The most common type of childhood cancer is acute lymphocytic leukemia (ALL), a blood and bone marrow cancer that creates immature white blood cells that can’t perform their typical functions. Because of this, the disease worsens quickly.
Most likely to occur in early childhood, ALL is more common in boys than girls, according to the American Cancer Society. Children younger than 5 are at highest risk for developing the disease.
Asmaa Ferdjallah, M.D., a Mayo Clinic pediatric hematologist and oncologist, treats children of all ages with ALL. Here’s what she wants families to know about this disease:
- 1. ALL is rare and has a collection of persistent symptoms.
The American Cancer Society estimated that 6,540 new cases of ALL would be diagnosed in both children and adults in 2023. This represents less than 0.5 percent of all cancers in the United States.
ALL symptoms vary and can resemble symptoms of flu and other common illnesses. Ferdjallah says most high fevers, swollen lymph nodes and bruises are part of typical childhood development. Parents should call their child’s health care professional if those symptoms persist.
“With ALL, we often see frequent or daily high fevers that you can’t explain,” Ferdjallah said. “We’ll often see rapid weight loss that doesn’t make sense for a child’s activity level. And we always ask about lumps or bumps, which can indicate swollen lymph nodes, as well as night sweats, bone pain, and any new bruising or bleeding.”
If your health care specialists suspect your child has ALL, they will draw blood for testing. “We would expect to see changes in blood counts” in a child with ALL, Ferdjallah said.
Health care professionals may also use a bone marrow test, imaging tests and a spinal fluid test to diagnose the disease.
Having one symptom, such as a bruise or one low blood count, generally isn’t something to worry about, Ferdjallah said: “ALL declares itself. It’s not going to sneak up on you. It creates a constellation of symptoms that we see.”
- 2. Children diagnosed with ALL have well-researched options for precision care.
Your child’s care team can tailor a treatment plan based on factors that indicate standard risk or high risk for relapse.
“Somebody with standard risk is usually between the ages of 1 and 10,” Ferdjallah said. “A child in this age group with a white blood cell count of less than 50,000 is considered standard risk. Patients outside these parameters need more intense therapy and are considered high risk.”
For standard-risk patients, treatment typically involves chemotherapy given by infusion. “We also deliver chemotherapy into the spine via a spinal tap, because we know some leukemias are very good at hiding in that space,” Ferdjallah said.
Treatment can take two to three years. The first few months are the most intense.
“After the first six months, the patient enters a period called maintenance,” Ferdjallah said. “Then we see patients less often because they need less intense therapy. Kids return to school, and their immune system is a little stronger. They can go on vacation, and their hair starts to grow back. ALL starts to feel like an annoying thing to manage and less like a life-altering, devastating illness.”
The care team will perform a bone marrow biopsy to determine whether ALL is in remission. “If there’s no leukemia in the biopsy, that’s the best sign that the patient is in remission,” Ferdjallah said.
There are many other options for children with high-risk genetic mutations or aggressive diseases for whom chemotherapy isn’t effective. ALL treatments may include targeted therapy, radiation therapy, bone marrow transplant, CAR-T cell therapy and clinical trials.
“We have multiple lines of therapy for these patients,” Ferdjallah said. “Scientists and doctors have worked collaboratively for a long time to create networks, such as the Children’s Oncology Group, to conduct powerful clinical trials. The results of that research have informed us of the best therapy approaches.”
- 3. The outlook for kids diagnosed with ALL is excellent.
The five-year survival rate for children with ALL is about 90 percent. If a child remains cancer-free five years after treatment, they are likely cured.
“Children diagnosed with ALL do well in survivorship. They’re able to live normal, healthy lives — get married, have kids and have a normal life span,” Ferdjallah said.
Meanwhile, treatment options keep improving.
“One of the most promising new treatment options is CAR-T cell therapy for pediatric patients, which uses a patient’s T cells and genetically engineers them to target and kill their leukemia cells,” Ferdjallah said.
