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In 2019, in the United States, approximately 10,590 children younger than 15 years of age were estimated to be diagnosed with cancer, and leukemia accounted for approximately one-third of these childhood cancer cases (American Cancer Society, 2019; Ward, DeSantis, Robbins, Kohler, & Jemal, 2014). Acute leukemia, which is an overproduction of immature cells (stem cells), is classified based on which cells in the bone marrow are involved: myeloid cells or lymphocytes. Acute lymphoblastic leukemia (ALL) accounts for approximately 80% of childhood leukemias and 26% of childhood cancers (Ward et al., 2014). There is a peak in ALL incidence rates between ages 2 and 4 years. For children diagnosed with ALL, the 5-year survival is 90% (Ward et al., 2014).
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Medical intervention for children with leukemia varies according to the type of leukemia and the medical and research protocols. 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 ALL has a relapse, meaning that the cancer has returned, a stem cell transplant (SCT), bone marrow transplant (BMT), or immunotherapy is typically administered. Children with acute myeloid leukemia (AML) often receive chemotherapy for a few months and then receive a SCT, BMT, or immunotherapy. 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. Immunotherapy uses the patient’s own immune system to recognize, target, and destroy cancer cells. The protocols for children with leukemia commonly include some or all of the following phases:
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Induction 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 last 1 to 2 months. High doses of chemotherapy are given to eliminate any remaining cancerous cells.
Maintenance therapy lasts 2 to 3 calendar years. Low doses of chemotherapy are given with the goal of preventing relapse.
SCT or BMT may be performed after a child has received chemotherapy or after a relapse of disease. Children are admitted to the hospital approximately 1 week before receiving the transplant for what is called conditioning. This is the time when children receive chemotherapy agents, such as thiotepa or Cytoxan, and total body irradiation with the goal of depressing their bone marrow. The child’s age will determine whether the child will receive the total body irradiation or just chemotherapy due to the risk of irradiation to the developing nervous system. During this period, the children are at risk for infection, bruising, and fatigue.
Immunotherapy may be performed after relapse of disease. It can be administered during a hospitalization, but often during outpatient clinic visits at specialized centers. Treatments vary from daily to monthly and are administered ...