More than 50 years ago, it was rare for any child to survive childhood leukemia. Happily, that situation has changed for the better. With advances in treatment, children with the disease have up to a 90% survival rate, with many going on to live happy, productive lives.

Leukemia is the most common type of childhood cancer that we treat at Yale Medicine, and one in which our physicians have extensive experience.

Leukemia is cancer of the bone marrow, which is the factory for all of the blood cells in the body. Pediatric leukemia refers to this type of cancer when it occurs in patients 18 years of age or younger. It can affect children differently from adults, and many types of pediatric leukemia are more treatable than they would be in an adult. 

Leukemia is often described as being acute or chronic. Acute leukemias develop more rapidly. Chronic leukemia progresses relatively slowly. 

The most common and treatable form of pediatric leukemia is acute lymphocytic leukemia (ALL). Other acute forms include acute myelogenous leukemia (AML) and hybrid or mixed lineage leukemia. Chronic forms include chronic myelocytic leukemia (CML) or chronic lymphocytic leukemia (CLL).

In many cases, leukemia is not easy to detect. This cancer is largely asymptomatic; when symptoms are present, they can be mistaken for other illnesses. Parents of children diagnosed with leukemia are often surprised by the diagnosis.

When they are present, typical symptoms of pediatric leukemia can include:

• Pain
• Fever
• Skin that is pale in appearance
• Unexplained bruises on the body
• A swollen lymph node
• The presence of an unusual infection

Diagnosis of pediatric leukemia is made through a bone marrow aspiration and biopsy. In this procedure, a needle is inserted into the bone marrow space, which is a hollow area at the center of the bone. The bone marrow contents are then extracted.

The contents are then analyzed under a microscope, and a molecular genetic analysis is performed. This is so that if a leukemia is confirmed, doctors can then tailor the treatment approach to that particular type of leukemia.

Treatment varies, depending on the severity of the pediatric leukemia. The use of chemotherapy is common, and the treatment course generally lasts for 30 to 42 months. It begins more intensely and then shifts to a maintenance phase of therapy.

Because standard chemotherapy injected into the veins often cannot reach the central nervous system, Yale Medicine cancer specialists may also deliver the necessary medications through the spine. A needle is inserted in the base of the spinal canal, allowing chemotherapy to enter directly into the central nervous system. 

Chemotherapy uses powerful medications, and Yale Medicine physicians keep a very close eye on what the medications can do.

Immunotherapy (activating the body's immune system to fight disease) is also coming to the forefront of pediatric leukemia treatment. 

In a word, experience. The more cases a medical team sees, the better insights it has for planning an individualized treatment for each patient. We treat more patients for pediatric leukemia than for any other childhood cancer. And, we pay close attention both to eliminating the existing cancer and to the future quality of every young patient's life.

Also, some of the most sophisticated cancer research in the world is being done by Yale scientists. Yale Medicine patients have the opportunity to enroll in clinical trials that offer access to the newest treatments.