Published on July 22, 2020
Childhood Acute Lymphoblastic Leukemia is Different Than Adult ALL
Acute lymphoblastic leukemia (ALL) is a type of cancer that starts in the bone marrow where blood cells are made. It is more common in children than adults and children have better outcomes. This year, approximately 6,150 new cases of ALL will be diagnosed in the United States. It’s a rare cancer, accounting for less than 1 percent of all cancer diagnoses, but leukemia is the most common childhood cancer, and most kids are diagnosed before age five.
Determining Optimal Treatment
Chromosomal changes play a major role in the risk assessment of ALL. When the medical team tests and determines what the chromosomal abnormalities are, this information can be used to determine the risk group, treatment and likely prognosis. It can also inform when to start treatment.
Pediatric Versus Adult ALL
Leukemia in children is not the same as in adults. Kids are not tiny adults and they experience illnesses and treatments differently than their grown-up counterparts. They also have their own challenges. Kids who undergo cancer treatment may experience side effects such as fatigue, growth delays, thyroid dysfunction, difficulty fighting infections, and hearing loss. They are also at risk of developing a secondary cancer during their lifetime — even if the ALL is cured.
Parents should also consider fertility preservation for their kids. This is an important conversation to have with the medical team because cancer treatment during childhood can affect a person’s ability to have a family down the road.
“When we treat a child for cancer, we don't only treat their cancer, and we never should only treat their cancer, we need to treat the whole child,” said Dr. Debra Friedman, Director, Division of Hematology-Oncology, Vanderbilt University School of Medicine.
Kids have different needs than adults.
“Sometimes we need other subspecialists, medical subspecialists, cardiologists, infectious disease doctors, kidney doctors, et cetera. But also, we need support from non-medical specialties. We need support from social work and child life and psychology and psychiatry and nutrition and physical therapy and occupational therapy,” Dr. Friedman explains in a Patient Power exclusive, I Survived Acute Lymphoblastic Leukemia: Now What?
But there is good news. More than 80 percent of pediatric patients experience long-term survival, compared with 40 percent of adults.1 Acute lymphoblastic leukemia treatments include chemotherapy, stem cell transplants, targeted therapy drugs, immunotherapy, and immune checkpoint inhibitors for both children and adults. Children’s bodies are better equipped to handle aggressive treatments, which is what to leads to better outcomes.2
Children and Young Adults
A recent clinical trial shows promise for patients between the ages of 1 and 30. The treatment, blinatumomab (Blincyto) might be better than chemotherapy in getting patients to bone marrow transplant after they've experienced a relapse, according to Dr. Patrick Brown, Director, Pediatric Leukemia Program Kimmel Cancer Center, Johns Hopkins.
“In terms of the comparison, the blinatumomab was much less toxic than chemotherapy, so much lower side effects and lower death rates, etcetera, from that,” Dr. Brown said.
“It was better able to make patients' bone marrows go from having disease to having no disease, from being MRD-positive, we call it, to MRD-negative. And then, after transplant, their survival was better. More patients are alive,” he added.
Further trials and cancer research will help determine the next best treatment for these different age groups and perhaps change the standard of care for all patients with ALL who have experienced a relapse in their cancer.
To learn more about risk factors and types of treatment from Dr. Brown, watch ALL Clinical Trial Shows Promise in Young Adults. Sign up for e-news to get more cancer-specific content sent directly to your inbox.
~Lauren Evoy Davis
1Sallan SE, et al. Myths and Lessons from the Adult/Pediatric Interface in Acute Lymphoblastic Leukemia. Hematology Am Soc Hematol Educ Program. (2006) (1): 128–132.
2Key Statistics for Acute Lymphocytic Leukemia (ALL). American Cancer Society.
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