The document provides an overview of childhood leukemia, detailing its types, symptoms, diagnosis, and treatment options. It emphasizes that leukemia is a cancer originating from progenitor cells in the bone marrow, with various subtypes like acute lymphoblastic leukemia and acute myelogenous leukemia being the most common. The treatment approach includes chemotherapy, radiation, and bone marrow transplantation, with stages focusing on inducing remission and maintaining a leukemia-free state.

1. Leukemia in Children
Presented by : Mariam Tarek Hassan
ID:221001627
Lecturer : dr. Mohamed Hamden

2. Types
Chemotherapy Handling
Risk factors
Diagnosis
Symptoms
Definition
Treatment
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Childhood Leukemia
Most common form of cancer in childhood
➢ Leukemias are cancers of progenitor cells in bone marrow
➢ Most often starts in early forms of white blood cells, but
some may start in other blood cell types
➢ The bone marrow makes abnormal blood cells “Blast
cells” that are immature and don’t work as healthy cells
“compete for nutrients with other healthy cells”

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5. In bone marrow
“soft, spongy center
of certain bones”
Blood cells formation

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7. It is determined by where the cell is in the
stage of development when it becomes
malignant, or cancerous
Types of Leukemia

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Acute Leukemia Subtypes

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Types of Childhood Leukemia
➢ Acute lymphoblastic leukemia (ALL) ~ 80% “ages of 2 - 4 years”
➢ Acute myelogenous leukemia (AML) ~ 15% “very young children
& teenagers” - more common in elderly
➢ Hybrid or mixed lineage leukemia ~ rare with features of both
ALL & AML
➢ Chronic leukemias ~ rarely seen in children
➢ Juvenile myelomonocytic leukemia (JMML) ~ rare type neither
chronic nor acute “children < age 4”

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Congenital Leukemia
➢ Quite rare (<1% of all childhood leukemias)
➢ Occurs within 4 - 6 weeks of birth
➢ Unfortunately, the 6-month survival rate is only 1/3,
despite aggressive chemotherapy
➢ However spontaneous remissions have been reported,
but science has not offered definitive answers as to
how this might occur

15. • Having a risk factor does not
mean that you will get cancer;
• Not having risk factors doesn’t
mean that you will not get
cancer
Risk factors

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Risk factors
➢ Exposure to x-rays before birth, radiation or
chemotherapy
➢ Certain genetic conditions such as: Down syndrome,
Neurofibromatosis type 1, Bloom syndrome,
Fanconi anemia, Ataxia-telangiectasia,
Li-Fraumeni syndrome
➢ Certain changes in the chromosomes
or genes “oncogenes”

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19. Initial symptoms are often
related to irregular bone
marrow function
Symptoms

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22. In addition to a complete medical
history and physical examination,
Diagnostic procedures for leukemia
may include:
Diagnosis

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Diagnostic procedures
1. Complete blood count (CBC) with differential
2. Additional blood tests
Include blood chemistries, liver and kidney
functions
3. Bone marrow aspiration and/or biopsy
Involves taking a small amount of bone marrow
fluid (aspiration) or solid tissue (core biopsy),
usually from hip bones, or breastbone

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Diagnostic procedures (Cont.>>)
4. Spinal tap/lumbar puncture (LP)
➢ Special needle is placed into lower
back in the spinal canal
➢ CSF sample is tested to determine if
there are leukemia cells, infection, or
other problems
This procedure is done after leukemia is diagnosed to
find out if leukemia cells have spread to CNS or not
(Intrathecal chemotherapy)

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Diagnostic procedures (Cont.>>)
5. X-ray
6. Computed tomography scan (CT or CAT scan)
7. Magnetic resonance imaging (MRI)
8. Ultrasound (sonography)
9. Lymph node biopsy

26. Determined based on:
➢ Child's age, overall health, and medical history
➢ Type of leukemia & certain chromosomal changes
➢ Extent of the disease
➢ Child's tolerance for certain medications
➢ Physician’s opinion or preference
[Patient’s Risk Classification]
Treatment

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Treatment
May include (alone or in combination) of the following:
➢ Chemotherapy
➢ Intrathecal chemotherapy
➢ Radiation therapy
➢ Bone marrow transplantation
➢ Targeted therapy (especially with CML)

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29. 1. Induction of Remission
2. Consolidation (Intensification)
3. Continuation (Maintenance)
Stages of leukemia treatment

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1. Induction of Remission
➢ Combination of chemotherapy and/or radiation given to
stop process of abnormal cells formation in bone marrow
➢ Remission is the goal in this stage of treatment (means
the leukemia cells are no longer being made), although
this is not necessarily a cure
➢ Phase may last approximately one month & can be
repeated

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2. Consolidation (Intensification)
➢ Continued chemotherapy treatment (usually for a couple of
months)
➢ Leukemia cells may not be visible in a blood or bone
marrow examination, but it is possible that they are still
present in the body

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3. Continuation (Maintenance)
➢ Maintains leukemia-free bone marrow by continuing less
intense chemotherapy for a longer duration
➢ Regular visits to doctor are required in order to
determine response to treatment, detect any recurrent
disease & manage any side effects

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Relapse
➢ May occur even with aggressive therapy
➢ Bone marrow begins making abnormal cells again
➢ Can occur at any stages of
treatment, or may occur months or
years after treatment has ended

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Other Treatments
➢ Blood transfusions → red blood cells, platelets
➢ Supportive Medications → to prevent or treat damage to
other systems of the body caused by leukemia treatment (as TLS
“Tumor Lysis Syndrome”, CINV “chemotherapy-induced nausea
and vomiting”)
➢ Antibiotics → to prevent or treat infections
(FN “Febrile Neutropenia”)

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44. References
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45. Chemotherapy Handling
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Chemotherapy drugs are
bio hazardous agents

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Hazardous Drugs
National Institute for Occupational Safety and Health
(NIOSH) has defined hazardous drugs as:
➢ Carcinogenicity
➢ Teratogenicity or other developmental toxicity
➢ Reproductive toxicity
➢ Organ toxicity at low doses
➢ Geno toxicity (mutagenicity)
Examples: Antineoplastic, Immunosuppressant, Antiviral agents

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50. References
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