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Treatment

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Treatment and care of children with cancer is usually provided by a team of health professionals called a multidisciplinary team. Members of this team are specialists in children’s cancers – they understand the differences between children’s cancer and adult cancer, and each team member brings different skills in managing care to meet the needs of both you and your child.

The team will be led by a childhood cancer specialist (paediatric oncologist). Other members of the team depend on the age of your child and their type of disease, and may change over time as your child's needs change. A list of team members who might make up the multidisciplinary team can be found in The treatment team.

Treatment for leukaemia depends on the age of your child, the biological features of the cancer and other factors identified during diagnosis. Treatment will be tailored to your child’s particular situation, and may involve one or more of the following (see How is cancer treated for more detail).

Surgery

Because leukaemia cells spread throughout the body in the blood, surgery is not used to treat leukaemia. However, your child might have surgery to insert a venous access device (also called a central venous catheter, portacath or central venous line) into a large blood vessel, usually in their chest or upper arm. This is a small plastic tube that either sticks out of the body or sits just under the skin. It allows medicines, including chemotherapy, to be given intravenously, and can also be used to take blood samples for testing.

Chemotherapy

Chemotherapy uses anti-cancer medicines to destroy cancer cells. It is often given as a combination of medicines to try to prevent the cancer cells from becoming resistant to just one or two medicines.

Chemotherapy medicines are given together in courses, often over a few days. Once the body has recovered from the side effects, the next course is given. Most children receive multiple courses of chemotherapy.

Chemotherapy is often used to treat leukaemia, and can be given by mouth or injected into a vein, under the skin or into a muscle.

If your child’s doctor thinks that the leukaemia may have spread to the brain or spinal cord, chemotherapy can also be given directly into the cerebrospinal fluid through a device called a ventricular access catheter, which is inserted during a minor operation. This device has a small tube that passes into the area of the brain where the cerebrospinal fluid flows. The treatment team can inject chemotherapy medicines directly into it, and also take samples of fluid out of it to run tests.

Radiation therapy

Radiation therapy (also called radiotherapy) uses high-energy X-rays or other types of radiation to destroy cancer cells or stop them from growing. External beam radiation therapy may be used to treat leukaemia if the cancer has spread (or if it might spread) to the brain or other parts of the central nervous system.

Radiation therapy can have long-term side effects in children. If radiation therapy is included in your child’s treatment, special care will be taken to reduce these risks.

Targeted therapy

Some medicines can target the specific changes in cancer cells that make them different from normal cells. This means that they work differently from standard chemotherapy, and they usually have fewer side effects, or the side effects are not as severe.

Drugs known as tyrosine kinase inhibitors (TKIs), such as imatinib, may be used to treat certain types of acute lymphocytic leukaemia. Monoclonal antibodies may be used to treat acute myeloid leukaemia.

Targeted therapies are often used in combination with other treatments such as chemotherapy.

Stem cell transplant

Some children may be treated using a stem cell transplant (also known as a bone marrow transplant), in combination with high-dose chemotherapy or radiation therapy. However, this is usually only done for children whose leukaemia has come back after the initial treatment (relapsed). It is rarely used as the first treatment for acute lymphocytic leukaemia.

Other treatments

Some children are very ill when they are first diagnosed with leukaemia. These children might have immediate treatment such as blood or platelet transfusions (where blood or platelets from a donor are given intravenously) before they begin other treatments.

published: Sunday, 23 August, 2015