Childhood Leukemia

Joy Browne

What is Leukemia?

Formation of mature blood cells from stem cells

• Leukemia is cancer of the blood and bone marrow (blood producing tissue).

• Leukemia is a result of uncontrolled proliferation of immature white blood cells

• Immature cells accumulate in the bone marrow, hindering the production of mature blood cells, platelets and functioning white blood cells.

• Type of leukemia is dependent on which type of cell begins uncontrolled division

Four Major Types of Leukemia

ALL AML

CLL CML

Acute lymphocytic leukemia

Acute myeloid leukemia

Chronic lymphocytic leukemia

Chronic myeloid leukemia

ACUTE : progress rapidly, worsen quickly – characterized by uncontrolled division of immature white blood cells.CHRONIC : progress slowly, worsen over time, respond worse to treatment – characterized by uncontrolled division of more mature white blood cells.

Diagnosis

Imaging Tests

CT scan MRI scan Ultrasound

Diagnostic Tests

Blood tests Bone marrow aspiration Spinal tap Chemical

stains

Physical Exam

Check symptoms

TreatmentImmediate Therapy• Needed in severe cases before standard treatment

Radiation Therapy• Targeted treatment to prevent spread to specific areas of the

body

Chemotherapy• Systematic treatment; commonly introduced via cerebrospinal

fluid because of swift spread

High-dose Chemo with stem cell transplant• More intensive treatment for cases with poor prognosis

IncidenceOverall

• 2.9% of all new cancer within the US – relatively rare cancer

• 30% of all childhood cancer• 4.3 per 100,000 persons per year• Approx. 3,600 children will be diagnosed

with leukemia in 2013

ALL• 80% of all leukemia in children is ALL• 3.6 per 100,000 per year• Highest incidence in white and Hispanic

children• Higher incidence in boys compared to girls

Trends• Peak incidence seen in early childhood

(birth to 3 years old)• Subtle increase cases (about 0.3% per year)

MortalityOverall

• Approx. 437 children and adolescents will die from leukemia in 2013.

• Leukemia causes more deaths than any other cancer among children

ALL• 16% of childhood cancer related deaths• 50% of all childhood leukemia deaths• Boys have higher mortality rate than

girls• White and Hispanic children have higher

mortality rate, compared to other races/ethnicities

Trends• Mortality rate of childhood leukemia has

declined by 80% from 1969-2010.

SurvivalOverall

• Survival in children is much better than survival in adults.

ALL• Estimated 5-year survival rate for ALL

is more than 90%. • 91.7% in children and adolescents

younger than 15• 92.6% in children younger than 5

Trends• Drastic improvements in survival

since the 1960s. • The 5-year survival rate for ALL in the

1960s was only 3%; increased to 57% in the late 70s, and have continued to increase to over 90%.

Global Trends

Incidence rates of Leukemia worldwide

Risk FactorsBiological Factors

• Genetic Disorders• Infectious Exposure Theories

Environmental Factors• Radiation Exposure• Chemical Exposure

Lifestyle Factors• Socioeconomic Status

Suspected/Unproven Factors• Exposures to electromagnetic fields• Living near a nuclear power plant• Mother’s age during pregnancy• Smoking history of parents• Fetal exposure to hormones (i.e. birth control pills)• Paternal workplace exposure to chemicals• Chemical contamination of ground water

Prevention

• Limit exposure to known and suspected risk factors• Limit exposure to radiation for pregnant women

Primary Prevention

• Currently, there are no widely accepted blood tests or screening exams• Monitor changes in child's behavior closely to identify any symptoms early

Secondary Prevention

• Managing and maintaining remission status – i.e. monitoring health closely, detecting health issues and secondary cancers early• Children who have been through leukemia treatment have an increased

risk for developing other cancers and health issues later in life.

Tertiary Prevention

Current ResearchCurrent research in childhood leukemia predominantly covers two main

facets: understanding causation and determining ways to improvetreatment and reduce the long term consequences of treatment.

Causation/Risk Factors

• Examining the feasibility of screening for predictive biomarkers of childhood leukemia

• Examining the effect of parental lifestyle (i.e. smoking status) on childhood leukemia

Reducing long-term consequences

• Studying the effects of alternations in chemotherapy process to reduce recurrence and development of secondary cancers in children with ALL