Leukemia & Lymphoma Program

The leukemia and lymphoma program at Children's is the largest in Minnesota and one of the largest in the Upper Midwest. We diagnose and treat children with all types of leukemia and lymphoma, including acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), chronic myeloid leukemia (CML), Hodgkin's lymphoma and non-Hodgkin's lymphoma.

What are Leukemia and Lymphoma?

Leukemia is cancer of the blood cells. The bone marrow, where blood cells are made, makes cells that are abnormal in growth and function. The three general types of leukemias found in children are acute lymphoblastic leukemia (ALL) , acute myeloid leukemia (AML) and chronic myelogenous leukemia (CML).

Lymphoma is cancer of the lymphatic system. Lymph nodes, located throughout the body, are responsible for filtering waste products and damaged cells out of the body. The nodes are connected through a system of blood vessels. The two main categories of lymphoma found in children are Hodgkin's lymphoma and non-Hodgkin's lymphoma.

Why Choose Children's?

One of the largest leukemia and lymphoma programs in the region. Children's Hospitals and Clinics of Minnesota provides care for the majority of children diagnosed with leukemia & lymphoma in the state of Minnesota and is also the trusted regional treatment center for many children in North Dakota, South Dakota, Iowa and Wisconsin.

Access to the latest treatment options. As a leading member of the Children's Oncology Group, Children's provides active participation and access to the most current national and international treatment protocols for chemotherapy and radiation that allow team members to treat children with new experimental drugs. Through these memberships and participation your child is assured access to the most current treatment options.

Experts work together for your child. Our multidisciplinary team includes pediatric specialists from a wide variety of disciplines, including radiation oncology, surgery, anesthesia, pain management, psychology, pharmacy, exercise medicine, physical therapy, occupational therapy, nutrition, and others.

Physical therapists specialized in cancer care and chemotherapy related issues work in the clinic with the team and your child to promote normal motor development during treatment and recovery.

Neuropsychological Testing and the School Re-entry program offer testing, support and practical recommendations for your child and their school. Neuropsychologists work proactively with patients, families, and schools to help patients reach their maximum intellectual and social potential.

Second opinions for children not seen in our program. At Children's, we provide consultation services for children who are not seen in our program but would like input from our expert team. If you or your child's doctor would like us to review your child's case, you may arrange to have health records and test results for your child sent to us. The child does not need to live in the area or be seen in our clinic.

What is acute myeloid leukemia (AML)?

Acute myeloid leukemia (AML) is a cancer that involves a type of white cell in the bone marrow. The condition develops in the bone marrow, where the body's blood cells are made. The malignant cells in AML are immature, myeloid blood cells. Normal myeloid cells mature into white cells, red cells, and platelets. In AML, the myeloid cells somehow escape the normal controls that direct their maturing into normal blood cells. These immature cells are called blasts.

Acute myeloid leukemia can occur in all ages. The cause of AML is not known, but it is not hereditary nor is it contagious. Possible factors that are currently being researched include environment and genetics.

As the leukemic blast cells accumulate in the bone marrow, they begin to crowd out the normal cells that develop there. Eventually, they occupy so much room that red blood cells, platelets, and normal white blood cells cannot be produced. When this happens, a child develops symptoms indicating normal blood cells are not being manufactured in adequate numbers.

What are the symptoms of AML?

When red blood cells are crowded out, the hemoglobin will drop. The child may look pale and feel tired and irritable. When platelets are low, the child may bruise more easily and have bleeding problems such as bleeding gums, or nose bleeds. When normal, mature white blood cells are crowded out, no cells remain to fight bacteria and infections may occur. The accumulation of blasts in the bone marrow can also cause increased pressure and result in bone pain.

The leukemic cells can "spill out" from the bone marrow and travel anywhere in the body that blood goes. They can spread or travel to the lymph nodes, spleen and liver, which may cause these organs to become enlarged. Leukemic cells can also spread into the spinal fluid that surrounds the spinal cord and brain. Sometimes leukemia cells collect in the skin tissue. These are called myeloid sarcomas.

How is AML diagnosed?

To diagnosed AML, your doctor takes a history of your child's symptoms, performs a physical examination, and completes a microscopic examination of your child's blood cells, bone marrow cells and spinal fluid.

A bone marrow aspiration/biopsy is obtained by inserting a needle into the hipbone and removing some marrow cells to test under the microscope. Leukemia starts here and this test established the diagnosis. A lumbar puncture, also called a spinal tap, is when a needle is inserted into the spinal canal and spinal fluid is removed and tested for leukemia cells. These tests are done under sedation or general anesthesia.

How is AML treated?

The treatment of AML is the administration of chemotherapy (cancer-fighting drugs). Chemotherapy will be given in two phases.

The first phase is called induction, during which high doses of chemotherapy are given. The purpose of this phase is to induce a remission by killing leukemia cells as quickly as possible. Your child will need to be in the hospital during chemotherapy. Bone marrow tests will be done three to five weeks into treatment to determine when a remission is achieved. Cycles of induction chemotherapy are repeated twice. It can take the patient three to five weeks to recover from each cycle of induction chemotherapy. Patients must remain in the hospital during their recovery until their blood counts recover.

The next phase of treatment is called intensification. The goal is to solidify remission through intensive chemotherapy drugs. More chemotherapy is given in the hospital and again patients must stay in the hospital to recover. There are three treatment cycles during intensification. Children with acute myeloid leukemia who have a sibling donor may have a bone marrow transplant after one cycle of intensification as part of their treatment. Your physician will discuss this possibility with you. Recovery after each cycle is about three to five weeks. Patients must remain in the hospital during their recovery until their blood counts recover.

Following completion of chemotherapy, your child will be followed with routine visits in the clinic. Blood tests will be done periodically to be sure your child's leukemia remains in remission.

About treatment for AML at Children's

Children's hematology/oncology program consistently achieves treatment results ranking it as one of the top 10 programs in the U.S. Children's treats the majority of children with cancer and blood disorders in Minnesota and provides patients with access to a variety of clinical trials of groundbreaking new treatments. Through our renowned leukemia/lymphoma program, patients experience unparalleled family support, a nationally renowned pain management team, and compassionate, coordinated care.

Contact Us

If you are a family member looking for a Children's hematologist or oncologist or wanting to schedule an appointment, please call our clinic at Children's – Minneapolis at (612) 813-5940.

If you are a health professional looking for consultation or referral information, please call Children's Physician Access at 1-866-755-2121 (toll-free) and ask for the on-call hematologist/oncologist.

What is acute lymphoblastic leukemia (ALL)?

Acute lymphoblastic leukemia (ALL) is a cancer that involves the white blood cells of the bone marrow. The condition develops in the bone marrow where blood cells are produced. The bone marrow produces three kinds of blood cells: red blood cells, white blood cells and platelets. The malignant cell in ALL is a lymphocyte, which is a type of white blood cell.

In ALL, the lymphocytes somehow escape the normal controls that direct the way they mature. Instead of aging in a way that allows them to do their part in helping to fight infection, they remain young, continue to multiply and are not effective in fighting infection. These immature lymphocytes are called lymphoblasts, blasts or leukemic cells. There are many kinds of lymphocytes, including B cell and T cell lymphocytes. Leukemia can occur in any type of lymphocyte; the most common type of ALL is early or pre-B cell leukemia.

Acute lymphoblastic leukemia is the most common leukemia diagnosed in children. Most children are diagnosed between the ages of two and eight, and it is more prevalent in boys than girls. The cause of ALL is not known, but it is not hereditary nor is it contagious. Nothing done or not done by the child, parent or family has caused the cancer in your child. Possible factors that are currently under study include the environment and genetics.

What are symptoms of ALL?

As the leukemic blast cells accumulate in the bone marrow, they begin to crowd out the normal cells that develop there. Eventually, they occupy so much of the space that red blood cells, platelets, and normal white blood cells cannot be produced. When this happens, a child develops symptoms indicating that normal, mature blood cells are not being manufactured in adequate numbers.

When red blood cells are crowded out, a child's hemoglobin levels will drop. The child may look pale and feel tired and irritable. When platelets are low, the child may bruise more easily and have bleeding problems such as bleeding gums or nose bleeds. When normal, mature white blood cells are crowded out, no cells remain to fight bacteria, and infections may occur. The accumulation of blasts in the bone marrow can also cause increased pressure and result in bone pain.

The leukemic cells can "spill out" from the bone marrow and travel anywhere in the body that blood goes. They can spread or travel to the lymph nodes, spleen and liver, which may cause these organs to become enlarged. Leukemia cells can also spread into the spinal fluid that surrounds the spinal cord and brain.

How is ALL diagnosed?

A doctor takes a history of your child's symptoms, performs a physical examination, and completes a microscopic examination of your child's blood cells, bone marrow cells, and spinal fluid.

Because leukemia starts in the bone marrow, patients undergo a bone marrow aspiration/biopsy to confirm the diagnosis. During this procedure, the physician inserts a needle into the hipbone and removes some marrow cells to test under the microscope. A lumbar puncture (LP) or spinal tap is when a needle is inserted into the spinal canal and spinal fluid is removed and tested for leukemia cells. These tests are often done under sedation or general anesthesia.

How is ALL treated?

The treatment for ALL is the administration of chemotherapy and generally consists of five or more phases: induction, consolidation, interim maintenance, delayed intensification, and maintenance. Radiation therapy to the head is used if leukemic cells have spread to the spinal fluid and in certain high-risk types of ALL.

The goal in induction therapy is to achieve a complete remission or disappearance of all leukemic cells. During induction, your child receives medications to kill as many leukemia cells as possible. Bone marrow tests are done to determine when a remission is achieved. Induction therapy usually lasts about four weeks. The length of your child's hospital stay will depend on the type of treatment he or she receives and whether or not any complications occur.

The next phase is consolidation. The goal is to solidify remission through use of chemotherapy drugs. During this phase, chemotherapy is frequently given into the spinal fluid during spinal tap procedures as well as into the vein. This destroys any leukemia cells that can hide in the spinal fluid. Chemotherapy given into the bloodstream does not cross well into the spinal fluid therefore chemotherapy must be given directly into it.

Leukemia cells can escape the medicines given in induction by hiding in the fluid that bathes the spinal cord and brain. This is possible because of a mechanism called "the blood-brain barrier" which stops passage of materials from the blood into the brain and spinal cord. Central nervous system prophylaxis (prevention) therapy is necessary to destroy any leukemic cells hidden in the cerebral spinal fluid. During this phase, your child will receive frequent spinal taps so medications can be given directly into the cerebral spinal fluid. This phase lasts about four weeks, and is usually given on an outpatient basis. If your child requires radiation therapy, it is usually done during consolidation.

Interim maintenance is a phase designed to give a break of less intense therapies between each course of delayed intensification. This phase is usually two months long and consists mostly of medications given by mouth at home. The phase of interim maintenance followed by delayed intensification is repeated.

The goal of the next phase, delayed intensification, is to give intense chemotherapy when the amount of leukemia cells is very low in order to destroy this small, undetectable number of cells. This medication is given as an outpatient, however patients may need to be hospitalized for some side effects such as low blood counts and fever. Delayed intensification lasts approximately eight weeks.

Maintenance therapy is aimed at keeping your child in remission and destroying any leukemia cells that may remain in your child's body. During this phase your child receives medication in the clinic once every three to four weeks and takes oral medication at home. Spinal taps are necessary about every three months. Maintenance therapy continues for about two to three years. During maintenance, children's hair grows back and school age children can return to school on a regular basis. Once your child has completed maintenance therapy, blood tests are done periodically to monitor your child's response to treatment.

About treatment for acute lymphoblastic leukemia at Children's

Children's cancer and blood disorders program consistently achieves treatment results ranking it as one of the top ten programs in the U.S. Children's treats the majority of children with cancer and blood disorders in Minnesota and provides patients with access to a variety of clinical trials of ground-breaking new treatments. Through our renowned leukemia/lymphoma program, patients experience unparalleled family support, a nationally renowned pain management team, and compassionate, coordinated care.

Contact Us

If you are a family member looking for a Children's hematologist or oncologist or wanting to schedule an appointment, please call our clinic at Children's – Minneapolis at (612) 813-5940.

If you are a health professional looking for consultation or referral information, please call Children's Physician Access at 1-866-755-2121 (toll-free) and ask for the on-call hematologist/oncologist.