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Pediatric Leukemias Diagnosis | Memorial Sloan Kettering Cancer Center

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The MSK Kids Approach to Diagnosing Leukemia

Children and young adults with leukemia have the best chance of beating the disease when they receive an accurate diagnosis and start treatment as soon as possible. At MSK Kids, we use a quick and thorough approach to diagnose the cause of your child’s symptoms to determine if they are due to leukemia. We then go further, using the most-advanced genetic testing and other technologies to see what mutations are driving the cancer’s growth. This helps your child’s care team better understand how aggressive the leukemia may be. With a wealth of information from these tests, we can match your child with the most effective and personalized leukemia treatment.

Symptoms of Leukemia in Children

Leukemia can cause symptoms, such as:

• fatigue (feeling tired), reported by more than 90 percent of children with leukemia
• bone pain, which could make your child limp or refuse to walk
• signs of bleeding, including bruising easily or seeing small spots of blood, called petechiae, under the skin
• fevers that last for various amounts of time, with no apparent cause
• repeated infections
• an enlarged liver, spleen, or lymph nodes found during a doctor’s exam, experienced by about 70 percent of children

Take your child to the doctor if any of these symptoms continue and don’t seem to be going away.

What tests will my child have?

A blood test is the first test we will do. We’ll examine your child’s blood counts to see how many red blood cells, white blood cells, and platelets are present, if the counts are in the normal range, and if there are any blood cells that look abnormal. Your child’s doctor will also do a complete physical exam to look for any signs of leukemia, such as bruising, lumps, or an enlarged liver, spleen, or lymph nodes.

Not all children with leukemia have abnormal blood counts, but they may have other signs of leukemia found through a physical exam or by looking at their blood cells under a microscope. If your child’s doctor suspects leukemia, we will remove a sample of bone marrow for analysis. We will place your child under anesthesia briefly to perform this test and will ensure that they are comfortable and relaxed.

Genetic testing is also done on a blood or bone marrow sample. Through the MSK Kids Pediatric Translational Medicine Program, every child with leukemia has their cancer cells analyzed for genetic mutations. This process is called genomic profiling. It may provide valuable clues that our doctors can use to refine and improve the diagnosis, define the response to therapy, monitor your child, and find the most-effective treatments, including targeted therapies. Because all of this testing can be done right here at MSK Kids, you’ll get the results quickly. We know how anxious you are feeling and how important that is to you.

What are leukemia risk groups?

When we start treating your child, we are aiming for remission. That means the treatment has destroyed nearly all of the abnormal blood cells and the body is back to producing normal blood cells. But sometimes remission doesn’t last. A risk group is a classification we assign to your child’s leukemia. It indicates how likely it is that the cancer might come back after remission. We treat children with low-risk leukemia less intensively than those with high-risk leukemia. Your child’s doctor will tell you which risk group your child’s cancer is in and how it will affect the intensity of therapy.

Leukemia in children and adolescents

What is leukemia?

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Leukemia is a cancer of the blood and bone marrow. It is the most common cancer in children and adolescents. In the United States, about 3,500–4,000 cases of childhood leukemia are diagnosed each year.

Leukemia occurs when the normal functioning of the bone marrow is disrupted. Bone marrow is the soft inner part of the bone. It works like a factory for the production of blood cells: it produces all the blood cells. Their formation begins with the formation of hematopoietic cells (hematopoietic cells). If the bone marrow is functioning properly, these blood-forming cells become cells that eventually turn into red blood cells, white blood cells, and platelets.

• Acute lymphoblastic leukemia (ALL)

• Acute myeloid leukemia (AML)

• Chronic myeloid leukemia (CML)

• Juvenile myelomonocytic leukemia (JMML)

• Acute lymphoblastic leukemia (ALL) in infants

• Relapse of acute lymphoblastic leukemia (ALL)

Patients with leukemia do not have proper maturation of hematopoietic cells. The blood produces too many immature blood cells or leukemic cells.

When this happens, the function of the blood is disturbed. It becomes insufficient in it:

• Erythrocytes - their task is to deliver oxygen to the organs of the body. A person has a strong feeling of fatigue due to anemia.
  
• Leukocytes - their task is to fight infections and diseases. The person gets sick.
  
• Platelets - they are responsible for blood clotting. A person easily bleeds and bruises.

Leukemias are either acute or chronic. In acute cases, the symptoms develop rapidly: without treatment, the disease will progress rapidly. In a chronic course, the disease and symptoms develop slowly.

Acute leukemia most often occurs in children.

The process of hematopoiesis leading to the formation of blasts.

Signs and symptoms of leukemia

Signs and symptoms include:

• Fever
  
• Frequent infections
  
• Weakness
  
• Increased fatigue
  
• Easily occurring bleeding and bruising
  
• Pain in bones and joints

Diagnosis of leukemia

• Medical examination and medical history
• Blood tests
  
• Puncture and biopsy of bone marrow
  
• Chest x-ray
  

Treatment of leukemia

Treatment depends on the type of leukemia and risk group. The most common treatment is chemotherapy.

Other possible treatments:

• Targeted therapy
• Immunotherapy
• Hematopoietic cell transplant (also called bone marrow or stem cell transplant)
  

Leukemia treatment prognosis (outcome)

When discussing cancer survival statistics, physicians often use a number called 5-year survival, referring to the percentage of patients who live at least 5 years after they are diagnosed with cancer. In acute leukemia, children with no disease after five years are likely to be completely cured. This is explained by the fact that after so many years the return of this cancer is very rare. Survival rates are a conditional value. For information about survival in the specific case your family is facing, it is best to contact your child's primary care physician.

Acute leukemia

The overall 5-year survival rate for acute lymphoblastic leukemia (ALL) in children is approximately 90%.

The overall 5-year survival rate for children with acute myeloid leukemia (AML) is 65–75%. However, survival rates vary by AML subtype and other factors. For example, the cure rate for acute promyelocytic leukemia (APML), one subtype of AML, is currently above 90%, but rates for some other subtypes of AML are lower.

Chronic leukemias

For chronic leukemias, a 5-year survival rate is less useful because children can live with leukemia for a long time without actually being cured. In the past, 5-year survival rates for chronic myeloid leukemia (CML) were 60-80%, but they are now much higher.

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Modified June 2018

My 2 year old son was diagnosed with leukemia a month ago. He will get better, I have no doubt. Now we are undergoing treatment with hormones and chemotherapy. Before the start of treatment, my child was balanced and calm, there were never tantrums and crying. Now he has changed a lot. Because of the hormones, he constantly asks for food, if I don’t give it, a tantrum begins.

A month ago, my two-year-old son was diagnosed with leukemia. He will get better, I have no doubt. Now we are undergoing treatment with hormones and chemotherapy. Before the start of treatment, my child was balanced and calm, there were never tantrums and crying. Now he has changed a lot. Because of the hormones, he constantly asks for food, if I don’t give it, a tantrum begins. Gets irritated and cries at the slightest provocation or for no reason at all. I have a question: how to communicate with my son?

Hello!

As a caring mother, you are doing everything right on the way to your son's recovery, look for outside support, including in our person.

How does your child feel physically, how does he cope with chemotherapy? After all, not even every adult patient endures such procedures. You write about the action of hormones that cause a strong appetite in a child - yes, this happens. Have you talked to your doctor about nutrition, diet? Advise that you can give the baby often, but without harm to him.

I would like to commend you for your confidence in your recovery, because your inner mood and positive thoughts mobilize your body's reserves and are passed on from you to your son.

Do you think your baby understands that he is sick, have you talked to him about it. If yes, how? Does he feel your unconditional love?

Because you are describing a sudden change in the behavior of the child, he understands that something is wrong with him, but he cannot express his feelings, his fear of doctors, pain from injections, resentment towards adults. Help him find an outlet for his emotions, become his guide in this world that has already sent him trials at such an early age. Even the fact that a child constantly asks for food may indicate that he is under severe stress, although the role of hormones cannot be ignored. Remember that often in stress people lean on sweets, pastries and simply on plentiful food, that is, a person is looking for positive emotions in what can distract him from the problem, deliver positive emotions.

A two-year-old child can get positive emotions from games, fairy tales - this is the main mechanism for understanding the world! At this age, children are only developing figurative thinking, perception of the world. Take a soft toy, play doctor, let the baby give “injections”, thereby projecting his feelings onto the toy, while pitying the toy - it hurts, but it will definitely get better! These images will help the baby understand himself and live more calmly and recover in this situation.

Drawing is also very helpful for kids to express their emotions, let them draw whatever they want on paper. Try to carefully find out from him what he portrayed, what each character he draws feels, how he himself could help them.

You can also try to compose fairy tales together with your child, where the characters are endowed with emotions experienced by their son, help the characters find ways out of difficult situations and always end with a victorious ending.

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