Acute Childhood Leukemia Assignment Help

What is Childhood Leukemia?

Leukemia is also known as cancer of the blood. This cancer starts in the cells that would otherwise develop into different types of blood cells. Most leukemias start in the white blood cells although some may start in other types of blood cells.

Acute Childhood Leukemia Assignment Help

Acute Childhood Leukemia Assignment Help

Types of Leukemia in Children

There are various types of leukemia affecting children and are based on:

  • whether the leukemia is chronic (slower growing) or acute (fast-growing)
  • whether leukemia begins in lymphoid or myeloid cells.
  • Acute Leukemia – a majority of childhood leukemias are acute. They progress very fast and require immediate treatment. The main types of acute leukemia are:
  1. acute myeloid leukemia is also known as acute non-lymphocytic, acute myelocytic, or acute myelogenous leukemia. This leukemia starts in the myeloid cells that form white blood cells, platelets, or red blood cells.
  2. acute lymphocytic leukemia – 3 in every 4 children with leukemia will have this type of leukemia. It starts in lymphocytes.
  • Chronic leukemias – these leukemias are rare. They are more difficult to cure and they grow slowly. They are further subdivided into:
  1. Chronic myeloid leukemia – this leukemia is also known as chronic myelogenous. It is rare in children.
  2. Chronic lymphocytic- it is very rare in children.
  • Juvenile myelomonocytic leukemia – this type of leukemia is neither acute nor chronic and it is very rare. It affects children who are 2 years. Its symptoms are cough, enlarged lymph nodes, spleen or liver, pale skin, easy bleeding or bruising, and trouble breathing.

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Normal blood, bone marrow, and lymph tissue

It is important to understand the blood, bone marrow, and lymph systems to understand leukemia.

  • Blood – blood is divided into red blood cells, white blood cells, and platelets. Red blood cells are responsible for transporting oxygen from the lungs to all parts of the body and carrying carbon dioxide from the rest of the body back into the lungs.

Platelets are cell fragments made by megakaryocytes; a type of bone marrow cell. They are responsible for stopping bleeding.

White blood cells help the body to fight off infections. White blood cells are divided into the following types:

  1. Lymphocytes – these are the cells that make up the lymph tissue. They are divided into two types: T cells and B cells.
  2. Granulocytes – these cells develop from myeloblast. They are divided into 3 types; basophils, eosinophils, and neutrophils.
  • Monocytes – these cells develop from monoblasts.
  • Bone marrow – this is the soft inner part of some bones. Bone marrow is made up of fat cells, supporting tissues, and blood-forming cells. Some of the blood-forming cells are blood stem cells.

Blood stem cells go through a series of changes to make new cells. These cells can either become lymphocytes or other blood-forming cells like myeloid cells. Myeloid cells develop into white blood cells, platelets, or red blood cells.

How does Leukemia start and spread?

Leukemia begins in the bone marrow. The leukemia cells build up and crowd out normal cells. Leukemia cells often spill into the bloodstream quite fast. Some types of leukemia can spread to the spleen, testicles, lymph nodes, liver, central nervous system, or other organs.

Cancer of the white blood cells is the most common cancer in children and teens. In this case, there is the formation of abnormal white blood cells in the bone marrow. These abnormal cells move through the bloodstream and go on to crowd out the healthy cells.

It is very hard for parents whose children are diagnosed with cancer. However, there is good news. Treatment of childhood leukemia is mostly successful.

Risk factors for Childhood Leukemia

There are not many known risk factors for childhood leukemia.

  • Genetic risk factors – some forms of childhood leukemia are linked to genetic causes. Genetic disorders that are likely to increase the risk of a child developing leukemia are;
  1. Down syndrome – children with acute leukemia are often more likely to develop acute myeloid leukemia or acute lymphocytic leukemia than other children. Down’s syndrome is also linked to transient leukemia.
  2. Li-Fraumeni syndrome – this is a rare condition. Children with this condition are at a higher risk of developing leukemia.
  • Inherited immune system problems – several inherited conditions increase the risk of immune system problems in children. Coupled with the increased risk of infections that comes with these conditions, children with these conditions may be at a higher risk of leukemia.
  • Having a sibling with leukemia – children whose siblings have leukemia are more likely to develop leukemia too although the overall risk is not that high. However, the risk is higher in identical twins.

If a parent develops leukemia in their adulthood, it does not increase the risk of their children developing leukemia.

  • Lifestyle-related risk factors – some studies suggest that if pregnant mother drinks alcohol, they might increase the risk of their child developing leukemia.
  • Environmental risk factors – environmental factors that may increase the risk of leukemia in children include exposure to certain chemicals and radiation.
  1. radiation exposure – exposure to certain levels of radiation can increase the risk for childhood leukemia. If a newborn gets exposed to radiation within the first months, they could be at increased risk of developing leukemia. The level of risk for leukemia in children who are exposed to low levels of radiation is unknown.
  2. exposure to chemotherapy and certain chemicals – research has shown that there is a possible connection between childhood leukemia and exposure to household pesticides. This happens if the mother is exposed during pregnancy or in the early childhood of the baby.

However, more research is being done to give more specific information and confirm the findings.

  • children receiving intensive treatment to suppress their immune system are at an increased risk of cancers like lymphoma.
  • Uncertain, controversial or unproven risk factors – other risk factors linked to childhood leukemia are;
  1. living near a nuclear power plant
  2. exposure to electromagnetic fields
  • mother’s age when the child
  1. infections
  2. parents with a history of smoking
  3. chemical contamination of groundwater
  • father’s workplace exposure to solvents and chemicals
  • fetal exposure to birth control pills or hormones.

Causes of Childhood Leukemia

The exact cause of childhood leukemia remains unknown. In most cases of childhood leukemia, there are no known risk factors. What is known is that changes in DNA inside normal bone marrow cells can trigger them to grow abnormally and become leukemia cells.

Mutations of DNA can turn off or turn on tumor suppressor genes. Changes in genes may be inherited or may be random. There is a type of DNA change that often leads to leukemia. This DNA change is known as a chromosome translocation.

Normally, the human DNA is packed into 23 pairs of chromosomes. When chromosome translocation occurs, DNA from one chromosome will break off and attach to a different chromosome.

The point where the breaking off happens can affect tumor suppressor genes or oncogenes. Nearly all cases of chronic myeloid leukemia in children are a result of translocation that leads to a swap of DNA between chromosomes 9 and 22.

Inherited versus acquired gene mutations

Several children are born with inherited DNA mutations. This increases their risk for cancers such as leukemia. Some cases of childhood leukemia are caused by certain inherited conditions though not all cases of childhood leukemia.

DNA mutations that are related to leukemia usually develop after conception and are not inherited. These are called acquired mutations. Some acquired mutations occur before birth. Exposure to cancer-causing chemicals or radiation may cause rare cases of acquired mutations.

Combination of genetic and environmental factors

Studies suggest that a lot of childhood leukemias are caused by a combination of environmental and genetic factors. Certain genes are responsible for controlling how bodies break down and get rid of harmful chemicals.

This version of genes may be different in some people and maybe less effective. When exposed to harmful chemicals, children who inherit these gene changes may not be able to break them down as they should.  A combination of exposure and genetics might increase the risk of childhood leukemia.

Other studies suggest that some cases of childhood leukemia are caused by a combination of gene changes that occur in the early life of a child and late exposure to certain viruses also known as delayed infection.

This is because delayed infections are likely to affect the immune system in a manner that may cause leukemia. There is a lot of research that is still going on to establish further other possible causes of childhood leukemia.

Until now, the exact cause of childhood leukemia is not known. There is a need for more research because there is a possibility that the different types of childhood leukemia have different causes.

Symptoms of Childhood Leukemia

The good thing with the onset of the symptoms of leukemia is that they will always prompt a visit to the doctor. This means that in most cases, the disease is found earlier than it would have if the symptoms were not so worrying. This early diagnosis leads to more successful treatment.

Signs and symptoms of childhood leukemia begin soon as leukemia cells crowd out the normal cells. The most common symptoms of leukemia include:

  • coughing
  • pale skin
  • fatigue
  • easy bleeding or bruising
  • coughing
  • shortness of breath
  • weakness

Other symptoms of childhood leukemia include;

  • gum problems
  • joint or bone pain
  • loss of appetite or weight loss
  • rashes
  • swelling in the face, abdomen, sides of the neck, or groin area
  • vomiting
  • swelling above the collarbone
  • headaches, balance problems, seizures, or abnormal vision

Diagnosing Childhood Leukemia

During diagnosis of childhood leukemia, the doctor will perform a physical exam and thoroughly check the medical history of the child. The doctor will also order tests that will help diagnose childhood leukemia as well as classify it.

Tests done to diagnose childhood leukemia include:

  • bone marrow aspiration and a biopsy were taken from the pelvic bone
  • blood tests are done to measure the number of blood cells and their appearance
  • spinal tap or lumbar puncture to check how much leukemia has spread the fluid that bathes the spinal cord and the brain.

During a blood test, a pathologist will examine cells under a microscope. The pathologist will check samples of bone marrow to check the number of fat cells and blood-forming cells. Additional tests may also be done to diagnose childhood leukemia.

Carrying out these tests helps the doctor to predict how the leukemia is going to respond to treatment. After treatment, some tests may be repeated to see how the child is responding to treatment.

Treatment for Childhood Leukemia

Treatment for childhood leukemia is usually overseen by the pediatric oncologist. He/she will work with the following pediatric health professionals:

  • neurologist
  • pediatrician
  • social worker
  • hematologist
  • medical oncologist
  • neurologist
  • psychologist
  • child-life specialist
  • pediatric surgeon
  • pediatric intensivist
  • neuroradiologist
  • rehabilitation specialist
  • radiation oncologist
  • pediatric nurse specialist

Parents whose children have childhood leukemia should talk to their child’s doctor and other members of the cancer care team to discuss the best treatment option for their child. The method of treatment will depend on the type of leukemia and other factors.

Over time, survival rates for the majority of childhood leukemia have gone up. Treating childhood leukemia at special centers is more advantageous due to the specialized care given. Generally, childhood cancers respond better to treatment compared to adult cancers.

In some cases, it may be necessary to deal with illness complications before the cancer treatment starts. for instance, changes in blood cells may lead to severe bleeding, affect the amount of blood that gets to body tissues and even lead to infections. In such a scenario, treatment will involve blood transfusion, antibiotics, and other interventions to treat infections.

The main treatment for childhood leukemia is chemotherapy. Anticancer drugs will be administered by mouth or through the spinal cord or into a vein. Maintenance therapy in cycles for 2-3 years will be needed to prevent leukemia from coming back.

In some cases, the doctor may find it necessary to use targeted therapy. Targeted therapy works by targeting particular parts of cancer cells. It is different from chemotherapy. Targeted therapy is an effective treatment for particular types of childhood cancer. Its side effects are less severe.

An additional type of childhood leukemia treatment is radiation therapy. Radiation therapy uses high-energy radiation to shrink tumors and destroy cancer cells. Radiation therapy can treat childhood leukemia and prevent it from spreading to other body parts.

Surgery is rarely considered a treatment for childhood leukemia. In cases where standard treatment does not prove to be effective, the best option usually is a stem cell transplant. Stem cell transplant involves transplanting a blood-forming stem cell. This is done after radiation is done on the whole body combined with high-dose chemotherapy. This is done to destroy the bone marrow of the child.

Gene therapy has also been approved by the FDA as a treatment option for childhood leukemia. However, this treatment has only been approved for children and adults up to 25 years of age. A version for people above 25 years of age is still being worked on.

Another treatment option is CAR T-cell therapy. This treatment involves using the child’s T cells to treat leukemia. These T cells are taken out by the doctor and they are then changed by adding new genes to them. The new version of the T cells can work more effectively to locate and kill leukemia cells.  

Phases of Childhood Leukemia Treatment

Treatment of childhood leukemia is done in the following phases:

  1. remission induction – this is the first phase whose goal is to kill leukemia cells in the bone marrow and cells. This phase remits leukemia.
  2. consolidation/intensification – this is the second phase and it starts once the leukemia is in remission. Its goal is to kill leukemia cells that may remain in the body that may cause a relapse.
  • maintenance – this is the third phase and its purpose is to kill remaining leukemia cells that may regrow and trigger a relapse. This phase is also called the continuation therapy phase.

Side effects of treatment of Childhood Leukemia

Side effects that begin after treatment of childhood leukemia and continue for months or years are called late effects. Late effects of childhood leukemia treatment include:

  • changes in feelings, mood, learning, thinking, and memory.
  • second cancers or new types of cancers and other medical conditions such as myelodysplastic syndrome and brain tumors
  • physical problems such as problems with bones and blood vessels.

Factors that affect prognosis and treatment options

The prognosis for childhood leukemia depends on the following:

  • if the child has Down’s syndrome
  • age of the child at the time of diagnosis
  • sex, ethnic background, and race of the child
  • the weight of the child at diagnosis and during treatment
  • if leukemia cells are found in cerebrospinal fluid
  • number of white blood cells at the time of diagnosis
  • whether the leukemia cells began from T lymphocytes or B lymphocytes
  • whether there is a change in the genes or chromosomes of the leukemia cells.

Conclusion

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