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Pediatric Leukemia: Literature Review

Anna Grimes

Dixie State University

Childhood Cancer: Leukemia

The author of this paper is a nurse at Primary Children’s Medical Center on the Oncology unit. The author will be working with the unit educator; together they will create an outline and a teaching guide on Pediatric Leukemia. The author will then compile the information to create a lecture, she will then present and teach the information on Pediatric Leukemia to newly hired nurses on the Oncology unit.

Pediatric Leukemia: Literature Review

Pediatric leukemia is a type of cancer that affects children under the age of fifteen years. It accounts for at least one-third of cancer related deaths among children. However, in the recent years, the number of leukemia related deaths are constantly increasing. For example, more than 3300 new leukemia deaths are reported in the United States on a yearly basis. The main types of leukemia affecting children include acute myeloid (AML) and acute lymphoblastic leukemia (ALL). Nonetheless, ALL is the most predominant cancer among the children accounting for over seventy-five percent of all leukemia cases (Wiemels, 2012). Additionally, AML accounts for at least twenty percent of the total childhood leukemia with a yearly frequency of eight to ten new cases in a population of one million people.

Leukemia is predominant in young children between the ages of three to ten years with its peak being among the children aged six years. Children are vulnerable to leukemia infections due to genetic factors. For example, mutations in chromosomal genes are widespread in children, thereby resulting in translocations of genes. These types of mutations occur mostly among infants, with a prevalence of eighty-five percent and ninety-seven percent being congenital and prenatal leukemia. However, the mutations associated with leukemia are considered deficient to result in the development of the disease (Krishnan and Rajasekaran, 2014).

The prevalence of acute myeloid leukemia decreases with advancement in age among the children, with the acute lymphoblastic Leukemia prevalence increasing among the older children. Nonetheless, incidents of type ALL and MLA leukemia tend to disappear among the youth. However, their ages make them susceptible to leukemia associated with adults.

The cause of leukemia is not well known, however it is attributed to factors such as genetics, environment, and exposure to ionizing radiations. For example, it is indicated that leukemia is prevalent in areas with high socioeconomic status such as United States while it is absent in undeveloped nations including Africa. In addition, studies indicate that infants exposed to hazardous chemicals such as benzene are likely to develop leukemia because the substance has carcinogenic properties (Schrappe et al., 2012).

Additionally, other sources indicate that exposure to chemicals such as pesticides and herbicides during pregnancy or infancy stage increases the risks of a child from developing leukemia. However, reviews indicate that these factors accounts for a small percentage of the overall causes of the leukemia. For example, genetic factors are identified to as accounting for two to three percent of the causes while exposure to radiations accounts for ten to twelve percent.

These predisposing factors cause the development of leukemia by inducing mutations in blood formation process. During the fetal infancy stage of a child, blood formation is quite rapid. The degree of blood formation makes the cells vulnerable to infections. As a result, the exposure an infant to these factors causes damage to blood cell resulting to mutations and duplication of genes and chromosomes thereby causing the development of leukemia. For example, ALL type of leukemia is caused by uncontrolled multiplication of undeveloped white blood cells and lymphoid cells within the bone marrow (Wiemels, 2012).

In addition, it has been confirmed that exposure to ionizing radiations coming from atomic bombs and diagnostic imaging during infancy and early childhood results to developing acute leukemia. Nonetheless, it is identified that other factors including parental smoking, traffic fumes, household chemicals, and mother and infant diet contribute to leukemogenesis (Pui et al., 2014). For example, MLL translocation is linked to chemical substances containing topoisomerase, which causes both lymphoid and myeloid leukemia.

The initial stage of leukemia development among the children is identified as fetal stage. For example, a study of neonatal blood belonging to a patient suffering from leukemia indicates that the translocation of chromosomes occur at prenatal stage, thereby initiating the development of the disease. However, a small fraction of the preleukemic clones that developed in the prenatal progresses to the acute stage of leukemia. Furthermore, a weak immune system exposes children to viral causing diseases, which increases the chances of leukemic mutations thereby resulting to increased chances of developing acute leukemia (Wiemels, 2012).

Although vaccination and immunity developed from normal disease infections offer protection against common ailments, children who are born with leukemia have a weaker immunity system making them vulnerable to disease attacks. For example, United Kingdom Childhood Cancer Study (UKCCS) determine that children born with leukemia frequently suffered from infections as compared with those born without it. Additionally, children born with leukemia have higher infectious occurrences when they engage in outdoors social activities, a phenomenon which is not observed in children who are born healthy. The study demonstrated that a weak immune system, which is susceptible to common ailments, is an underlying factor behind the development of leukemia in children. Consequently, children born with dysfunctional immunity system are likely to develop leukemia in comparison to those who were born with strong immune system. Additionally, a blend of postnatal infections and abnormal immune response advances the development and progression of leukemia to its fatal stages.

According to Krishnan and Rajasekaran (2014), the improvement of therapeutic interventions to pediatric cancer has increased the survival rate of children suffering from leukemia type ALL by more than ninety percent. The treatment of leukemia involves administration of combined chemotherapeutics interventions in doses that can be tolerated by the affected individuals. The utilization of such of combined interventions allows achievement of a complete and lasting remission. Additionally, combined therapies aid in preventing multiplication of cancerous cells and reduce the development of resistance of the cancer chemotherapy. Examples of drugs used in chemotherapy include dexamethasone, carboplatin, and methotrexate (Wiemels, 2012).

Furthermore, conventional chemotherapeutics are used in the treatment and management of leukemia by inducing cytotoxic compounds into the rapidly multiplying cell. However, conventional chemotherapeutics negatively affects cell division and denatures cells thereby resulting to side effects, including reduced immunity and anemia. Although, current therapeutic interventions have greatly aid in saving the lives of children suffering from leukemia, the drugs used affects both normal cells and cancerous. As a result, there is need to emphasize the usage of drugs that have been approved to reduce side effects related to chemotherapy in children (Krishnan & Rajasekaran, 2014).

However, the successes of therapeutic interventions to leukemia are hampered by the complication resulting from the administration of drugs and chemotherapy. The examples of complications related with treatment of leukemia include relapse, cardiac and pulmonary diseases, secondary cancer, and impaired growth. Relapse has been identified as the major cause of failure in treatment of leukemia. According to research, relapse is caused by administration of inadequate therapy. Relapse commonly occur in patients who fail to finish remission or who are in the early stages of induction. Nonetheless, relapses can be addressed by individualizing therapy practices to suit the condition of a patient (Schrappe et al., 2012).

Therefore, leukemia is a blood cancer, which is commonly prevalent among the children. Its major types include ALL acute lymphoblastic leukemia. Leukemia type ALL adversely affects children especially in their earlier stages of development. However, the rate of acute myeloid leukemia prevalence is lower accounting to twenty percent leukemia deaths while ALL accounts for over eighty percent of the deaths. Studies indicate that the main cause of leukemia is not known but factors such as environment, genetics, and exposures to ionizing radiations contribute to its development. These factors alter the process of blood formation resulting to uncontrolled multiplication of blood cells, a major characteristic of leukemia. Nonetheless, other factors including exposure to chemicals, diet and cigarette smoking propagate the development of leukemia among the children. A weak immune system and frequent infections are attributed to a higher rate of the development of leukemia (Wiemels, 2012).

The literature review indicates clearly that pediatric leukemia is responsible for more than one-third of all cancer related deaths among the children. Despite the importance of vaccination and immunity in offering protection against common ailments, children born with leukemia have a weaker immunity system, thereby making them vulnerable to disease attacks. This indicates the need for effective interventions and treatment methods that can contribute toward improving the health status of the affected children (Krishnan & Rajasekaran, 2014).

Furthermore, therapeutic interventions, including chemotherapy, have been used to treat leukemia among children. The use of chemotherapy in the treatment of leukemia is characterized by both positive and negative results. For example, with chemotherapy the lives of ninety percent of the children affected have been saved. However, the administration of chemotherapy leads to negative implications, including relapse, secondary cancer, and respiratory infections (Schrappe et al., 2012). Nonetheless, with the use of appropriate drugs and adequate therapy, successful treatment of pediatric cancer can be realized.

Conclusion

The literature review has allowed the author to research the topic of Pediatric Leukemia. Childhood Leukemia is classified by the following two criteria; the first is the onset and natural course of the illness. This differentiates between acute and chronic this is determined by the timing of the diagnosis, the onset of symptoms and the start of treatment. The second is the cell lineage from which the leukemic cells arise. This is important to understand as it defines the classification of leukemia such as ALL and AML. This research review’s purpose is to help newly hired nurses understand the criteria and teach on pediatric leukemia. The author and the newly hired nurses care for a high population of children on their unit with a diagnosis of leukemia. It is significant to understand the researched criteria as it relates to the disease process, the different types of leukemia, immunity and treatment. The teaching objectives will focus on these topics.

References

Krishnan, V., & Rajasekaran, A. K. (2014). Clinical nanomedicine: A solution to the chemotherapy conundrum in pediatric leukemia therapy. Clinical Pharmacology & Therapeutics, 95(2), 168-78.

Pui, C. H., Pei, D., Campana, D., Cheng, C., Sandlund, J. T., Bowman, W. P., ... & Howard, S. C. (2014). A revised definition for cure of childhood acute lymphoblastic leukemia. Leukemia, 28(12), 2336-2343.

Schrappe, M., Hunger, S. P., Pui, C. H., Saha, V., Gaynon, P. S., Baruchel, A., ... & Escherich, G. (2012). Outcomes after induction failure in childhood acute lymphoblastic leukemia. New England Journal of Medicine, 366(15), 1371-1381.

Wiemels, J. (2012). Perspectives on the causes of childhood leukemia. Chemico-biological interactions, 196(3), 59-67.

UKCCS-Welcome. (n.d). Retrieved February 07, 2017, from

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