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The type and subtype of leukemia a child has plays a major role in both treatment options and the child’s outlook (prognosis). Determining the type (acute lymphocytic leukemia (ALL), acute myeloid leukemia (AML), etc.) and subtype of the leukemia is done by testing samples of the blood, bone marrow, and sometimes lymph nodes or cerebrospinal fluid (CSF), as described in Tests for Childhood Leukemia.
Be sure to ask your health care team or your child's doctor if you have any questions about the subtype of your child’s leukemia.
Acute lymphocytic leukemia (ALL) is a fast-growing cancer of lymphocyte-forming cells called lymphoblasts. There are several subtypes of ALL, which are based mainly on:
Most often in children with ALL, the leukemia starts in early forms of B cells. There are several subtypes of B-cell ALL. Mature B-cell ALL (also called Burkitt leukemia), a rare subtype, is essentially the same as Burkitt lymphoma (a type of non-Hodgkin lymphoma) and is treated the same way. (See Treatment of Non-Hodgkin Lymphoma in Children, by Type and Stage.)
This type of leukemia affects older children more than B-cell ALL does. It often causes an enlarged thymus (a small organ in front of the windpipe), which can sometimes lead to breathing problems. It may also spread to the cerebrospinal fluid (CSF, the fluid that surrounds the brain and spinal cord) early in the course of the disease.
For more detailed information on the subtypes of ALL, see Acute Lymphocytic Leukemia (ALL) Subtypes and Prognostic Factors.
Aside from the subtype of ALL, other factors are important in determining a child's outlook (prognosis). These are described in Prognostic Factors in Childhood Leukemia.
Acute myeloid leukemia (AML) is typically a fast-growing cancer that starts in one of the following types of early (immature) bone marrow cells:
AML has many subtypes, which are based mainly on:
Acute promyelocytic leukemia (APL) is a special subtype of AML. It is treated differently from other subtypes of AML, and it tends to have a better outlook.
For more detailed information on the subtypes of AML, see Acute Myeloid Leukemia (AML) Subtypes and Prognostic Factors.
Aside from the AML subtype, other factors are important in determining a child’s outlook (prognosis). These are described in Prognostic Factors in Childhood Leukemia.
Chronic myeloid leukemia (CML) is typically a slower-growing cancer of early (immature) myeloid bone marrow cells. CML is not common in children, but it can occur.
CML does not have subtypes. Instead, the course of CML has 3 phases, based mainly on the number of immature white blood cells – myeloblasts (or blasts) – that are seen in the blood or bone marrow. CML can sometimes progress to more advanced phases over time.
In this earliest phase, children usually have fairly mild symptoms (if any), and the leukemia usually responds well to standard treatments. Most children are in the chronic phase when they are diagnosed.
Children whose CML is in accelerated phase may have symptoms such as fever, night sweats, poor appetite, and weight loss. CML in the accelerated phase might not respond as well to treatment as CML in the chronic phase.
In this phase, the leukemia cells often spread to tissues and organs outside the bone marrow. Children with CML in this phase often have fever, poor appetite, and weight loss. At this point the CML acts much like an aggressive acute leukemia (AML or, less often, ALL).
For more detailed information on the phases of CML, see Phases of Chronic Myeloid Leukemia.
The American Cancer Society medical and editorial content team
Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.
Arceci RJ, Meshinchi S. Chapter 20: Acute Myeloid Leukemia and Myelodysplastic Syndromes. In: Pizzo PA, Poplack DG, eds. Principles and Practice of Pediatric Oncology. 7th ed. Philadelphia Pa: Lippincott Williams & Wilkins; 2016.
Horton TM, Steuber CP. Risk group stratification and prognosis for acute lymphoblastic leukemia in children and adolescents. UpToDate. 2018. Accessed at www.uptodate.com/contents/risk-group-stratification-and-prognosis-for-acute-lymphoblastic-leukemia-in-children-and-adolescents on December 29, 2018.
Rabin KR, Gramatges MM, Margolin JF, Poplack DG. Chapter 19: Acute Lymphoblastic Leukemia. In: Pizzo PA, Poplack DG, eds. Principles and Practice of Pediatric Oncology. 7th ed. Philadelphia Pa: Lippincott Williams & Wilkins; 2016.
Rabin KR, Margolin JF, Kamdar KY, Poplack DG. Chapter 100: Leukemias and Lymphomas of Childhood. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 10th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2015.
Tarlock K, Cooper TM. Acute myeloid leukemia in children and adolescents. UpToDate. 2018. Accessed at www.uptodate.com/contents/acute-myeloid-leukemia-in-children-and-adolescents on December 29, 2018.
Last Revised: February 12, 2019
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