A child is more likely to develop ALL if he or she:

• Has a history of chemotherapy or radiation therapy.

• Has certain genetic disorders, such as Down syndrome.

• Has a brother or sister who has ALL.

• Has been exposed to certain chemicals.

Symptoms of ALL may include:

• Poor appetite or weight loss.

• Point-shaped dark spots under the skin (petechiae), or easy bleeding from small cuts, nosebleeds, or bruising.

• Tiring easily or shortness of breath.

• Fever or repeated infections.

• Swollen lymph nodes or pain or aches in the bones or joints.

• Pale skin or skin rash.

• Vomiting or headache.

ALL may be diagnosed based on:

• Cell morphology.This involves blood tests to check blood cell counts and the shape of the blood cells.

• Aspiration and biopsy. These are bone marrow tests to check for leukaemia cells.

• Genetic testing, which may be done to:

  • Determine the best outcome of the disease (prognosis).

  • Understand the risks that your child faces from the disease (risk stratification).

  • Determine the best treatment options.

• Imaging tests, such as X-rays, ultrasound, and CT scan.

• A lumbar puncture, which tests a small amount of the fluid that surrounds the brain and spinal cord. The fluid is examined for leukaemia cells.

Treatment for this condition depends on the type of ALL that your child has, your child’s age, and his or her test results. Treatment can last for up to 2–3 years. It aims to destroy leukaemia cells and stop new diseased cells from growing. Treatment may include:

• Chemotherapy. These medicines kill cancer cells anywhere in the body.

• Radiotherapy. High-energy X-rays or gamma rays are used to kill cancer cells in a specific location in the body.

• Targeted chemotherapy to attack, or target, specific proteins, genes, or other components that cause a cancer cell to grow. Targeted chemotherapy:

  • May be used by itself or with chemotherapy.

  • Usually causes fewer side effects than chemotherapy.

• Stem cell transplant, which involves replacing diseased bone marrow with healthy bone marrow tissue from a donor.

• Participating in clinical trials to find out if new, or experimental, treatments are effective.

• Immunotherapy. This uses medicines to help the immune system destroy cancer cells.

Your child may also be given:

• Antibiotics to prevent lung infection (pneumonia).

• Other medicines to relieve treatment side effects.

• Donated blood (transfusions).

Medicines

• Give your child over-the-counter and prescription medicines only as instructed by your child’s healthcare provider.

• If your child was prescribed antibiotics, give them as instructed by your child’s healthcare provider. Do not stop giving the antibiotic even if your child’s condition improves.

• Do not give your child dietary or herbal supplements unless your child’s healthcare provider tells you to give them. Some supplements can interfere with how well the treatment works.

General instructions

• You, your child and any visitors should frequently wash hands for at least 20 seconds. It is especially important to wash hands:

  • Before and after meals.

  • After being outside.

  • After using the toilet.

• Have your child avoid contact sports and other rough activities. Ask your child’s healthcare provider what activities are safe.

• Encourage your child to eat regular, healthy meals and snacks. Some treatments may affect appetite.

• Keep all follow-up appointments as instructed by your child’s healthcare provider. This is important. Your child will need to continue working with a healthcare provider even after treatment has been completed.