Childhood Leukemia

Leukemia is a form of cancer that affects the blood and bone marrow. It is the most common childhood cancer. At Banner Children's, our caring pediatric cancer experts help your family through it all. Understand more about the disease, including the types, causes, treatments and long-term outlook.

What is childhood (pediatric) leukemia?

Leukemia is a cancer that mainly affects white blood cells in the blood and bone marrow (the spongy material in bones). 

White blood cells called leukocytes are made in the bone marrow and help fight infections and other diseases. Normally, the bone marrow in your body makes the correct amount of white blood cells. 

In children with leukemia, however, white blood cells don't grow as they should. These abnormal cells – leukemia cells – don't respond to signals telling them when to stop and when to produce cells. The bone marrow creates too many cells, overcrowding the bone marrow and spilling into the bloodstream.

As more leukemia cells develop, there is less room for healthy blood cells, including red blood cells and platelets.

Types of leukemia 

Some types of leukemia are acute, meaning they develop quickly. Others are chronic and grow slowly. Leukemias in children are almost always acute.

The two most common in children are:

• Acute lymphoblastic leukemia or acute lymphocytic leukemia (ALL): ALL is the most common type of childhood leukemia. It affects lymphoid cells, which produce infection-fighting white blood cells. Most children with ALL are between 2 and 5 years old.
• Acute myeloid leukemia or acute myelogenous leukemia (AML): AML is a type of cancer that affects the myeloid cells responsible for making red blood cells, platelets and certain types of white blood cells. It tends to happen in either the first two years of life or during the teenage years. 

Less common types of childhood leukemia include:

• Chronic myelogenous leukemia (CML)
• Juvenile myelomonocytic leukemia (JMML)
• Chronic lymphocytic leukemia (CLL)

What causes childhood leukemia?

Currently, the cause of childhood leukemia is unknown. Environmental or lifestyle factors do not cause it and there is nothing you can do to stop your child from developing the disease.

Certain genetic conditions (passed on from parents to children) may increase the risk for childhood leukemia, but most types of leukemia aren’t genetic in nature. 

Scientists believe leukemia may be connected to a type of gene mutation. Most of these changes happen spontaneously early in a child’s life.

Most children diagnosed with leukemia do not have any known risk factors. However, several factors may increase a child’s risk:

• Certain conditions: Down syndrome, Li-Fraumeni syndrome, Louis-Bar syndrome, neurofibromatosis
• Prior treatment with radiation therapy and chemotherapy
• Having a sibling with leukemia

What are the symptoms of leukemia?

The signs and symptoms of leukemia in children can vary based on the type and stage of the disease. It’s important to note that some symptoms may also be related to other childhood illnesses.

Symptoms may include:

• Fatigue and weakness: Children may become tired easily and struggle to join physical activities
• Pale skin and increased bleeding: Leukemia can cause a decrease in red blood cells and platelets, leading to anemia (low iron), pale skin, easy bruising and excessive bleeding
• Frequent infections: The reduced number of healthy white blood cells can weaken the immune system, making children more catch infections more easily
• Bone and joint pain: Leukemia cells can crowd the bone marrow, leading to pain and discomfort in the bones and joints 
• Swollen lymph nodes: Enlarged lymph nodes, particularly in the neck, groin and armpits, may be a sign of leukemia

Other symptoms may include:

• Poor appetite and weight loss
• Fevers with no other symptoms
• Stomach pains
• Wheezing, coughing or painful breathing

Because the disease is rare and symptoms vary, diagnosing it can be difficult. If these signs continue or get worse, contact your child’s health care provider. If the provider suspects leukemia, they’ll act quickly to arrange tests and treatment. 

How is leukemia diagnosed in children?

Your child will have tests to check for leukemia. If the tests show your child has leukemia, your provider will order additional tests to figure out the exact type of cancer and the best course of treatment.

In addition to a complete medical history and exam, some of the tests your child may receive include:

• Bone marrow aspiration and/or biopsy: These tests are usually done together to look for and collect leukemia cells. The procedure takes a small amount of bone marrow fluid or tissue from your child, usually from the hip bone.
• Complete blood count (CBC): This blood test measures many things, including the number of each type of cell in the blood: red cells, white cells and platelets.
• Other blood tests: These may include blood chemical levels, liver and kidney function and genetic tests.
• Medical imaging and scans: Leukemia doesn’t usually form tumors. However, if leukemia is suspected, your provider may order these tests to get a better idea of how much the disease has spread or to look for other problems. Imaging tests may include an X-ray, ultrasound, MRI (magnetic resonance imaging) and/or CT (computed tomography) scan.
• Lumbar puncture (spinal tap): This test looks for leukemia cells in the cerebral spinal fluid, the liquid in the brain and the spinal cord. A special hollow needle is used to draw out the spinal fluid.

How is leukemia treated in children?

The good news is that childhood leukemia is a highly treatable cancer. Your child will have a team of caring people at the hospital to support them throughout treatment. The pediatric cancer team will explain all treatment options and help you and your child prepare for each phase of treatment.

Specific treatments will be determined based on:

• Your child’s age, overall health and medical history
• The type and stage of the leukemia
• How the disease is expected to progress
• How well your child tolerates treatments
• Genetics
• Your preference

Your child’s treatment may include one or more therapies, depending on their needs:

• Chemotherapy: The main treatment for childhood leukemia. Dosages and drugs may differ based on your child’s age and the type of leukemia. The medicines can be given by mouth (orally), injections (shots) or intravenously (IV). These drugs target and destroy leukemia cells to prevent the cancer from coming back.
• Radiation therapy: This treatment uses a beam of intense energy to kill cancer cells, most often with X-rays. Other types of radiation therapy include proton radiation. Radiation therapy is usually used along with other treatments and carefully planned to minimize side effects.
• Stem cell transplantation (bone marrow transplant): This procedure replaces leukemia cells and other cells that were destroyed by chemotherapy with fresh, healthy new blood-forming cells. To do this, donated stem cells are given by IV. These stem cells can come from a “matched” related or unrelated donor (allogeneic transplant) or from the child's own previously collected stem cells (autologous transplant). Stem cell transplantation is usually only used in high-risk or relapsed (returning) leukemia cases.
• Targeted therapy: This type of therapy is a newer approach to cancer treatment and a major focus of research. These therapies use medications to attack the genes or proteins that help cancer cells grow and divide. Targeted therapy has less severe side effects and may help if traditional chemotherapy is not working.
• Immunotherapy: This is another newer type of therapy that uses your child’s own immune system to fight the cancer. 

Parents should know that cancer treatments may have difficult side effects including hair loss, nausea, fatigue and higher risk of infections. Your child’s health care team will give you detailed information about any side effects, including how to lessen their impact and help your child feel better.

Parents should have open and ongoing discussions with their child’s health care team to understand the child’s tailored treatment plan and any possible long-term effects. Know that your child’s health care team will closely monitor their response to treatment and make adjustments as necessary to make sure your child has the best possible outcome.

Supportive care 

The physical and emotional needs of children with leukemia are just as important as treatment. Supportive care focuses on managing side effects (including pain), nutritional support and emotional, physical, social and spiritual support for both your child and your family.

Support groups and services can help your family cope with the challenges of leukemia. In fact, studies show supportive care leads to better treatment outcomes. 

Your child and family can access this care anytime, even during active cancer therapy. Your care team will help you find the services you need. 

Learn more about supportive care.

Clinical trials

Ongoing research and advancements continue to improve treatments for childhood leukemia. Researchers are studying new treatment strategies, targeted therapies and immunotherapies to make treatment more effective with fewer side effects.

Banner Children’s continues to research new cancer treatments for children. If you’d like to learn more, your child’s health care provider can help you learn more about clinical trials. 

What is the long-term outlook for childhood leukemia?

Advances in medical research and treatment options have greatly improved the survival rate for children with leukemia. The five-year survival rate for ALL is about 90% and for AML it is in the range of 65% to 70%, with many children in long-term remission.

Ongoing research continues to shape the future of childhood leukemia treatment, offering hope for an even brighter tomorrow.

Our expert cancer specialists

Having a child diagnosed with or being treated for cancer can feel overwhelming. At Banner Children’s, a team including pediatric oncologists (cancer doctors), nurses, social workers and psychologists will form a supportive, personalized care team for your child and family. Your child’s care team will be there to guide you through treatment and beyond, answering all of your questions along the way. 

Our #1 goal is to help your child beat cancer - and our team never forgets your child is not just a patient, but also a kid. We provide pediatric oncology (cancer) services at:

• Banner Children’s at Desert 
• Banner Children’s at Thunderbird
• Diamond Children’s Medical Center

You are not alone. In addition to our treatment and care options, Banner Health offers a variety of support groups to help you, your child and the rest of your family navigate this challenging journey.