What is ALL?

Simply put, ALL (Acute Lymphocytic Leukemia) is a cancer in the blood. Normal white blood cells reproduce, and then mature to fight sickness. They are like little soldiers in the blood. When a child develops ALL, his white blood cells reproduce, but those cells do not mature, they just continue to reproduce. Those cells are called Blasts, and they crowd out the good, mature cells, causing the child to catch illnesses more quickly.

Symptoms of ALL

Though there are varied symptoms for the onset of ALL Leukemia, the following are a few red flags that can help determine whether a child should be seen by a physician:

• Aches in arms, legs, back (some children will complain that their hip or leg hurts)
• Black-and-blue marks for no apparent reason (indicating a low red blood cell count)
• Enlarged lymph nodes
• Fever without obvious cause (or prolonged low grade fever)
• Headaches
• Pale-looking skin (low red blood cells)
• Prolonged bleeding from minor cuts (low platelets)
• Shortness of breath during physical activity
• Tiredness (low red blood cells)
• Vomiting.

Children may seem to have the flu, acting listless, and not wanting to eat or drink. In interpreting symptoms, consider whether the child has been with other children recently that are sick with the same symptoms.

Diagnosis

Once a child is diagnosed with ALL, treatment will begin immediately. A Mediport or Broviac port will be inserted into the child’s chest to make blood draws, and chemotherapy treatments easier. Hospital stays are usually about a week, and then treatments are given as outpatient appointments.

Chemotherapy for ALL

Chemotherapy will be administered by mouth, into the vein through the port, and also injected into the spinal cord (this is to prevent blasts from hiding out in the spinal fluid in the spine and brain). The following are some of the medicines that a child may receive:

• MTX (Methotrexate)
• VCR (Vincristine)
• 6MP (Mercaptipurine)
• Decadron (Dexamethazone- a steroid that raises white blood cell counts, and also combats leukemia blasts),
• Bactrim (a pneumonia preventative).
• Zofran may also be helpful to lessen the severity of nausea and vomiting due to the chemo.
• Miralax helps counteract the constipating side effects of Vincristine.

The treatment will be very intense for the first month in order to remove the blasts. Many children are in remission after the first month.

Schedule of Leukemia Treatment

The first 6 months of treatment for ALL will consist of weekly treatments in clinic, and daily chemotherapy given by mouth, and also Lumbar Punctures where they take samples of the fluid to check for blasts, and inject Methotrexate. Blood counts will be analyzed every appointment, and chemo doses will be adjusted, or sometimes put on hold depending on how low the white blood cell counts are.

Sometimes, because of the chemo, other counts will be low, and transfusions will be necessary. Red blood cell transfusions, and Platelet transfusions are given through the port, and can last a few hours on a slow drip. Near the end of the first 6 months, there will be a more intense time of extra chemotherapy.

After that, there is a maintenance period of treatment that continues to control the white blood cell count. This usually lasts around 3 years for boys, and 2 years for girls. A chemotherapy schedule is more relaxed, of monthly VCR, weekly MTX, and quarterly LP and IT MTX (injected into the spinal cord), and daily 6MP by mouth, plus the Decadron after VCR treatments.

Limitations

Because of the low blood counts, and also the risk of infection to the port, it will be important to limit children with leukemia in regards to being in crowds, going to school, and being in places that contain molds and germs. Beaches and outside sand will be off limits for a while, as will leaf piles, and other places that bacteria and mold grow. They may be more sensitive to the sun, and to bright light. Also, due to loss of hair in the first 6 months, a hat will be necessary to protect from cold and sun.

End of Treatment

The end of treatment date is set at the beginning of the maintenance period, and at the End of Treatment, the port will be removed, and the child will be allowed to stop taking chemotherapy. Appointments at the clinic will still continue on a monthly basis, to check the blood counts, and make sure the Leukemia doesn’t return.

Encouragement for The Treatment Years

Though, at the beginning it seems overwhelming, the new life of caring for children with ALL does become easier as each day passes. The schedules and new limitations become almost normal, and more comfortable to accept. Every day will have small blessings, and if those little joys are noticed and remembered, even the treatment years can be thought of with fondness. Families become closer to each other, and find faith and strength that never would have surfaced without this trial.

Note: many treatments and medications vary depending on the unique circumstances of each child.