What is Leukemia in Children? Symptoms, Causes, and Treatment Methods

Leukemia is a type of blood cancer that begins in the bone marrow. It is the most common type of cancer in children. Approximately one-third of cancer cases in children and adolescents are due to leukemia. In this disease, abnormal blood cells multiply uncontrollably in the bone marrow and accumulate, reducing the number of healthy blood cells. The vast majority of childhood leukemias are rapidly progressing (acute), while chronic forms are very rare.

What is Leukemia in Children?

Bone marrow is the soft, spongy tissue where blood cells (white blood cells, red blood cells, platelets) are produced. In leukemia, immature forms of white blood cells (blasts) usually multiply abnormally and accumulate in the bone marrow. This leads to a decrease in healthy blood cells (including oxygen-carrying red blood cells and bleeding-stopping platelets). Most leukemia in children is acute. The most common type is acute lymphoblastic leukemia (ALL), which accounts for approximately 75% of childhood leukemias. While the majority of the remaining cases are acute myelocytic leukemia (AML), chronic myeloid (CML) and chronic lymphocytic (CLL) leukemias are very rarely seen in children.

What Are the Symptoms of Leukemia in Children?

Leukemia causes various symptoms due to the impairment of blood cell production in the bone marrow. Symptoms of leukemia in children include:

Fatigue and paleness: Anemia develops due to a decrease in the number of red blood cells.

High fever and night sweats: Frequent fever spikes may occur during the disease.

Easy bruising and bleeding: Due to a decrease in the number of platelets (clotting cells), bruises may form even from minor impacts, and nosebleeds or gum bleeding may occur.

Recurrent infections: Although numerous, the white blood cells in leukemia are dysfunctional, making it difficult for the body to fight infections. The child may frequently experience symptoms such as fever, colds, or ear/throat infections.

Bone and joint pain: The accumulation of abnormal cells inside the bone marrow can lead to bone pain.

Abdominal swelling, loss of appetite, and weight loss: Leukemia cells can cause enlargement of the liver, spleen, and lymph nodes, which leads to a feeling of fullness in the abdomen and loss of appetite.

These symptoms may indicate leukemia. Symptoms increase as the disease progresses; even a mild fatigue in the early stages can rapidly worsen in the future. Headaches in children can be a symptom of leukemia, especially if accompanied by vomiting and vision problems.

What Are the Types of Leukemia in Children?

Leukemias in children are generally classified as acute. Acute lymphoblastic leukemia (ALL) is the most common type of leukemia in children and the most frequent type of childhood cancer. In ALL, a large number of immature lymphocyte-type white blood cells are produced in the bone marrow. Acute myelocytic leukemia (AML) is another acute type originating from the stem cells of the bone marrow that produce white blood cells, red blood cells, or platelets. Chronic leukemias (CML, CLL) are very rare in children; these forms are usually seen in adulthood. In addition to these, there are very rare subtypes such as juvenile myelomonocytic leukemia (JMML). In summary, the majority of childhood leukemias are of the acute (rapidly progressing) type.

How is Leukemia Diagnosed in Children?

The diagnosis of leukemia begins with the suspicion raised by the doctor's physical examination and detailed medical history. Blood tests (complete blood count) are performed; an increase in white blood cell count, a decrease in red blood cell/platelet count, or the presence of abnormal cells (blasts) in these tests raises suspicion of leukemia. For a definitive diagnosis, bone marrow aspiration and biopsy are usually taken from the hip bone; the tissue samples obtained in this procedure are subjected to cellular examination in the laboratory. Furthermore, genetic and chromosome analyses are used to determine the subtypes of leukemia cells, and the treatment plan is shaped accordingly. If necessary, additional tests such as cerebrospinal fluid examination (lumbar puncture) are performed to investigate whether the disease has involved the central nervous system. Once the diagnosis is made using these methods, treatment options are evaluated.

What Are the Treatment Methods for Leukemia in Children?

The treatment process for leukemia in children may include chemotherapy, supportive treatments, and, if necessary, bone marrow transplantation. The treatment method for leukemia is planned according to the type of leukemia, its subtype, the child's age, and their general condition. The foundation of treatment is chemotherapy. In most children, multi-phase chemotherapy protocols using various drugs in different doses and combinations are applied. In the first stage (induction phase), the goal is to achieve remission rapidly; children are usually monitored in the hospital during this period. Once success is achieved in induction, consolidation and maintenance phases are used to eliminate leukemia cells remaining at the microscopic level.

Hematopoietic stem cell transplantation (bone marrow transplant) can be a treatment option, especially in high-risk or relapsed cases; in bone marrow transplantation, stem cells are transferred from a healthy donor. Radiotherapy is generally not part of the routine treatment of leukemia, but it may be used if there is spread through the cerebrospinal fluid or in specific situations before transplantation.

Today, targeted drugs (such as imatinib in Philadelphia chromosome-positive ALL) or experimental immunotherapy methods (CAR-T cell therapies, etc.) can also be used in some specific subtypes. Approaches such as blood transfusion and supportive treatment against infections are also applied during and after treatment. In general, childhood leukemias are cured at a high rate thanks to standard treatment protocols applied in advanced centers; treatment usually yields successful results. However, since the treatment process can be long and intensive, children require long-term follow-up and care.

Frequently Asked Questions

Leukemia usually develops due to genetic changes that occur over time after birth. This disease is not directly transmitted to the body like an environmental or hereditary infection. It does not stem from environmental factors or a condition carried during the neonatal period; it mostly arises as a result of genetic predisposition or randomly occurring DNA changes. It is not a disease passed directly from parent to baby. The development of leukemia is usually random, but some conditions may increase the risk. For example, genetic syndromes such as Down syndrome and ataxia-telangiectasia increase the risk of leukemia. Having received intensive radiation therapy or chemotherapy in the past also increases the risk. Having a sibling diagnosed with leukemia may slightly increase the risk, although this is very rare. Apart from this, there is no known definitive environmental or lifestyle-related cause; most children have no risk factors. Leukemia is usually identified by the symptoms listed above. The child appearing constantly fatigued, pale, or having a history of unexplained fever or bleeding raises the doctor's suspicion. The doctor investigates the suspicion of leukemia with physical examination and blood tests. If there are abnormal findings in the complete blood count, a bone marrow examination is performed. This confirms the presence of leukemia cells and the disease is identified. Early diagnosis means catching leukemia before it progresses. Leukemia in children can be understood by examining blood values; especially low hemoglobin, platelet, and high leukocyte levels are important. Starting treatment while the disease is less spread makes it easier to control the disease and increases treatment success. When leukemia in children is caught in the early stages and appropriate treatment is received, the chance of success is usually high. Additionally, when treatment is started early, the risks of severe complications can be reduced and the patient's quality of life can be preserved. In the treatment of childhood leukemias, the induction phase, in particular, usually requires hospitalization at the beginning. The child is monitored in the hospital for the first week or longer, and intensive chemotherapy is administered during this period. In the consolidation and maintenance phases, treatment is mostly continued on an outpatient basis or with short hospital stays, but if fever, infection, or other side effects develop, it may be necessary to apply to the hospital again. Hospitalizations may recur from time to time during treatment, but the entire treatment process is not spent in the hospital. Chemotherapy is the primary treatment method in childhood leukemias; chemotherapy is applied in almost every case. Radiotherapy, on the other hand, is usually used only in special cases, for example, if there is central nervous system involvement or as an addition in certain treatment plans. In modern treatment protocols, radiotherapy is avoided as much as possible; most children are treated with chemotherapy alone. Leukemia is not a contagious or hereditary disease, meaning it is not transmitted from person to person through contact and is not directly passed from parent to child through genetics. This disease does not arise due to a child's immune system or lifestyle, but usually as a result of abnormal changes that occur in the development of blood cells. In the vast majority of childhood leukemia cases, there is no history of any cancer or specifically leukemia in the family. This shows that the disease mostly develops randomly or under the influence of environmental factors. In conclusion, leukemia in children is a serious disease that can be controlled at a high rate with early diagnosis and treatment. Symptoms can appear in different ways in every child; therefore, findings such as prolonged fatigue, bruising, recurrent infections, or unexplained headaches must be taken seriously. Changes in blood values provide important clues in the diagnostic process.

The incidence of leukemia in children is reported as approximately 4-5 cases per 100,000 per year. Diagnosis of leukemia in children is made with blood tests, bone marrow biopsy, and genetic analysis. In conclusion, leukemia in children is a serious disease that can be controlled at a high rate with early diagnosis and treatment. Being aware as families and not neglecting regular health check-ups can increase the chance of treatment by noticing the disease in the early stages. It should not be forgotten that the most powerful weapon in leukemia treatment is early diagnosis.

If your child has one of the symptoms of leukemia, consult an expert Pediatric Hematologist without delay. The Hisar Hospital Pediatric Hematology department is with you with early diagnosis and modern treatment methods. You can contact us to make an appointment immediately.