Around 80% of leukaemias in children are Acute Lymphoblastic Leukaemias and can be classified as standard risk, medium risk, high risk or very high risk.

Signs and symptoms of ALL include:

• Bruising and bleeding

• Tiredness

• Pallor

• Bone pain

• Fever

• Enlarged liver, spleen, lymph nodes

Diagnosis

There are a number of steps to ensure correct diagnosis of ALL.

• A physical examination and consideration of the patient’s history.

• Your child’s doctor will do a full blood count test, which is a blood test to measure levels of different components of the blood such as number of platelets, amount of haemoglobin and number of white blood cells.

• A Bone Marrow Aspirate (BMA) will also be used. This is where a needle is inserted into the hip bone to draw out a small amount of marrow for testing under a microscope. This will show which cell the leukaemic cells are derived from and what stage of development they have reached.

• A Lumbar Puncture (LP), may also be used. This is where a spinal needle is inserted into the lower back. A few millilitres of spinal fluid is removed and examined in the laboratory to detect the presence of any leukaemia cells.

Treatment

There are a number of different phases to treat ALL. The first phase of treatment is called induction and is designed to bring the leukaemia under control and put the patient into remission. Remission is the term used when leukemic cells can no longer be detected anywhere in the body. It does not mean the cancer is cured because if treatment was stopped at this stage, the leukaemia would inevitably return.

The next phase of treatment is aimed at consolidating and intensifying the remission. Doctors will then focus on maintaining the remission, which is called the maintenance stage.  In most patients the total treatment lasts for two years.  Overall, the vast majority of treatment may be given as an outpatient, although there may be many unplanned admissions to hospital required to treat the side effects of the chemotherapy.

• The main form of treatment is chemotherapy which can come in a number of different forms including; tablets or injection, to ensure the drugs enter the blood stream and get access to wherever the leukaemic cells are hiding.

• Intrathecal therapy is another form of treatment and involves injections of chemotherapy directly into the spinal fluid via a lumbar puncture. Drugs given orally or intravenously cannot reach the spinal cord so intrathecal therapy is given to treat leukaemic cells that may be hiding in this protected site.

• For a small percentage of patients, radiation therapy must also be given to the brain. It uses high-energy radiation to kill cancer cells by damaging their DNA. It is administered every day over about two weeks.

• Intravenous chemotherapy for children with ALL is administered via a Central Venous Access Device (CVAD).  This reduces the need for the painful insertion of drips.

• A Bone Marrow Transplant is only used to treat a small number of patients with high risk or patients who have relapsed. It is a procedure using high dose chemotherapy and/or radiation therapy to eliminate leukaemia cells and to replace damaged or destroyed bone marrow with healthy bone marrow stem cells.

Side effects of treatment

Patients may suffer a range of side effects from undergoing chemotherapy.

These may include

• Nausea

• Vomiting

• Diarrhoea

• Hair loss

• High risk of infection

• Bruising/bleeding

• Lethargy

Prognosis

Around 97% of children with ALL successfully achieve remission after treatment.  If the child remains in remission for five years then they are considered ‘cured’.  If the leukaemia returns within that period, it is classified as a relapse. How this is treated depends on many factors, but there are usually other treatment options available. Overall, with modern treatment, approximately 85% of children newly diagnosed with ALL can be cured of their disease.

Prognosis depends on a number of factors including:

• The precise type of leukaemia cells found in the blood

• The genetic changes found in the leukaemia cells

• The response to the first week of steroid treatment

Measurement of Minimal Residual Disease (MRD) levels during treatment using a highly sensitive test to detect trace amounts of residual leukaemia