Treatment Options for Childhood Leukemia: What to Expect
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Each year, around 4,000 children are living with leukemia, according to Children’s Hospital of Philadelphia . The outlook for kids with this cancer has improved dramatically over the years, thanks in large part to new treatments. About 98 percent of children with acute lymphoblastic leukemia (ALL), the most common type of leukemia, go into remission within a few weeks after they start treatment, say experts at St. Jude Children’s Research Hospital . And about 90 percent of those who go into remission can be cured. In childhood leukemia , cancer cells multiply inside the blood and bone marrow. Those abnormal cells crowd out healthy blood cells, causing symptoms like bleeding, bruising, fatigue, and more frequent infections. Treatment aims to kill off the cancer cells and put leukemia into remission. For most children, that starts with chemotherapy, says the American Cancer Society .
Chemotherapy Chemotherapy This leukemia treatment uses strong drugs that travel throughout the child’s body to kill cancer cells. Chemotherapy is the main treatment for ALL, acute myeloid leukemia (AML), and acute promyelocytic leukemia (APL). Chemotherapy for leukemia can be given in a few different ways: Into a vein through an IV As a shot into a muscle Into the fluid around the brain and spinal cord through a spinal tap (lumbar puncture) If your child is getting chemotherapy through an IV, they might have a small procedure first to place a small plastic tube called a port into a blood vessel under their skin. The chemotherapy will go into this tube to prevent them from going through multiple needle sticks over the many months or years of treatment. Usually, chemotherapy is divided into three phases: 1. Induction During this period, which lasts about a month, your child will receive a combination of different chemotherapy drugs. The goal is to put their cancer into remission, meaning there are no more signs of leukemia cells in their blood and bone marrow. Children with ALL and AML may also get chemotherapy into their cerebrospinal fluid (the fluid around their brain and spinal cord) to kill any leukemia cells that may have spread there. This type of chemotherapy is delivered through a spinal tap. More than 95 percent of children with ALL and up to 90 percent of those with AML will go into remission within a month after starting on induction treatment, says the American Cancer Society. This means there are no signs of cancer cells in their bone marrow and blood. The cancer isn’t necessarily cured at this stage, but it is under control. During this intense treatment period, your child will make many trips to the doctor. They may also need to stay in the hospital periodically to manage any treatment complications, like infections. 2. Consolidation This next phase starts once your child is in remission, and it lasts for several months. Consolidation is a more intense phase that involves getting a combination of several chemotherapy drugs to kill any remaining cancer cells. Kids with high-risk leukemia (their cancer has certain gene changes that make it more resistant to treatment or more likely to return) may get additional chemotherapy drugs to prevent the cancer from coming back. 3. Maintenance The last phase of treatment is designed to prevent the cancer from relapsing. Kids with ALL will get a combination of medicines, but often in lower doses than in the first two phases, according to the Leukemia and Lymphoma Society . There is no maintenance phase for AML. Instead, children with this cancer will get higher doses of chemotherapy for a shorter period of time — often less than a year, according to the American Cancer Society . Chemotherapy Side Effects Because chemotherapy doesn’t target cancer cells specifically, it can also kill some healthy cells. The most common side effects with this treatment are: Hair loss Nausea and vomiting Appetite loss Increased risk of infections Tiredness Easy bruising and bleeding Diarrhea Mouth sores Most side effects will go away once your child finishes treatment. Their oncologist can prescribe medicines to prevent some of them, including nausea, vomiting, tiredness, and bleeding.
Stem Cell Transplant Stem Cell Transplant This treatment, also called a bone marrow transplant, starts by giving the child very high doses of chemotherapy. The treatment wipes out the leukemia cells inside their bone marrow. Because the chemotherapy drugs also kill healthy blood-forming cells, the child will need a transplant to replace those blood cells with stem cells from a donor. A stem cell transplant could potentially cure leukemia, says the American Cancer Society . But this intense treatment will require your child to stay in the hospital for a long period of time. It also has potentially serious risks, like infections, bleeding, and immune system reactions. That’s why a stem cell transplant isn’t often used as the first treatment. A stem cell transplant may be an option for children with: ALL that is high risk or that relapses after treatment AML that comes back or is likely to return Less common leukemia types, such as juvenile myelomonocytic leukemia (JMML) and chronic myelogenous leukemia (CML)
Targeted Drugs Targeted Drugs Chemotherapy kills cancer cells all over the body, and sometimes destroys healthy cells in the process. Targeted treatments are different. They work against specific gene changes or proteins that help the cancer grow. And they can improve the outlook for some children who don’t respond well to chemotherapy, according to a review in the International Journal of Molecular Sciences . Tyrosine Kinase Inhibitors (TKIs) This group of targeted drugs works against cancer cells that contain the Philadelphia chromosome. Almost all children with CML and some with ALL have this abnormal chromosome in their cancer cells, says the American Cancer Society . TKIs come as pills or capsules. If your child can’t swallow pills, some of the medicines can be crushed or sprinkled into water or apple juice. A TKI may be added to chemotherapy for kids with ALL. Those with CML will often get a targeted drug first, followed by a stem cell transplant if the TKI no longer works. Monoclonal Antibodies These are lab-made proteins linked to chemotherapy drugs that attach to certain targets on the cancer cells. Gemtuzumab ozogamicin (Mylotarg) delivers chemotherapy straight to the cancer. Children with AML may get Mylotarg with chemotherapy during induction therapy, or by itself if the cancer doesn’t respond to chemotherapy or it comes back. The medicine comes as an IV infusion. Bortezomib (Velcade) Velcade blocks substances called proteasomes that remove old proteins from cancer cells. Without proteasomes, the proteins build up and the cancer cells die. Doctors sometimes use this medicine in children with ALL who have relapsed. Velcade comes as a shot under the skin or as an infusion. All-Trans-Retinoic Acid (ATRA) Children with APL often get this active form of vitamin A, alone or with chemotherapy, as their first treatment, according to the American Cancer Society . APL cells have gene changes that keep them immature and prevent them from growing into normal white blood cells. ATRA helps those cells mature. Side Effects of Targeted Therapy Side effects of targeted therapy depend on the drug used, but can include: Nausea and vomiting Diarrhea Tiredness Muscle pain Rashes Fever Infection Mouth sores Bleeding
Radiation Therapy Radiation Therapy This treatment kills cancer cells using high-energy radiation. It was more common in the past to give radiation therapy to children with high-risk ALL or those who had leukemia cells in their brain and spinal fluid, but it’s used less often now because of the possible side effects on a child’s growth and development, says the American Cancer Society .
After Treatment After Treatment Chemotherapy and other treatments can put most children with leukemia into remission or cure them. Learning that your child has finished treatment and is cancer-free can come as a huge relief, but their journey isn’t over. They will need many years of follow-up visits with their doctor to be monitored for long-term side effects and checked for relapses. It’s rare for ALL or AML to come back once a child has had no signs or symptoms of cancer for two years, according to the American Cancer Society . Once your child passes that mark, they should be in the clear.
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