Leukemia and Lymphoma
Dr. William Slayton, MD
Division Chief & Stop Children’s Cancer Palm Beach County Chair
Constance Stichweh, ARNP
Maggie Gulig, RN – Nurse Educator
Leukemia is the most prevalent childhood cancer, and represents about 1/3 of all cancers in children. It is a cancer of the blood that starts in the bone marrow where blood cells are made. In children, it primarily affects the cells that develop into white blood cells (WBC), the cells that help us to fight off infections. Signs of leukemia in children include excessive or unexplained bruising, bleeding, tiredness, severe and persistent bone pains. There are two primary forms of leukemia, acute lymphoblastic leukemia (ALL) and acute myelogenous leukemia (AML). Other rare forms of leukemia that are occasionally seen in children are chronic myelogenous leukemia (CML), biphenotypic leukemias, bilineage leukemias, and juvenile myelo-monocytic leukemia (JMML).
Of these, the most common is ALL and it is considered highly curable. However, approximately 10 percent of children with leukemia will relapse. Features that predict relapse WBC >50,000, age <1 yr or >10 years, delay or no response to induction chemotherapy, and certain genetic changes in the leukemia cells such as the 9;22 translocation, or the Philadelphia chromosome. In patients who relapse, many may still achieve cure with additional, more aggressive chemotherapy and hematopoietic stem cell transplants (HSCT). Even as ALL is considered curable in most patients, treatments are long and difficult, and can lead to complications such as stroke, diabetes, severe arthritis and learning disabilities.
The other major form of leukemia in childhood is AML. Although it is considered to be more aggressive and achieving remission and cure may be more difficult, it is still considered a curable disease. The treatment for AML is usually not as long as it is for ALL, but may require hospitalizations that last months at a time. AML frequently needed a HSCT to cure the disease. The complication rates may also be higher due to the greater aggressiveness of the treatment.
Leukemia in infants is particularly hard to cure. Other than when it is detected in children with Down Syndrome, infant leukemia is considered to be a high risk disease. Infants have a more difficult time tolerating the side effects of the treatment and have a higher risk of developing complications afterwards. HSCT transplants can be used in the treatment of infant leukemias, but they may not be as effective as they are in older children. (In more recent years, the use of Chimeric-Antigen T-Cell (CART) has offered more hope to curing those patients that have been difficult to cure in the past).
Lymphomas are also a cancer of the blood, but they do not start in the bone marrow. Rather, they begin in the lymph nodes in our bodies. Lymphomas are most frequently seen in the neck and chest, but can occur wherever lymph nodes are found. Two major types of lymphoma are Hodgkin’s Lymphoma and Non-Hodgkin’s Lymphomas (NHL). In addition to many of the symptoms that are seen in leukemia, children with lymphoma are also noted to have rapid, large, and continuous swelling of their lymph nodes. Sometimes when the swelling cannot be seen, it can block the function of lungs or other organs. The treatment of most lymphomas usually includes combination chemotherapy. There are also situations when radiation therapy and HSCT may be used. Lymphomas are largely curable and have cure rates that are as high or higher than ALL.
The treatment and cure of leukemias and lymphomas, as well as most other cancers, require a dedicated team of professionals all working together to achieve this goal. The team is led by the family and the physician, but also includes specially trained nurses and case coordinators, social workers, physical therapists, psychologists, child-life specialist, pediatric surgeons, and occasionally a radiation therapist and bone marrow transplanter. The UF Health Shand’s Children’s Hospital is proud to be able to offer all of these services in a family centered way that is world class in expertise and outcome, but respectful and kind to all of the needs of the child and the family.
The Ringing of the Captain’s Bell
A special moment that we hope comes in the treatment of all children with cancer is the time when the treatment is complete. Whenever this time arrives for one of our children, our tradition is that the child has the opportunity to ring the Captain’s Bell to announce this important milestone. The celebration includes a well deserved trophy and a well practiced song by our treatment team. We strive so that one day all of our children are able to ring this bell and look forward to wearing it out!
Camp Boggy Creek
The experience of going to a summer camp invokes many fond memories from our childhood in most of us. Unfortunately, it may be difficult to have this experience as a child when you have been diagnosed with cancer. Luckily, we are proud to have the help of Camp Boggy Creek, which is only 45 minutes away in Eustis, FL. It is a camp designed around the special needs of children who have complex medical problems who wouldn’t be able to attend a camp otherwise. Camp Boggy Creek was founded in 1996 by Paul Newman and General H. Norman Schwarzkopf, with one simple premise in mind, that every child, no matter their illness, could experience the transformational spirit and friendships that go hand in hand with camp. Every summer for one week, every child with cancer age 7-16 years old are invited to come to camp with other children united by their journey with cancer and with the peace of mind for their parents that they will be looked after by medical professionals and all their health needs will be met. For those parent who would like to relive those memories with their children, Camp Boggy Creek also offer Family Retreat Weekends.
Brandon Ling Memorial Sports Camp
Each year, the University of Florida and the Climb for Cancer Foundation hosts a sports camp and features past and current University of Florida student-athletes. The event happens on the campus of the University of Florida and feature the student-athletes teaching the children about how to stay active in sports. The children get a chance to meet the student-athletes and to get their autographs, but the student-athletes often get to learn a great deal more from the children.
Stop Children’s Cancer Holiday Traditions
While it is designed as a fundraising event for Stop Children’s Cancer Foundation each winter, the occasion also gives opportunity for many of our children to show off their talents. The event features a silent auction where everyone can bid on donated art pieces that have been created by the children being treated for their cancer at the hospital throughout the year. The concert includes chorus and orchestra from around Gainesville and highlights the musical talents of many of our children who are going through cancer treatment in their own performances.
Children’s Oncology Group (COG)
The Children’s Oncology Group (www.childrensoncologygroup.org) is the world’s largest organization devoted exclusively to childhood and adolescent cancer research. The COG’s mission is to improve the outcome for all children with cancer. It unites more than 9,000 experts in childhood cancer at more than 200 leading children’s hospitals, universities, and cancer centers across North America, Australia, New Zealand, and Europe in the fight against childhood cancer. The University of Florida is a proud member of the COG. Dr. Slayton is a leader in the Children’s Oncology Group and serves on the Leukemias and Lympomas disease committees. Dr. Slayton is the study chair for AALL0622, a trial that evaluates the use and safety of dasatinib, a newer type of tyrosine kinase inhibitor, for the treatment of Ph+ ALL. In addition to treatments for ALL, the COG has protocols developed and research in all types of children’s cancers.
University of Florida
Dr. Ostrov has been a member of the University of Florida since 2002. Dr. Ostrov’s particular interests include T-cell immunobiology, structure-based drug design, and X-ray crystallography. Dr. Ostrov’s group utilizes methods in structure-based drug design to discover and develop novel therapies for preventing and treating human diseases. His team focuses on developing novel therapeutic approaches to treat breast, colon, esophageal, lung, lymphoma and prostate cancer, drug-resistant childhood leukemia, Type I diabetes, graft-versus-host disease, rheumatoid arthritis, autism spectrum disorders and drug-resistant pathogens. such as HIV.
Dr. Cogle is a professor of medicine, and a physician-scientist with clinical and research expertise in the myelodysplastic syndromes, acute leukemias, and bone marrow failure syndromes. He uses bone marrow transplantation as a treatment option for patients who need more than chemotherapy to eradicate disease. Dr. Cogle runs a stem cell research laboratory where he dissects the mechanisms of bone marrow-derived blood vessels. His research has made significant impact in the fields of cancer and cardiology. Dr. Cogle’s overall goal is to design safer and more effective methods of treating diseases by tapping into the potential of hematopoietic stem and progenitor cells.
Dr. Licht, MD, is the Director of the University of Florida Health Cancer Center, holding the Marshall E. Rinker, Sr. Foundation and David B. and Leighan R. Rinker Chair. NCI funded for nearly 25 years, Dr. Licht is Principal Investigator of a Leukemia and Lymphoma Society Specialized Center and a Multiple Myeloma Research Foundation program grant both in epigenetics. He is an investigator in the Dana-Farber SPORE in myeloma and co-leader in a NCI-funded Chicago Physical Sciences Oncology Center. His laboratory studies aberrant gene regulation, specifically the role of abnormal function of histone methyl transferases and histone demethyalses in diseases such as multiple myeloma and is developing small molecule strategies to normalize gene regulation and treat disease.
Dr. Chang’s is a professor of Molecular Genetics and Microbiology in the College of Medicine. His lab studies the life cycle of retroviruses, in particular, the retrovirus which causes AIDS, also known as human immunodeficiency virus (HIV). The current research is focused on the development of novel gene transfer tools, experimenting with small animal models, and developing HIV and cancer vaccines and immuno-therapeutic strategies. The lab is interested in characterizing cellular and immune modulatory factors that are essential to the development of protective immunity targeting HIV and cancer. His laboratory has established reagents and protocols for improved lentiviral vector gene transfer, siRNA delivery and high-titer vector production.