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Childhood Cancer Types — Parent’s Guide
Childhood leukemia — blood cancer in children, explained
Medically reviewed by Dr. C. Raghavendra Reddy, DM (Medical Oncology, Gold Medal) · Last reviewed June 2026
If your child has been diagnosed with leukemia — or if you are worried about symptoms and searching for answers — you deserve a clear, honest explanation. Childhood leukemia is a cancer of the blood and bone marrow. It is also the most common childhood cancer, and one of the most treatable cancers in the world when managed at a specialist centre. This page explains what it is, the different types, how it is recognised early, and what the treatment journey looks like.
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Understanding childhood leukemia
Types of leukemia in children — what every parent should know
Leukemia in children is not a single disease. Understanding which type your child has — or which type you are reading about — matters because the treatment, the timeline, and the outcomes differ. Here are the main types of childhood leukemia.
Most common type in children
Acute Lymphoblastic Leukaemia (ALL)
ALL is the most common cancer in children. It arises when abnormal lymphocytes — one type of white blood cell made in the bone marrow — multiply uncontrollably and crowd out healthy cells. ALL typically develops quickly (hence “acute”) and needs prompt treatment, but it also responds very well to structured chemotherapy programmes. The vast majority of children with ALL achieve remission with initial treatment.
- Most common from ages 2 to 5, but occurs at any age
- Bone pain, pallor, and bruising are frequent early features
- Treatment spans roughly two to three years
Less common than ALL
Acute Myeloid Leukaemia (AML)
AML arises from a different bone marrow cell line — the myeloid cells, which normally become red blood cells, platelets, and certain white blood cells. AML is less common in children than ALL but tends to require a more intensive treatment course. Outcomes have improved significantly over recent years with better supportive care and more precise risk stratification at diagnosis. A small proportion of children with AML carry genetic changes that make the disease more responsive to treatment.
- Can occur at any childhood age; slightly more common in infants
- More intense treatment, shorter total duration than ALL
- Genetic testing of the tumour guides the treatment plan
Rare in children
Chronic Myeloid Leukaemia (CML)
CML is rare in childhood but does occur, most often in adolescents. Unlike ALL and AML, CML usually develops slowly (it is “chronic”) and may have few symptoms in its early phase. Most cases of CML carry a specific genetic change called the Philadelphia chromosome. This change has become a precise treatment target, and most children with CML are managed with oral targeted therapy rather than intensive chemotherapy, allowing relatively normal day-to-day life during treatment.
- Fatigue, enlarged spleen, and weight loss are common presentations
- Philadelphia chromosome (BCR-ABL fusion) present in most cases
- Oral targeted therapy is first-line for most children
Under 12 months
Infant Leukaemia
Leukemia diagnosed in children under one year of age is classified separately because it has distinct biological features. Infant leukemia often involves a rearrangement of the KMT2A gene (previously called MLL). It can be aggressive and requires specialised treatment protocols designed specifically for this age group. Supportive care considerations are also different in infants — the team needs expertise in managing very young children through intensive treatment. Infants should be referred to centres with dedicated paediatric oncology experience.
- Rapid onset; may present with very high white cell counts
- Requires specialist protocols adapted for infant physiology
- Supportive care expertise is as important as the treatment itself
Leukemia is one of several types of blood cancer in children. For a broader overview of all childhood cancers, visit the Pediatric Cancer hub. For information about minimal residual disease (MRD) monitoring in leukemia, see our MRD in leukemia page.
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From first suspicion to remission
How childhood leukemia is diagnosed and treated — step by step
The diagnostic and treatment journey for leukemia in children follows a structured sequence. Understanding each step helps parents know what to expect — and what questions to ask.
First blood test — the full blood count (CBC)
The journey almost always begins with a full blood count — a simple blood test ordered because a child is pale, tired, bruising easily, or having repeated infections. In leukemia, the CBC often reveals an abnormal number of white blood cells (very high, very low, or normal but with abnormal-looking cells), combined with low red blood cells (anaemia) and low platelets. The blood film examined under a microscope may show immature cells called blasts. This combination raises the suspicion of leukemia and prompts urgent referral to a paediatric oncologist.
Bone marrow test — confirming the diagnosis
A blood count alone cannot confirm leukemia. The definitive test is a bone marrow aspirate and biopsy, in which a small sample of marrow is taken from the back of the hip bone under sedation or general anaesthesia — a procedure that takes about 15 to 20 minutes. The sample is examined under a microscope to count blast cells (more than 20% confirms acute leukemia), and is also subjected to immunophenotyping — a laboratory technique that identifies the exact type of leukemia cell (lymphoid or myeloid, and which subtype). This distinction determines the treatment protocol.
Genetic and molecular testing — understanding the disease’s biology
Modern leukemia diagnosis goes well beyond the microscope. Specialised tests — including cytogenetics (chromosome analysis), fluorescence in situ hybridisation (FISH), and molecular testing — look for specific genetic changes inside the leukemia cells. Certain genetic findings place a child in a low-risk, standard-risk, or high-risk group. This risk category directly determines which treatment protocol the child will receive and how intense it needs to be. A lumbar puncture (spinal tap) is also done at or shortly after diagnosis to check whether any leukemia cells have entered the fluid around the brain and spinal cord.
Induction chemotherapy — the first phase of treatment
Once the diagnosis and risk group are established, treatment begins with the induction phase — typically four to six weeks of intensive chemotherapy. The goal of induction is to eliminate as many leukemia cells as possible and bring the disease into remission: a state in which leukemia cells are no longer detectable on standard bone marrow examination. At the end of induction, a bone marrow test is repeated to confirm remission. If the child’s marrow shows remission, treatment continues to the next phase. The child is usually hospitalised for part of induction and closely monitored throughout.
Consolidation — eliminating hidden disease
Achieving remission does not mean all leukemia cells are gone — some remain at levels too low to detect on standard tests. The consolidation phase uses additional cycles of chemotherapy to attack these residual cells. In some children with ALL, this phase also includes chemotherapy delivered directly into the spinal fluid through a lumbar puncture — called intrathecal chemotherapy — to protect the central nervous system. Consolidation typically lasts several months. During this time, the child may be treated as an outpatient for most visits, with admissions only if complications arise.
Maintenance — long-term protection against relapse
After consolidation, children with ALL enter a maintenance phase lasting one to two years. This phase uses lower doses of chemotherapy, often in oral tablet form that can be taken at home, combined with regular clinic visits for blood tests and monitoring. The goal of maintenance is to keep any remaining leukemia cells suppressed long enough for the immune system and the treatment to clear them completely. During maintenance, many children attend school and carry out normal activities. At the end of maintenance, if the child remains in remission, treatment is stopped and the child is monitored with regular follow-up appointments.
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Common questions
Your questions about childhood leukemia — answered
What is childhood leukemia and why does it happen?
Leukemia is a cancer of the blood-forming cells in the bone marrow. In a healthy child, the bone marrow produces red blood cells (to carry oxygen), white blood cells (to fight infection), and platelets (to stop bleeding). In leukemia, one abnormal white blood cell line grows out of control, crowding out the normal cells. The bone marrow fills with leukemia cells that cannot do any of the jobs healthy blood cells do — which is why children with leukemia are pale, tired, prone to infection, and bruise easily. In most children, leukemia arises without any identifiable cause. It is not something the child or the family did. A small number of cases are linked to known genetic conditions such as Down syndrome, but most cases occur in otherwise healthy children with no family history of cancer.
What are the early warning signs of leukemia in children?
The most common early warning signs of leukemia in children are: persistent unusual tiredness or pallor (pale skin) that does not improve with rest or iron; easy bruising or unexplained bruises, especially in unusual places like the trunk or face; tiny flat red or purple spots on the skin (called petechiae) caused by low platelets; repeated infections that take longer than expected to clear; swollen lymph glands in the neck, armpit, or groin that are not going away; unexplained bone or joint pain, particularly at night; and a prolonged fever with no obvious infection. These signs alone do not mean a child has leukemia — they each have many common and harmless causes. However, when several are present together, or when any one of them persists for more than two to three weeks without explanation, a doctor’s evaluation with a full blood count is the right next step.
What is the difference between ALL and AML in children?
ALL (Acute Lymphoblastic Leukaemia) and AML (Acute Myeloid Leukaemia) are the two main types of childhood leukemia. ALL arises from abnormal lymphocytes (a type of white blood cell) and is the most common type — as well as the most common cancer in children overall. ALL tends to respond very well to treatment and has excellent long-term outcomes when treated at a specialist centre. AML arises from a different line of blood cells called myeloid cells and is less common in children. AML generally requires a more intensive treatment programme than ALL, though outcomes have also improved significantly over the past two decades. The distinction matters because the treatment approach differs substantially between the two — which is why a proper diagnosis including bone marrow testing is always needed before treatment begins.
How is leukemia in children diagnosed?
The diagnostic process typically begins with a full blood count (CBC) and blood film examination. In leukemia, the CBC often shows abnormal numbers of white blood cells (very high or very low), a low red blood count (anaemia), and low platelets. The blood film may show abnormal cells called blasts. This is enough to raise strong suspicion, but it is not a definitive diagnosis. Confirmation requires a bone marrow test (bone marrow aspirate and biopsy), which takes a small sample of marrow from the back of the hip bone under sedation or general anaesthesia. The marrow sample is examined under a microscope, tested with immunophenotyping (to identify the exact type of leukemia cell), and tested for genetic and molecular abnormalities — which helps determine the treatment protocol and the child’s risk category. A lumbar puncture (spinal fluid test) is also usually done at diagnosis to check whether leukemia cells have reached the cerebrospinal fluid.
Is leukemia in children treatable?
Yes — childhood leukemia, particularly ALL, is one of the most treatable cancers known to medicine, and many children go on to live full, healthy lives after treatment. Treatment is intensive and takes place over several months to a few years depending on the type and risk category, but it is structured to minimise disruption to the child’s development as much as possible. Treatment involves chemotherapy given in phases (induction to eliminate visible disease, consolidation to eliminate remaining cells, and maintenance to prevent relapse). Some higher-risk children may need additional treatment. Whether the child needs a stem cell transplant depends on specific factors including the type and genetic profile of the leukemia, how the child responds to initial treatment, and whether the disease returns. The paediatric oncology team at CION reviews every case at a multidisciplinary tumor board before recommending any protocol. We do not make rushed decisions.
How long does treatment for childhood leukemia take?
The total duration of treatment for ALL typically spans two to three years. The first phase (induction) lasts four to six weeks and aims to bring the disease into remission — meaning leukemia cells are no longer detectable on standard tests. The second phase (consolidation or intensification) lasts several months and uses additional chemotherapy to eliminate any remaining leukemia cells that may not be visible. The final phase (maintenance) uses lower-dose chemotherapy given at home in tablet or oral form and continues for one to two years. Throughout this period, the child is monitored closely with blood counts and, in some cases, bone marrow tests to check that the disease remains in remission. For AML, treatment is shorter but more intensive — typically six to eight months. The CION team will explain the specific treatment plan and timeline for your child in the consultation.
Medical disclaimer: This page is for general information only. It does not replace a consultation with a qualified medical professional. If you are worried about symptoms in your child, please see a doctor. CION Cancer Clinics does not diagnose conditions through this website.
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