20 years ago, children had 50 percent chance; today, survival is 85 percent, and improving thanks to clinical trials

“It was a Sunday afternoon and we were out shopping,” recalls Kiessel. “When Angela was trying on a pair of pants I noticed bruises all over her body. It wasn’t normal. When we came home, I called the emergency room right away.”

An hour after arriving at the Emergency Department at the University of Michigan Health System, physicians diagnosed Angela with acute lymphocytic leukemia (ALL), the most common form of childhood leukemia that strikes children between the ages of 2 and 10. To fight the disease, Angela would need 2 ½ years of chemotherapy treatment.

Although Angela’s family was stunned by the devastating diagnosis, Kiessel says her daughter was a “trooper with a smile on her face during treatment.” And today, at age 16, Angela has been healthy and cancer-free for five years.

Recent advances in childhood leukemia treatment have given more children like Angela a greater chance of life after cancer. Only 20 years ago, children diagnosed with leukemia had a 50 percent survival rate. Today, due mostly to clinical trials, the cure rate is 85 percent and still improving, says Valerie Castle, M.D., a pediatric oncologist and chair of the Department of Pediatrics at the U-M Health System.

“During the past two decades, treatment of leukemia has dramatically changed,” notes Castle, who diagnosed and treated Angela more than seven years ago. “There have been a number of remarkable improvements in chemotherapeutic agents, how we treat children, and what we’ve learned about the disease.”

Leukemia is a form of cancer that arises from the bone marrow. Sometimes described as blood cancer, it affects the white blood cells, which help the body combat infection. In ALL, immature white blood cells divide uncontrollably, accumulating in the bloodstream, bone marrow and lymph system. This invasion of abnormal cells interferes with the production and function of the healthy blood cells making the person with leukemia highly susceptible to infections with little or no defense. It may also cause significant organ dysfunction.

While the exact causes of leukemia are unknown, it is possible that children are genetically predisposed to develop the disorder, and it may be triggered when infections occur during normal growth and development.

But even though it is difficult to pinpoint the specific cause of the disease, children are still winning the war against leukemia.

Now with an 85 percent chance of survival, Castle’s conversations with families and patients have dramatically changed since her days as a pediatric resident nearly 20 years ago.

“I remember being on the wards with my attending physicians and when we spoke with these families, we told them that their child had a 50-50 chance for survival,” recalls Castle. “Today, we have very different discussions with families in our clinic. We’re able to introduce them to children that are survivors of childhood leukemia – those who have gone on to college, and even have children of their own.”

Castle attributes two major factors to the improved survival rates for childhood leukemia. The first is the fact that pediatric oncologists, for the past three decades, have made a point to work closely together to care for children with certain types of cancer, particularly leukemia.

Secondly, due in large part to clinical trials, there have been major advances in chemotherapeutic agents and the way they are used to treat patients. These cooperative treatment trials, Castle says, have allowed pediatric oncologists to figure out which drugs are the most important to use in treating childhood leukemia, as well as how they should time its delivery to the patient.

“For any child diagnosed at our institution, or at any other of the major medical institutions across the country, clinical trials are making it possible to improve their treatment, and they continue to increase children’s chances for survival,” says Castle.

Still, a leukemia diagnosis and its subsequent treatment can have major physical and emotional impact on a child. Often times, their treatment regime may prevent them from attending school or decrease their level of activity. However, Castle believes that in a nurturing and supportive family environment, children will make it through treatment without any lasting negative effects.

In fact, Angela fondly remembers her chemotherapy treatment. “When I went in for treatment, there were a lot of other kids there that I could interact with, and there was always so much stuff to do like watch movies, play with toys, and arts and crafts,” she says. “Everyone there was just really nice.”

Even when Angela’s hair fell out as a result of her treatment, her family and her faithful Corduroy Bear stuffed animal helped her keep a positive attitude. Angela recalls even bringing Corduroy with her to the hospital when she would get chemotherapy or radiation therapy. When Angela would lay on her stomach or wear a mask during treatment, Corduroy would do the same.

Overall, Angela feels like her leukemia diagnosis made a positive impact on her life. “It’s changed me a lot because I really appreciate life more and everyone around me, like my friends and family,” she says. “I don’t really know what I want to do with my life, but I’m glad that I have the option of being able to do something with it.”

Facts about childhood leukemia:

• Leukemia is a form of cancer that arises from the bone marrow. It affects the white blood cells, which help the body combat infection.
• Acute lymphocytic leukemia (ALL) is the most common form of childhood leukemia. It strikes children between the ages of 2 and 10.
• Twenty years ago, children diagnosed with leukemia had a 50 percent survival rate. Today the cure rate is 85 percent and still improving.
• Clinical trials have allowed for major advances in chemotherapeutic agents and the way they are used to treat patients.
• Although the exact causes of leukemia are unknown, it is possible that children are genetically predisposed to develop the disorder, which may be triggered when infections occur during normal growth and development.

For more information, visit the following Web sites:

U-M Pediatric Cancer Information: Childhood Leukemia – Questions and Answers
www.cancer.med.umich.edu/learn/leukemia03.htm

U-M Department of Radiation Oncology: Leukemia Clinical Trials www.med.umich.edu/radonc/clin/clinleu.htm

American Cancer Society: Children’s Leukemia
www.cancer.org/docroot/CRI/CRI_2_3x.asp?dt=24

National Cancer Institute: Leukemia
www.nci.nih.gov/cancer_information/cancer_type/leukemia/

The Leukemia & Lymphoma Society
www.leukemia-lymphoma.org

Written by Krista Hopson