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Acute Basophilic Leukemia in Children

Leukemia is a blood cancer. A blood cancer that gets worse quickly if not treated is known as acute leukemia. Leukemia accounts for one of every four cancers in children, and almost all leukemias in children are the acute type.

Anatomy of  a bone, showing blood cells
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Most blood cells are made in the bone marrow, the spongy insides, of long bones. Red blood cells, white blood cells, and platelets are all made in bone marrow. Red blood cells carry oxygen to the body. White blood cells fight infections. Platelets help blood clot. When leukemia develops, the cells that would have become healthy white blood cells lose the ability to control their growth and development, and they crowd out all other types of blood cells. 

Facts about acute basophilic leukemia

Acute basophilic leukemia (ABL) is a rare type of acute leukemia. In ABL, the abnormal white blood cells that are being overproduced are the basophils. Basophils are the rarest type of white blood cell. They usually make up less than 1 percent of all white blood cells.

Doctors do not know what causes ABL. Other types of acute leukemia have been linked to certain changes in genes, called mutations, or to certain types of genetic diseases that babies are born with, such as Down syndrome. No specific genetic abnormalities or genetic disease have been linked to ABL.

Symptoms

Acute leukemia symptoms are caused by the decrease in all healthy blood cells. The abnormal white blood cells in acute ABL are not mature and don't function like healthy white blood cells, so they do not help fight infections. This can lead to frequent infections. A decrease in red blood cells can cause pale skin and weakness. A decrease in platelets can cause easy bleeding, bruising, or bursting of tiny blood vessels in the skin.

Other symptoms are caused by the buildup of abnormal white blood cells inside bones and other parts of the body:

  • Fever

  • Night sweats

  • Lumps in the skin

  • Pain in the bones or joints

  • Stomach pains

  • Trouble breathing

Diagnosis

Diagnosis begins with a complete medical history and physical examination. Blood tests and an examination of body tissues under a microscope are the most important ways for doctors to tell if a child has acute leukemia.

These tests may be done:

  • Complete blood count. Blood is drawn, and the number of red cells, white cells, and platelets are measured. The amount of oxygen carried by the red blood cells is also measured.

  • Peripheral blood smear. A blood sample is looked at under a microscope to see what type of white blood cell is present. In ABL, there may be many immature basophils and few mature basophils.

  • Bone marrow biopsy. This test uses a hollow needle to remove pieces of bone marrow to be examined under a microscope. A specialist called a pathologist will look at this tissue to see if there is cancer in the bone marrow. Other areas of the body where cancer cells may be present may also be biopsied.

  • Cytogenic analysis. This test looks at cells from the blood or bone marrow in special ways to see if there are any genetic abnormalities in the cells.

  • Lumbar puncture, or spinal tap. This test is done by placing a needle into the spinal area to withdraw spinal fluid, which is then checked to see if it contains any blood cancer cells.

Treatment

Treatment for ABL depends on the child's age, symptoms, and overall health. These are common treatments:

  • Chemotherapy. This drug-based treatment works by interfering with a cancer cell's ability to keep growing. These drugs may be given as pills, injections, through an intravenous line, or through a needle into the spinal cord area.

  • Radiation therapy. This treatment uses X-rays to target cancer cells.

  • Stem cell bone marrow transplant. Stem cells are cells that can develop into healthy blood cells. Chemotherapy, sometimes combined with radiation therapy, can be used to destroy cancer cells in the bone marrow, and then healthy stem cells from a matched donor are used to replace the cancer cells.

  • Supportive treatment. Symptoms of low red blood cells (anemia) or low platelets may be temporarily treated with a blood transfusion. Antibiotics may be used to treat infections.

Treatment of ABL is done in stages. In the first stage, called induction, chemotherapy is given to stop the growth of cancer cells. This stage can last about one month. Then, if cancer cells can no longer be seen under a microscope, the child is said to be "in remission."

Intensification or consolidation is the next stage. Because remission doesn't mean that the cancer is gone, cancer cells will continue to be targeted with chemotherapy. Chemotherapy may be given into the spinal cord area during this stage to prevent the cancer from spreading to the brain or spinal cord. Radiation therapy may also be given.

Managing ABL

Acute leukemia in children is a disease that affects the whole family. Treatment and management requires a complete caregiving team that includes medical specialists, as well as nursing, nutritional, social, and psychological support. Parents should learn as much as they can about acute leukemia and work closely with their child's treatment team.

Follow-up care to find and treat any cancer relapse as soon as possible is extremely important and may last for several years. Because ABL is such a rare disease, little is known about long-term survival. Most children with acute leukemia now survive for five years after treatment, and most children who survive for five years will never have a recurrence.  

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