Alexa & Katie (2018): Leukemia in High School

Heather Wordham's Netflix sitcom opens on the first day of high school. Alexa Mendoza is already in treatment for leukemia. Her best friend, Katie Cooper, shaves her own head so that Alexa will not be the only bald girl in the year.

Netflix released the show in four parts between 2018 and 2020, and it stays deliberately small. Wigs that cost more than Katie's family can spare. A basketball tryout Alexa is not cleared for. A rumour about which of the two girls actually has cancer. A winter formal she can only attend in a mask, during a flu outbreak. Weeks stuck at home because her immune system is too weak for school.

Later she reaches her final treatment appointment and is deflated by what it means. She is not finished with hospitals. She is moving to survivorship follow-up. She meets Spencer, who has Hodgkin lymphoma, and finds supporting him through chemotherapy harder than she expected. The show ends with both friends graduating, starting at different universities, and coming home for Thanksgiving.

The ending is described below.

Most cancer drama reaches for the crisis. This show is interested in the admin, and that is why it works.

Chemotherapy here is long, dull and cumulative rather than violent. Hair loss matters enormously, because Alexa is fifteen. The implanted port is on screen, and so is the flushing that keeps it working. A low neutrophil count sends her home from school and makes her miss the dance. A flu outbreak is a genuine danger, not a plot inconvenience.

It is honest that a leukemia protocol runs for years rather than weeks, and honest that the last dose is not the end of anything.

It is also sharp on the social cost. The pity Alexa cannot stand. Friends who overcorrect. A father who cannot cope with seeing her without hair. A younger brother rearranging himself around it. A best friend quietly carrying losses nobody asks about.

Alexa is rarely shown genuinely unwell. There are no mouth ulcers, no vomiting, no steroid mood swings and no emergency admissions for fever. All of those are routine on real protocols.

Her cancer is never staged or subtyped, and no drug is ever named, so the medicine is decorative. Hospital stays are short and cheerful. The family's finances appear untouched. There is no relapse, no serious talk about long-term effects, and no death in Alexa's own storyline.

That is a defensible choice for a show aimed at families. It is worth knowing before you hand it to a child who is actually in treatment, because the gap between this and their week may sting.

Alexa's subtype is never named. In her age group the commonest is acute lymphoblastic leukemia, so that is the useful anchor.

The National Cancer Institute describes treatment in phases. First comes remission induction, which aims to clear the leukemia from the blood and marrow. Then consolidation, also called intensification, which goes after cells that survived. Then maintenance, sometimes called continuation, given at lower doses to stop the disease returning.

Chemotherapy is also put directly into the spinal fluid. That is called intrathecal treatment, and its job is to keep leukemia out of the brain and spinal cord.

NCI puts the usual total at two to three years of chemotherapy. That is why a character can plausibly spend most of high school in treatment.

Maintenance is mostly tablets taken at home, which sounds like the easy part and is not. NCI notes that not taking mercaptopurine reliably during maintenance carries a real risk of the leukemia coming back. If pills are being missed, that is a thing to tell the team, not to hide.

Neutrophils are the white cells that deal with everyday bacteria. Chemotherapy knocks them down, and the show is right that this is what governs a family's calendar.

When the count is low, an infection that would be nothing in a well child can become an emergency. CDC lists a fever of 100.4°F (38°C) or higher as a sign of infection during treatment, along with chills, cough or sore throat, diarrhoea, mouth sores, a rash, and redness or swelling around a line.

One detail the show never mentions is worth more than any plot point. NCI advises talking to your doctor or nurse before giving anything for a fever, including paracetamol or ibuprofen. Those drugs bring the temperature down and can hide the problem the team needs to see.

Every unit sets its own threshold for coming in. Ask for yours in writing, and ask for the out-of-hours number at the same time.

Alexa expects a bell and gets a follow-up schedule. That disappointment is well observed.

Survivorship care exists because treatment given during growth can leave marks that surface years later. Follow-up looks for late effects on the heart, the endocrine system, fertility, bones and learning, and for second cancers. It also covers vaccinations, which often have to be repeated.

Ask for a written survivorship care plan: what was given, at what total dose, what to watch for, and who is now responsible for checking. That document is the thing an adult survivor will still need at thirty.

Cancer Explained is free and ad-free. Nothing is sold on this page. No sponsor sits behind it.

Did this page help you understand something about Alexa & Katie, or nudge you toward a question you had been avoiding? Reader support is what keeps this page on Alexa & Katie free, along with every other page here. Support our work.

Alexa & Katie is a kind show and a partial one. It is good on the shape of a treatment year and silent on the worst days inside it.

There is no screening test for childhood leukemia, and none is recommended. It is found when a child is unwell and someone orders a blood count. Persistent tiredness, bruising, fevers or bone pain in a child are worth a visit and a full blood count. See possible warning signs and screening.

• Childhood Acute Lymphoblastic Leukemia Treatment (PDQ®) — Health Professional Version — National Cancer Institute.
• Childhood Acute Lymphoblastic Leukemia Treatment (PDQ®) — Patient Version — National Cancer Institute.
• Infection and Neutropenia During Cancer Treatment — National Cancer Institute.
• Late Effects of Treatment for Childhood Cancer (PDQ®) — National Cancer Institute.

This page discusses Alexa & Katie for education. It is not medical advice, and nothing here is a judgement of anyone's real medical care. Spotted an error? Please email corrections@cancerexplained.org.