Childhood Leukemia
The Global Effects Of Leukemia
Medha Das and Dr.Lopamudra Das Roy
Published 2021
@BreastCancerHub, All Rights Reserved
Abstract
This research paper will provide an insight into childhood leukemia,a type of blood cancer in the bone marrow which produces an abnormal amount of white blood cells. This paper will go in depth about the global scenario of childhood leukemia as well as risk factors, main symptoms and ethnic and gender susceptibility. The paper will highlight how developing countries can decrease mortality rates of Childhood Leukemia and how they can spread awareness about the disease.Through the process of writing this paper, there have been many sources used including The American Cancer Society, John Hopkins, PubMed and The WHO.
What is leukemia?
Leukemia, a type of blood cancer in which the bone marrow produces an abnormal amount of white blood cells, is the most common form of childhood cancer, 30% of all pediatric cancers are leukemia. There are 12 different types of leukemia with the main ones being acute myeloid leukemia(AML), chronic myeloid leukemia(CML), acute lymphocytic leukemia(ALL) and chronic lymphocytic leukemia(CLL). ALL is the most common type of leukemia and compromises about 75% of leukemia cases. Leukemia is split into two main categories, chronic leukemia(slow disease progression) and Acute leukemia(fast progression of disease).[1]
Symptoms of Leukemia[5]
Risk Factors/Causes
Although there isn't one factor that can cause leukemia there are some known causes to the disease. Environmental factors such as radiation and chemical exposure play a large role in the development of leukemia.[2] Exposure to drugs and alcohol during pregnancy can also increase the chances of a child developing leukemia. While genetics seems like a major risk factor, cases caused by genetics make up only 10% of total childhood leukemia cases. A recent study in the state of California showed that Hispanic children had a higher chance of developing leukemia than Caucasian, African-American and Asian children. This study suggests that Hispanic children in the state of California were exposed to more harmful chemicals compared to everyone else. There are many major chemicals that contribute heavily to leukemia, a main one being ionizing radiation. Ionizing radiation has mainly been linked to the development of AML but depends strongly on the amount of radiation. For example, in Hiroshima and Nagasaki leukemia rates were 20 fold higher after the atomic bomb explosion. Another example of how radiation affects childhood leukemia is when parents are exposed to radiation at work and then passes it down to the child during conception.[6]
Genetic factors
Although genetic factors only make up for about 10% of childhood leukemia cases, there are a few genes that can higher the risk of childhood leukemia. The ETV6 mutation has been known to cause many blood cancers including ALL. A more recent study asserts that another gene linked to leukemia is the PAX5 gene mutation,this is the gene that is responsible for maintaining the function of B cells, if regulated, can lead to the development of ALL.[14] Down syndrome, a genetic disorder, can make children more susceptible to leukemia overall.
Ethnicity/Gender susceptibility to Leukemia
Gender and ethnicity may also affect the risk of getting the disease, females have a higher chance of developing leukemia in their first year of life and the rate of Caucasain children developing ALL is twice of African American children. Another study that has been done shows that children of Hispanic descent are more susceptible to developing leukemia opposed to other races. In this study it has been determined that this could be caused by the higher birth weight in the Hispanic race as well as a difference in diet compared to other races. In the study we are also informed that African American children are the least susceptible to Leukemia.[13] Asians were seen to be overall more susceptible to AML and ALL.
Prevention/early detection
Although the exact cause of Childhood Leukemia is unknown there are some preventionary steps that can be taken to lower the risk of developing Childhood Leukemia. Not drinking or smoking during pregnancy can reduce a child's risk of Leukemia by 10 times. If a child is experiencing symptoms of Leukemia there are many tests that can be used such as a complete blood count, blood smear and a bone marrow aspiration. Although there isn't a way to detect Leukemia early, if a child develops the symptoms it is helpful to get tested right away.
Screening/Diagnosis
As discussed there are many ways that can be used to screen for Leukemia.
Complete blood count- a sample of blood is taken from a child’s vein, then the different types of blood cells are counted in a lab. Children with Leukemia usually have too many white blood cells
Blood smear- blood is taken from the finger and studied underneath a microscope. The cells will look different if the child has Leukemia.
Bone marrow aspiration and biopsy- A needle is put into the hip and a small amount of bone marrow is taken out and scientists look to see if Leukemia cells are present in the bone marrow.
Treatment
The main treatment for Leukemia is chemotherapy which happens in many phases
Induction: to kill Leukemia cells in the blood and return to a normal blood count. This phase lasts about 4 weeks and requires the child to stay in the hospital.
Consolidation: Additional Chemotherapy drugs are given in order to kill off any cells that were still there after induction.
Maintenance: to kill off any cancer cells that were there after the first two stages, this part of treatment can last up to 2 ½ years but most children will be able to still take part in daily activities.
Treatment may not always occur in this particular order, in some cases chemotherapy fails so alternate methods are needed. Bone marrow/stem cell transplant is a common therapy when chemotherapy fails. In this therapy, the affected bone marrow is destroyed by high doses of chemotherapy and then healthy donor stem cells are given to the patient and travel to the bone to recreate the bone marrow. However, this treatment comes along with many risks and can cause life threatening infections and bleeding.[7]
Global statistics
About 6 in every 100,000 children will get leukemia and ALL is the most common type of Leukemia. Although the United States has low mortality rates for the disease the global scenario,however, is not as promising.[7]
Childhood Leukemia in developed countries versus developing countries
In developed countries such as the United States the mortality rate for leukemia has decreased by 20% over the half century. The cure rate for ALL is about 90% and for AML it is about 45%. Whereas in third world countries the survival rate dwells at 20% and is mainly caused by a delay in care, high dropout rates and the lack of healthcare workers available. However there have been a few programs that have been developed in order to help the treatment of childhood leukemia in poorer countries.``Twinning” which pairs up a pediatric oncology unit of a developing country with a hospital in a developed country. Most of these programs,however, focus on ALL since it is the most curable type of leukemia. One of the most popular programs is the partnership between St.Judes Children's Research Hospital and a hospital in Recife,Brazil. Over the past 15 years, the pediatric oncology unit in Recife survival rates of ALL has improved from 32% to 63%. They were able to achieve this by establishing a consistent blood supply, making sure chemotherapy drugs were available, and making sure that doctors had special training in pediatric oncology. Another tactic that has been used to decrease the mortality rate is addressing abandonment. Since treatment can be very expensive, most families have to discontinue care but with the implementation of financial aid programs many families will be able to continue treatment. For example, Recife has implemented the NACC( a financial aid program for childhood cancer treatment) the abandonment rates for ALL treatment have gone down from 16% to .5%. Even with the implementation of these programs there is still a lot of work to be done about spreading awareness about childhood cancer in developing countries as there isn't a surplus of information about it.
Conclusion
To sum it up, childhood leukemia is the most common type of pediatric cancer across the world. ALL is the most common type of leukemia and makes up over 75% of cases, fortunately, it is the easiest to treat and has high cure rates(about 90%). There are many risk factors that contribute to the development of leukemia such as radiation, a mother smoking or drinking while pregnant and exposure to harmful chemicals during childhood. Ethnicity also plays a big role in the development of leukemia, with Hispanic children being the most affected. Genetics however is not a huge risk factor and only contributes to 10% of cases. Globally ,however, the survival rates are not that promising for Childhood Leukemia. Due to the lack of resources available for childhood leukemia in developing countries, the survival rate dwells at 15-45%. However, there have been programs implemented such as “Twinning” and financial aid programs which have helped to decrease mortality rates in developing countries.
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