Paediatric Acute Lymphocytic Leukaemia

Paediatric acute lymphocytic leukaemia (also called acute lymphoblastic leukaemia, ALL) is a blood cancer that starts in young white blood cells called lymphocytes in the bone marrow (the soft centre of bones that makes blood cells). In this disease, many abnormal “blast” cells grow very fast and do not grow into healthy cells. These blasts crowd out normal red cells, white cells, and platelets, so the child can become tired, get infections easily, and bleed or bruise more. ALL is the most common cancer in children, and it usually develops quickly, over days to weeks, so early diagnosis and treatment are very important. Cancer.gov+1

Paediatric acute lymphocytic leukaemia (ALL) is a cancer of the blood and bone marrow in children. In this disease, the bone marrow makes too many immature white blood cells called lymphoblasts. These abnormal cells crowd out normal red cells, platelets, and healthy white cells. This can cause fever, tiredness, bruising, infections, bone pain, and swelling of lymph nodes or the belly. Modern treatments have made survival very high, especially when care is given in a specialised paediatric cancer centre. Cancer.gov+2Cancer.gov+2

Paediatric ALL is usually diagnosed when at least about one quarter of the bone marrow cells (25% or more) are leukaemia blast cells of lymphoid type. Doctors use blood tests, bone marrow tests, and other studies to confirm the diagnosis and decide the treatment plan. Blood Cancer United+1

Another Names

Paediatric acute lymphocytic leukaemia has several other names. Doctors often use these different names to mean the same or very similar conditions. Cancer.gov+1

1. Childhood acute lymphoblastic leukaemia (childhood ALL)
This is the most common name in medical books. “Childhood” shows that it happens in children. “Acute” means the disease grows fast. “Lymphoblastic” means it starts from immature lymphocyte cells. Cancer.gov

2. Paediatric acute lymphoblastic leukaemia (paediatric ALL)
“Paediatric” means in children and teenagers. This name is often used in children’s cancer centres and research articles. It is the same disease as childhood ALL. Cancer.gov+1

3. Acute lymphocytic leukaemia in children
“Lymphocytic” is another word instead of “lymphoblastic.” Many doctors and older articles use “acute lymphocytic leukaemia (ALL)” to mean the same thing. The main idea is still a fast-growing leukaemia of lymphocyte cells in children. PubMed+1

4. Childhood B-cell acute lymphoblastic leukaemia
This name is used when the abnormal lymphoblasts come mainly from B cells (one type of lymphocyte). B-cell ALL is the most common type of ALL in children. Cancer.gov+1

5. Childhood T-cell acute lymphoblastic leukaemia
This name is used when the blasts come from T cells (another type of lymphocyte). T-cell ALL is less common than B-cell ALL but is still an important type in children and teens. Cancer.gov+1

Types

Doctors divide paediatric ALL into types, because types can affect treatment and prognosis (outlook). Cancer.gov+1

1. B-cell precursor ALL
This is the most common type in children. The cancer starts from early (precursor) B cells. It often responds very well to modern chemotherapy when found and treated early. Cancer.gov+1

2. T-cell ALL
This type starts from T-cell lymphoblasts. Children with T-cell ALL may have a large mass in the chest and more white cells at diagnosis. Treatment is more intensive, but outcomes have improved with modern protocols. Cancer.gov+1

3. Standard-risk (low-risk) ALL
This is not a different cell type, but a risk group. Standard-risk ALL usually means the child is between about 1–10 years old, has a lower white blood cell count at diagnosis, and has certain favourable lab features. These children often have an excellent chance of cure with usual therapy. Cancer.gov+1

4. High-risk ALL
High-risk ALL means the child has features such as very high white blood cell counts, very young age (under 1 year) or older age (over 10 years), certain chromosome changes, or slower response to early treatment. High-risk ALL needs stronger treatment and closer follow-up. Cancer.gov+1

5. Relapsed or refractory ALL
Relapsed ALL means the disease comes back after it was in remission. Refractory ALL means it never went fully into remission after treatment. These types are harder to treat and may need special drugs or stem-cell transplant. Cancer.gov+1

Causes

For most children with ALL, doctors cannot find one clear cause. Instead, they talk about “risk factors,” which are things that may increase the chance of disease. Having a risk factor does not mean a child will definitely get leukaemia. Cancer.gov+1

1. Unknown main cause
In many children, no specific cause is found. The disease may come from a mix of genes and environment acting together in ways we still do not fully understand. PMC

2. Inherited genetic changes
Some children are born with gene changes (mutations) that can increase the risk of ALL. These changes can affect how blood cells grow and repair DNA damage. PMC+1

3. Down syndrome (Trisomy 21)
Children with Down syndrome have a higher risk of acute leukaemias, including ALL, because their extra chromosome and related gene changes can make blood cell development more unstable. Cancer.gov+1

4. Other inherited syndromes
Conditions such as Li-Fraumeni syndrome, neurofibromatosis type 1, and some DNA repair disorders can raise leukaemia risk. These conditions affect tumour-suppressor genes or DNA repair genes. PMC+1

5. High-dose ionising radiation before birth or in early life
Exposure to high levels of ionising radiation (for example, from atomic bomb explosions or some medical radiation used in the past) is a proven environmental risk for acute leukaemia in children. PMC

6. Previous chemotherapy for another cancer
Children treated earlier with certain chemotherapy drugs for a different cancer can later develop secondary leukaemia, including ALL, because the drugs can damage bone marrow DNA. Cancer.gov+1

7. Family history of leukaemia
If a close family member (such as a sibling) had leukaemia, the risk is slightly higher, possibly due to shared genes and shared environment, although the absolute risk is still low. PMC

8. Parental exposure to high-dose radiation or some chemicals
Some studies suggest that parents who work with large amounts of ionising radiation or certain chemicals like benzene might have a slightly higher chance of having a child with leukaemia, although results are not always consistent. PMC

9. Benzene and similar industrial chemicals
Benzene is a chemical used in some industries and is known to damage bone marrow. Long-term, high-level exposure is linked to blood cancers, including leukaemia, although this is more clearly proven in adults. PMC

10. Very high-dose radiation therapy to the child
When a child receives high-dose radiation therapy (for example, for brain tumours), there is a small long-term risk of later developing leukaemia, because the bone marrow and DNA can be damaged. Cancer.gov+1

11. Certain viral infections (possible, not proven)
Some researchers study whether early-life infections or abnormal immune responses might play a role in triggering leukaemia in children who already have pre-leukaemic cells, but there is no single proven leukaemia virus for common paediatric ALL. PMC

12. Older parental age at birth
Several studies show a small increase in childhood leukaemia risk when mothers or fathers are older at the time of the child’s birth, maybe because of more gene changes in reproductive cells. PMC

13. Very high birth weight
Some research links high birth weight with a slightly higher risk of ALL. This may be related to growth factors and hormones that affect marrow cells before birth. PMC

14. Planned pre-labour caesarean section (small risk increase)
A large Swedish study found a modestly higher risk of ALL in children born by planned caesarean section before labour, possibly due to differences in stress hormones or early microbiome exposure. However, the overall risk is still very low. Live Science

15. Tobacco smoke during pregnancy or early life (possible risk)
Exposure to tobacco smoke before birth or in early life may slightly increase the risk of childhood leukaemia, because smoke contains chemicals that can damage DNA. PMC

16. Strong environmental pollution exposure
Living near heavy industrial pollution, some pesticides, or traffic air pollution has been studied as a possible risk, but results are mixed and usually show only small effects, if any. PMC

17. Abnormal immune system regulation
Some theories suggest that in children with certain gene changes, a delayed or abnormal response of the immune system to infections might help trigger ALL. This is still being studied and is not fully proven. PMC

18. Pre-leukaemic clones before birth
Studies of newborn blood spots show that some babies already have early gene changes (pre-leukaemic clones). Most of these babies never develop cancer, but if more hits (extra mutations) occur later, ALL can appear. PMC+1

19. Male sex
ALL is a little more common in boys than in girls. Sex-linked biological differences, such as hormones or immune responses, may play a role, but reasons are not fully known. Cancer.gov+1

20. Interaction of many small factors
Most experts think that childhood ALL happens because several small genetic and environmental factors work together over time. No single factor explains the disease for most children. PMC+1

Symptoms

Symptoms of paediatric ALL often appear over a short time, because the bone marrow fills with blasts and normal blood cells fall. Cancer.gov+1

1. Fever
Many children have repeated or long-lasting fevers. The fever may come from infections (because white cells do not work well) or from the cancer itself causing inflammation. Cancer.gov+1

2. Weakness and tiredness (fatigue)
Because the marrow makes fewer red blood cells, the child’s body carries less oxygen. This causes tiredness, low energy, and sometimes dizziness or shortness of breath with small efforts. Cancer.gov+1

3. Pale skin (anaemia)
Low red blood cells (anaemia) make the child look pale, especially on the face, lips, and inside the eyelids. The child may also feel cold more easily. Cancer.gov+1

4. Easy bruising and bleeding
With low platelets, the child bruises easily, may have frequent nosebleeds, bleeding gums, or bleeding that is hard to stop after small cuts. Cancer.gov+1

5. Tiny red or purple spots on the skin (petechiae)
Very small spots can appear on the skin from bleeding under the skin due to low platelets. They do not fade when pressed. Cancer.gov

6. Bone or joint pain
Leukaemia cells can build up inside the bone marrow and press on bone lining and joints, causing pain or tenderness. Children may limp or refuse to walk or play. Cancer.gov+1

7. Swollen lymph nodes
Painless swellings can appear in the neck, underarms, groin, or above the collarbones. These happen when leukaemia cells collect in lymph nodes. Cancer.gov+1

8. Swollen belly (enlarged liver or spleen)
The liver and spleen can grow because leukaemia cells settle there. The child may feel full, have belly pain, or look like the tummy is big. Cancer.gov+1

9. Frequent infections
Although the white blood cell count can be high, many of these cells are abnormal and do not fight germs well. The child can get repeated infections, such as sore throats, ear infections, or chest infections. Cancer.gov+1

10. Shortness of breath or trouble breathing
Low red cells, chest infections, or a large mass in the chest (especially in T-cell ALL) can make breathing hard. The child may breathe fast or struggle when lying flat. Cancer.gov+1

11. Loss of appetite and weight loss
Children may not feel like eating due to tiredness, belly fullness, or feeling unwell, which can lead to weight loss over weeks or months. Cancer.gov+1

12. Headache, vomiting, or vision problems
If leukaemia reaches the brain or spinal fluid, the child can have headaches, morning vomiting, neck stiffness, or visual changes. These are signs that need urgent medical care. Cancer.gov+1

13. Night sweats or feeling very hot at night
Some children sweat a lot during sleep, sometimes soaking clothes or bed sheets. This can be a “B symptom” of blood cancers. Cancer.gov+1

14. Irritability and behaviour changes
Feeling tired, in pain, or unwell can make a child more irritable, clingy, or less active. Parents may notice school performance going down or the child not wanting to play. Children’s National Hospital+1

15. Swelling of the testicles (in boys)
In some boys, leukaemia cells can collect in the testicles, causing one or both to swell or feel firm, usually without pain. Cancer.gov+1

Diagnostic Tests

Doctors use many tests together to diagnose paediatric ALL, to see how far it has spread, and to plan treatment. Cancer Research UK+1

Physical Exam Tests

1. Full medical history and physical examination
The doctor asks about symptoms (fever, bruising, pain, weight loss) and checks the whole body. They look at the child’s general appearance, growth, movement, and any signs of illness. This helps decide which tests to do next. Cancer.gov+1

2. Vital signs check (temperature, pulse, breathing, blood pressure)
Nurses and doctors check fever, heart rate, breathing rate, and blood pressure. These basic signs show how sick the child is and help guide urgent care, such as fluids or antibiotics. Children’s National Hospital+1

3. Skin, gums, and nose examination
The doctor looks for bruises, petechiae, very pale skin, bleeding gums, or frequent nosebleeds. These signs suggest problems with platelets or red cells and support the suspicion of leukaemia. Cancer.gov+1

4. Belly and lymph node examination
The doctor gently presses on the neck, armpits, groin, and abdomen to feel lymph nodes, liver, and spleen. Enlarged organs or nodes can be a clue that abnormal blood cells are collecting outside the bone marrow. Cancer.gov+1

Manual Tests (bedside assessments done by hand)

5. Bone and joint palpation
By pressing on bones and moving joints, the doctor checks for pain or tenderness. Pain in long bones or joints can be a sign of marrow packed with leukaemia cells. Cancer.gov+1

6. Manual measurement of liver and spleen size
Using their hands and a measuring tape, doctors estimate how far the liver and spleen extend below the ribs. Changes in size over time help judge how the disease responds to treatment. Parkway Cancer Centre+1

7. Simple neurological bedside tests
The doctor checks strength, reflexes, balance, and sensation with simple bedside methods (like tapping tendons or asking the child to walk). These tests look for nervous system problems that might be due to leukaemia in the brain or spine. Cancer.gov+1

Lab and Pathological Tests

8. Complete blood count (CBC) with differential
This blood test counts red cells, white cells, and platelets and shows different white cell types. Many children with ALL have low red cells and platelets and either low or very high white cells. Abnormal blasts may be seen in the blood. Cancer Research UK+1

9. Peripheral blood smear
A thin blood layer is placed on a slide and looked at under a microscope. The pathologist checks the shape and size of blood cells and can often see blast cells that suggest leukaemia. Cancer Research UK+1

10. Blood chemistry tests
These tests measure how well organs like the liver and kidneys work and check minerals and chemicals in the blood. They help see if there are problems like tumour lysis (fast cell breakdown) or organ stress before and during treatment. Cancer Research UK+1

11. Coagulation (clotting) tests
Tests such as PT, aPTT, and fibrinogen show how well the blood is clotting. Some children with ALL have clotting problems, and doctors must know this before procedures like lumbar puncture. Cancer Research UK+1

12. Bone marrow aspiration
A needle is put into a large bone (usually hip bone) to take liquid marrow. The sample is examined to count blasts, to confirm leukaemia, and to learn what type of ALL it is. Diagnosis usually needs at least about 25% blasts in the marrow. Cancer Research UK+1

13. Bone marrow biopsy (trephine)
A small core of bone and marrow is removed with a slightly thicker needle. This shows the marrow structure and how full it is of blasts. Aspiration and biopsy are often done together. Cancer Research UK+1

14. Flow cytometry (immunophenotyping)
This test uses special antibodies and a machine to study markers on the surface of blast cells. It tells whether the leukaemia is B-cell or T-cell type and helps classify the exact subtype. Cancer.gov+1

15. Cytogenetic and molecular tests (karyotyping, FISH, PCR)
These tests look at chromosomes and genes in leukaemia cells. They can find changes such as extra or missing chromosomes or fusion genes (for example, BCR-ABL1). These results help place the child in standard-risk or high-risk groups and guide targeted therapies. Cancer.gov+1

Electrodiagnostic Tests

16. Electrocardiogram (ECG / EKG)
An ECG records the heart’s electrical activity. Children with ALL often need an ECG before and during treatment, because some chemotherapy drugs can affect the heart. This test helps check that the heart rhythm is safe. Cancer.gov+1

17. Electroencephalogram (EEG) when there are seizures or CNS symptoms
If a child with ALL has seizures or concerning neurological symptoms, an EEG may be used to record brain electrical activity. This test does not diagnose leukaemia itself but helps detect brain irritation or seizures due to disease or treatment problems. Cancer.gov+1

Imaging Tests

18. Chest X-ray
A chest X-ray can show a large mass in the centre of the chest (mediastinum), enlarged lymph nodes, or lung problems such as infection. This is especially important in T-cell ALL, where a big chest mass can affect breathing. Cancer Research UK+1

19. Abdominal ultrasound
Ultrasound uses sound waves to look at organs in the belly. It can show enlarged liver, spleen, or lymph nodes and can help check for other problems such as fluid or organ damage. Parkway Cancer Centre+1

20. CT or MRI scans (head, chest, abdomen)
CT scans use X-rays and computers, while MRI uses magnets, to make detailed pictures of inside the body. These scans can help detect masses, organ enlargement, or brain and spinal involvement. They are used when physical exam or other tests suggest deep-seated disease. Cancer.gov+1

Non-pharmacological treatments (therapies and others)

1. Family education and counselling
   Education means explaining the disease, treatment plan, possible side effects, and long-term outlook in very simple words to parents and older children. Counselling helps families cope with fear, stress, and sadness. Better understanding makes it easier to follow complex treatment schedules and to notice side effects early. This support is evidence-based and part of standard care in paediatric oncology centres. Cancer.gov+1

2. Psychological support and play therapy
   Psychologists and play therapists use games, stories, drawing, and role play to help children express emotions and reduce anxiety about hospital tests and chemotherapy. This lowers distress, improves sleep and appetite, and can make procedures easier to perform. Emotional support is linked to better treatment adherence and quality of life during long ALL therapy. Cancer.gov+1

3. School support and cognitive rehabilitation
   Because treatment can last two to three years, children may miss school and sometimes have attention or memory problems from illness or therapy. Hospital teachers, special education plans, and simple cognitive exercises help protect learning and social development. Early support can reduce long-term school difficulties after completion of ALL treatment. Cancer.gov+1

4. Physical activity and physiotherapy
   Gentle, supervised exercise and stretching help maintain muscle strength, balance, and joint movement. Physiotherapists design safe activities, especially when children feel weak or have steroid-related muscle problems. Regular movement can reduce fatigue, prevent stiffness, and support heart and bone health during and after chemotherapy. PMC+1

5. Infection-prevention hygiene practices
   When white blood cells are low, simple hygiene steps become vital. These include frequent handwashing, masking when needed, avoiding sick contacts, careful food handling, and prompt care of cuts. Hospitals also use isolation rules when counts are very low. These measures lower the risk of serious infections in neutropenic children with ALL. Cancer.gov+1

6. Nutrition counselling
   Dietitians monitor weight, growth, and nutrient intake. They help families choose safe, appealing foods that meet energy and protein needs, even when nausea or mouth sores are present. Evidence suggests that extremely strict “neutropenic diets” may not always be necessary, but food safety and adequate nutrition are essential for recovery and healing. The Lancet+2PMC+2

7. Management of treatment side effects without drugs (where possible)
   Non-drug strategies include small, frequent meals for nausea, mouth rinses for mucositis, gentle massage or distraction for pain, and sleep hygiene for insomnia. These approaches are used together with medicines, not instead of them, to make chemotherapy more tolerable and to maintain quality of life. Cancer.gov+1

8. Social work and financial support services
   Social workers help families with transport to hospital, temporary housing near treatment centres, financial aid, school letters, and communication with employers. This practical support can reduce stress and prevent interruptions in treatment caused by money or travel problems. Cancer.gov+1

9. Fertility and long-term effect counselling (age-appropriate)
   Some treatments for ALL can affect fertility or cause later health problems. Oncologists discuss possible long-term effects with parents and, when appropriate, with older children or teens. They may refer to fertility specialists or survivorship clinics. Knowing these issues early helps families plan and attend follow-up care. Cancer.gov+1

10. Spiritual and cultural support (where desired)
    Many families find comfort in religious or cultural practices. Hospitals may offer chaplaincy services or space for prayer and meditation. Respecting cultural beliefs while following medical guidelines can improve trust and cooperation with the treatment plan. Cancer.gov+1

Drug treatments for paediatric acute lymphocytic leukaemia

Chemotherapy and newer targeted or cellular therapies are the main drug treatments for paediatric ALL. Exact drug choices, doses, and timing follow strict protocols developed in large clinical trials and must be customised by paediatric oncologists. Cancer.gov+2PMC+2

1. Vincristine (Vincasar, others)
   Vincristine is a chemotherapy drug from the plant alkaloid class. It blocks cell division by interfering with microtubules inside dividing cells. It is given by intravenous infusion on specific days during induction, consolidation, and maintenance in many protocols. Dose and schedule are carefully calculated by body size and age because of risks like nerve damage and constipation. FDA Access Data+2FDA Access Data+2

2. Prednisone or dexamethasone (steroids)
   These corticosteroids help kill leukaemia cells and reduce inflammation. They are usually given orally or intravenously in the induction phase and sometimes later phases. They also help shrink swollen lymph nodes. Doses, often taken once or several times daily for set courses, are adjusted by weight or body surface area. Side effects can include increased appetite, mood changes, high blood sugar, and infection risk. Cancer.gov+2Haematologica+2

3. Asparaginase (L-asparaginase, PEG-asparaginase)
   Leukaemia cells need the amino acid asparagine to grow. Asparaginase removes asparagine from the blood, starving these cells. It is given by injection into a vein or muscle on scheduled days, mainly during induction and consolidation phases. Side effects may include allergic reactions, pancreatitis, blood clot or bleeding problems, and liver enzyme changes, so careful monitoring is essential. Cancer.gov+2Haematologica+2

4. Methotrexate (oral, intravenous, intrathecal)
   Methotrexate is an antimetabolite chemotherapy drug that blocks folate pathways needed for DNA synthesis. It is used by mouth for maintenance, in higher IV doses during consolidation, and directly into spinal fluid (intrathecal) to protect the brain and spinal cord from ALL cells. Doses and timing vary by protocol and require blood-level monitoring to avoid kidney or liver toxicity. Haematologica+2Cancer.gov+2

5. 6-mercaptopurine (6-MP)
   6-MP is another antimetabolite used daily by mouth during long maintenance therapy. It interferes with purine metabolism in leukaemia cells. The dose is adjusted based on blood counts and liver tests. Too much can cause severe low blood counts and liver injury; too little may raise the risk of relapse, so careful adherence and monitoring are vital. Haematologica+2Cancer.gov+2

6. Cytarabine (Ara-C)
   Cytarabine is a nucleoside analogue chemotherapy used especially in higher-risk ALL or in certain treatment blocks. It is given by IV infusion or injection, sometimes intrathecally. It blocks DNA synthesis in rapidly dividing cells. Side effects can include low blood counts, nausea, diarrhoea, and, at high doses, eye irritation or neurological effects, so protocols include eye drops and close monitoring. Cancer.gov+2Cancer.gov+2

7. Anthracyclines (daunorubicin, doxorubicin)
   These drugs insert into DNA and generate free radicals that damage cancer cells. They are powerful components of induction and consolidation in some regimens, especially for higher-risk disease. Because they can damage the heart at high lifetime doses, paediatric oncologists strictly limit total exposure and may use protective strategies. Side effects commonly include hair loss, nausea, and low blood counts. Cancer.gov+2Cancer.gov+2

8. Blinatumomab (BLINCYTO)
   Blinatumomab is a bispecific antibody that connects T-cells and CD19-positive B-cell leukaemia cells, helping the immune system destroy them. It is given as a continuous intravenous infusion over several weeks in cycles, mainly for relapsed or high-risk B-cell ALL. The FDA label warns about serious side effects such as cytokine release syndrome and neurological toxicities, so treatment occurs in specialised centres. FDA Access Data+2FDA Access Data+2

9. Tisagenlecleucel (KYMRIAH CAR-T therapy)
   Tisagenlecleucel is a cellular therapy where a patient’s own T-cells are collected, genetically changed to target CD19 on B-cells, and then reinfused as a single IV dose. It is approved for patients up to 25 years old with B-cell precursor ALL that is refractory or in second or later relapse. It can bring deep remissions but carries risks such as severe cytokine release syndrome and neurotoxicity, requiring expert ICU-level care. PubMed+3U.S. Food and Drug Administration+3U.S. Food and Drug Administration+3

10. Supportive medicines (antibiotics, antifungals, anti-nausea drugs, growth factors)
    Alongside anti-leukaemia drugs, children often receive antibiotics, antifungals, and antivirals to prevent or treat infections, plus anti-nausea medicines and sometimes growth factors for white blood cell recovery. Each medicine has its own FDA label and dosing rules. The oncology team balances benefits against side effects like allergic reactions, organ toxicity, or interactions with chemotherapy. Cancer.gov+2FDA Access Data+2

Dietary molecular supplements

Supplements are never a substitute for chemotherapy in paediatric ALL. Any vitamin or supplement must be approved by the oncology team to avoid interactions with treatment. Cancer.gov+1

1. Standard multivitamin without high antioxidant doses
   A simple children’s multivitamin may be used when diet is poor, but doctors avoid very high doses of antioxidants that might interfere with chemotherapy-induced oxidative damage to cancer cells. The usual plan is one age-appropriate tablet or liquid dose daily, if approved. Its main function is to cover basic vitamin needs, not to “cure” leukaemia. PMC+1

2. Vitamin D (if deficient)
   Many children with cancer have low vitamin D levels, which can affect bone health and immunity. If blood tests show deficiency, doctors may prescribe vitamin D drops or tablets in carefully calculated doses. The function is to support normal bone mineralisation and immune function. Over-the-counter self-dosing is unsafe because very high levels can damage kidneys and cause high calcium. PMC+1

3. Calcium (if intake is inadequate)
   When steroid therapy and reduced activity put bones at risk, dietitians may recommend extra calcium from food or supplements. The aim is to maintain strong bones and prevent fractures. Dose is chosen based on age, dietary intake, and blood levels. Too much calcium can cause constipation and kidney problems, so it must be supervised. Cancer.gov+1

4. Omega-3 fatty acids from food or approved products
   Omega-3 fats from fish or certain supplements may help general heart and brain health and may modestly reduce inflammation. In children on chemotherapy, only oncologist-approved products and doses should be used, because omega-3s may affect platelets and bleeding risk at high doses. The main goal is supportive nutrition, not direct anti-cancer action. PMC+1

5. Probiotic foods (used cautiously)
   Some centres allow pasteurised, clinically tested probiotics or yoghurt-type foods when white blood cell counts are safe, to support gut health and reduce antibiotic-related diarrhoea. However, in very immunocompromised children, live bacteria may be risky. Decisions about type, timing, and dose are made by the oncology and nutrition team, not by families alone. PMC+1

6. High-energy oral nutrition drinks
   These are special drinks with balanced protein, carbohydrate, fats, vitamins, and minerals. They are used when children struggle to eat enough solid food. Dose is usually one or more cartons per day as advised by the dietitian. Their function is to prevent weight loss and nutrient deficiencies during intensive chemotherapy. Cancer.gov+1

7. Protein supplements (when severely undernourished)
   Protein powders or drinks may be added to meals or beverages in children who have lost significant muscle mass. They support tissue repair, immune function, and recovery after infections or procedures. The exact amount is based on weight and kidney function; excessive protein without medical guidance can strain the kidneys. Cancer.gov+1

8. Trace element replacement (zinc, magnesium, etc.)
   If blood tests show low levels of zinc, magnesium, or other trace elements, doctors may prescribe replacement. These small molecules help many enzymes work properly and may support wound healing and appetite. Doses are individualised; too much can cause toxicity or disturb other mineral levels. Cancer.gov+1

Immune-supporting and regenerative / stem cell–related treatments

1. Granulocyte colony-stimulating factor (G-CSF)
   G-CSF is a medicine that stimulates the bone marrow to make more neutrophils. In some regimens, it is used after certain chemotherapy blocks or during infections to shorten the time of very low white cell counts. The dose and schedule are decided by the oncology team. It does not treat the leukaemia itself but helps the body recover from chemotherapy. Cancer.gov+1

2. Intravenous immunoglobulin (IVIG)
   Some children develop very low antibody levels or recurrent infections. IVIG is a concentrated mixture of antibodies from healthy donors, given by IV infusion over several hours. It temporarily boosts the child’s ability to fight infections. Dosing intervals depend on blood levels and infection history. It is not a cure for ALL but an immune support for selected patients. Cancer.gov+1

3. Allogeneic haematopoietic stem cell transplantation (bone marrow transplant)
   In higher-risk or relapsed ALL, doctors may recommend a stem cell transplant from a donor. High-dose chemotherapy (and sometimes radiation) first destroys the child’s bone marrow. Donor stem cells are then infused through a vein, where they grow and rebuild the blood system. This procedure can be curative but has serious risks, such as graft-versus-host disease, infections, and organ damage, so it is used only in carefully selected cases. Cancer.gov+1

4. CAR-T cell therapy (tisagenlecleucel)
   As described earlier, CAR-T therapy uses the child’s own T-cells modified to target leukaemia cells. This is a type of living “drug” that can persist in the body and continue to fight cancer cells. It is used mainly for refractory or multiply relapsed B-cell ALL and is available only in specialised centres with intensive monitoring for severe immune-related side effects. U.S. Food and Drug Administration+2U.S. Food and Drug Administration+2

Surgeries and procedures

1. Central venous catheter (port or line) insertion
   A surgeon places a soft tube into a large vein in the chest or neck under anaesthesia. This line is used to give chemotherapy, blood products, and IV nutrition and to take blood samples. It reduces the need for repeated needle sticks in small veins and protects the veins from irritating drugs. Risks include infection and clotting, so care instructions are crucial. Cancer.gov+1

2. Bone marrow aspiration and biopsy
   Doctors use a special needle to take bone marrow samples from the hip bone, usually under sedation or anaesthesia. This procedure is done at diagnosis, during treatment, and sometimes after treatment to check how many leukaemia cells remain (minimal residual disease). The results help guide risk classification and treatment adjustments. Cancer.gov+1

3. Lumbar puncture with intrathecal chemotherapy
   A lumbar puncture uses a small needle in the lower back to collect cerebrospinal fluid and to inject chemotherapy directly around the brain and spinal cord. This prevents or treats leukaemia in the central nervous system. The procedure is usually done under sedation to reduce pain and fear. Headache and back discomfort are common short-term side effects. Cancer.gov+1

4. Testicular biopsy or surgery (rare, selected cases)
   In boys with suspected testicular involvement, an ultrasound and sometimes biopsy or surgical removal of affected tissue may be needed. Today, many cases are treated successfully with systemic and local chemotherapy alone without surgery, but in special situations surgery helps confirm diagnosis or remove residual disease. Cancer.gov+1

5. Stem cell collection for transplant or CAR-T
   For autologous cell therapies or donor transplants, a procedure called apheresis collects stem cells or T-cells from blood. A machine separates the needed cells and returns the rest. The procedure can take several hours and may be repeated. It is not a “surgery” in the cutting sense but is an invasive procedure requiring central access and close monitoring. U.S. Food and Drug Administration+2PubMed+2

Prevention and risk reduction

We cannot fully prevent paediatric ALL, because many risk factors are not under family control. However, we can reduce complications and improve outcomes once the disease exists. Cancer.gov+1

1. Early medical review for worrying symptoms
   Seeing a doctor early for persistent fever, bruising, bone pain, or swollen glands can lead to earlier diagnosis and treatment, which is linked to better results in many cancers. Genetic Diseases Center+1

2. Strict adherence to treatment schedules
   Following the exact timing of oral medicines and clinic visits helps keep leukaemia under control and reduces relapse risk, especially during long maintenance phases. Cancer.gov+1

3. Infection prevention habits
   Handwashing, avoiding crowds during neutropenia, and quick care for fevers (often straight to hospital) help prevent life-threatening infections. Cancer.gov+1

4. Vaccination of family members (where recommended)
   Vaccinating household contacts against flu and other illnesses can provide a protective “cocoon” around the immunocompromised child. The oncology team advises which vaccines and when. Cancer.gov+1

5. Avoiding unnecessary herbal or alternative products
   Unregulated herbs and high-dose supplements can interact with chemotherapy and increase toxicity. Oncologists recommend avoiding them unless specifically approved. Cancer.gov+1

6. Safe food and water practices
   Using clean water, cooking meat and eggs well, avoiding raw seafood, and washing fruits and vegetables carefully reduces the risk of food-borne infections, especially during low white cell counts. PMC+1

7. Sun protection
   Some drugs increase sun sensitivity, and survivors have a higher long-term risk of skin problems. Using hats, clothing, and sunscreen helps protect the skin. Cancer.gov+1

8. Healthy weight and activity (as allowed)
   Maintaining a healthy weight and some level of activity during and after treatment supports heart health and reduces long-term metabolic complications linked to steroids and inactivity. Cancer.gov+1

9. Regular long-term follow-up in survivorship clinics
   Even after cure, survivors need periodic check-ups to detect and treat late effects early. Attending these visits is a key part of long-term health protection. Cancer.gov+1

10. Avoiding smoking and second-hand smoke
    Exposure to tobacco smoke damages lungs and heart and may increase the risk of other cancers later in life. Families are encouraged to keep the child’s environment smoke-free. Cancer.gov+1

When to see doctors

Parents or caregivers should contact the paediatric oncology team or emergency services immediately if a child with ALL has fever, chills, breathing difficulty, new bruises or bleeding, severe pain, confusion, seizures, or sudden weakness. These may signal sepsis, brain involvement, or treatment complications that need urgent care. Any worries about medicine doses, missed doses, vomiting after pills, or new side effects should be discussed quickly with the team rather than adjusted at home. Regular planned visits for blood tests and examination are also essential during and after treatment. Cancer.gov+2Blood Cancer UK+2

What to eat and what to avoid

1. Eat well-cooked meats, eggs, and fish to provide safe protein for growth and healing. PMC+1

2. Eat a variety of cooked vegetables and peeled fruits as tolerated, to supply vitamins and fibre, following the centre’s food-safety advice. The Lancet+1

3. Eat soft, moist foods (porridge, soups, yoghurt-style products if allowed) when mouth sores or nausea make chewing hard. PMC+1

4. Eat small, frequent meals and energy-dense snacks to prevent weight loss during intensive treatment. PMC+1

5. Drink plenty of safe fluids (boiled or treated water, approved juices, oral rehydration solutions) to protect kidneys and prevent dehydration. PMC+1

6. Avoid raw or undercooked meat, fish, and eggs because they can carry germs dangerous during neutropenia. UPMC Hillman Cancer Center+1

7. Avoid unpasteurised milk and soft cheeses made from unpasteurised milk, as they may contain harmful bacteria. UPMC Hillman Cancer Center+1

8. Avoid salad bars, buffet foods, and street foods where temperature and hygiene are uncertain. UPMC Hillman Cancer Center+1

9. Avoid very high-dose vitamin or herbal products not approved by the oncology team, because of possible drug interactions and toxicity. PMC+1

10. Avoid sugary drinks in large amounts; they add calories without nutrients and may worsen weight gain from steroids, though small amounts are sometimes used to encourage fluid intake. Cancer.gov+1

Frequently asked questions (FAQs)

1. Is paediatric acute lymphocytic leukaemia curable?
   Yes. With modern risk-adapted therapy in specialised centres, about 85–90% of children with ALL can be cured, especially those younger than 15 years. Outcomes depend on the leukaemia subtype, response to early treatment, and other risk factors, so each child’s prognosis is individual. Cancer.gov+1

2. How long does treatment usually last?
   Treatment is usually divided into induction (about one month), consolidation or intensification (several months), and maintenance (often about two years for standard-risk disease). Some high-risk protocols are longer or more intensive, and relapsed disease often needs more complex plans. American Cancer Society+2American Cancer Society+2

3. Why are so many different drugs used together?
   ALL cells can quickly become resistant if only one drug is used. Combining drugs that attack cells in different ways increases the chance of killing all leukaemia cells and lowers the risk of relapse. Protocols are carefully tested in large trials to balance effectiveness and side effects. PMC+2Cancer.gov+2

4. Are the side effects permanent?
   Many side effects such as hair loss, nausea, and low blood counts are temporary and improve after treatment. Some drugs can cause long-term problems (e.g., heart, fertility, learning difficulties) in a minority of patients, which is why survivors are followed long term in specialised clinics. Cancer.gov+1

5. Can diet alone treat or cure ALL?
   No. Diet is very important for strength and healing, but it cannot replace chemotherapy, targeted therapy, or transplant. Any advice claiming to cure ALL with food or herbs alone is not evidence-based and can be dangerous if it delays proper treatment. Cancer.gov+1

6. Is ALL caused by something the parents did wrong?
   In almost all cases, no. Most children with ALL have no clear preventable cause. Research suggests a mix of genetic changes and environmental factors, many of which are not under family control. Parents should not blame themselves. Cancer.gov+1

7. Can my child go to school during treatment?
   Many children return to school during maintenance therapy with precautions. The oncology team will advise based on blood counts, infection risk, and how the child feels. School contact helps with normal development but must be balanced with safety. Cancer.gov+1

8. Will my child be able to have children in the future?
   Some treatments may affect fertility, depending on drug types and doses. For many children on current protocols, the risk is moderate or low, but for those needing transplant or intensive regimens it can be higher. Fertility and long-term effects should be discussed with the oncology team, who may involve fertility specialists. Cancer.gov+1

9. What happens if we miss a dose of oral chemotherapy?
   Families should not double doses or guess. They should call the oncology team, who will explain whether to skip, repeat, or adjust the plan. Studies show that poor adherence to oral 6-MP can increase relapse risk, so honest communication is very important. Cancer.gov+1

10. Can my child receive traditional or herbal remedies?
    Some traditional practices may be harmless, but many herbs and supplements can interact with chemotherapy or increase toxicity. Families should always tell the oncology team about any traditional medicines and never give them without approval. Cancer.gov+1

11. What is minimal residual disease (MRD) and why is it important?
    MRD is the tiny number of leukaemia cells that may remain after treatment, measured using sensitive lab tests. Low or undetectable MRD early in therapy is linked to better outcomes, while higher MRD may lead doctors to intensify treatment. Cancer.gov+1

12. Why might my child need a stem cell transplant or CAR-T therapy?
    These intensive treatments are usually reserved for children whose ALL is very high-risk, does not respond well to standard chemotherapy, or has relapsed. They offer another chance for cure but come with serious risks, so the benefits and dangers are weighed very carefully. Cancer.gov+2PubMed+2

13. Is it safe for my child to get vaccines?
    Some vaccines (especially live vaccines) are not safe during intense chemotherapy, but others may be recommended at specific times. Household contacts are usually encouraged to stay fully vaccinated. The oncology team provides an individual vaccine plan. Cancer.gov+1

14. How can we support our child emotionally?
    Listening, honest but gentle explanations, maintaining routines, and involving play therapists or psychologists can help. Encouraging questions and giving age-appropriate information reduce fear. Peer support groups or talking with other families may also help both children and parents. Cancer.gov+1

15. Where can we find reliable information?
    Trusted sources include major cancer organisations and national institutes, such as the National Cancer Institute, American Cancer Society, and recognised paediatric oncology societies. These sites are regularly updated and based on scientific evidence, unlike many unverified internet sources. Cancer.gov+2American Cancer Society+2

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: December 31, 2025.

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