Childhood Leukemia: The Future Looks Bright

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    Laura Hogan, MD, is a pediatric oncologist and childhood leukemia expert at Stony Brook Long Island Children’s Hospital. She is also an Assistant Professor of Pediatric/Hematology Oncology, Department of Pediatrics, Stony Brook University School of Medicine. At the age of three, she was diagnosed with acute lymphocytic leukemia (ALL), the most common form of childhood leukemia. By the age of six, with her health fully restored, Dr. Hogan went on to lead a completely normal childhood. She has devoted her life’s work to children with ALL.

    What is leukemia?
    Leukemia, which is also known as the “liquid tumor,” is cancer of the blood. It starts in the bone marrow, the spongy internal part of the bone where new blood is made, and spreads to the blood system. Acute lymphocytic leukemia (ALL) accounts for approximately 25 to 30 percent of all childhood cancers. “Acute” means that the disease progresses rapidly. According to the Children’s Oncology Group (COG), the largest cooperative research entity in the world, about 2,900 new cases of ALL are diagnosed in children and adolescents (0 to 21 years of age) in the United States each year.

    What causes it?
    The causes of childhood leukemia are unknown, however, family history and exposure to radiation may play a role. What we do know is that leukemia starts when a single, young white blood cell called a “blast” develops a series of mutations that allows it to grow uncontrollably. These abnormal cells crowd out healthy blood cells. The healthy cells are unable to perform their infection-fighting function in the bloodstream.

    What are the symptoms?
    A child with ALL is more likely to bleed and have infections. Fatigue, pallor, fever, bone pain and bruising or flat red spots under the skin caused by bleeding are also common symptoms. Diagnosis is made through a physical exam, blood tests and a bone marrow aspiration and biopsy.

    What is the survival rate?
    The survival rate for children with ALL is now at 80 to 90 percent. This tremendous improvement from just four decades ago is due largely to the standardization of therapy using a combination of new chemotherapeutic agents, transfusions of blood platelets or red blood cells, and antibiotics to fight infection. Cooperative group studies have also shown that when the central nervous system is treated, the survival rate also increases.

    What kind of care does Stony Brook offer?
    Our patients receive a nationally recognized standard of care from topexperts in leukemia. State-of-the-art treatment is delivered right here, so there is no need to travel miles away from home. Stony Brook is part of the COG, which is composed of more than 6,500 physicians, nurses and other researchers. COG-member hospitals treat 90 percent of the children in the U.S. with cancer, using identical treatment protocols. We enroll most of our young patients with leukemia in COG-standardized clinical trials and this has tremendously improved the outcomes of children with cancer nationwide including Stony Brook. Children are very adaptable; their bodies tolerate more frequent and intense cancer therapy better than adults. We are currently developing a program to identify those patients who are at risk for developing neurocognitive problems in childhood cancer survivors, including those with ALL, and to develop strategies to address these issues.

    How does the Stony Brook School Re-Entry Program help your patients?
    This groundbreaking, nationally and internationally acclaimed program was developed by nurse practitioners and child life specialists at Stony Brook to ensure a smooth, back-to school transition for our young patients who have just undergone intensive cancer therapy. The program helps educate students, teachers, school administrators and other parents about childhood cancer, while creating a productive and supportive environment to meet the individual needs of the patient. It’s a testament to the success of the program that every school district in Suffolk County now offers this program, and many schools in Nassau County have embraced it as well.

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