The bone marrow and blood cells
All of the blood cells in the body are produced in the bone marrow: the spongy tissue that is found in the middle of the bones. All blood cells start their lives as stem cells. These grow and divide within the bone marrow and mature into:
- Red blood cells that carry oxygen around the body
- White blood cells that help fight infection
- Platelets that help clot the blood to control bleeding and bruising.
When leukaemia occurs, the bone marrow produces a large amount of immature white blood cells. This prevents the normal production of healthy blood cells.
Leukaemia usually affects the production of white blood cells, of which there are several types. Acute lymphoblastic leukaemia (ALL) is named after the early lymphoid white blood cells (which are called ‘lymphoblasts’) that it affects.
Acute myeloid leukaemia (AML) is named after the early white myeloid blood cells it affects.
ALL can affect young people of any age, but it is most common in children aged one to four. It is slightly more common in males than females.
- Anaemia: the number of red blood cells is reduced, leaving your child feeling tired, breathless and constantly run down
- Bruising and bleeding: the number of platelets is reduced, which means your child's blood is not able to clot as well as it did previously
- Infections: your child may get infections more often as there are less healthy blood cells to fight them.
ALL is usually suspected from a blood test, which may show changes in the numbers of healthy white blood cells, red cells and platelets. If the blood test suggests that leukaemia is present, a specialist will need to take a sample of bone marrow. This sample will be looked at under a microscope to work out what type of leukaemia your child has.
Your specialist will also need to do a lumbar puncture to see if the spinal fluid contains any leukaemia cells.
ALL is treated with chemotherapy, which involves a combination of drugs being delivered into your child's bloodstream to kill the leukaemia cells and allow the bone marrow to work normally.
There are four different phases of ALL treatment:
- The first phase aims to destroy your child's leukaemia cells with chemotherapy and get them into remission. When your child is in remission, there are no leukaemia cells visible through a microscope in their blood or bone marrow.
- They will then have consolidation therapy to stop the leukaemia coming back. This most often involves more chemotherapy.
- The next stage is interim maintenance therapy to help keep the leukaemia in remission, followed by a ‘delayed intensification’ block where your child will receive a number of different anti-cancer drugs over several weeks.
- In the final maintenance phase, your child will receive low-dose chemotherapy. Girls will receive two years treatment after the start of interim maintenance and boys three years after the start of interim maintenance. This treatment is done in an outpatient setting and is much less disruptive to your normal life than earlier parts of the treatment.
A few young people require a bone marrow or stem cell transplant early in their treatment, once they are in remission. Others may require a transplant if the leukaemia comes back once they have finished the treatment.
Your child's particular treatment plan will depend on their leukaemia and how it responds to treatment, so it’s best to talk to your specialist about what will be involved.
If your child is undergoing chemotherapy, they may experience tiredness, sickness, diarrhoea and temporary hair loss. They will also be at greater risk of infections. Talk to your specialist or nurses about ways to manage side effects, or see the side effects section of our website.
After your child's treatment is complete they will still need to be seen regularly at an outpatient clinic. At this clinic, your specialist will be looking for any signs that their cancer has returned (this is known as a relapse). They will also check that their major organs, such as their heart and lungs, are still functioning correctly and haven’t been affected by their cancer treatment.
Once your child's risk of relapse has reduced, ongoing care will focus on looking out for potential long-term side effects of treatment. The risk of this depends on the type of cancer your child had and the treatment they received.
A personalised surveillance plan is usually created that outlines the specific long-term follow up and ongoing investigations that they will require. Many people are at low risk of future health problems but some will have significant ongoing health needs.
Long-term side effects
The standard treatment for ALL, received by most children and young people, carries a low risk for long-term health problems. However, if your child needs more intensive treatment or a transplant, they may later experience fatigue, a lower resistance to infections, infertility, heart or thyroid problems, or other health issues.
Talk to your specialist about the potential long-term side effects of your child's treatment.
- Read about the different treatments for cancer
- Prepare for life on the ward with our practical tips for hospital stays
- Parents tell us it's hard talking to their child about cancer and treatment. Here are our tips and tools on how to make it easier
Updated November 2017, next review due 2019.