The MSK Kids Approach to Diagnosing Leukemia

Children and young adults with leukemia have the best chance of beating the disease when they receive an accurate diagnosis and start treatment as soon as possible. At MSK Kids, we use a quick and thorough approach to diagnose the cause of your child’s symptoms to determine if they are due to leukemia. We then go further, using the most-advanced genetic testing and other technologies to see what mutations are driving the cancer’s growth. This helps your child’s care team better understand how aggressive the leukemia may be. With a wealth of information from these tests, we can match your child with the most effective and personalized leukemia treatment.

Symptoms of Leukemia in Children

Leukemia can cause symptoms, such as:

• fatigue (feeling tired), reported by more than 90 percent of children with leukemia
• bone pain, which could make your child limp or refuse to walk
• signs of bleeding, including bruising easily or seeing small spots of blood, called petechiae, under the skin
• fevers that last for various amounts of time, with no apparent cause
• repeated infections
• an enlarged liver, spleen, or lymph nodes found during a doctor’s exam, experienced by about 70 percent of children

Take your child to the doctor if any of these symptoms continue and don’t seem to be going away.

What tests will my child have?

A blood test is the first test we will do. We’ll examine your child’s blood counts to see how many red blood cells, white blood cells, and platelets are present, if the counts are in the normal range, and if there are any blood cells that look abnormal. Your child’s doctor will also do a complete physical exam to look for any signs of leukemia, such as bruising, lumps, or an enlarged liver, spleen, or lymph nodes.

Not all children with leukemia have abnormal blood counts, but they may have other signs of leukemia found through a physical exam or by looking at their blood cells under a microscope. If your child’s doctor suspects leukemia, we will remove a sample of bone marrow for analysis. We will place your child under anesthesia briefly to perform this test and will ensure that they are comfortable and relaxed.

Genetic testing is also done on a blood or bone marrow sample. Through the MSK Kids Pediatric Translational Medicine Program, every child with leukemia has their cancer cells analyzed for genetic mutations. This process is called genomic profiling. It may provide valuable clues that our doctors can use to refine and improve the diagnosis, define the response to therapy, monitor your child, and find the most-effective treatments, including targeted therapies. Because all of this testing can be done right here at MSK Kids, you’ll get the results quickly. We know how anxious you are feeling and how important that is to you.

What are leukemia risk groups?

When we start treating your child, we are aiming for remission. That means the treatment has destroyed nearly all of the abnormal blood cells and the body is back to producing normal blood cells. But sometimes remission doesn’t last. A risk group is a classification we assign to your child’s leukemia. It indicates how likely it is that the cancer might come back after remission. We treat children with low-risk leukemia less intensively than those with high-risk leukemia. Your child’s doctor will tell you which risk group your child’s cancer is in and how it will affect the intensity of therapy.