Treatments and Services

High-Risk Leukemia Program

What is high-risk leukemia?

“High-risk” leukemia (loo-KEE-mee-uh) is cancer of the blood that is harder to treat and more likely to come back after treatment. Doctors say leukemia is high-risk if:

  • When your child is first diagnosed, the cancer cells show signs like abnormal chromosomes or certain proteins on the cell surface that are known to resist treatment or make the leukemia more likely to come back
  • It does not go into remission quickly with treatment (refractory)
  • It comes back after treatment (relapsed or recurrent)
  • A bone marrow transplant is likely to be needed as part of treatment

If your child’s leukemia is high-risk, they need a different approach. Our High-Risk Leukemia team will assess your child, review all the options and recommend the best treatment for them. Your family can consult us about the best care possible for your child either in-person or through a phone visit. After reviewing all the medical records you provide, we can see your child in the clinic or set up a call with your family and child’s doctors to discuss the best approach.

Our doctors are known worldwide for improving care and cure rates for childhood leukemia. We treat children and young adults with all types of leukemia, including relapsed acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML).  

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

Consistently ranked one of the nation's best cancer programs by U.S. News and World Report.From first visit to follow-up, our experts in high-risk leukemia diagnosis, care and research will work as a team to give your child seamless care. The close collaboration between high-risk leukemia experts across various specialties – including bone marrow transplant and immunotherapy clinical trials – sets us apart from other pediatric hospitals.

We leave no stone unturned to find the best possible treatment options specific to your child. Our team is experienced in delivering therapies designed to improve survival and quality of life for children with the toughest cases of leukemia. The program is part of Seattle Children’s Cancer and Blood Disorders Center.

A boy"It was scary hearing the cancer had returned especially since at first, we didn’t think we had any options. It was really encouraging to know there was another option out there and this wasn’t the end of the line.” – Melissa Goldsmith, mom of Fuller, who took part in a T-cell research study after his ALL relapsed.

  • Advanced diagnostics and personalized medicine
    • In addition to standard diagnostics, our team uses state-of-the-art tests like molecular profiling and next-generation sequencing (NGS). We examine your child’s cancer cells for certain proteins that can serve as targets for treatment and starting points for the design of new drugs.
    • These tests help us find what is different about your child’s leukemia and identify the best treatment options for them. Whenever possible, we use results from NGS to match your child with therapies that target their specific cancer. This approach is called precision (or personalized) medicine. These therapies could be medicines already approved for another disease or clinical trials of new treatments.
    • We watch your child closely during treatment, using advanced tests to track how they are doing. This lets us know sooner if a different approach is needed.
    • In addition to targeted therapies, we offer advanced treatment options such as new chemotherapies, immunotherapies, radiation therapy and bone marrow transplants.
  • Seamless care from world-class experts

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

    • To create a custom treatment plan for your child, our whole team will talk in detail about your child’s case. This includes their diagnosis, treatment and relevant research studies.
    • 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.
    • Your child will have comprehensive visits with the High-Risk Leukemia team at key milestones. These include their first visit to Seattle Children’s, before-transplant visit, 100 days after-transplant and 1-year follow-up.
    • At each visit, your child will see a childhood cancer doctor (pediatric oncologist), transplant doctor, advanced practice provider (APP), nurse coordinator, pharmacist, social worker and child life specialist.
    • As needed, your child also will see experts in infectious disease, cardio-oncology, nutrition, pain management, radiation oncology and palliative care.
    • Your nurse coordinator will manage your child’s individualized care all through their treatment, starting from first visit. Your nurse coordinator is your single point of contact who will communicate among all members of your child’s team – including you.
    • At Seattle Children's, we work with children and families from around the Northwest and beyond. Whether you live nearby or far away, we can help with financial counseling, schooling, housing, transportation, interpreter services and spiritual care. Read about our services for patients and families.
  • Pioneers in bone marrow transplants and improved outcomes

    For most children, treatment for high-risk leukemia includes very high doses of chemotherapy medicines and a bone marrow transplant to replace the body's system for making blood cells and introduce a new immune system. This reduces the risk of leukemia relapse. We work closely with Fred Hutchinson Cancer Center, whose doctors pioneered this lifesaving procedure. 

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

  • Research to improve care and cure rates

    As leaders in cancer research, we can offer the very latest treatments being studied. These include phase 1 clinical trials, which many centers do not offer. Early studies are especially relevant for children with high-risk leukemia.

    At Seattle Children’s these include:

    • T-cell immunotherapies such as PLAT CAR T-cell 
    • New drugs that fight cancer with fewer side effects, like Dr. Kasey Leger’s work on treatments that limit damage to the heart.
    • Better approaches to bone marrow transplant to increase effectiveness and reduce side effects.

High-Risk Leukemia Team

Todd CooperTodd Michael Cooper, DO

Dr. Todd Cooper is the section head of Oncology and the director of the Leukemia and Lymphoma Program. Cooper initially helped develop Seattle Children’s High-Risk Leukemia Program and served for eight years as the program’s co-director. He is the co-lead of The Leukemia & Lymphoma Society’s Pediatric Acute Leukemia (PedAL) Initiative, chair of the Children’s Oncology Group (COG) Myeloid Diseases Committee and also the leader of a national COG phase 3 study for children who are newly diagnosed with AML. COG is the largest consortium in the world focused on childhood cancers.

Marie BleakleyMarie Bleakley, MD, PhD

Dr. Marie Bleakley at Fred Hutch. With funding from the National Institutes of Health, her lab works to identify proteins on leukemia cells that can be used as targets in new immunotherapy clinical trials. Her laboratory developed a new type of T-cell therapy for people with acute leukemia that persists after donor bone marrow transplant. This new therapy is being assessed in a phase 1 clinical trial. Bleakley also leads a national clinical trial of a new way to transplant bone marrow in youth with leukemia, pioneered by her team.

Meet the other doctors who care for children, teens and young adults with high-risk leukemia.

Soheil MeshinchiSoheil Meshinchi, MD, PhD

Dr. Soheil Meshinchi is an expert in leukemia biology, next-generation gene sequencing, targeted therapies for AML patients and bone marrow transplants for children with leukemia. He provides scientific leadership for many national and worldwide cooperative research efforts. These include the PedAL Initiative, COG AML Biology Committee and the TARGET AML Initiative.

Katherine TarlockKatherine Tarlock, MD

Dr. Katherine Tarlock works in the Meshinchi lab to identify genetic changes in AML that can lead to new therapies. She leads 2 national COG clinical trials for targeted therapies in childhood AML. Learn more about AML lab research at Seattle Children’s.

Adam LambleAdam Joseph Lamble, MD

Dr. Adam Lamble leads a national phase 1 clinical trial through COG that is testing a new drug for relapsed or refractory AML. He works on high-throughput drug screening with Tarlock.

Headshot of Dr. Colleen AnnesleyColleen Annesley, MD

Dr. Colleen Annesley leads the liquid malignancy immunotherapy program at Seattle Children’s, and she is the study chair of several CAR T cell clinical trials for high risk or relapsed acute leukemia and lymphoma.

Contact Us

The High-Risk Leukemia Program is part of our Cancer and Blood Disorders Center. If you would like an appointment, ask your child’s primary care provider to refer you.

If you have a referral or would like a second opinion, contact the Cancer and Blood Disorders Center at 206-987-2106 or by email: A second opinion is a chance to confirm the features of your child's disease and get advice on the best treatment options.

Providers, see how to refer a patient.

Schedule an appointment

Telemedicine at Seattle Children’s

You may be offered a telehealth (virtual) appointment. Learn more.

Paying for Care

Learn about paying for care at Seattle Children’s, including insurance coverage, billing and financial assistance.

“We gather all of a child’s providers under the same roof at the same time, to look at patients from every angle and provide the best possible care every step of the way. Coordinating care in this way also makes life easier for families.” – Dr. Todd Cooper, co-director, High-Risk Leukemia Program.