Childhood Acute Lymphoblastic Leukemia

Childhood Acute Lymphoblastic Leukemia

Risk Groups
Once childhood acute lymphoblastic leukemia has been diagnosed, tests are done to determine if the cancer has spread to the central nervous system (brain and spinal cord), the testicles, or other parts of the body. The extent or spread of cancer is usually described as stages. For childhood acute lymphoblastic leukemia, risk groups are used instead of stages.

Risk groups for childhood acute lymphoblastic leukemia include:

* Standard (low) risk
* High risk
* Recurrent.

Current Treatment for This Type of Leukemia
Different types of treatment are available for patients with childhood acute lymphoblastic leukemia (ALL). Some treatments are standard (the currently used treatment), and some treatments are being tested in clinical trials.

Current childhood ALL treatment options include:

* Chemotherapy
* Radiation therapy
* Chemotherapy with stem cell transplant.

There are also three phases of childhood ALL treatment. These phases include:

* Induction therapy
* Consolidation/intensification therapy
* Maintenance therapy.

Choosing the most appropriate childhood ALL treatment is a decision that ideally involves the patient, the family, and the healthcare team.

What Is the Prognosis?
The improvement in survival for childhood acute lymphoblastic leukemia over the past 35 years is one of the great success stories of cancer treatment. In the 1960s, less than 5 percent of children with ALL survived for more than five years. Today, approximately 85 percent of children with ALL will live five years or more after diagnosis.

The chance of survival for children with ALL is dependent upon a number of factors. The most important factor is receiving optimal care at a center experienced in the treatment of childhood acute lymphoblastic leukemia. However, even with optimal care, some children with ALL are much more difficult to treat successfully than others.

In the past, factors such as age and white blood cell count at diagnosis were commonly used to predict outcome. For example, children who are 1 to 9 years of age have higher survival rates than infants or older children. However, factors such as age and white blood cell count at diagnosis are, at best, crude predictors of outcome.

It is now clear that the patient's subtype of ALL has a powerful impact on survival. For example, infants commonly have a subtype of ALL in which a specific gene is modified. This subtype of ALL is very hard to treat successfully, and only a minority of infants with this subtype of ALL will survive with current therapy. Other subtypes of ALL in which different genes are modified occur more commonly in older children and have a much more favorable outcome.

It is now common practice for the leukemia cells of children with ALL to be tested for the gene modifications. The type of treatment is then based on the particular change that is seen in the leukemia cells.