What is leukaemia?

Leukaemia is a type of cancer that affects the blood. It starts in the bone marrow, where blood cells are made, and spreads to the blood.

Leukaemia happens when the bone marrow makes too many white blood cells. White blood cells are a part of the immune system and help to fight infection.

Types of leukaemia

There are many types of leukaemia. They are named according to:

• whether the cancer is acute or chronic
• the type of white blood cells involved ('lymphoid' or 'myeloid')

In acute leukaemia, the bone marrow makes too many abnormal 'blast' (immature) cells. These cells build up and interfere with the production of normal blood cells. Most childhood leukaemias are acute.

In chronic leukaemia, abnormal mature white blood cells slowly build up in your blood, bone marrow and other organs.

There are several types of leukaemia seen in children, including:

• acute lymphoblastic leukaemia (ALL), also called acute lymphocytic leukaemia — this is the most common type of leukaemia in children
• acute myeloid leukaemia (AML), also called acute myeloblastic leukaemia
• chronic lymphocytic leukaemia (CLL) — this is rare in children but common in adults
• chronic myeloid leukaemia (CML) — this is rare in children but more common in teenagers

Most children with leukaemia have acute lymphoblastic leukaemia (ALL), often between 2 and 4 years of age.

What are the symptoms of childhood leukaemia?

Signs of leukaemia may include:

• fever and night sweats
• unexplained bruising or bleeding, or small red spots under the skin
• lumps in the neck, underarms, abdomen (tummy) or groin, or around the eyes
• pale skin
• dry skin rash

Other symptoms of leukaemia include:

• pain in the bones or joints, or under the ribs
• tiredness or weakness
• loss of appetite or weight
• feeling of fullness or swelling in the abdomen (tummy)

What causes childhood leukaemia?

The exact causes of leukaemia in children are not known, but it's likely that several factors are involved.

Your child may have a higher chance of developing leukaemia if they have:

• a family history of leukaemia
• certain genetic conditions, such as Down syndrome
• been exposed to radiation — such as an x-ray done when they were in utero (during pregnancy) or radiation therapy to treat cancer
• previously had chemotherapy

No one is to blame if a child develops cancer. It's not because of something they or their parents did.

When should I take my child to the doctor?

If you are worried that your child has symptoms of leukaemia, talk to your child's doctor.

Many common conditions can cause symptoms similar to leukaemia. If you notice any of these symptoms, it doesn't mean that your child has leukaemia, but it's a good idea to take them to the doctor for a check-up.

How is childhood leukaemia diagnosed?

Many symptoms of childhood leukaemia can be caused by other illnesses. To make a diagnosis of leukaemia, your child's doctor will give them a physical examination and arrange blood tests.

If the blood test shows large numbers of abnormal white blood cells, or low numbers of healthy blood cells, your child will need to have further tests to confirm the diagnosis of leukaemia. These may include:

• bone marrow biopsy
• lumbar puncture (spinal tap)

A bone marrow biopsy uses a syringe to take a sample of bone marrow, usually from the hip bone, for examination under a microscope and genetic testing.

During a lumbar puncture, a needle is put into the space between the bones of the lower back. Fluid from around the spinal cord is removed for examination under a microscope.

Staging

The stage of leukaemia describes how far the cancer has spread. Medical imaging tests can help with staging. These can include:

• chest x-ray
• ultrasound
• computed tomography (CT) scan
• magnetic resonance imaging (MRI) scan
• positron emission tomography (PET) scan

How is childhood leukaemia treated?

The treatment for leukaemia depends on:

• the age of your child
• whether the cancer has spread to their spinal fluid

The main treatments given to children with leukaemia are:

• chemotherapy
• radiotherapy
• targeted therapy
• stem cell transplant

Other treatments your child may receive include:

• antibiotics to prevent infections
• blood products to restore their blood

Children with leukaemia usually need treatment for 2 to 3 years, as well as ongoing regular check-ups.

What are the side effects of treatment?

Many cancer medicines have unwanted effects (side effects). This is because they damage normal cells as well as destroying the cancer cells.

The side effects can vary between children, even if they receive the same treatment.

Treatments for leukaemia in children can cause a range of short term side effects, such as:

• hair loss
• bruising or bleeding
• infections
• nausea (feeling sick) and vomiting
• tiredness

Long term effects, called 'late effects', can develop any time after treatment. These depend on the type and amount of medicine your child receives. Ongoing check-ups are needed to check for these.

Living with childhood leukaemia

It's important that children with leukaemia live as normal a life as possible. Whenever they feel well enough, they should be encouraged to do their usual activities. This includes going to school or day care. This can provide a sense of normalcy and hope for the future.

Watch this video from Cancer Australia about what it can be like to have cancer as a child:

More information is available on the following pages:

• Support for children with cancer
• Support for parents and carers of children with cancer

What are the complications of childhood leukaemia?

Childhood leukaemia and its treatment can lead to complications that affect different parts of the body. These may include:

• infections due to low white blood cell counts
• bleeding problems due to low platelets
• anaemia caused by low red blood cells

Some children may experience delayed growth or development, especially if treatment affects hormone levels or bone health.

Long-term complications, called late effects, can appear months or years after treatment.

These may include:

• learning or concentration difficulties
• heart or lung problems
• changes in hormone function
• increased chance of developing another cancer later in life

You may be worried about how treatment will affect your child's fertility (ability to have their own children). Your doctor will discuss this with you before treatment starts.

The type and severity of complications depend on the child's age, the specific type of leukaemia and the treatments used. Doctors will monitor your child closely during and after treatment to manage any complications early and support their long-term health and wellbeing.

Can childhood leukaemia be prevented?

No, because the causes of childhood leukaemia aren't fully understood, it's not possible to prevent the disease.

Resources and support

For more information and support, try these resources.

Information about leukaemia

• Visit the Cancer Council for information about leukaemia symptoms, diagnosis and treatment. Call the Cancer Council on 13 11 20 for information about leukaemia and support.
• Visit the Leukaemia Foundation for a wide range of information about childhood leukaemia, including practical and emotional support, referral services and books explaining blood cancers to children. Call 1800 620 420 to talk to a Blood Cancer Support Coordinator.

Family support

Caring for a child with leukaemia can be challenging and stressful. Many support services exist to help families.

• Cancer Australia has links to support organisations for children with cancer and their families, as well as current clinical trials and a list of children's hospitals in Australia.
• Visit the Canteen website for emotional and practical support.
• The Children's Cancer Foundation provides family support and information about the latest treatments.
• Kids with Cancer Foundation Australia provides financial assistance to children with cancer and their families or call 1800 255 522.

Languages other than English

• The Paediatric Integrated Cancer Service has a library of resources in many community languages.
• Canteen provides a guide for young cancer patients translated into languages other than English.
• The Cancer Institute NSW has general information about cancer in several languages.

Information for Aboriginal and/or Torres Strait Islander peoples

• Cancer Australia has cancer information for Aboriginal and/or Torres Strait Islander peoples.
• Cancer Council has support and resources for Aboriginal and/or Torres Strait Islander peoples.