Leukemia and Lymphoma

Every year, more than 10,000 children are diagnosed with cancer. Of those, nearly one in three cases are a form of leukemia, making it the most common childhood cancer. Another 1,700 children under 21 are diagnosed with lymphoma each year. At Cook Children's our goal is to reduce those numbers to zero.

Lucy's triumph over leukemia

When spunky, Lucy Garza, woke up in extreme pain and unable to walk, her parents rushed to Cook Children's Medical Center in Fort Worth for answers. They weren't sure what to expect. Lucy, age 3, was diagnosed with acute lymphoblastic leukemia (ALL). From entering the emergency department, to after two years of treatment with complications, Lucy was able to ring the bell. This is her story.

Our highly respected team of pediatric hematologists and oncologists have extensive expertise in treating childhood leukemia and lymphoma, including:

Acute lymphoblastic leukemia
Acute myeloblastic leukemia
Chronic myeloid leukemia
Hodgkin's lymphoma
All non-Hodgkin's lymphomas (diffuse large B cell lymphoma, lymphoblastic lymphoma, anaplastic large cell lymphoma)
Other rare lymphomas

The pediatric oncologists and hematologists at Cook Children's are actively involved in research to find treat and ultimately bring an end to leukemia and lymphoma.

heym-totalxvii

Total Therapy Study XVII

Dr. Kenneth Heym Medical Director, Oncology Program, Cook Children's Medical Center, talks about our participation in a new Total Therapy XVII clinical research trial. This important investigational research is currently the best available targeted therapy for ALL and LLy cancers.

The Incredible Promise of Total Therapy XVII

Leukemia

Genetic risk factors are those that are part of our DNA. DNA is the substance that carries our genes, the instructions for nearly everything our cells do. Learn all about genetics.

Leukemia can be either fast growing (acute), or slower growing (chronic). Almost all leukemia in children is acute.

There are two main types of acute leukemia:

Acute lymphocytic leukemia (ALL), also called acute lymphoblastic leukemia, accounts for about 3 out of 4 cases of childhood leukemia. This leukemia starts from the lymphoid cells in the bone marrow.
Acute myelogenous leukemia (AML), also called acute myeloid leukemia, accounts for most of the remaining cases. This leukemia starts from the cells that form white blood cells (other than lymphocytes), red blood cells or platelets.

Chronic myeloid leukemia (CML) is rare in children but the incidence increases with age and is more commonly seen in teenagers and young adults. CML arises in bone marrow from myeloid cells.

While we don't know the exact cause of most leukemia cases, during the past few years scientists have made great progress in learning how certain changes in DNA can cause bone marrow stem cells to develop into leukemia.

Children with certain genetic conditions such as Li-Fraumeni syndrome, Down syndrome, Klinefelter syndrome and others have an increased risk of leukemia. Other genetic diseases that cause children to be born with an abnormal immune system may also increase their risk of getting leukemia.

Though some genetic factors increase the risk of childhood leukemia, most cases of leukemia are not linked to any known genetic causes. There may also be environmental factors that contribute to childhood leukemia. These may include:

Exposure to high levels of radiation such as X-rays or CT scans
Chemotherapy drugs
Exposure to chemicals and pesticides

The symptoms of leukemia are not always obvious. If you notice the following symptoms in your child it is wise to talk with your pediatrician about them:

Easily tires, is weak or dizzy
Pale or ashen skin
Shortness of breath, trouble breathing or an unexplained cough
A fever or infection that doesn't get better
Bleeds or bruises easily, the gums may bleed often when brushing the teeth, recurrent nosebleeds
Continual bone or joint pain
A swollen belly
Swollen lymph nodes on the sides of the neck, underarms or groin area
Headaches, seizures, vomiting
Non itchy rashes caused by bleeding under the skin

Please bring your child's medical records to your appointment. We will create a complete medical history of your child including any past illnesses, environmental and genetic risk factors, what symptoms your child has had, and how for long. Once the history has been taken, the doctor will determine which tests your child may need. Tests may include:

A thorough physical exam
An exam of the nervous system
A check of the eyes and mouth
A complete blood count (CBC)
Bone marrow aspiration and biopsy
Spinal tap (lumbar puncture)
Pathology or lab tests including cytochemistry, cytogenetics, flow cytometry, FISH and immunohistochemistry
Blood tests to check liver, kidneys and other organs
Imaging may be required and might include: chest x-rays, CT scans, PET/CT scans, MRI, ultrasound, gallium scan and bone scan.

Treatment will depend on your child's diagnosis, and is different for every patient. As part of the hematology and oncology team, you will be included in choosing the course of care that is right for your child. Treatment may include one or a combination of:

Lymphoma

Lymphoma is actually the name for many types of lymphatic cancers. Every year, nearly 2,200 children in the U.S. are diagnosed with a type of lymphoma cancer. These cancers start in the lymphocyte cells of the immune system and most often affect the lymph nodes and other lymph tissues like the tonsils or thymus. They can affect bone marrow and other organs. There are two main types of lymphoma:

Hodgkin's lymphoma is very rare in children younger than 5. Onset usually occurs in the teen years or young adulthood. Nodular sclerosis is the most common subtype of Hodgkin's seen in children. Two other subtypes are mixed cellularity and lymphocyte predominance; these are most common in younger children. The causes of Hodgkin's lymphomas are still unknown, but the Epstein-Barr virus appears to play a role in approximately half of all children diagnosed with these forms of cancer.
Non-Hodgkin's lymphomas include diffuse large B cell lymphoma, lymphoblastic lymphoma and anaplastic large cell lymphoma. Some of these cancers may be aggressive, fast growing, and behave very differently from the types found in adults. They are also more common in boys than girls.

The most common symptoms are:

Enlarged lymphnodes, usually in the neck, above the collar bone or in the underarm or groin area. These nodes are usually painless.
Coughing or difficulty breathing
Unexplained fever
Night sweats
Abdominal swelling
Loss of appetite or weight loss

If your pediatrician suspects that your child has lymphoma or if your child has been diagnosed and you are seeking a second opinion, the team at Cook Children's is here and ready to put their expertise to work for you. Tests are determined by your child's symptoms and additional tests may be performed to assure the most accurate diagnosis for your child.

The tests offered at Cook Children's include:

A complete medical history of your child including illnesses, environmental and genetic risk factor, what symptoms your child has had, and for how long.
A thorough physical exam
Blood tests, including complete blood count (CBC)
Blood chemistry, including tests of liver and kidney function
Bone marrow biopsy or aspiration
lumbar puncture (spinal tap) to check for cancer that may have spread to the central nervous system (brain and spinal cord)
Ultrasound
Computed tomography (CT) of the chest and abdomen, and sometimes X-rays
Magnetic resonance imaging (MRI)
Bone scan, gallium scan, and/or positron emission tomography (PET) scan (when a radioactive material is injected into the bloodstream to look for evidence of tumors throughout the body)

Just as no two children are alike, no two cancers are exactly alike either. Once the results and diagnosis are in, the hematology and oncology team will create a personalized plan for your child. Depending on the diagnosis and stage of your child's cancer, that plan may include one or a combination of the following treatments:

Active leukemia & lymphoma research studies

A Phase 2 Study of Blinatumomab (NSC# 765986, IND# 125462) in Combination with Nivolumab (NSC# 748726, IND# 125462), a Checkpoint Inhibitor of PD-1, in B-ALL Patients Aged >/=1 to <31 Years Old with First Relapse

Primary Investigator: Heym MD, Kenneth

IRB ID: 2021-006 (TEMPORARILY CLOSED TO ACCRUAL)

Study Information
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A Phase 2 Study of Inotuzumab Ozogamicin (NSC# 772518, IND# 133494) in Children and Young Adults with Relapsed or Refractory CD22+ B-Acute Lymphoblastic Leukemia (B-ALL)

Primary Investigator: Heym MD, Kenneth

IRB ID: 2017-049 (OPEN)

Study Information
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A Phase 3 Randomized Trial for Patients with de novo AML Comparing Standard Therapy Including Gemtuzumab Ozogamicin (GO) to CPX-351 with GO, and the Addition of the FLT3 Inhibitor Gilteritinib for Patients with FLT3 Mutations

Primary Investigator: Heym MD, Kenneth

IRB ID: 2020-072 (TEMPORARILY CLOSED TO ACCRUAL)

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A Phase 3 Randomized Trial of Inotuzumab Ozogamicin (IND#:133494, NSC#: 772518) for Newly Diagnosed High-Risk B-ALL; Risk-Adapted Post-Induction Therapy for High-Risk B-ALL, Mixed Phenotype Acute Leukemia, and Disseminated B-LLy

Primary Investigator: Heym MD, Kenneth

IRB ID: 2020-022 (OPEN)

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A Phase 3 Trial Investigating Blinatumomab (IND# 117467, NSC# 765986) in Combination with Chemotherapy in Patients with Newly Diagnosed Standard Risk or Down syndrome B-Lymphoblastic Leukemia (B-ALL) and the Treatment of Patients with Localized B-Lymphoblastic Lymphoma (B-LLy)

Primary Investigator: Heym MD, Kenneth

IRB ID: 2019-059 (OPEN)

Study Information
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A Phase I Study of Tagraxofusp With or Without Chemotherapy in Pediatric Patients with Relapsed or Refractory CD123 Expressing Hematologic Malignancies

Primary Investigator: Heym MD, Kenneth

IRB ID: 2023-008 (OPEN)

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A Randomized Trial of Levocarnitine Prophylaxis to Prevent Asparaginase-Associated Hepatotoxicity in Adolescents and Young Adults Receiving Acute Lymphoblastic Leukemia Therapy

Primary Investigator: Albritton MD, Karen

IRB ID: COG_ACCL1931_Albritton (TEMPORARILY CLOSED TO ACCRUAL)

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A retrospective cohort study of response and survival in pediatric patients with relapsed and refractory acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LLy) treated with contemporary salvage therapy

Primary Investigator: Heym MD, Kenneth

IRB ID: 2021-016 (OPEN)

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ALTE22C1: Chronic Health Conditions in Down Syndrome-Associated Acute Leukemia: The Down Syndrome Phenotyping Acute Leukemia Study in Survivors (DS-PALS Survivors)

Primary Investigator: Beam MD, Donald

IRB ID: 2024-009 (OPEN)

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APAl2020SC

Primary Investigator: Vallance MD, Kelly

IRB ID: 2024-008 (OPEN)

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Assessment of Clonal Hematopoiesis and its Relationship to Cardiovascular Disease in Hodgkin Lymphoma Survivors. A COG Groupwide Observational Study.

Primary Investigator: Beam MD, Donald

IRB ID: COG_ALTE21C1_Beam (OPEN)

Study Information
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COG_AHOD2131_Albritton

Primary Investigator: Albritton MD, Karen

IRB ID: 2023-056 (OPEN)

Study Information
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Randomization of Cytarabine Monotherapy versus Standard-of-Care Vinblastine/Prednisone for Frontline Treatment of Langerhans Cell Histiocytosis

Primary Investigator: Ray MD, Anish

IRB ID: 2019-067 (OPEN)

Study Information
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Reducing Ethnic Disparities in Acute Leukemia (REDIAL) Consortium Retrospective Chart Review

Primary Investigator: Heym MD, Kenneth

IRB ID: 2019-051 (OPEN)

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SELCLAX

Primary Investigator: Heym MD, Kenneth

IRB ID: 2021-056 (OPEN)

Study Information
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Venetoclax EAP IND 152442

Primary Investigator: Heym MD, Kenneth

IRB ID: 2020-080 (OPEN)

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We are here to help.

If your child has been diagnosed, you probably have lots of questions. We can help. If you would like to schedule an appointment, refer a patient or speak to our staff, please call our offices at 682-885-6152.

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Leukemia and Lymphoma

Lucy's triumph over leukemia

Total Therapy Study XVII

Leukemia

What is leukemia?

Who gets leukemia?

What are the symptoms of leukemia?

Testing and diagnosis

Leukemia treatment

Lymphoma

What is lymphoma?

What are the symptoms of lymphoma?

Testing and diagnosis

Lymphoma treatment

Active leukemia & lymphoma research studies

We are here to help.

Ask a librarian