A leukemic cell is a type of immature white blood cell that accumulates in the marrow, blood, and tissue. Because they are immature and poorly differentiated, they have a prolonged life span and rapid rate of proliferation. Production of normal red cells, white cells, and platelets is inhibited. A lymphoblast is an immature white cell that crowds out normal cells, resulting in pancytopenia and immunosuppression. In a child with ALL, the bone marrow may be replaced by 80-100% blast cells.

Leukemic cells can cross the blood-brain barrier, causing involvement of the central nervous system (CNS). Because of this, presenting symptoms in ALL include fever, pallor, bruising, and bone pain. Lymphadenopathy, splenomegaly, and hepatomegaly caused by infiltration of lymphoblasts are common in ALL. In AML, children may present with vague flulike symptoms, or symptoms may be severe and life-threatening with bleeding and severe hemorrhage. There is a higher incidence of CNS involvement at the time of diagnosis.

A bone marrow aspiration and blood work confirm the diagnosis. In ALL, the white blood count and age of the child at diagnosis are prognostic indicators. Children between the ages of 3 and 5 and those with a white blood cell count less than 50,000/mm3 have the best prognosis. Children who are younger than 2 years or older than 10 years of age at diagnosis and those with a white blood cell count over 50,000/mm3 have a poorer prognosis.

Chemotherapy is the treatment of choice and is started shortly after confirmation of diagnosis. The goal of the first phase is remission, meaning that there is no detectable sign of leukemia on physical exam or lab
results. This usually occurs within 4 weeks. CNS prophylaxis is also administered intrathecally into the cerebrospinal fluid space.

Consolidation is the next phase of treatment and starts after remission has been attained to further decrease the number of leukemic cells in the body. Chemotherapy is again given in high doses to eradicate any residual leukemic cells. This phase is intense and lasts several months.

The goal of maintenance therapy is to prolong remission with monthly blood counts to evaluate the marrow’s response to the drugs. Almost 80% of children achieve a long-term disease-free life. The maintenance phase lasts for 2-3 years after diagnosis.

Hodgkin’s disease most often originates in the cervical lymph node regions, and a definitive cure is possible depending on staging, histology, and time of diagnosis. In 60-90% of cases individuals present with nontender enlarged lymph nodes. In children, anorexia, malaise, and weight loss may also be accompanying symptoms. Hodgkin’s disease is classified as either “A” or “B” depending on whether or not significant weight loss, fever, or night sweats are present (“A,” not present; “B,” present). As the disease progresses metastasis to the liver, lungs, digestive tract, and spleen may occur.