Children and adolescents with relapsed acute lymphoblastic leukemia (ALL) are treated by our experts at Dana-Farber/Boston Children's Cancer and Blood Disorders Center through the Childhood Leukemia Program, one of the top pediatric leukemia treatment programs in the world. Our Program has played a leading role in refining treatment for childhood leukemia, resulting in today's cure rates of more than 90 percent for ALL, and we continue to lead clinical trials designed to increase cure rates, decrease treatment-related side effects, and improve care for long-term survivors.
We are also a certified treatment center for providing KYMRIAH®, the FDA-approved CAR T-cell therapy for relapsed B-cell ALL for patients who are up to 25 years old.
About Childhood Relapsed ALL
Relapsed acute lymphoblastic leukemia, or relapsed ALL, refers to the return of acute lymphoblastic leukemia (ALL) in patients who have already undergone treatment for the disease. Between 15 and 20 percent of children who are treated for ALL and achieve an initial complete remission will have the disease return.
In relapsed ALL — as with newly diagnosed ALL — lymphocyte stem cells (a type of blood stem cell) become immature white blood cells called lymphoblasts or "blasts." These blasts do not become healthy white blood cells. Instead, they build up in the bone marrow, so there is less room for healthy white blood cells, red blood cells, and platelets. In addition, these abnormal cells are unable to fight off infection.
The symptoms of relapsed ALL are the same as those for newly diagnosed ALL, including:
- Bone and joint pain
- Bruising or petechiae (small red spots on the skin)
- Recurrent infections
- Abdominal pain
- Swollen lymph nodes
- Dyspnea or difficulty breathing
The prognosis for children with relapsed ALL depends on a number of factors, including:
- The site of relapse (i.e., bone marrow, central nervous system, testicles)
- The length of time between initial diagnosis and relapse
- Age of child at initial diagnosis
- Response after the first month of reinduction treatment
- Biological features of the relapsed cells
- How many relapses your child has experienced (first, second, etc.)
How We Diagnose Childhood Relapsed ALL
To make a diagnosis of pediatric relapsed acute lymphoblastic leukemia, a doctor may order a variety of different tests including:
- Complete blood count
- Bone marrow aspiration and biopsy
- Lumbar puncture (spinal tap)
- Chromosomal analysis, which may help determine the way the leukemia is treated
After all tests are completed, doctors will be able to outline the best treatment options.