Pediatric Leukemias: Managing Side Effects

Pictured: Maura Byrnes-Casey Nurse practitioner Maura Byrnes-Casey with a young patient.

Fast-growing leukemic cells are very similar to fast-growing normal cells in the body. Therefore, leukemia treatments can also harm normal cells in the process of destroying leukemia.

For more than 35 years, our pediatrics team has selected approaches that minimize and treat the unavoidable physical side effects of cancer therapy. The most significant side effect of leukemia treatment is low counts of red blood cells, white blood cells, and platelets. This and other physical side effects are usually temporary and improve after the dose of the medication is reduced or after treatment has ended.

We also have experts who can help patients and families manage the anxiety, stress, and other psychosocial challenges that emerge when a child is ill.

Preventing Infection

To help prevent and treat infections that result from low white blood cell counts associated with leukemia and its treatments, we make sure our patients are appropriately treated with antibiotics. At Memorial Sloan Kettering, we also discovered a therapy for severely low levels of one type of white blood cell that reduces the risk of infection.(1),(2)The therapy, called granulocyte colony-stimulating factor (GCSF), is now used around the world.

In addition, to protect your child from exposure to infections, we might request that he or she stay in an isolated room, and that visitors wear gowns, masks, and gloves as preventive measures. It is essential for visitors with any sign of cold or other infection to avoid contact with a child who is undergoing treatment for leukemia.

Managing Low Platelet & Red Blood Cell Counts

Low platelet counts can mean that your child bruises and bleeds easily, so we can help teach you injury-prevention techniques. We might recommend that your child receive a transfusion of platelets to reduce the risk of bleeding, and give hormones to female patients who are at the age of menstruation to temporarily stop their periods. It is very important for children who have low platelet counts to avoid medications containing aspirin or ibuprofen because these medications prevent platelets from working properly and can increase the risk of bleeding.

Low red blood cell counts can cause anemia, which can be treated with a blood transfusion to relieve symptoms, including weakness, shortness of breath, and elevated heart rate.

At Memorial Sloan Kettering, we have our own Blood Bank and Donor Room. Our platelet and blood supplies are as safe as possible. However, it is important to minimize the number of transfusions. We encourage you to bring in friends and family to donate blood. If the donated blood is healthy and has the same blood type as your child, we can arrange to direct these donations to your child.

Coping with Hair Loss & Other Physical Side Effects

Another type of fast-growing cell affected by leukemia treatments is cells in the hair follicles. Unfortunately, most children will temporarily lose their hair two to three weeks after starting chemotherapy. This can be distressing to parents and patients, especially teenagers. You or your child will have the opportunity to speak with former patients about the process of losing and regaining their hair. We can also help you find wigs, hats, and scarves.

Other side effects from some chemotherapy medications can include:

  • Fatigue
  • Nausea and vomiting
  • Diarrhea
  • Change in the taste of foods
  • Abnormal feelings in the fingers and toes
  • Poor balance
  • Painful mouth ulcers/inflammation of mucous membranes in the mouth and gastrointestinal tract, which can be managed with oral care routines, pain medications, and special diets

Dealing with Psychosocial Concerns

The initial course of treatment, physical side effects, stress of hospitalization, lack of sleep, and homesickness can be very difficult for children and families — especially for siblings who may not understand the sudden switch in focus from the family's usual daily activities to the needs of the child with leukemia.

Patients frequently regress, act younger than their age, and act out. Patients receiving steroids as part of chemotherapy can have temporary personality changes or become moody and irritable. In addition, children and young adults often find it difficult — even overwhelming — to carry on normal activities.

Our team at Memorial Sloan Kettering will do everything in our power to minimize the discomfort, sadness, and stress that are common during treatment. Social workers, psychiatrists, psychologists, play therapists, child life specialists, and volunteers are available to help you and your child cope with the ups and downs.

You have the option to speak with patients who have experienced the same process and have successfully overcome their disease. There is strength in numbers, and knowing you are not alone may provide comfort. In addition, clergy are available to listen and provide spiritual support and guidance. Social workers can also help with financial issues related to treatment.

Even though a child or teen is being treated for cancer, he or she does not need to fall behind on schoolwork. We have a branch of the New York City Public School System, called P.S. 401, assigned to Memorial Sloan Kettering. Teachers come daily to help inpatient and outpatient children keep up with their studies during the treatment and recovery process.