Infant Acute Lymphoblastic Leukemia

What is infant ALL?

Acute lymphoblastic leukemia (ALL) is a cancer of the blood and bone marrow. ALL is the most common form of childhood cancer.

Infant ALL occurs in children ages 1 year and younger. ALL in infants is rare. About 90 cases occur each year in the United States.

Infant ALL is different from ALL in older children. Treating cancer in infants is a challenge. Infant ALL is usually aggressive.

The main treatment is chemotherapy. Some children may receive a stem cell (bone marrow) transplant.
 

Symptoms of infant ALL

Symptoms of relapsed or refractory ALL include:

• Fatigue
• Fever
• Pain in the bones or joints
• Frequent infections
• Easy bruising and bleeding that is hard to stop
• Tiny, flat, dark-red skin spots (petechiae)
• Lumps in the neck, underarm, stomach, or groin
• Pain or fullness below the rib cage
• Paleness
• Loss of appetite
• Shortness of breath
• Enlarged liver
• Enlarged spleen

Treatment of infant ALL

The main treatment for ALL in infants is chemotherapy with many different medicines. Treatment has different phases. It usually lasts about 2 years.

Medicines used to treat infant ALL may include:

• Cyclophosphamide
• Cytarabine
• Daunorubicin
• Dexamethasone
• Erwinia asparaginase
• Etoposide
• Methotrexate
• Leucovorin
• Mercaptopurine
• Mitoxantrone
• Pegaspargase
• Prednisone
• Thioguanine
• Vincristine

Other treatments

Some patients may receive a stem cell (bone marrow) transplant.

Treatment options may include clinical trials.

Prognosis of infant ALL

Physicians base treatment decisions on the risk of the disease coming back (relapse). Patients with a higher risk of relapse will receive more intensive treatment than those with lower risk.

Most infants have a change in a gene (rearrangement) called MLL (mixed lineage leukemia). Another name for MLL is KMT2A.

When treating infant ALL, physicians consider:

• Gene changes: Having an MLL rearrangement predicts a poorer response to therapy.
• Age: Infants closer to age 1 usually respond better to treatment than infants younger than 6 months.
• Number of white blood cells: A very high white blood cell count when your child is first diagnosed predicts a poorer response to therapy.
• Timing of response to early therapy: Children who show a positive response to initial treatment have a lower risk of relapse.

The survival rate for infants with ALL is less than 60%. Infants with the MLL (KMT2A) rearrangement have a high risk of relapse. Most relapses occur within a year of diagnosis.

New insights into the disease show promise in developing new treatments. These include adding immunotherapy and targeted therapy to standard chemotherapy used to treat ALL in infants. Promising new therapies include:

• Blinatumomab
• Vorinostat
• Azacytidine
• Venetoclax
• Menin inhibitors

Support for infants with ALL

Side effects vary among children. The care team will work with families to try to prevent and lessen side effects. The team will watch closely for side effects and treat them.

Infants are vulnerable to:

• Infections, particularly respiratory, such as respiratory syncytial virus (RSV)
• Mucositis (including mouth and throat sores)
• Toxic effects on liver, kidneys, and central nervous system

Questions to ask your care team

• What are our treatment options?
• What are the possible side effects of each treatment?
• What can be done to manage side effects?
• Will my child need to be in the hospital for treatment?
• Where is the treatment available? Is it close to home or will we have to travel?