Introduction
Leukemia is a type of cancer that affects kids more than any other kind of cancer, making up about 30% of all cancers in children. It happens when the bone marrow, which is where blood cells are made, starts producing abnormal white blood cells that don’t work right. These bad cells take over and push out the healthy blood cells, which can cause a bunch of problems like anemia, getting sick easily, and bruising or bleeding too much. But the good news is that if we catch it early and use modern treatments, kids with leukemia are much more likely to get better and live healthy lives. Doctors can use special tests to diagnose leukemia, and then they can come up with a plan to help the child get the right treatment. With the right care, many kids with leukemia are able to beat the disease and go on to live normal, healthy lives.
Definition
Leukemia is a malignant disorder characterized by the abnormal proliferation of immature white blood cells in the bone marrow and peripheral blood.
Types of Leukemia in Children
- Acute Lymphoblastic Leukemia (ALL)
- Most common type (about 75–80% of childhood leukemias).
- Originates from lymphoid precursor cells.
- Acute Myeloid Leukemia (AML)
- Accounts for 15–20% of cases.
- Originates from myeloid precursor cells.
- Chronic Myeloid Leukemia (CML)
- Rare in children.
- Juvenile Myelomonocytic Leukemia (JMML)
- Rare childhood leukemia affecting young children
1. Acute Lymphoblastic Leukemia (ALL)
Acute Lymphoblastic Leukemia (ALL) is the most common type of leukemia in children, accounting for approximately 75–80% of all childhood leukemia cases. It originates from immature lymphoid precursor cells called lymphoblasts. Normally, these cells mature into B lymphocytes or T lymphocytes, which play an important role in the immune system. In ALL, these immature cells fail to mature and multiply rapidly, replacing normal bone marrow cells.
The peak incidence of ALL occurs between 2 and 5 years of age. Children commonly present with fever, pallor, weakness, fatigue, bone pain, recurrent infections, easy bruising, and bleeding manifestations. Enlargement of lymph nodes, liver, and spleen is frequently observed. Bone pain occurs because leukemic cells infiltrate the bone marrow and increase pressure within the bones.
Diagnosis is established through complete blood count, peripheral blood smear, and bone marrow examination, which reveals a large number of lymphoblasts. Modern treatment consists of combination chemotherapy administered in several phases, including induction, consolidation, and maintenance therapy. ALL has an excellent prognosis, and more than 85–90% of children can achieve long-term survival with appropriate treatment.
2. Acute Myeloid Leukemia (AML)
Acute Myeloid Leukemia (AML) is the second most common leukemia in children and accounts for approximately 15–20% of cases. It arises from myeloid precursor cells, which normally develop into granulocytes, monocytes, red blood cells, and platelets. In AML, immature myeloid cells called myeloblasts accumulate in the bone marrow and interfere with normal blood cell production.
Children with AML usually present with symptoms similar to ALL, including fever, pallor, fatigue, recurrent infections, and bleeding manifestations. However, certain features are more characteristic of AML, such as gum hypertrophy, skin infiltration (leukemia cutis), and chloromas (localized collections of leukemic cells). Bone pain and enlargement of the liver and spleen may also occur.
Laboratory investigations reveal anemia, thrombocytopenia, and elevated or reduced white blood cell counts. Bone marrow examination demonstrates an increased number of myeloblasts. Auer rods, which are needle-shaped cytoplasmic inclusions, may be seen and are characteristic of AML.
Treatment involves intensive chemotherapy, and some patients may require hematopoietic stem cell transplantation. Although AML is less common than ALL, advances in treatment have significantly improved survival rates.
3. Chronic Myeloid Leukemia (CML)
Chronic Myeloid Leukemia (CML) is a rare leukemia in children, accounting for less than 3% of pediatric leukemia cases. Unlike ALL and AML, which are acute and rapidly progressive, CML develops slowly and is characterized by uncontrolled proliferation of mature and immature myeloid cells.
The hallmark of CML is the presence of the Philadelphia chromosome. This abnormal chromosome is formed due to a translocation between chromosomes 9 and 22, designated as t(9;22). This genetic abnormality creates the BCR-ABL fusion gene, which produces an abnormal protein with continuous tyrosine kinase activity. This abnormal protein stimulates excessive production of white blood cells.
Children with CML may initially have few symptoms. As the disease progresses, they may develop fatigue, fever, weight loss, excessive sweating, abdominal discomfort, and a markedly enlarged spleen. Blood examination typically reveals a very high white blood cell count with cells at various stages of maturation.
CML progresses through three phases. The chronic phase is relatively stable and responds well to treatment. The accelerated phase represents disease progression, while the blast crisis resembles acute leukemia and is associated with a poor prognosis.
The introduction of tyrosine kinase inhibitors such as Imatinib has revolutionized the treatment of CML and significantly improved survival rates. Stem cell transplantation may be considered in selected cases.
4. Juvenile Myelomonocytic Leukemia (JMML)
Juvenile Myelomonocytic Leukemia (JMML) is a rare but aggressive myeloproliferative disorder that primarily affects infants and young children, usually below five years of age. It is characterized by excessive proliferation of monocytes and granulocytes in the bone marrow.
JMML is associated with mutations affecting the RAS signaling pathway and may occur in children with genetic disorders such as Neurofibromatosis Type 1 and Noonan syndrome. The abnormal cells infiltrate various organs, leading to significant clinical manifestations.
Children with JMML commonly present with persistent fever, pallor, recurrent infections, skin rash, enlarged lymph nodes, hepatomegaly, splenomegaly, and failure to thrive. Splenomegaly is often massive and is an important clinical finding.
Laboratory investigations reveal monocytosis, anemia, thrombocytopenia, and elevated fetal haemoglobin levels. Bone marrow examination helps confirm the diagnosis.
JMML is generally more aggressive than other forms of childhood leukemia. Conventional chemotherapy provides only temporary benefit, and hematopoietic stem cell transplantation is currently the only curative treatment. Early diagnosis and prompt referral to specialized centers are essential for improving outcomes.
Aetiology
The exact cause is unknown, but several factors increase the risk:
- Genetic disorders:
- Down Syndrome
- Fanconi Anemia
- Bloom Syndrome
- Exposure to ionizing radiation
- Previous chemotherapy
- Certain genetic mutations
- Family history of leukemia
- Immune deficiency disorders
Clinical Features
General Symptoms
- Fever
- Fatigue
- Pallor
- Weight loss
- Loss of appetite
- Night sweats
Due to Bone Marrow Failure
- Anemia → weakness, breathlessness
- Thrombocytopenia → petechiae, purpura, bleeding gums
- Neutropenia → recurrent infections
Organ Infiltration
- Hepatomegaly
- Splenomegaly
- Lymphadenopathy
- Bone and joint pain
Central Nervous System Involvement
- Headache
- Vomiting
- Seizures
- Cranial nerve palsies
Investigations
- Complete Blood Count (CBC)
- Peripheral Blood Smear
- Bone Marrow Aspiration and Biopsy
- Immunophenotyping by Flow Cytometry
- Cytogenetic and Molecular Studies
- Lumbar Puncture for CNS evaluation
- Liver and Renal Function Tests
Treatment
Conventional Management
- Chemotherapy (main treatment)
- Targeted therapy in selected cases
- Immunotherapy
- Hematopoietic stem cell transplantation
- Supportive care:
- Blood transfusions
- Platelet transfusions
- Antibiotics
- Nutritional support
Homeopathic Therapeutics
1. Arsenicum Album
- Extreme weakness and exhaustion
- Anxiety and restlessness
- Burning pains
- Marked debility after illness
2. Phosphorus
- Bleeding tendency
- Pallor
- Weakness
- Recurrent respiratory infections
3. China Officinalis
- Debility after blood loss
- Marked anemia
- Exhaustion and dizziness
4. Ferrum Phosphoricum
- Early anemia
- Weakness
- Recurrent fever
5. Carcinosinum
- Strong family history of cancer
- Constitutional prescribing based on symptom totality
6. Calcarea Phosphorica
- Poor growth
- Bone pains
- Weak and undernourished children
Conclusion
When it comes to kids, the most common type of cancer they get is leukemia. It’s really important to find out if a child has leukemia as soon as possible and to treat it thoroughly. The kind of leukemia that kids get most often is called acute lymphoblastic leukemia, or ALL for short. Luckily, because of new and better chemotherapy and supportive care, many more kids are surviving leukemia than they used to. Even though the regular treatments that paediatric oncologists use are still the main way to manage and cure the illness, homeopathy can be used as a extra way to support the child’s treatment, but only if it’s tailored to the child’s specific symptoms.
References
- Nelson Textbook of Pediatrics .
- IAP Textbook of Pediatrics.
- Boericke’s Materia Medica.
- Kent’s Lectures on Homeopathic Materia Medica.
- Metayer C, Dahl G, Wiemels J, Miller M. Childhood Leukemia: A Preventable Disease. Pediatrics. 2016 Nov;138(Suppl 1):S45-S55. doi: 10.1542/peds.2015-4268H. PMID: 27940977; PMCID: PMC5080868.
Guide-
Dr. Jyoshna Shivaprasad, Associate professor of paediatric department, Father Muller Homeopathic Medical College, Mangalore
