Education

How is leukemia best treated?

Over 70 percent of children with leukemia who receive optimal treatment are cured of the disease. At diagnosis, parents are confused about how to find the best doctors and treatment plan for their child. The best care avail­able is obtained from institutions who are part of the Children’s Cancer Group or the Pediatric Oncology Group. These two study groups, composed of pediatric oncologists of every description, establish the standard of care for pediatric cancer patients. conduct new studies to discover better therapies or fine-tune the old Ones, and now, with so many survivors, set the blueprint for follow-up If the treatment center you are referred to is a member of one of these groups. you can rest assured that your child will have access to the best thinking on the treatment of pediatric cancers.

Types of leukemia

The two broad classifications of leukemia are acute (rapid progression) and chronic (slow progression). The acute leukemias are characterized by abnor­mal numbers of immature white cells (blasts). In chronic leukemia, mature white cells predominate. Chronic leukemia accounts for less than five percent of all childhood leukemia.

At the end of maintenance, spinal tap and bone marrow samples are exam­ined to ensure that the cerebrospinal fluid and bone marrow are free of leu­kemia. If no cancer is found, treatment ends.

Bone marrow transplantation (BMT)

Bone marrow transplants are not the treatment of choice for children newly diagnosed with ALL. However, for many children with ALL in second remis­sion, bone marrow transplantation may be recommended.

Newest treatment options

To learn of the newest treatments available, call 1-800-4-CANCER and ask for the PDQ (physicians data query) for ALL. These free statements explain the disease, state-of-the-art treatments, and ongoing clinical trials. There are two versions available: one for patients that uses simple language and con­tains no statistics and one for profesionals that is technical, thorough, and includes citations to the scientific literature.

Acute myeloid leukemia (AML)

AML is cancer of the granulocytes. Because treatment for AML and ALL are very different, it is crucial that sophisticated laboratory studies are per­formed on the bone marrow samples to determine whether the child has AML or ALL. Eight thousand cases of AML are diagnosed in the U.S. each year, most often in adults over forty. It is also seen in infants or older teens, but can also strike children at any age. AML accounts for approximately 15 percent of all cases of childhood leukemia. There are seven different classifi­cations or types of AML (Ml to M7) based on the type of granulocyte involved.

My six-year-old daughter had been getting bad headaches. The school would call me to pick her up, and she would throw up all the way home. She had an appointment with the optometrist who noticed an odd­looking vein in her eye and that she looked pale and had some bruising. He recommended taking her in for blood work. We did, and she was diagnosed with AML type M2.

Another method sometimes used for children without a matched, or closely matched, donor is called autologous BMT. In this type of transplant, marrow is removed from the child, may be treated chemically to remove all leukemia cells, and frozen After the child’s own diseased marrow has been destroyed, the frozen marrow is thawed and returned to the patient intravenously. Clinical trials have found autologous transplants to be no more effective than intensive chemotherapy in treating AML.

Newest treatment options

To learn of the newest treatments available, call 1-800-4-CANCER and ask for the PDQ (physicians data query) for AML. These free statements explain the disease, state-of-the-art treatments, and ongoing clinical trials. There are two versions available: one for patients that uses simple language and con­tains no statistics and one for profesionals that is technical, thorough, and includes citations to the scientific literature

Chronic myelogenous leukemia (CML)

CML is a rare type of leukemia, accounting for less than five percent of all childhood leukemias. This disease is characterized by increased production of granulocytes in the bone marrow, and progresses slowly It is usually asso­ciated with a specific chromosomal abnormality The two major forms are the juvenile form, which occurs mostly in infants, and the adult form, which occurs primarily in adults and adolescents.

Juvenile CML

Juvenile CMI. usually strikes children under five years of age The symptoms arc similar it) that of the acute leukemias: pale skin, bruising, fatigue, head­aches, sweating, and recurrent infection. Also usually present are a face rash, enlarged lymph nodes, enlarged spleen and liver, and low platelet count. Unlike the adult form of CML, the juvenile form does not have a chronic phase Once diagnosed, progressive deterioration usually occurs.

Because chemotherapy has not proven to generally be a successful treatment for juvenile CML, bone marrow transplantation provides the only hope for a cure.

Treatment for AML has dramatically improved in the last decade. Today, 75 to 85 percent of children who receive optimal treatment at a major pediatric medical center achieve a complete remission. Of the children who achieve remission, 40 to 50 percent remain in remission for five years, and are con­sidered cured.

Treatment for AML

Treatment for AML is very intensive, lasts one to three years, and is poten­tially hazardous. It is vital that children with this disease are treated at a major pediatric hospital with expertise in treating acute leukemias. Chemo­therapy is the primary treatment Radiation of the brain and sometimes the spinal cord is also used in some protocols. Bone marrow transplantation is used with increasing frequency to treat childhood AML in first or second remission.

As with ALL, chemotherapy drugs for AML are more successful if two, three, or four are used simultaneously. The most common drugs used to treat AML are: ARA-C (cytarabine), daunomycin (daunorubicin), etoposide, thiogua­nine, vincristine, and prednisone. Chemotherapy can be administered by mouth (orally), intravenously (through the IV), intramuscularly (injection in the muscle), or intrathecally (through a needle in the lower part of the back). Chemotherapy, for an in-depth discussion of each drug, possible side effects, and parent suggestions

The two phases of treatment for AML are induction and post-remission therapy

Induction

Induction is the most intense part of treatment, its purpose is to quickly kill as many cancer cells as possible Several weeks of hospitalization are usually required. As the toxic chemotherapy drugs damage normal cells as well as leukemic cells, leaving the child susceptible to infections and excessive bleeding Biologic response modifiers such as granulocyte-macrophage colony-stimulating factor or granulocyte colony-stimulating factor are used to shorten the duration of nutropenia (low white counts) Transfusions of blood and platelets are usually necessary.