Leukemia in Children - Specialists and Information

The exact causes of this malignant disease remain largely unknown. Genetic factors appear to play a role. For example, patients with trisomy 21 (Down syndrome) have a risk of developing the disease that is up to twenty times higher.

Environmental factors may also influence the development of leukemia in children. Frequent exposure to both ionizing and non-ionizing radiation is under discussion as a risk factor. 

The liquid organic compound benzene could also be a possible trigger. Viral infections, on the other hand, are a controversial factor in the development of the disease.

The signs of leukemia can vary greatly depending on the type. 

Acute myeloid leukemia is caused by a degeneration of the hematopoietic system. The part of the system that produces white and red blood cells is affected. 

This leads to a rapid proliferation of immature precursor cells and, in many cases, to an excess of white blood cells (leukocytosis). 

As a result, normal blood formation is no longer possible. This leads to a deficiency of red blood cells, platelets (thrombocytes), and functional granulocytes.

Granulocytes are leukocytes that act as phagocytes and can engulf and destroy pathogens.

Due to the lack of red blood cells, affected children suffer from typical symptoms of anemia:

• Paleness
• Weakness
• Shortness of breath on exertion

Due to the platelet deficiency, there is an increased tendency to bleed. This manifests as:

• Bruising
• Bleeding gums or nosebleeds 
• Petechiae (pinpoint hemorrhages in the skin)

Children with leukemia bruise easily or get nosebleeds because their blood doesn’t clot properly @ KMPZZZ /AdobeStock

Patients also lack functional white blood cells. As a result, their ability to fight off infections is severely impaired. This leads to serious infections such as pneumonia or tonsillitis. 

Inflammation of the oral mucosa and fungal infections of the mouth are also common. The spleen and lymph nodes tend to be moderately swollen.

Acute lymphoblastic leukemia develops from malignant precursor cells of the lymphocytes. Bone marrow function in affected individuals declines very rapidly (bone marrow failure). 

This leads to a deficiency of red blood cells and platelets.

Just as with AML, children suffer from:

• Anemia with difficulty concentrating
• Fatigue and pallor. 
• An increased tendency to bleed, including spontaneous bleeding 

The relative shortage of functional white blood cells weakens the immune system. This leads to life-threatening infections.

In ALL, the liver, spleen, and lymph nodes are often swollen. More than half of patients have a fever. 

In children, bone pain is often the first symptom of the disease. However, it is not uncommon for this to be misdiagnosed as growing pains. Chronic leukemias, which occur only in exceptional cases in children, progress much more slowly.

Treatment depends primarily on the type of leukemia. Children with ALL are usually treated with chemotherapy immediately after diagnosis. 

This involves the use of drugs that inhibit cell growth (cytostatic agents). As a rule, various cytostatic agents are combined in the treatment to achieve the greatest possible effect.

Patients in whom leukemia cells have spread to the central nervous system also receive CNS radiation therapy to prevent a later recurrence of leukemia. 

Conventional chemotherapy drugs cannot reach these cells due to the filtering function of the blood-brain barrier.

In some cases, a bone marrow or stem cell transplant may also be necessary. Depending on the course of the disease, the stem cells may come from the patient themselves or from a stem cell donor.

Patients with acute myeloid leukemia also receive intensive chemotherapy. 

The goal of treatment is:

• To eliminate the symptoms of the disease 
• To normalize blood counts 
• To clear the bone marrow of abnormal cells

This therapy causes the white blood cell count to drop so significantly that patients are at increased risk of infection. Therefore, face masks are required when interacting with patients.