Leukaemia in Children: Symptoms, Diagnosis and Treatment

What is leukaemia?

A form of cancer known as leukaemia affects the body's blood-forming tissues, including the lymphatic system and bone marrow. It is characterised by the quick development of aberrant, poorly functioning white blood cells.

Numerous varieties of leukaemia are categorised primarily according to their growth rate—acute (fast-growing) or chronic (slow-growing).

How does leukaemia affect children? 

A type of cancer that affects the blood is leukaemia. With around 30% of all paediatric malignancies, it is the most prevalent malignancy in kids. A blood cell's DNA is mutated in leukaemia.

What are the symptoms of leukaemia in children?

Symptoms of leukaemia in children vary depending on the type of leukaemia, but common signs and symptoms include:

• Flu-like illness
• Fatigue
• Lack of appetite
• Headaches
• Frequent infections
• Pale skin
• Bruising or bleeding easily
• Swollen lymph nodes

It's important to understand that many of these symptoms can also indicate other illnesses, and most often, these symptoms are not caused by leukaemia.

Risk Factors for Childhood Leukaemia

While the exact cause of childhood leukaemia is unknown, some factors may increase a child's risk of developing the disease. 

Some of the risk factors for childhood leukaemia include:

Genetic disorders: Certain genetic factors, such as Down syndrome, ataxia telangiectasia, or Bloom syndrome, can increase a child's chance of leukaemia later in life.

Radiation exposure: Children exposed to high radiation levels, such as those who have undergone radiation therapy or nuclear fallout, may have an increased risk of developing leukaemia.

Exposure to certain chemicals: Children exposed to certain chemicals, such as benzene, may have an increased risk of developing leukaemia.

Chemotherapy in the past: Children undergoing chemotherapy for another type of cancer may have an increased risk of developing leukaemia later in life.

It's important to note that most children with leukaemia do not have any known risk factors, and having one or more of them does not necessarily mean that a child will develop leukaemia.

If you're concerned about your child's risk of developing leukaemia, speaking with a healthcare professional is recommended.

Diagnosis of Leukaemia in Children

If your child gets diagnosed with leukaemia, the treatment can get pretty complicated, depending on the type and other factors.

Blood tests

The first test usually done is a blood test, which can reveal deficient levels of standard white blood cells, red blood cells, and platelets. 

Bone marrow aspiration and biopsy

Diagnosing leukaemia in children involves several tests, including blood tests, bone marrow aspiration, and biopsy.

Bone marrow is the spongy liquid portion of the bone where blood cells are generated and is examined through bone marrow aspiration and biopsy.

Other tests, such as lumbar puncture, X-ray and other imaging tests, and physical exams, may also be done to help diagnose leukaemia in children.

The bone marrow examination directly helps to diagnose malignancies involving the marrow, infections, storage disorders, metabolic conditions, and relapse of haematological malignancies.

Treatment for Leukaemia in Children

Common treatments include chemotherapy, radiation therapy, targeted therapy and stem cell transplant.

Chemotherapy

Chemotherapy is the primary treatment for most childhood leukaemia. It is the use of anti-cancer drugs that kill leukaemia cells or refrain from growing. Chemotherapy can be given in different ways, such as through a vein (IV).

The treatment for childhood leukaemia usually has three phases: induction, consolidation, and maintenance. Induction aims to kill as many leukaemia cells as possible and make the blood counts normal. Consolidation aims to kill any remaining leukaemia cells that could cause a relapse. 

Chemotherapy may induce adverse reactions, including alopecia, oral ulcers, emesis, diarrhoea, hemorrhagic complications, fatigue, and tumour lysis syndrome. Most side effects tend to subside upon completion of the treatment.

Radiation therapy

Leukaemia can be treated without radiation therapy in specific circumstances.

Radiation therapy can be given to a specific body part, such as the brain, the testicles, or the whole body. The dose and duration of radiation therapy depend on the type and stage of leukaemia, the risk group and other factors.

Radiation therapy is given by a machine that aims the rays at the target area. The treatment is painless, but setting up may take some time. Some younger children may need to be sedated to keep them still during the treatment.

Radiation therapy can cause side effects such as:

• Growth problems
• Learning difficulties
• Hormone problems

Bone marrow transplant

A bone marrow transplant is a medical procedure that involves the replacement of diseased bone marrow with healthy blood-forming stem cells. The bone marrow, the soft tissue located within the bones, is responsible for producing blood cells. Within this marrow are immature cells known as stem cells, which can develop into different types of blood cells.

Leukaemia may be treated with a bone marrow transplant in the following circumstances:

• When chemotherapy or other treatments cannot control leukaemia or cause it to go into remission.
• When high doses of radiation therapy or chemotherapy damage the bone marrow.
• When the leukaemia returns after remission or does not respond to other treatments.

Types of bone marrow transplant

There are multiple bone marrow transplants, depending on the stem cells:

Autologous transplant: The stem cells are collected from the patient's blood or bone marrow before treatment and stored until needed. This type of transplant avoids the risk of rejection or graft-versus-host disease (GVHD) when the donor cells attack the patient's tissues.

Allogeneic transplant: The stem cells are donated by someone with a tissue type similar to the patient. This type of transplant can help fight leukaemia cells but also has a higher risk of rejection.

Umbilical cord blood transplant: After a baby is born, the blood in the placenta and umbilical cord is harvested to obtain the stem cells. This type of transplant has a lower risk of rejection or GVHD, but it may not provide enough stem cells for some patients.

Prevention of Leukaemia in Children

The exact causes of leukaemia in children are not known, but some factors may increase the risk of developing it, such as:

• Having certain genetic disorders, such as Down syndrome or Li-Fraumeni syndrome.
• Having a family history of leukaemia or certain blood disorders.
• Having a weakened immune system due to organ transplant, HIV infection or other conditions.

Unfortunately, there is no sure way to prevent leukaemia in children, as most cases are not linked to known risk factors. 

However, there are some steps that parents and caregivers can take to reduce the possible risk of leukaemia in children, such as:

• Avoid smoking during pregnancy and around children, as tobacco smoke contains harmful chemicals that may damage the DNA of blood cells.
• Avoid unnecessary exposure to radiation or chemicals that may cause cancer, such as X-rays, CT scans, pesticides, or solvents.
• Follow the recommended schedule of vaccinations for children, as some infections may trigger leukaemia in children with specific genetic mutations.
• Seek medical attention for any symptoms or signs of leukaemia in children, such as fever, fatigue, Bruising, bleeding, bone pain, swollen lymph nodes or weight loss.
• Consult a genetic counsellor if there is a family history of leukaemia or other inherited conditions that may increase the risk of leukaemia.

These prevention tips may not guarantee that a child will not develop leukaemia, but they may help lower the chance of getting it. They may also benefit the child's overall health and well-being.

Conclusion

Leukaemia is a severe disease, but it is treatable. With early diagnosis and treatment, most children with leukaemia can go on to live everyday lives.

You can do several things to help your child cope with leukaemia, including staying positive, being there for your child, Educating yourself about leukaemia and finding a support group.

If your child is diagnosed with leukaemia, it is essential to remember that you are not alone. Many resources are available to help you and your child through this challenging time.