B-Cell Acute Lymphoblastic Leukemia in Children
To find out whether your child has B-cell ALL, the doctor may ask you
Defintion
Acute lymphoblastic leukemia (ALL) is the most common type
of cancer in children. It affects certain cells in the immune system,
called B cells and T cells. ALL usually affects B cells in children.
It's natural to feel worried when you learn your child has acute
lymphoblastic leukemia, but keep in mind that almost all children can
be cured of this disease.
B-cell ALL makes your child more likely to get infections, because he
doesn't have the protection of those B cells.
The disease starts in your child's bone marrow, which is the spongy
center of bones where new blood cells grow. The leukemia cells grow
very fast and crowd the bone marrow, so the bone marrow has trouble
making enough normal cells.
Your child will get chemotherapy to treat the disease. Some kids may
need a stem cell transplant, too. During treatment, it's important to keep
sick people away, so your child doesn't catch what they have.
Once your child is done with treatment, he may be free of ALL. He'll
need to keep up with doctor appointments to make sure it doesn't come
back.
Causes
Most of the time, doctors don't know what causes B-cell ALL in
children.
Some things make this disease more likely, including exposure to
high doses of X-rays and other forms of radiation, or cancer
treatment with chemotherapy. Children with certain genetic
diseases, such as Down syndrome, are also more likely to get ALL.
Symptoms
ALL symptoms start when leukemia cells crowd out normal blood
cells in bone marrow. The types of symptoms your child has will
depend on the numbers of cancer cells and healthy blood cells.
Children with B-cell ALL may:
 Bleed or bruise more easily than usual
 Feel very tired
 Get infections more often
 Lose their appetite
Other symptoms include:
 Bone or joint pain
 Limping
 Fever
 Pale skin
 Red or purple spots called petechiae on the skin
 Swollen lymph nodes in the neck, underarms, or groin
If the cancer cells travel to your child's liver and spleen, these
organs can grow large enough to make the belly swell. In some
boys, the testicles can also grow larger.
Getting a Diagnosis
questions like:
 When did you notice a change in your child?
 What symptoms does your child have?
 Does anyone in your family have ALL?
 Does your child have Down syndrome or any other genetic
disease?
The doctor may do blood tests to find out whether your child has ALL,
and if so, what type it is. They use blood tests to check the number of
blood cells and look for sick white blood cells.
Your child might also need a bone marrow test. The doctor will take
samples of the bone marrow, usually from his leg or spine.
For this test, your child will lie down on a table and get a shot that will
numb the area. Then the doctor uses a very thin needle to take a small
amount of liquid bone marrow and check it under a microscope,
looking at the size and shape of the white blood cells. Those that look
like they haven't developed fully could be signs that your child has B-
cell ALL.
Questions to Ask Your Doctor
When your child is diagnosed with any kind of cancer, you're
bound to have a lot of questions for your doctor, such as:
 What treatments will work best for my child's ALL?
 How long will it last?
 What are the chances that it will cure my child?
 What side effects might it cause? How long will these
side effects last?
 What should I tell my child about the cancer and its
treatment?
Treatment
Because this type of ALL grows quickly, your child needs to start
treatment as soon as possible. It's best to do that at a center that
specializes in childhood cancers.
Your child will get treated in phases:
Phase one: Your child will go to the hospital and get
chemotherapy drugs to kill all the leukemia cells that doctors can
find. The goal is to put the cancer in remission. This isn't a cure,
but it will let your child's bone marrow start to make healthy blood
cells again. Most kids go into remission after 1 month of treatment.
Your doctor may call this phase "induction."
Phase two: Your child will get chemotherapy drugs to kill any cancer
cells that are left in his body. Your doctor may call this phase
consolidation or intensification. It lasts 4 to 6 months.
Next, your child will get therapy to get rid of all the cancer in his body
and keep it from coming back. This is called maintenance. He will get
lower doses of chemotherapy for 2 to 3 years.
Your doctor will closely check on how the treatment is going. He will
test your child's bone marrow soon after treatment starts to make sure
it's beating the leukemia. At the end of treatment, the doctor may do
blood tests to make sure all the cancer is gone. If the doctor finds
cancer cells, your child may need more treatment.
Stem cell transplant. If your child doesn't get better with treatment, or
the ALL comes back, he may need a stem cell transplant to get the
bone marrow working right again. These are not the "embryonic" stem
cells you may hear about in the news. These are cells that live in bone
marrow and help make new blood cells.
When your child gets a stem cell transplant, he'll get cells from a donor.
That person might be a close relative, such as a brother or sister, or a
matched donor who isn't in your family. The cells might also come
from a donated umbilical cord.
To prepare for the transplant, doctors will probably give your child
high doses of radiation or chemotherapy to kill the cancer cells. After
that, he'll get the new stem cells through an IV. It won't hurt.
After the transplant, it will take at least a few days for the stem cells to
multiply and start making new blood cells. During this time, he may
need to stay in the hospital until his white blood cell count rises enough
to protect him from infection.
Once your child is back at home, he will need to visit a clinic every day
for a few weeks to get checked. It can take about 6 months until the
number of normal blood cells in his body gets back to what it should
be.
CAR T-cell Therapy. The FDA has approved a type of gene therapy
for  both children and adults whose B-cell ALL doesn't get better with
other treatments.  and spinal cord or other parts of the body.
CAR T-cell therapy uses some of your own immune cells, known as T
cells, to treat your cancer. Doctors take the cells out of your blood and
change them by adding new genes. The new T cells can work better to
find and kill cancer cells.
Taking Care of Your Child
Treatments for B-cell ALL can make infections more likely. Try to
keep him away from anyone who is sick. Everyone who is close to
your child should get vaccinated for diseases like the
flu and pneumonia, and should wash their hands often.
A cancer diagnosis can be very hard for a child. He may have questions
or fears you don't know about. Make sure your child gets the emotional
support he needs during this time. Friends, family members, social
workers, and therapists can all be a big help. Your child also may need
extra tutoring to make up for lost time at school.
What to Expect
Treatments for B-cell ALL have improved a lot over the last 30
years. Today, most children treated for this cancer are cancer-free.
After being cured, your child will still need to see the doctor often,
to make sure the cancer doesn't come back. The doctor will also
check for problems ALL treatments can cause, including damage
to the heart and other types of cancers. Over time, your child will
visit the doctor less often.
Getting Support
To learn more about B-cell acute lymphoblastic leukemia in
children, or to find a support group in your area, visit the websites
of the Childhood Leukemia Foundation and the Leukemia &
Lymphoma Society.
Diagnostic
Tests and procedures used to diagnose acute lymphocytic leukemia
include:
 Blood tests. Blood tests may reveal too many white
blood cells, not enough red blood cells and not enough
platelets. A blood test may also show the presence of blast
cells — immature cells normally found in the bone
marrow.
 Bone marrow test. During bone marrow aspiration, a
needle is used to remove a sample of bone marrow from
the hipbone or breastbone. The sample is sent to a lab for
testing to look for leukemia cells.
Doctors in the lab will classify blood cells into specific
types based on their size, shape and other genetic or
molecular features. They also look for certain changes in
the cancer cells and determine whether the leukemia cells
began from the B lymphocytes or T lymphocytes. This
information helps your doctor develop a treatment plan.
 Imaging tests. Imaging tests such as an X-ray,
computerized tomography (CT) scan or ultrasound scan
may help determine whether cancer has spread to the brain
 Spinal fluid test. A lumbar puncture test, also called a
spinal tap, may be used to collect a sample of spinal fluid
— the fluid that surrounds the brain and spinal cord. The
sample is tested to see whether cancer cells have spread to
the spinal fluid.
Treatment
In general, treatment for acute lymphocytic leukemia falls into
separate phases:
 Induction therapy. The purpose of the first phase of
treatment is to kill most of the leukemia cells in the blood
and bone marrow and to restore normal blood cell
production.
 Consolidation therapy. Also called post-remission
therapy, this phase of treatment is aimed at destroying any
remaining leukemia in the body, such as in the brain or
spinal cord.
 Maintenance therapy. The third phase of treatment
prevents leukemia cells from regrowing. The treatments
used in this stage are often given at much lower doses over
a long period of time, often years.
 Preventive treatment to the spinal cord. During each
phase of therapy, people with acute lymphocytic leukemia
may receive additional treatment to kill leukemia cells
located in the central nervous system. In this type of
 treatment, chemotherapy drugs are often injected directly
into the fluid that covers the spinal cord.

Depending on your situation, the phases of treatment for acute

lymphocytic leukemia can span two to three years.

Treatments may include:

 Chemotherapy. Chemotherapy, which uses drugs to

kill cancer cells, is typically used as an induction therapy
for children and adults with acute lymphocytic leukemia.
Chemotherapy drugs can also be used in the consolidation
and maintenance phases.

 Targeted therapy. Targeted drugs attack specific

abnormalities present in cancer cells that help them grow
and thrive.

A certain abnormality called the Philadelphia chromosome

is found in some people with acute lymphocytic leukemia.
For these people, targeted drugs may be used to attack
cells that contain that abnormality. Targeted therapy may
be used during or after chemotherapy.

 Radiation therapy. Radiation therapy uses high-

powered beams, such as X-rays or protons, to kill cancer
cells. If the cancer cells have spread to the central nervous
system, your doctor may recommend radiation therapy.

 Bone marrow transplant. A bone marrow transplant,

also known as a stem cell transplant, may be used as
consolidation therapy in people at high risk of relapse or
for treating relapse when it occurs. This procedure allows
someone with leukemia to re-establish healthy bone
marrow by replacing leukemic bone marrow with
leukemia-free marrow from a healthy person.

A bone marrow transplant begins with high doses of

chemotherapy or radiation to destroy any leukemia-
producing bone marrow. The marrow is then replaced by
bone marrow from a compatible donor (allogeneic
transplant).

 Clinical trials. Clinical trials are experiments to test

new cancer treatments and new ways of using existing
treatments. While clinical trials give you or your child a
chance to try the latest cancer treatment, treatment benefits
and risks may be uncertain. Discuss the benefits and risks
of clinical trials with your doctor.

ALL in older adults

Older adults, such as those older than 60, tend to experience more
complications from ALL treatments. And older adults generally
have a worse prognosis than children who are treated for ALL.

Discuss your options with your doctor. Based on your overall

health and your goals and preferences, you may decide to undergo
treatment for your ALL.

Some people may choose to forgo treatment for the cancer, instead
focusing on treatments that improve their symptoms and help them
make the most of the time they have remaining.