, sensitivity to infection, recurrent high fevers, etc.
• Acute leukemia can be treated by chemotherapy, but patients with cancer cells that are resistant to treatment or patients in whom the disease returns after chemotherapy may need to receive stem cell transplants, also known as bone marrow transplants.

It is known as a blood cancer and is the result of abnormalities in the blood-forming stem cells of the bone marrow, causing the bone marrow to produce too many immature white blood cells. These cells are unable to mature as they should. Hence, they over-produce, crowding out and inhibiting the growth of cells that produce red blood cells, white blood cells and platelets. 

Once a patient has the disease, symptoms begin to appear within a short amount of time. These include paleness, fatigue or lack of energy, abnormal bleeding, bruising due to low platelet count, sensitivity to infection, and recurrent high fevers, among others. Additionally, there may be other abnormalities due to cancer cells infiltrating other tissues, often resulting in enlarged lymph nodes, liver and spleen, lumps or swelling under the skin and neurological symptoms.

Acute leukemia is a disease that has many types of pathogens at a cellular level, meaning it can be divided into several subtypes. Each type has a different progression and prognosis, and, as a result, the specific subtypes of the disease must be taken into account when determining the choice of treatment. There are several systems for differentiating between subtypes, including classification according to the shape (morphology) of the cell, grouping according to chromosomal abnormalities, and grouping by genomic abnormalities.

• Fever
• Paleness
• Abnormal bleeding
• Enlarged lymph nodes, spleen or/and liver 
• Weight loss

Other symptoms include a rash or spots on the skin, testicular enlargement, bone pain, or joint pain. Some acute leukemia patients may also have neurological abnormalities, including headaches, nausea or vomiting as a result of the cancer cells spreading into the cerebral cortex tissue which can cause increased intracranial pressure.

Diagnosis of acute leukemia mainly relies on blood tests and bone marrow tests. Patients often have a history of a fairly rapid onset of symptoms. These signs and symptoms are usually associated with bone marrow failure and the spread of cancer cells into various tissues that interfere with the normal functioning of those organs, along with abnormalities caused by the presence of a large number of cancer cells in the body.

Acute leukemia can be treated by chemotherapy. The type of chemotherapy used and the length of the treatment depends on the type of leukemia, which will be determined by the results of tests carried out on the cancer cells from the bone marrow. Generally speaking, treatment of acute leukemia in children is known to be effective, although the effectiveness of [PS1] the treatment does depend on the type of cancer cells. The patient’s response to the chemotherapy is also an important factor. As stated, a bone marrow transplant may be appropriate in cases where other treatments have failed.

Our team of pediatric oncology specialists, led by Professor Suradej Hongeng, M.D., Associate Professor Samart Pakakasama, M.D., and Pornchanok Iamsirirak, M.D., represent some of the leading pediatric hematology and oncology specialists in Thailand. Most recently, they have introduced a new form of treatment whereby bone marrow from a child’s parents is used in a type of bone marrow transplantation known as Haploidentical Hematopoietic Stem Cell Transplantation, for the successful treatment of thalassemia and leukemia in children. 

Previously, this type of treatment was unavailable due to incompatibility issues between the bone marrow cells of both parties and a strong negative reaction in the body to the foreign cells. This caused many pediatric patients to have excessively long waiting times for transplants, often dying from the disease before having the chance to be treated.