What is high-risk leukemia?

Leukemia (loo-KEE-mee-uh) is cancer of the blood. The most common types in children are acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML).

“High risk” means the leukemia is harder to treat and more likely to come back after treatment. Doctors use these factors to tell if leukemia is high risk:

  • The cancer cells show signs like abnormal chromosomes or certain proteins on the cell surface.
  • It does not go into remission quickly with treatment (refractory).
  • It improves with treatment but then gets worse (relapsed) or comes back after treatment (recurrent).
  • A stem cell transplant is likely to be needed as part of treatment.

What’s special about the High-Risk Leukemia Program at Seattle Children’s?

We are the only children’s hospital where experts in high-risk leukemia research, diagnostics and treatment work as a team to give your child seamless care from first visit to follow-up. At each visit, your child will see a cancer doctor (pediatric oncologist), stem cell transplant doctor (if needed) and other specialists.

Each time you visit, the full High-Risk Leukemia team will talk in detail about your child’s case, including diagnosis, treatment, and appropriate research studies. This close collaboration by experts in many different specialties sets us apart.

We leave no stone unturned in finding treatments designed to improve survival for children with high-risk leukemia. The program is part of Seattle Children’s Cancer and Blood Disorders Center, which is consistently ranked among the best in the nation by U.S. News & World Report.

  • Our team of experts are leading the way in:

    • Using state-of-the-art diagnostics – like advanced gene sequencing – to find what’s different about each child’s leukemia
    • Matching kids with therapies that target their particular cancer instead of one-size-fits-all drugs
    • Developing new targeted therapy drugs that attack specific gene changes (mutations) in AML
    • Creating new T-cell therapies that use a child’s immune system to fight ALL
    • Taking new approaches to stem cell transplants to reduce the risk of relapse
    • Groundbreaking research to understand the biology of leukemia and how to fight it

  • For some children, treatment for high-risk leukemia includes very high doses of chemotherapy medicines and a stem cell transplant to replace the body’s system for making blood cells. We work closely with Fred Hutch, whose doctors pioneered this lifesaving procedure 40 years ago. Fred Hutch is our partner in the Seattle Cancer Care Alliance (SCCA).

    Dr. Marie Bleakley, co-director of our program, runs a research lab at Fred Hutch that focuses on improving outcomes for children with high-risk leukemia. Her lab is developing T-cell immunotherapies aimed at preventing relapse in children after stem cell transplants.

    Our team works with your family through the whole process – preparing for transplant, doing the transplant here at Seattle Children’s and caring for your child as they recover.

    Your child’s cancer doctor and transplant doctor work together to plan and monitor treatment. This includes:

    • How to get your child’s disease in remission, including new approaches like immunotherapy
    • The best kind of transplant for your child, if one is needed
    • How to reduce the risk of cancer coming back

  • Our entire focus is on helping your child beat their disease and thrive. Our team coordinates all aspects of your child’s diagnosis and care.

    • At each visit to the High-Risk Leukemia Program, your child will see a childhood cancer doctor, transplant doctor, advanced practice provider (APP), research nurse, pharmacist, social worker and child life specialist. Your child also will see other experts for care they may need, such as specialists in nutrition or infectious disease.
    • You will have a single point of contact who will communicate among all members of your child’s team – including you – and help coordinate care. Our program’s dedicated intake coordinators, nurse coordinators and social workers are here for your family throughout your child’s care.
    • Each time you visit, our entire team will talk in detail about your child and any test results, including state-of-the-art gene sequencing. This helps us personalize treatment for your child.
    • Your child will visit the High-Risk Leukemia Program at key milestones, such as their first visit to Seattle Children’s, pre-transplant visit, 100 days post-transplant and 1-year follow-up.
    • We will explain our recommended treatment plan to you and to your referring doctor. Between visits to the High-Risk Leukemia Program, the plan guides your child’s care at Seattle Children’s. If you choose to get care at another hospital, your child’s referring doctor can use the plan.
    • By combining our different skills and knowledge, we provide the most effective, comprehensive and coordinated treatment plan for your child.

The Experts Your Child Needs

Our physician-scientists are world leaders in improving care and cure rates. Meet the doctors who care for children, teens and young adults in our High-Risk Leukemia Program.

  • Dr. Todd Cooper, director, is chair of the Children’s Oncology Group’s (COG's) committees on New Agents for AML and Relapsed AML. He chairs a national COG phase 2 clinical trial for kids with relapsed AML. The study uses a new medicine (CPX-351) designed to kill leukemia cells while limiting damage to the heart. He also leads a national COG phase 3 study for children who are newly diagnosed with AML. Learn more about why Cooper has devoted his career to improving care for high-risk leukemia.
  • Dr. Marie Bleakley, co-director, is a member of the American Society of Hematology (ASH) Scientific Committee on Immunology and Host Defense. Her lab works to identify proteins (antigens) on leukemia cells that can be used as targets in new immunotherapy clinical trials.
  • Dr. Soheil Meshinchi leads our work on next-generation gene sequencing and chairs the COG AML Biology Committee. He is an international leader in defining the genetic makeup of childhood AML and finding new targets for AML therapies. His lab focuses on developing better, personalized treatments for kids with AML.
  • Dr. Katherine Tarlock works in the Meshinchi lab to identify genetic changes that can be targeted in new AML therapies. She is helping to develop and will lead 2 national COG clinical trials for targeted therapies in childhood AML. Learn more about AML lab research at Seattle Children’s.
  • Dr. Michael Jensen is director of the Ben Towne Center for Childhood Cancer Research, with a proven track record of moving innovations from the research bench to our patients.
  • Dr. Rebecca Gardner, a member of the COG’s ALL Steering Committee, is clinical leader of ALL immunotherapy studies at Seattle Children’s.

Read about lab research and clinical trials at Seattle Children’s.

Contact Us

The High-Risk Leukemia Program is part of our Cancer and Blood Disorders Center. You can contact the center at 206-987-2106 for an appointment, a second opinion or more information.

If a doctor at another hospital or clinic has diagnosed leukemia in your child or teen, you can request a second opinion at Seattle Children’s. A second opinion is a chance to confirm the features of your child’s disease and the best treatment options.

Schedule an appointment