RADIATION THERAPY FOR PEDIATRIC ACUTE
LYMPHOBLASTIC LEUKEMIA (pALL)

Radiation therapy¹⁷ uses high-energy radiation to kill cancer cells. While it is not the main treatment used to treat Pediatric Acute Lymphoblastic Leukemia (pALL), it is used to treat leukemia that has spread to the brain and spinal fluid, and is a key step before patients undergo a stem cell transplant.

COMMON SIDE EFFECTS

The possible short-term side effects depend on where the radiation is aimed and can include:

• Sunburn-like skin changes
• Hair loss
• Nausea, vomiting, diarrhea (from radiation to the abdomen)
• Fatigue
• Increased risk of infection

TARGETED THERAPY FOR PEDIATRIC ACUTE
LYMPHOBLASTIC LEUKEMIA (pALL)

Targeted therapy¹⁸ uses new drugs that have been developed to target specific parts of cancer cells. They are used instead of or along with chemotherapy.

Targeted drugs such as tyrosine kinase inhibitors (TKIs) help to detect a specific protein, Philadelphia chromosome, that can be found in about 1 out of 4 adult patients with pALL. Thus, targeted therapy with TKI alongside chemo may help some patients achieve complete recovery.

COMMON SIDE EFFECTS

For targeted medication often used to treat pALL, the common side effects include:

• Diarrhea, nausea, muscle pain, fatigue, and skin rashes
• Swelling around the eyes, hands, or feet (possibly caused by the drugs’ effects on the heart)
• Lower red blood cell and platelet counts when treatment starts
• May slow a child’s growth, especially if used before puberty

STEM CELL TRANSPLANT FOR PEDIATRIC ACUTE LYMPHOBLASTIC LEUKEMIA (pALL)

Stem cell transplants¹⁹ aim to replace damaged bone marrow with healthy cells, which are impaired (due to chemotherapy or radiation) or diseased. The healthy cells replacing the damaged or cancerous ones are obtained from the patient’s bone marrow (autologous transport) or a suitable donor (allogeneic transplant).

There are 2 types of stem cell transplants:

• Allogeneic transplant, where stem cells come from someone else or a matched donor. This is the preferred type of transplant when treating pALL, and donors are often family members with the same tissue type as you.
• Autologous transplant, where the stem cells are collected from the patient’s own body and saved.

Both types of transplants help patients create healthy blood cells, red blood cells or platelets, and reduce one’s risk of life-threatening infections, anemia, and bleeding.²⁰ However, a stem cell transplant is an intensive and complex treatment that can cause life-threatening side effects and transplant-related morbidities.

COMMON SIDE EFFECTS

Most short-term side effects²¹ are from the high doses of chemotherapy or radiation and would go away over time as your child recovers. Common side effects include:

• Increased risk of infections
• Low blood cell counts
• Low blood pressure
• Shortness of breath, coughing, chest pain, or tightness
• Fever or chills
• Hair loss
• Nausea, vomiting, diarrhea
• Mouth sores
• Loss of appetite
• Fatigue
• Bleeding

Some side effects may be long-lasting or show up many years later, such as:

• Growth of another kind of cancer
• Lung problems
• Damage to other organs, such as the heart, kidneys, or liver
• Lack of menstrual periods, which may mean ovary damage and inability to have children (infertility)
• Vision problems caused by damage to the lens of the eye (cataracts)
• Damage to joints

Another possible long-term side effect is graft-versus-host disease (GVHD). GVHD can only occur with an allogeneic transplant. It happens when the immune system cells in the donor’s stem cells attack the body. The cells can attack the skin, liver, gastrointestinal (GI) tract, mouth, or other organs and may cause symptoms such as:

• Skin rashes with itching and blistering
• Yellowing of the skin and eyes (jaundice)
• Severe diarrhea and belly cramps
• Nausea and vomiting
• Fatigue
• Muscle aches

IMMUNOTHERAPY FOR PEDIATRIC ACUTE
LYMPHOBLASTIC LEUKEMIA (pALL)

Immunotherapy²³ enhances one’s immune system to fight cancer. There are different types of immunotherapies that help the immune system in different ways, ranging from immune checkpoint inhibitors that stop attacks on your healthy cells, to helping to find hidden cancer cells and reprogramming immune cells to fight cancer.

Monoclonal antibodies are manufactured antibodies designed to attack specific cells, such as a protein on the surface of leukemia cells.

Both drugs help to treat certain types of B-cell Adolescent and Lymphoblastic Leukemia, typically after chemotherapy has been tried. While some drugs are given as a continuous infusion over 28 days, some are given once a week for 3 or more 4 weeks in a row. Depending on the patient, this process may be repeated for more cycles.

Chimeric Antigen Receptor (CAR) T-cell therapy is a type of adoptive cell immunotherapy that enhances the body’s natural ability to fight cancer with the help of modified T cells.

COMMON SIDE EFFECTS

Before each infusion of monoclonal antibodies, patients will be given medicine to prevent side effects such as:

• High fever or chills
• Dizziness or lightheadedness
• Headache
• Low blood potassium levels
• Severe muscle or joint pain
• Low blood potassium levels
• Low levels of blood cells (with increased risks of infection, bleeding, and fatigue)
• Seizures

When it comes to CAR-T cell therapy, all patients need to be monitored carefully after receiving it. CAR-T cell therapy can pose serious side effects ranging from mild to life-threatening. For example, damage to the brain or nervous system (neurological toxicities) resulting in seizures, difficulty speaking and understanding, and loss of balance; and Cytokine Release Syndrome (CRS), a condition that can lead to flu-like symptoms including:

• Difficulty breathing
• Fever
• Chills or shaking chills
• Severe nausea, vomiting, diarrhea
• Severe muscle or joint pain
• Very low blood pressure
• Dizziness or lightheadedness