Leukemia - Acute Lymphoblastic - ALL - Childhood

ON THIS PAGE: You will find information about the estimated number of children and teens who will be diagnosed with acute lymphoblastic leukemia (ALL) each year, also called childhood ALL. You will also read general information on surviving the disease. Remember, survival rates depend on several factors, and no 2 people with cancer are the same. Use the menu to see other pages.

Every person is different, with different factors influencing their risk of being diagnosed with this cancer and the chance of recovery after a diagnosis. It is important to talk with your doctor about any questions you have around the general statistics provided below and what they may mean for your child individually. The original sources for these statistics are provided at the bottom of this page.

How many children and teens are diagnosed with ALL?

ALL is the most common type of childhood cancer. In the United States, approximately 75% of people under age 20 diagnosed with leukemia are diagnosed with ALL. Most cases occur between ages 2 and 5. However, it can be diagnosed at any age. An estimated 400 people ages 15 to 19 in the United States are diagnosed with the disease each year.

ALL is less common in girls than boys. Hispanic children and White children are slightly more likely to develop ALL than Asian children and Black children.

What is the survival rate for childhood ALL?

There are different types of statistics that can help doctors evaluate a person’s chance of recovery from ALL. These are called survival statistics. A specific type of survival statistic is called the relative survival rate. It is often used to predict how having cancer may affect life expectancy. Relative survival rate looks at how likely people with ALL are to survive for a certain amount of time after their initial diagnosis or start of treatment compared to the expected survival of similar people without this cancer.

Example: Here is an example to help explain what a relative survival rate means. Please note this is only an example and not specific to this type of cancer. Let’s assume that the 5-year relative survival rate for a specific type of cancer is 90%. “Percent” means how many out of 100. Imagine there are 1,000 people without cancer, and based on their age and other characteristics, you expect 900 of the 1,000 to be alive in 5 years. Also imagine there are another 1,000 people similar in age and other characteristics as the first 1,000, but they all have the specific type of cancer that has a 5-year survival rate of 90%. This means it is expected that 810 of the people with the specific cancer (90% of 900) will be alive in 5 years.

It is important to remember that statistics on the survival rates for children and teens with ALL are only an estimate. They cannot tell an individual person if cancer will or will not shorten their life. Instead, these statistics describe trends in groups of people previously diagnosed with the same disease, including specific stages of the disease.

The 5-year relative survival rate for children 0 to 14 with ALL is 92%. The 5-year relative survival rate for teens ages 15 to 19 is 77%. The survival rates for children and teens with ALL vary based on several factors. These include the classification of the age and general health, and how well the treatment plan works.

For younger patients diagnosed with acute leukemia, those who remain free from the disease after 5 years are generally considered cured because it is rare for acute leukemia to recur after this amount of time.

Experts measure relative survival rate statistics for childhood ALL every 5 years. This means the estimate may not reflect the results of advancements in how ALL is diagnosed or treated from the last 5 years. Talk with your child’s doctor if you have any questions about this information. Learn more about understanding statistics .

Statistics adapted from the American Cancer Society's (ACS) publications, Cancer Facts & Figures 2023 and Cancer Facts & Figures 2020: Special Section - Cancer in Adolescents and Young Adults, and the ACS website. (All sources accessed February 2023.)

The next section in this guide is Medical Illustrations . It offers drawings of body parts often affected by childhood ALL. Use the menu to choose a different section to read in this guide.

ON THIS PAGE : You will find out more about the factors that increase the chance of developing childhood acute lymphoblastic leukemia (ALL). Use the menu to see other pages.

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do.

Although doctors don’t know what causes most childhood leukemia, some evidence shows that certain genetic factors play a role in ALL.

Children who are born with a condition that has been linked to genetic and immune system problems -- such as Down syndrome, ataxia telangiectasia , or Bloom syndrome -- may have a higher risk of developing leukemia.

A child with an identical twin that develops ALL before age 6 has an increased risk of developing leukemia. If an identical twin develops leukemia within the first few months of life, the other twin will almost always develop the same type of leukemia.

The next section in this guide is Symptoms and Signs . It explains what changes or medical problems that childhood ALL can cause. Use the menu to choose a different section to read in this guide.

ON THIS PAGE : You will find a list of the common tests, procedures, and scans that doctors can use to find the cause of a medical problem. Use the menu to see other pages.

Doctors use many tests to find, or diagnose, leukemia. They also do tests to learn if cancer has spread to another part of the body from where it started. If the cancer has spread, it is called metastasis. Doctors may also do tests to learn which treatments could work best.

How acute lymphoblastic leukemia (ALL) is diagnosed

There are many tests used for diagnosing ALL. Not all tests described here will be used for every person. Your child's doctor may consider these factors when choosing a diagnostic test:

• The type of cancer suspected

• Your child's signs and symptoms

• Your child's age and general health

• The results of earlier medical tests

A patient history, physical examination, complete blood cell count (CBC), and bone marrow aspiration (see below) are the main procedures used to diagnose ALL or rule out other conditions.

• Blood tests. A CBC provides a count of each type of cell in the blood. The blood count may also show abnormal leukemia cells. The blood count is abnormal, in some way, for nearly all children with ALL when they are diagnosed. A blood chemistry test gives information about the body’s kidney and liver function, as well as other measures, such as salt levels.

• Bone marrow aspiration and biopsy. These 2 procedures are similar and often done at the same time to examine the bone marrow. Bone marrow has both a solid and a liquid part. A bone marrow aspiration removes a sample of the fluid with a needle. A bone marrow biopsy is the removal of a small amount of solid tissue using a needle.

  A pathologist then analyzes the sample(s). A common site for a bone marrow aspiration and biopsy is the pelvic bone, which is located in the lower back by the hip. Doctors generally give a type of medication called anesthesia beforehand to numb the area. Anesthesia is medication that blocks the awareness of pain. Stronger types of anesthesia can also be used to lessen the pain.

  A bone marrow aspiration is recommended if the blood test shows unusual blood counts or immature cells, or if the doctor suspects that a child may have leukemia. From this test, the doctor can find out whether the child has leukemia and, if so, what type of leukemia it is. The doctor or other health care team member will collect more than one sample of bone marrow at the same time for other tests, such as chromosome and molecular genetic tests and immunophenotyping (see Classification ). These additional tests are important to plan the most appropriate treatments.

• Lumbar puncture (spinal tap). A lumbar puncture can determine if the leukemia has spread to the cerebral spinal fluid (CSF). CSF is the fluid that flows around the brain and the spinal cord. During a lumbar puncture, a needle is used to take a sample of the CSF to look for leukemia cells. Doctors may give an anesthetic to numb the lower back before the procedure and/or use anesthesia to block awareness of the pain. Knowing whether or not there is leukemia in the central nervous system helps doctors choose the most appropriate treatment. All children with ALL receive medicine to treat or prevent leukemia of the central nervous system at the same time as the lumbar puncture at specific times during treatment.

After diagnostic tests are done, your child’s doctor will review the results with you. If the diagnosis is ALL, these results also help the doctor describe the disease. This is called classification .

The next section in this guide is Classification. It explains the system doctors use to describe this type of cancer. Use the menu to choose a different section to read in this guide.

ON THIS PAGE : You will learn about the different types of treatments doctors use for children with acute lymphoblastic leukemia (ALL). Use the menu to see other pages.

In general, cancer in children is uncommon. This means it can be hard for doctors to plan treatments unless they know what has been most effective in other children. That is why more than 60% of children with cancer are treated as part of a clinical trial. A clinical trial is a research study that tests a new approach to treatment. The “standard of care” is the best treatments known based on previous clinical trials. Clinical trials may test such approaches as a new drug, a new combination of existing treatments, or new doses of current therapies. The health and safety of all children participating in clinical trials are closely monitored.

To take advantage of these newer treatments, children with cancer should be treated at a pediatric cancer center or a cancer center with access to specialists in pediatric cancer. Doctors at these centers have extensive experience in treating children with cancer and have access to the latest research. A doctor who specializes in treating children with cancer is called a pediatric oncologist.

How childhood ALL is treated

In many cases, a team of doctors works with a child and the family to provide care. This is called a multidisciplinary team . Pediatric cancer centers often have extra support services for children and their families, such as child life specialists, nutritionists, physical and occupational therapists, social workers, and counselors. Special activities and programs to help your child and family cope may also be available.

Treatment options and recommendations depend on several factors, including the classification of ALL, possible side effects, and the patient’s preferences and overall health. Take time to learn about all of your child’s treatment options and be sure to ask questions about things that are unclear. Talk with your child’s doctor about the goals of each treatment and what your child can expect while receiving the treatment. These types of talks are called “shared decision-making.” Shared decision-making is when you and the doctors work together to choose treatments that fit the goals of your child’s care. Shared decision-making is particularly important for childhood ALL because there are different treatment options. Learn more about making treatment decisions .

Descriptions of common types of treatments used for childhood ALL are listed below. Your child's care plan also includes treatment for symptoms and side effects, an important part of cancer care.

The 3 types of treatments used to treat childhood ALL are chemotherapy, radiation therapy, and stem cell transplantation/bone marrow transplantation. All children with ALL receive chemotherapy. Some children will also need radiation therapy or stem cell transplantation/bone marrow transplantation.

• Chemotherapy

• Radiation therapy

• Stem cell transplantation/bone marrow transplantation

• Physical, emotional, and social effects of cancer

• Remission and the chance of recurrence

• If treatment does not work

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells.

A chemotherapy regimen, or schedule, usually consists of a specific number of cycles of drugs given over a set period of time. A patient may receive 1 drug at a time or combinations of different drugs given at the same time.

Chemotherapy is the primary treatment for ALL. It may be given by mouth (orally), injected into a vein or muscle, or injected into the cerebral spinal fluid (CSF). It is generally done in four phases:

• Remission induction therapy uses chemotherapy to destroy as many of the leukemia cells as possible to cause the cancer to go into remission.

• Central nervous system directed therapy destroys any leukemia cells in the central nervous system and prevents the spread of the disease to the spinal fluid.

• Consolidation therapy begins when the child’s leukemia has gone into remission. Higher doses of chemotherapy, or drugs not used during previous treatment, are used to destroy most of the remaining leukemia cells.

• Continuation or maintenance therapy lasts for two to three years to destroy any remaining (residual) leukemia cells.

The side effects of chemotherapy depend on the individual and the dose used, but they can include short-term side effects like hair loss, fatigue, loss of appetite, nausea and vomiting, diarrhea, and kidney and liver problems. If a drug called vincristine (Oncovin, Vincasar) is part of your child’s chemotherapy, there may be muscle weakness and nerve pain. These side effects usually go away after treatment is finished. Other side effects related to chemotherapy that may last longer or develop after treatment is finished include bone and joint problems and learning problems.

The severity of the side effects depends on the type and amount of the drug being given and the length of time the child receives the drug. The side effects each child experiences may also be affected by other factors, including biological differences in the way the medications are processed by the body, the child or teen’s age when diagnosed, and their overall health. That's why it is important to let your child's cancer care team know if your child is experiencing any changes in how they are feeling. Talk with your child's doctor regularly about what side effects are likely and how they can be managed.

Learn more about the basics of chemotherapy .

Return to top

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time.

Radiation therapy for ALL is has recently been used when the leukemia has spread to the brain, spinal fluid, or the testicles, or in high-risk disease to help prevent the spread of leukemia to the spinal fluid. However, with current treatment regimens, radiation therapy is typically reserved for recurrent or refractory disease, and in some centers, patients with T-cell leukemia.

Side effects from radiation therapy may include hair loss, fatigue, mild skin reactions, upset stomach, and loose bowel movements. Talk with your child's doctor about what side effects may happen and how they can be managed. Most side effects go away soon after treatment is finished. However, long-term side effects of radiation treatment to the brain and body can occur and may possibly include hormone problems affecting growth and metabolism, learning problems, and an increased risk of developing a second cancer including a brain tumor , skin cancer, salivary gland cancer, and thyroid cancer can also occur after radiation treatment for ALL (see Follow-up Care ).

Learn more about the basics of radiation therapy .

Return to top

Bone marrow transplantation/stem cell transplantation

Bone marrow/stem cell transplantation is most often used as a treatment for recurrent or refractory ALL. Rarely, transplantation may be recommended as part of the initial therapy when leukemia is associated with very high-risk features.

A bone marrow transplant is a medical procedure in which bone marrow that contains cancer is replaced by highly specialized cells. These cells, called hematopoietic stem cells, develop into healthy bone marrow. Hematopoietic stem cells are blood-forming cells found both in the bloodstream and in the bone marrow. This procedure is also called a stem cell transplant or hematopoietic stem cell transplant.

Before recommending transplantation, doctors will talk with the patient about the risks of this treatment. They will also consider several other factors, such as the type of cancer, results of any previous treatment, and the patient’s age and general health.

There are 2 types of hematopoietic stem cell transplantation depending on the source of the replacement blood stem cells: allogeneic (ALLO) and autologous (AUTO). ALLO uses donated stem cells, while AUTO uses the patient’s own stem cells. In both types, the goal is to destroy all of the cancer cells in the marrow, blood, and other parts of the body using high doses of chemotherapy and/or radiation therapy and then allow replacement blood stem cells to create healthy bone marrow.

Side effects depend on the type of transplant, your child’s general health, and other factors. Learn more about the basics of stem cell and bone marrow transplantation .

Return to top

Physical, emotional, and social effects of cancer

Leukemia and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your child’s care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Palliative care focuses on improving how your child feels during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. Your child may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy or radiation therapy.

Before treatment begins, talk with your child’s doctor about the goals of each treatment in the recommended treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative care options. Many patients also benefit from talking with a social worker and participating in support groups. Ask your doctor about these resources, too.

During treatment, your child’s health care team may ask you to answer questions about your child’s symptoms and side effects and to describe each problem. Be sure to tell the health care team if your child are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.

Return to top

Remission and the chance of recurrence

A remission is when leukemia cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED.

A remission may be temporary or permanent. This uncertainty causes many people to worry that the leukemia will come back. While many remissions are permanent, it is important to talk with your child’s doctor about the possibility of the disease returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the leukemia does return. Learn more about coping with the fear of recurrence .

If the cancer returns after the original treatment, it is called recurrent ALL. If a recurrence happens, a new cycle of testing will begin again to learn as much as possible about it. After this testing is done, you and your child’s doctor will talk about treatment options. Often the treatment plan will include the treatments described above such as chemotherapy, radiation therapy, and/or stem cell transplantation but they may be used in a different combination or given at a different pace. Treatment of recurrent ALL depends on many factors, including the type of treatment the child received originally, the length of time between the initial diagnosis and the recurrence, and whether leukemia cells are found in the bone marrow, CSF, testicles, or in more than 1 of these sites when it recurs. Your child’s doctor may suggest clinical trials that are studying new ways to treat recurrent ALL. Just as for newly diagnosed patients, clinical trials typically offer the best chance of cure. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

When ALL recurs, patients and their families often experience emotions such as disbelief or fear. Families are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. Learn more about dealing with cancer recurrence .

Return to top

If treatment does not work

Although treatment is successful for many children with ALL, sometimes it is not. If a child’s leukemia cannot be cured or controlled, this is called advanced or terminal leukemia. This diagnosis is stressful, and advanced cancer may be difficult to discuss. However, it is important to have open and honest conversations with your child’s doctor and health care team to express your family’s feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families, and is there to help.

Hospice care is designed to provide the best possible quality of life for people who are expected to live less than 6 months. Parents and guardians are encouraged to talk with the health care team about hospice options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Some children may be happier if they can attend school part-time or keep up other activities and social connections. The child’s health care team can help parents or guardians decide on an appropriate level of activity. Making sure a child is physically comfortable and free from pain is extremely important as part of end-of-life care. Learn more about caring for a terminally ill child and advanced cancer care planning .

The death of a child is an enormous tragedy, and families may need support to help them cope with the loss. Pediatric cancer centers often have professional staff and support groups to help with the process of grieving. Learn more on grieving the loss of a child.

Return to top

The next section in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for children with cancer. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will read about the scientific research being done to learn more about this type of cancer and how to treat it. Use the menu to see other pages.

Doctors are working to learn more about acute lymphoblastic leukemia (ALL), ways to treat it, how to best treat it, and how to provide the best care to children diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your child’s doctor about the best diagnostic and treatment options for your child.

• Monitoring leukemia recurrence. New methods for detecting small numbers of leukemia cells that can’t be seen under a microscope were introduced in the 1990s. These techniques are now being used to detect minimal residual disease (MRD) after remission. There are times when measurements of MRD, in blood or bone marrow samples, will be used to determine your child’s risk level and treatment. Research is ongoing to determine the level of MRD, measured at specific time point, that affects the rate of recurrence. Currently, researchers are studying the relationship between the biology of the leukemia cells and these measurements.

• New treatments. Finding new ways to treat leukemia are important areas of research. New drugs to kill leukemia cells, such as the T-cell-specific drug nelarabine (Arranon), the antibody blinatumomab (Blincyto), and chimeric antigen receptor T-cells (CAR T-cells) are being studied and may improve the cure rate for children with ALL in the future. Other new treatments—antibodies, chemotherapy, and other biologically active treatments—are being studied with the hope that they will increase the cure rate and/or decrease the likelihood of side effects.

• Palliative care/supportive care . Clinical trials are underway to find better ways of reducing symptoms and side effects of current childhood ALL treatments in order to improve comfort and quality of life for patients.

Looking for More About the Latest Research?

If you would like more information about the latest areas of research in childhood ALL, explore these related items that take you outside of this guide:

• To find clinical trials specific to your diagnosis, talk with your child’s doctor or search online clinical trial databases .

• Visit the Cancer.Net Blog to review research announced at recent scientific meetings about childhood cancer treatment and survivorship.

• Visit the website of Conquer Cancer Foundation to find out how to help support cancer research. Please note that this link takes you to a different ASCO website.

The next section in this guide is Coping with Treatment . It offers some guidance in how to cope with the physical, emotional, social, and financial changes that cancer and its treatment can bring. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will read about your child’s medical care after cancer treatment is finished and why this follow-up care is important. To see other pages, use the menu.

Care for children diagnosed with cancer does not end when active treatment has finished. Your child’s health care team will continue to check that the cancer has not come back, manage any side effects, and monitor your child’s overall health. This is called follow-up care. All children treated for cancer, including acute lymphoblastic leukemia (ALL), should have life-long, follow-up care.

Your child’s follow-up care may include regular physical examinations, medical test, or both. Doctors want to keep track of your child’s recovery in the months and years ahead. Patients should receive follow-up care regularly to monitor for the possible side effects listed in the Types of Treatment section of this guide for each treatment option, as well as for the risk of liver disease from chemotherapy or transfusion-related infection (both very rare) and the child's bone health. Talk with your child's doctor about possible side effects based on your child's specific treatment plan.

At first, check-ups will occur often. Then over time, these appointments will become more spread apart. Your child’s doctor can recommend the necessary screening tests to monitor their health. Follow-up care should address your child’s quality of life, including any developmental or emotional concerns.

Learn more about the importance of follow-up care .

Watching for recurrence

One goal of follow-up care is to check for a recurrence, which means that the cancer has come back. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms.

During follow-up care, a doctor familiar with your child’s medical history can give you personalized information about the risk of recurrence. Your child's doctor will ask specific questions about your child’s health. Some children may have blood tests or imaging tests as part of regular follow-up care, but testing recommendations depend on several factors, including the type and classification of cancer originally diagnosed and the types of treatment given.

The anticipation before having a follow-up test or waiting for test results can add stress to you or a family member. This is sometimes called “scanxiety.” Learn more about how to cope with this type of stress .

Managing long-term and late side effects of childhood cancer

Sometimes, side effects may linger beyond the active treatment period. These are called long-term side effects. In addition, other side effects called late effects may develop months or even years after treatment has ended. Late effects can occur almost anywhere in the body. They include physical problems, such as heart problems , lung problems, and second cancers , which is a new type of cancer that happens in someone who has had cancer before. They can include problems with the patient's physical ability to have a child in the future, called infertility . They also include emotional problems, such as anxiety and depression , and problems with memory, thinking, and attention .

Based on the type of treatment your child received, the doctor will recommend what examinations and tests are needed to check for late effects. The possible long-term side effects associated with specific treatments are listed in the table below:

Follow-up care should address your child’s quality of life, including any developmental or emotional concerns.

The Children's Oncology Group (COG) has studied the physical and psychological effects that childhood cancer survivors face. Based on these studies, COG has created recommendations for long-term follow-up care for childhood, adolescent, and young adult cancer survivors that can be found on a separate website: www.survivorshipguidelines.org .

Keeping a child’s personal health record

You are encouraged to organize and keep a personal record of the child’s medical information. The doctor will help you create this. That way, as the child enters adulthood, he or she has a clear, written history of the diagnosis, the treatments, and the doctor’s recommendations about the schedule for follow-up care. ASCO offers forms to help create a treatment summary to keep track of the cancer treatment your child received and develop a survivorship care plan when treatment is completed.

Some children continue to see their oncologist, while others transition back to the care of their pediatrician, primary care doctor, or another health care professional. This decision depends on several factors, including the type and classification of cancer, side effects, health insurance rules, and your family’s personal preferences. Talk with the health care team about your child’s ongoing medical care and any concerns you have about their future health.

If a doctor who was not directly involved in your child’s cancer care will lead the follow-up care, be sure to share the cancer treatment summary and survivorship care plan forms with him or her, and with all future health care providers. Details about the specific cancer treatment given are very valuable to the health care professionals who will care for your child throughout their lifetime.

The next section in this guide is Survivorship. It describes how to cope with challenges in everyday life after a cancer diagnosis. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will find some questions to ask the doctor or other members of the health care team, to help you better understand your child’s diagnosis, treatment plan, and overall care. Use the menu to see other pages.

Talking often with the health care team is important to make informed decisions about your child’s health care. These suggested questions are a starting point to help you learn more about your child’s cancer care and treatment. You are also encouraged to ask additional questions that are important to you and your family. You may want to print this list and bring it to your child’s next appointment, or download Cancer.Net’s free mobile app for a digital list and other interactive tools to manage your child’s care. It may also be helpful to ask a family member or friend to come with you to appointments to help take notes.

Questions to ask after getting a diagnosis

• What type of leukemia does my child have?

• Can you explain my child’s pathology report (laboratory test results) to me?

• Will more tests be needed to confirm the diagnosis?

• What are the results of the analysis of the spinal fluid? What does this mean?

• What are the results of the bone marrow aspiration? What does this mean?

• What are the results of the cytogenetic studies done? What does this mean?

Questions to ask about choosing a treatment and managing side effects

• What are the treatment options?

• What is the goal of each treatment? Is it to eliminate the cancer, help my child feel better, or both?

• What clinical trials are open to my child? Where are they located, and how do I find out more about them?

• What treatment plan do you recommend? Why?

• Who will be part of my child’s health care team, and what does each member do?

• Who will be coordinating my child’s overall treatment?

• What are the possible side effects of this treatment, both in the short term and the long term?

• Could this treatment affect my child’s ability to become pregnant or have children in the future? If so, should I talk with a fertility specialist before treatment begins?

• What can I do to protect my child from infection during and after treatment?

• When should I call the doctor or hospital if there is a problem while at home with my child?

• How will this treatment affect my child’s daily life? Will he or she be able to attend school and perform their usual activities?

• If I’m worried about managing the costs related to my child’s cancer care, who can help me with these concerns?

• What support services are available to my child? To my family?

• If I have questions or problems, who should I call?

Questions to ask about planning follow-up care

• What follow-up tests will my child need, and how often will he or she need them?

• Are there blood tests or check-ups that can be done closer to home?

• What long-term side effects or late effects are possible based on the treatment my child received?

• What can be done to prevent or relieve the side effects?

• How do I get a treatment summary and survivorship care plan to keep in my personal records?

• What survivorship support services are available to my child? To my family?

• Whom should I call for questions or problems?

The next section in this guide is Additional Resources . It offers some more resources on this website that may be helpful to you. Use the menu to choose a different section to read in this guide.