Leukemia

Specific treatment for leukemia will be determined by your child's physician based on: 

• your child's age, overall health, and medical history
• the extent of the disease
• your child's tolerance for certain medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

Treatment usually begins by addressing the presenting symptoms such as anemia, bleeding, and/or infection. In addition, treatment for leukemia may include (alone or in combination) the following: 

• chemotherapy/intrathecal medications(medications are inserted through a needle into the spinal cord into the area called the subarachnoid space)
• radiation therapy - although never used as part of induction therapy
• bone marrow transplantation or peripheral blood stem cell transplantation - stem cell transplant is almost never used to treat ALL, except for certain rare subtypes of it the leukemia comes back after initial treatment with chemotherapy (and sometimes radiation)
• biological therapy - almost never used for the treatment of ALL
• medications (to prevent or treat damage to other systems of the body caused by leukemia treatment)
• medications (for nausea and side effects of treatment)
• blood transfusions (red blood cells, platelets)
• antibiotics (to prevent/treat infections)
• continuous follow-up care (to determine response to treatment, detect recurrent disease, and manage late effects of treatment)

What are the various stages of leukemia treatment? 

There are various stages in the treatment of leukemia, including the following:

Induction - a combination of chemotherapy and medications given to stop the process of abnormal cells being made in the bone marrow. Remission means the leukemia cells are no longer visible under the microscope when examining either the bone marrow or blood. However, even when remission is achieved, leukemia is still present in the body, which is why further treatment is necessary. the induction phase may last approximately one month and can be repeated if remission is not achieved.

Intensification or consolidation - continued treatment with chemotherapy to kill leukemia cells. Even though leukemia cells are not visible in a blood test or bone marrow examination, they are still present in the body. Therapy in this phase may include chemotherapy given to the central nervous system to kill any leukemia cells present there, or to prevent the spread of leukemia cells to the spinal cord or brain. Radiation therapy may also be given to the brain during this phase.

Maintenance or continuation - the goal of this phase is to eradicate all leukemia from the body. Usually, less intensive chemotherapy is used, much of which can be given at home. This phase can last months to several years. Regular visits to your child's physician are required in order to determine response to treatment, detect any recurrent disease, and manage any side effects of the treatment

What is relapse? 

Relapse may occur even with aggressive therapy. Relapse is when the bone marrow begins making abnormal cells again. Relapse can occur during any of the stages of treatment, or may occur months or years after treatment has ended. 

Long-term outlook for a child with leukemia: 

Prognosis greatly depends on: 

• the extent of the disease.
• disease response to treatment.
• genetic abnormalities of the leukemia.
• age and overall health of the child.
• your child's tolerance of specific medications, procedures, or therapies.
• new developments in treatment.

As with any cancer, prognosis and long-term survival can vary greatly from child to child. Prompt medical attention and aggressive therapy are important for the best prognosis. Continuous follow-up care is essential for the child diagnosed with leukemia.

Side effects of radiation and chemotherapy, as well as second malignancies, can occur in survivors of leukemia. New methods are continually being discovered to improve treatment and to decrease side effects of the treatment for the disease.