B-cell Acute Lymphoblastic Leukemia (ALL) in children

Acute Lymphoblastic Leukemia (ALL) is the most common type of cancer in children. It attacks certain immune system cells called B cells and T cells. ALL usually affects B cells in children.

It's natural to be excited when you find out that your child has ALL, but keep in mind that almost all children can be cured of this disease.

B-cell ALL makes your child more susceptible to infections because he does not have the protection of these B cells.

The disease starts in your child's bone marrow, which is the spongy center of the bones where new blood cells grow. Leukemia cells grow very quickly and invade the bone marrow, so the bone marrow has difficulty producing enough normal cells.

Your child will be given chemotherapy to treat this condition. Some children may also need a stem cell transplant. It is important to keep sick people away during treatment so that your child does not become infected with what they have.

After your child finishes treatment, they may no longer have ALL. They will need to keep up with the doctor's appointments to make sure he doesn't come back.

Causes

In most cases, doctors do not know what causes B-cell ALL in children.

Several factors make this disease more likely, including exposure to high doses of X-rays and other forms of radiation, or treatment of cancer with chemotherapy. Children with certain genetic conditions, such as Down syndrome, are also more likely to develop ALL.

Symptoms

Symptoms of ALL begin when leukemia cells crowd out normal blood cells from the bone marrow. The types of symptoms your child will have will depend on the number of cancer cells and healthy blood cells.

Children with B-cell ALL may:

Bleed or bruise more easily than usual
Feel very tired
Get infections more often
Lose their appetite

Other symptoms include:

Bone or joint pain
Limping
Fever
Pale skin
Red or purple spots called petechiae on the skin
Swollen lymph nodes in the neck, underarms, or groin

If cancer cells make their way into your child's liver and spleen, these organs can become large enough to cause bloating. Some boys may also develop testicles.

Get a diagnosis

To find out if your child has B-cell ALL, the doctor may ask you questions such as:

When did you notice a change in your child?
What symptoms does your child have?
Does anyone in your family have ALL?
Does your child have Down syndrome or any other genetic disease?

The doctor may do blood tests to find out if your child has ALL and, if so, what type it is. They use blood tests to check the number of blood cells and look for diseased white blood cells.

Your child may also need a bone marrow test. The doctor will take bone marrow samples, usually from the leg or spine.

For this test, your child will lie on a table and receive an injection that will numb the area. The doctor then uses a very thin needle to take a small amount of liquid bone marrow and examine it under a microscope, looking at the size and shape of the white blood cells. Those that don't seem to be fully developed may be signs that your child has B-cell ALL.

Questions to ask your doctor

If your child is diagnosed with any type of cancer, there are bound to be many questions to ask the doctor, such as:

What treatments will work best for my child's Acute lymphoblastic leukemia?
How long will it last?
What are the chances that it will cure my child?
What side effects might it cause? How long will these side effects last?
What should I tell my child about the cancer and its treatment?

Treatment

Because this type of ALL develops quickly, your child should start treatment as soon as possible. The best place to do this is at a pediatric cancer center.

Your child will be treated in stages:

Stage 1: Your child will be sent to the hospital where they will be given chemotherapy drugs to kill any leukemic cells that the doctors find. The goal is to put the cancer into remission. It's not a cure, but it will allow your child's bone marrow to start producing healthy blood cells again. Most children go into remission after 1 month of treatment. Your doctor may refer to this phase as an "induction."
Stage 2: Your child will receive chemotherapy drugs to kill any remaining cancer cells in his body. Your doctor may refer to this phase as consolidation or strengthening. It lasts from 4 to 6 months.

Your child will then go into therapy to get rid of all the cancer in their body and prevent it from coming back. It's called an interview. They will receive lower doses of chemotherapy for 2-3 years.

Your doctor will closely monitor the progress of your treatment. Shortly after starting treatment, they will check your child's bone marrow to make sure he has beaten leukemia. At the end of treatment, the doctor may do a blood test to make sure that all of the cancer cells are gone. If the doctor finds cancer cells, your child may need additional treatment.

Transplantation of stem cells. If your child does not get better after treatment, or if ALL comes back, he may need a stem cell transplant to get his bone marrow working properly again. These are not the "embryonic" stem cells you may have heard about in the news. These are cells that live in the bone marrow and help make new blood cells.

When your child gets a stem cell transplant, they receive cells from a donor. This person may be a close relative, such as a brother or sister, or a compatible donor who is not a member of your family. Cells can also come from a donor umbilical cord.

To prepare for the transplant, doctors will likely give your child high doses of radiation or chemotherapy to kill cancer cells. After that, they will receive new stem cells intravenously. It won't hurt.

After a transplant, it will take at least a few days for the stem cells to multiply and start producing new blood cells. During this time, they may have to stay in the hospital until their white blood cell count increases enough to protect them from infection.

Back home, your child will need to visit the clinic every day for several weeks for a checkup. It may take about 6 months before the number of normal blood cells in their body returns to what it should be.

CAR-T-cell therapy. A type of gene therapy for children and adults whose B-cell ALL does not improve with other treatments.

CAR T cell therapy uses some of your own immune cells, called T cells, to treat cancer. Doctors take cells from your blood and modify them with new genes. The new T cells are better able to find and destroy cancer cells.

Take care of your child

Treatment for B-cell ALL may increase the chance of infection. Try to keep them away from those who are sick. Everyone close to your child should be vaccinated against illnesses such as influenza and pneumonia and should wash their hands frequently.

A cancer diagnosis can be very difficult for a child. They may have questions or fears that you are not aware of. Make sure your child is getting the emotional support they need during this time. Friends, family members, social workers, and therapists can be of great help. Your child may also need extra classes to catch up on school.

The treatment of B-cell ALL has improved significantly over the past 30 years. Today, most children treated for this cancer recover.

Once cured, your child will still need to see the doctor often to make sure the cancer doesn't come back. The doctor will also check for problems that treatment for ALL can cause, including heart damage and other cancers. Over time, your child will visit the doctor less often.