Formation of mature blood cells from stem cells Leukemia is cancer of the blood and bone marrow (blood producing tissue). Leukemia is cancer of the blood and bone marrow (blood producing tissue). Leukemia is a result of uncontrolled proliferation of immature white blood cells Leukemia is a result of uncontrolled proliferation of immature white blood cells Immature cells accumulate in the bone marrow, hindering the production of mature blood cells, platelets and functioning white blood cells. Immature cells accumulate in the bone marrow, hindering the production of mature blood cells, platelets and functioning white blood cells. Type of leukemia is dependent on which type of cell begins uncontrolled division Type of leukemia is dependent on which type of cell begins uncontrolled division

ALLAMLCLLCML Acute lymphocytic leukemia Acute myeloid leukemia Chronic lymphocytic leukemia Chronic myeloid leukemia ACUTE : progress rapidly, worsen quickly – characterized by uncontrolled division of immature white blood cells. CHRONIC : progress slowly, worsen over time, respond worse to treatment – characterized by uncontrolled division of more mature white blood cells.

Imaging Tests CT scan MRI scan Ultrasound Diagnostic Tests Blood tests Bone marrow aspiration Spinal tap Chemical stains Physical Exam Check symptoms

Immediate Therapy Needed in severe cases before standard treatment Radiation Therapy Targeted treatment to prevent spread to specific areas of the body Chemotherapy Systematic treatment; commonly introduced via cerebrospinal fluid because of swift spread High-dose Chemo with stem cell transplant More intensive treatment for cases with poor prognosis

Overall 2.9% of all new cancer within the US – relatively rare cancer2.9% of all new cancer within the US – relatively rare cancer 30% of all childhood cancer30% of all childhood cancer 4.3 per 100,000 persons per year4.3 per 100,000 persons per year Approx. 3,600 children will be diagnosed with leukemia in 2013Approx. 3,600 children will be diagnosed with leukemia in 2013 ALL 80% of all leukemia in children is ALL80% of all leukemia in children is ALL 3.6 per 100,000 per year3.6 per 100,000 per year Highest incidence in white and Hispanic childrenHighest incidence in white and Hispanic children Higher incidence in boys compared to girlsHigher incidence in boys compared to girls Trends Peak incidence seen in early childhood (birth to 3 years old)Peak incidence seen in early childhood (birth to 3 years old) Subtle increase cases (about 0.3% per year)Subtle increase cases (about 0.3% per year)

Overall Approx. 437 children and adolescents will die from leukemia in 2013.Approx. 437 children and adolescents will die from leukemia in Leukemia causes more deaths than any other cancer among childrenLeukemia causes more deaths than any other cancer among children ALL 16% of childhood cancer related deaths16% of childhood cancer related deaths 50% of all childhood leukemia deaths50% of all childhood leukemia deaths Boys have higher mortality rate than girlsBoys have higher mortality rate than girls White and Hispanic children have higher mortality rate, compared to other races/ethnicitiesWhite and Hispanic children have higher mortality rate, compared to other races/ethnicities Trends Mortality rate of childhood leukemia has declined by 80% from Mortality rate of childhood leukemia has declined by 80% from

Overall Survival in children is much better than survival in adults.Survival in children is much better than survival in adults. ALL Estimated 5-year survival rate for ALL is more than 90%.Estimated 5-year survival rate for ALL is more than 90%. 91.7% in children and adolescents younger than % in children and adolescents younger than % in children younger than 592.6% in children younger than 5 Trends Drastic improvements in survival since the 1960s.Drastic improvements in survival since the 1960s. The 5-year survival rate for ALL in the 1960s was only 3%; increased to 57% in the late 70s, and have continued to increase to over 90%.The 5-year survival rate for ALL in the 1960s was only 3%; increased to 57% in the late 70s, and have continued to increase to over 90%.

Incidence rates of Leukemia worldwide

Biological Factors Genetic Disorders Infectious Exposure Theories Environmental Factors Radiation Exposure Chemical Exposure Lifestyle Factors Socioeconomic Status Suspected/Unproven Factors Exposures to electromagnetic fields Living near a nuclear power plant Mother’s age during pregnancy Smoking history of parents Fetal exposure to hormones (i.e. birth control pills) Paternal workplace exposure to chemicals Chemical contamination of ground water

Limit exposure to known and suspected risk factors Limit exposure to radiation for pregnant women Primary Prevention Currently, there are no widely accepted blood tests or screening exams Monitor changes in child's behavior closely to identify any symptoms early Secondary Prevention Managing and maintaining remission status – i.e. monitoring health closely, detecting health issues and secondary cancers early Children who have been through leukemia treatment have an increased risk for developing other cancers and health issues later in life. Tertiary Prevention

Current research in childhood leukemia predominantly covers two main facets: understanding causation and determining ways to improve treatment and reduce the long term consequences of treatment. Causation/Risk Factors Examining the feasibility of screening for predictive biomarkers of childhood leukemia Examining the effect of parental lifestyle (i.e. smoking status) on childhood leukemia Reducing long-term consequences Studying the effects of alternations in chemotherapy process to reduce recurrence and development of secondary cancers in children with ALL