Supportive therapy for childhood leukemia

Supportive therapy is an important part of treatment for childhood leukemia. It treats the complications that usually result from childhood leukemia and its treatments. These complications can include infection, bleeding and low blood cell counts. Other complications can include changes to the chemical processes in the body, such as breathing, eliminating wastes and toxins and metabolic abnormalities.

The following supportive therapies may be used.

Infection is a serious complication in children with leukemia. Infections can be caused by leukemia or its treatments. Children with suppressed immune systems are at risk for developing many different infections. A combination of risk factors, including poor nutrition, mouth sores and central venous catheters, can increase the risk of infection. The most common sites of infection are the blood, lungs, skin, gastrointestinal tract, mouth, esophagus and brain and spinal cord (called the central nervous system, or CNS). Different types of drugs are used to treat different types of infections.

Find out more about infection.

The healthcare team monitors blood cell counts during treatment. Your child may be given replacement therapy with blood transfusions to increase blood cell counts. Types of replacement transfusions include:

• packed red blood cells
• platelets
• fresh frozen plasma
• cryoprecipitate (a product that replaces clotting factors)

Find out more about blood transfusions.

Granulocyte colony-stimulating factors (G-CSFs), such as filgrastim (Neupogen, Grastofil) and pegfilgrastim (Neulasta, Lapelga), may be used to stimulate the bone marrow to make white blood cells. This shortens the length of time a child will have a low white blood cell (WBC) count and lowers the risk of infection.

The start of chemotherapy causes many cells to die quickly, which can result in an urgent situation called tumour lysis syndrome. When the cells die, they release their contents into the bloodstream. This creates abnormally high levels of uric acid, potassium and phosphorus. The following treatments are used to reduce the levels of these substances in the blood:

• increased intravenous fluids
• allopurinol (Zyloprim)
• sodium bicarbonate
• rasburicase (Fasturtec)

Find out more about tumour lysis syndrome.

Leukapheresis uses a special machine to remove large numbers of white blood cells from a sample of blood. The blood is then given back to the child. This is sometimes done to lower a very high white blood cell (WBC) count in children with leukemia.