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In 2007, in the United States, approximately 10,400 children younger than 15 years of age were diagnosed with cancer, and leukemia accounted for approximately one-third of these childhood cancer cases (American Cancer Society 2007; Ries et al., 2008). The diagnostic groups and specific diagnoses of pediatric leukemia are outlined in Table 22.1. These percentages are determined from data collected from the Surveillance, Epidemiology, and End Results 2001–2005 Program of the National Cancer Institute (Ries et al., 2008).
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Medical intervention for children with leukemia varies according to the type of leukemia and the protocol. Each medical institution uses specific protocols to guide the drugs and dosages that children will receive. All children with leukemia receive chemotherapy and in some cases radiation. If a child with acute lymphoblastic leukemia (ALL) has a relapse, meaning that the cancer has returned, a stem cell transplant (SCT) or bone marrow transplant (BMT) is typically administered. Children with acute myeloid leukemia (AML) often receive chemotherapy for a few months and then receive a BMT or SCT. SCT includes only the most immature type of cell, given before the cell has differentiated to a specific type. BMT involves administering marrow, including all types of cells. The protocols for children with leukemia commonly include some or all of the following phases:
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Induction, which lasts approximately 4 to 6 weeks. High doses of a combination of chemotherapy agents are given to eliminate the leukemia cells, with the goal of achieving remission.
The consolidation and intensification phases, which last 1 to 2 months. High doses of chemotherapy are given to eliminate any remaining cancerous cells.
Maintenance therapy, which for children with ALL lasts approximately 2 calendar years for girls and 3 calendar years for boys. Low doses of chemotherapy are given with the goal of preventing relapse. In the future boys may begin ...