home Folk remedies How does leukemia manifest in children? Why does malignant pathology appear? Signs of childhood leukemia according to laboratory tests

How does leukemia manifest in children? Why does malignant pathology appear? Signs of childhood leukemia according to laboratory tests

Oncological diseases, rightfully considered the plague of the 21st century, does not even spare children. According to statistics, the leading position among pediatric oncology is occupied by leukemia - a pathology of blood cells. It accounts for 35% of cases and is more often diagnosed in boys. It is important to recognize leukemia in time, symptoms in children detected on early stage, will not lead to serious complications. Let’s take a closer look at what this terrible pathology is in order to take timely measures and save the child’s life.

Leukemia - what is it

Leukemia, or leukemia, leukemia, is a malignant tumor pathology that affects the hematopoietic and lymphatic tissue. Leukemia in children is characterized by changes in bone marrow blood flow, accompanied by the replacement of healthy blood cells with immature leukocyte blasts.

The number of children suffering from leukemia is growing steadily. Child mortality from blood cancer is high.

Leukemia in a child is characterized by an uncontrollable accumulation of abnormal white blood cells in the bone marrow.

There are two forms of leukemia:

Acute, characterized by the absence of red blood cell production and the production of a large number of white immature cells.
The chronic form is accompanied by long-term replacement of healthy cells with pathological white blasts. Characterized by a more gentle course. According to statistics, patients diagnosed with chronic leukemia blood" live from 1 year or more.

Leukemia is not characterized by overflow of forms.

There are lymphoblastic and non-lymphoblastic types of acute leukemia.

Lymphoblastic leukemia is formed from lymphoblasts located in the red bone marrow, which subsequently spread to the lymph nodes and spleen.

Diagnosed in children over 1 year of age.

Nonlymphoblastic leukemia, or myeloid, is characterized by the formation of a myeloid blood cell tumor, accompanied by a very rapid proliferation of white blood cells. This type pathologies are diagnosed less frequently. Boys and girls aged two to three years are at risk.

Why does malignant pathology appear?

Scientists are still unclear about some of the causes of leukemia in children. However, there are some theoretical and practical justifications for answering the question of why children suffer from leukemia. Highlight following reasons leukemia in children:

Genetic predisposition. Pathological genes are formed as a result of intrauterine chromosomal changes, which produce substances that prevent the maturation of healthy cells.
Viral infection of the body. As a result of illnesses suffered by the child viral etiology, For example, chicken pox, mononucleosis, ARVI, etc., viruses are integrated into the cellular genome.
Immunodeficiency. The immune system cannot cope with the destruction of foreign organisms and ceases to destroy its own pathological cells, including malignant ones.
Radiation causes mutations in blood cells. Risk factors include maternal exposure to radiation (X-rays, tomography) during gestation, as well as living in a radioactive zone.
Adverse habits of parents, especially mothers. Smoking, drinking alcohol and drug addiction.
Secondary leukemia after radiation or chemotherapy for another cancer.

Leukemia also develops in children due to the formation of ozone holes as a result of active solar radiation. The causes of leukemia in children also lie in genetic pathologies, such as Down syndrome, Bloom syndrome, etc., as well as polycythemia.

How to recognize pathology

Typically, the first signs of leukemia manifest themselves gradually and are accompanied by symptoms characteristic of other pathologies:

increased fatigue;
lack of appetite;
sleep disorder;
causeless increase in temperature;
bone and joint pain.

As you can see, these signs of leukemia in children are similar to the symptoms of a common cold. They are often accompanied by the appearance of red spots throughout the body, as well as an enlargement of the liver and spleen.

This requires immediate medical attention.

There are cases of childhood leukemia, the symptoms of which are characterized by a sudden onset of severe poisoning of the body (nausea, vomiting, weakness) or bleeding, most often from the nose.

Symptoms of leukemia in children depend on the characteristics of the development of the malignant disease. Pathological cells, affecting the body, continue to actively reproduce, leading to an acute form of leukemia.

It is characterized by the following symptoms of leukemia in children:

A sharp drop in hemoglobin. Anemia develops, accompanied by lethargy, muscle pain, and rapid fatigue.
A decrease in platelet levels provokes the development of hemorrhagic syndrome, manifested by various hemorrhages, bleeding from the nose, gums, stomach, intestines, and lungs. Even a scratch becomes a source of active bleeding in children.
Immunodeficiency syndrome manifests itself as a result of an increased concentration of leukocytes in the blood, which makes the child’s body vulnerable to infectious and inflammatory processes. Gingivitis, stomatitis, tonsillitis and other infections often occur. Very often, children with leukemia die due to the development of severe forms of pneumonia or sepsis.
Intoxication of the body is manifested in childhood leukemia by a feverish state, anorexia, vomiting, and leads to the development of malnutrition. Dangerous complication of leukemic infiltration of the brain.
Cardiovascular disorders with signs of tachycardia, arrhythmia, changes in the heart muscle.
Pronounced pallor or yellowness of the mucous membranes and epidermis.
Painful enlargement of lymph nodes.
When the brain is damaged due to leukemia, children experience dizziness, migraine-like pain, and paresis of the limbs.

Leukemia in newborns is recognized by obvious developmental delays.

There are three stages of leukemia; according to the symptoms in children, they manifest themselves as follows:

The initial stage is expressed by a slight deterioration in health ( early signs described above).
The expanded stage takes place against a bright background severe symptoms, listed earlier. Everyone talks about the need for a complete examination of the body to exclude serious diseases.
There is no cure for the terminal stage. Accompanied complete loss hair, strong pain syndrome, the formation of metastases leading to active spread pathological cells and leukemic damage to the entire body.

Seeing a doctor, early diagnosis of blood cancer, and strict adherence to all medical prescriptions will help prevent irreversible consequences.

Diagnosis of leukemia

The main responsibility in recognizing the primary manifestations of leukemia lies with the pediatrician, and then the child is treated by an oncohematologist.

Childhood leukemia is recognized using the following laboratory tests:

clinical blood test;
Strenal puncture and myelogram are mandatory methods in the diagnosis of leukemia;
trepanobiopsy;
cytochemical, cytogenetic and immunological studies;
Ultrasound internal organs, as well as lymph nodes, salivary glands, scrotum;
radiography;
CT scan.

In addition, mandatory consultation with a neurologist and ophthalmologist is required.

Treatment of a serious illness

At the very frequently asked question Whether leukemia can be treated in children, unfortunately, cannot be answered unequivocally. Statistics operate on the following facts: 10-20% of children cannot be cured. However, doctors claim that leukemia in children is not a death sentence, and 80-90% of children are cured thanks to early diagnosis and opportunities modern medicine.

The main goal in the treatment of blood cancer is the destruction of all immature blast cells of the leukocyte series through the use of complex therapy.

Treatment of leukemia in children is carried out strictly in a hospital under constant supervision medical personnel. Since the child’s body is susceptible to rapid infection, he is given a separate room, external contact is excluded, and he is required to wear a bandage that protects the respiratory organs.

With leukemia in children, the treatment of which requires a lot of time and effort, it is important for parents to be patient and support the child in everything to achieve a stable remission of the disease.

The main therapeutic method for leukemia is polychemotherapy, carried out with strict adherence rules, timing and dosage of drugs. The doctor’s main task is to select the exact dosage of medications in order to destroy pathological cells and not harm the health of the little patient. Often the treatment process is accompanied by very serious condition sick.

In addition to chemotherapy treatment of leukemia, the attending physician prescribes immunotherapy, including the administration of BCG, smallpox, and leukemia cell vaccines.

In some cases, bone marrow and stem cell transplants are used.

Based on the symptoms children exhibit, treatment for leukemia may vary.

In general, therapy that eliminates the symptoms of the disease includes the following procedures:

blood transfusion;
prescribing hemostatic drugs for hemorrhagic syndrome;
antibiotics to treat infections that often accompany leukemia;
detoxification by plasmapheresis, hemosorption.

Therapy for childhood leukemia is supported by proper balanced nutrition:

refusal of fatty, spicy, pickled products;
limiting the consumption of semi-finished products;
eating fresh, just cooked food in warm liquid form;
complete exclusion of probiotics.

Is it possible to prevent the recurrence of leukemia? Doctors answer positively if you strictly follow medical recommendations and conduct healthy image life.

What are the prognosis of the disease?

Untreated blood cancer in children is fatal. If detected early, leukemia is curable in 80% of cases. Most often, a favorable outcome is observed in the absence of relapses after chemotherapy for 5 years.

If the disease has not manifested itself for about 7 years, complete relief from the terrible illness is possible.

A less favorable outcome is in the chronic form of myeloid leukemia, as well as in the development of leukemia in a newborn (up to 1 year old) child.

However, these data are conditional; a complete relapse can also occur in acute leukemia. It is difficult to say exactly what affects the prognosis and course of the disease. It depends on each specific case.

The main thing to remember is that at the first symptoms of leukemia in children, you should immediately contact a medical facility. The life of a little patient depends on your actions and competent treatment prescribed by the doctor.

In contact with

Cancer is one of the most mysterious diseases, and one of the most dangerous. Despite the achievements of modern medicine and the development of high technologies, a cure for cancer has not yet been found. The only way to, if not cure, then at least prolong the life of the patient, remains an aggressive effect on the human body through chemotherapy and radiation therapy.

It is one of the most dangerous forms of cancer, which in most cases is fatal. But the worst thing is that this particular form of cancer affects very young children. Babies can only be saved if we start at the earliest stage of the disease.

How to recognize the signs of leukemia in children, what signals does the child’s body send to adults, crying out for help, and what factors contribute to the development of this disease? At the same time, every parent of a child with blood cancer is faced with the question of whether blood leukemia can be cured or not, and whether there is hope that their child will again begin to enjoy life as before.

Features of leukemia in children

The name "blood cancer" is usually applied to some form of leukemia (leukemia). However, in medical practice malignant blood diseases are called hemoblastoses, representing a group malignant tumors, affecting the system hematopoiesis.

A tumor arises as a result of the appearance of just one cell, which for some reason has undergone mutation. A mutant cell has the ability to multiply uncontrollably, suppressing the activity of healthy cells, and over time completely destroying them.

Leukemias are those in which cancer cells attack the bone marrow. Due to the fact that a significant number of immature leukocytes, that is, white cells, appear in the patient’s blood, this disease was previously called leukemia. However, this feature of the disease is not typical for all types of leukemia.

The incidence of leukemia among children is 4-5 people per 100 thousand. In this case, blood leukemia most often occurs in. Most favorable time The age of development of the disease is from 2 to 5 years. Pediatricians are especially concerned about the trend towards an increase in the number of children becoming ill and the high mortality rate.

Causes of leukemia

Why childhood leukemia develops is not known to science. However, there are certain factors that significantly increase the likelihood of developing blood cancer. These include:

chemotherapy;
radiotherapy;
radiation therapy;
impact chemical substances;
viral diseases;

disorders of the child’s psycho-emotional state;
maternal smoking during pregnancy;
poor ecology in the region of residence;
genetic predisposition.

It should be noted that the causes of leukemia in children remain unclear in 65% of cases. Therefore, the main version of the emergence of this disease It is generally accepted to consider mutations in the DNA of blood cells, in which their functions are disrupted and the ability to mature is lost.

Immature cells are called blast cells. Normally, their content in the bone marrow does not exceed 1-3%. However, by mutating, these cells multiply very quickly, creating many clones that suppress healthy hematopoiesis.

Once in the blood, they, along with its current, spread to all tissues and organs, infecting them and causing the development of metastases. If blast cells penetrate the protective barrier surrounding the brain, they infect its membranes and substances, contributing to the development of neuroleukemia.

It has been noted that blood cancer most often occurs in children with Down syndrome.

Types and forms of leukemia in children

Based on the type of course, two forms of the disease are distinguished. These include:

acute leukemia develops from blasts - immature cells;
chronic leukemia occurs against the background of mutation of maturing and mature cells.

Acute leukemia in children is characterized by a rapid course. In this form of the disease, the hematopoietic system stops producing red cells, and white cells take their place. This form of the disease is the most dangerous, since its characteristic feature is the child’s short life expectancy. Depending on the stage of the disease and the treatment provided, children can live no more than one and a half months.

Chronic blood cancer is milder because white cells gradually replace red ones.

Therefore, the life expectancy of such patients increases to 1-2 years.

It should be noted that acute form leukemia never turns into chronic, and chronic into acute. And they began to call them that solely for the sake of convenience. However, in the chronic form of leukemia, stages of exacerbation occur, in which the overall blood picture becomes similar to acute leukemia.

Types of acute leukemia

There are two types of acute leukemia:

non-lymphoblastic.

In the first case, cancer cells develop from lymphoblasts. In this case, the initial site of dislocation of malignant cells is the red bone marrow. As the disease progresses, they spread, forming metastases in the spleen, lymph nodes and nervous system. This type of disease occurs most often in children after 1 year. Moreover, it mainly affects boys.

The main category of patients with non-lymphoblastic leukemia includes children aged 2 to 3 years. This type of leukemia is scientifically called myeloid, since cancer cells affect the myeloid blood process.

Although this type of disease is quite rare, childhood leukemia in this form is characterized by rapid development and is characterized by the almost instantaneous division of white blood cells, which penetrate the bone marrow and prevent the growth of red cells.

Blood cancer is believed to be curable. However, treatment tactics and further prognosis are directly dependent on the stage of the disease. These include:

first or acute stage lasts from the moment the first signs appear until the child’s condition improves and the results of examinations performed after treatment;
the second stage occurs at the moment of complete (when the bone marrow contains no more than 5% of blast cells) or incomplete remission (if the content of blast cells does not exceed 20%);
the third stage is characterized by the development of relapse of the disease, when cancer cells are found in the internal organs of the child.

It should be noted that the third stage of leukemia is practically untreatable. Its outcome, as a rule, is death.

Signs of the disease

From all of the above, we can conclude that it is possible to cure blood cancer only if early diagnosis. Unfortunately, in most cases, a sad diagnosis can only be made when the disease takes an aggressive form. Symptoms of leukemia in children are nonspecific, and therefore, when they appear, parents rarely consult a doctor, citing a cold or overwork of the child.

When reaching a critical age, parents need to pay attention to the following manifestations:

increased fatigue;
causeless loss of appetite;
sleep quality disturbance;
pain in bones and joints;
causeless increase in body temperature;
bleeding gums, nosebleeds;
nausea, vomiting, abdominal pain and other signs of intoxication.

Other symptoms in children include paleness of the skin and mucous membranes. Since leukemia causes an enlargement of the liver and spleen, the skin may become jaundiced. With leukemia, infection of the mucous membranes occurs, so the child’s mucous membranes very often become inflamed oral cavity, gums and throat. Leukemia also causes enlargement of the lymph nodes and salivary glands.

Signs of blood cancer in children, characterized by deterioration in blood clotting quality, are of particular concern. As a result, bruising may occur on the skin, indicating internal hemorrhage. And since cancer cells inhibit the growth of red blood cells, sick children develop anemia, the severity of which depends on the degree of spread of blast cells.

But the most dangerous cancer is the one that infects the brain - neuroleukemia. This condition characterized by the following manifestations:

headaches;
dizziness;
impaired visual perception;
nausea;
loss of elasticity of the neck muscles.

If metastases spread to the substance of the spinal cord, sensitivity decreases in children lower limbs or paralysis of the legs develops.

Diagnosis and treatment

The final diagnosis is made after the following diagnostic measures:

laboratory blood test, including general and biochemical analysis;
Ultrasound of internal organs, allowing to assess their condition;
X-ray examination of the chest;
computed tomography;
red bone marrow puncture.

Blood cancer treatment is carried out in inpatient conditions. In this case, sick children are placed in separate rooms in which conditions are as close as possible to sterile. This makes it possible to exclude the addition of bacterial and viral infections to leukemia.

This disease is treated by chemotherapy, the main goal of which is the complete destruction of mutating cells. Deciding how to treat, namely which chemicals used to destroy malignant neoplasms, it is used based on the results of the examination and determination of the type and form of the disease.

Conclusion

It is important to understand that the prevention of this terrible disease does not exist. Basic preventive actions consist of regular visits to a pediatrician, which will allow you to catch the disease at the earliest stage of development. Only in this case the answer to the question of whether leukemia can be cured will be positive.

It should also be remembered that complete cure It will be possible to speak only after 6-7 years after the end of treatment, if during this time no relapse occurs.

GBOU VPO Tver State Medical Academy of the Ministry of Health and Social Development

Department of Pediatrics

Faculty of Pediatrics

Faculty of Pediatrics

Tver, 2011

Yulia Sergeevna Apenchenko – Associate Professor of the Department of Pediatrics, Ph.D.

Edited by head Department of Pediatrics, Professor S.F. Gnusaeva

Reviewer:

Krivosheina Elena Leonidovna – Professor of the Department of Pediatrics of the Faculty of Education and Training of the Faculty of Education and Training of the TSMA

The educational and methodological manual was approved at the meeting of the Central Medical Committee on teaching pediatric disciplines on November 8, 2007, protocol No. 5.

Yu.S. Apenchenko

Leukemia in children: educational and methodological manual. manual / ed. S.F. Gnusaeva. – Tver: ATANOR, 2011. – 23 p., ill.

The methodological development “Leukemia in Children” is intended for self-training of 5th year students of the Faculty of Pediatrics, and can also be used at various stages of postgraduate education.

The recommendations are devoted to the current topic of pediatric hematology. The increase in cancer incidence and increased cancer alertness attach particular importance to the problem. Success modern therapy leukemia in children dictate the need for early diagnosis of the disease.

The methodological recommendations describe the etiopathogenetic aspects of leukemia, issues of classification, clinical and laboratory diagnosis. The strategy and tactics of treatment, drugs for chemotherapy, and the possibilities of accompanying therapy are presented. Acute non-lymphoblastic leukemia and chronic myeloid leukemia are also considered.

The appendix presents a modern scheme of hematopoiesis and a protocol for the treatment of acute lymphoblastic leukemia.

Acute leukemia

Acute leukemia (AL) is the most common oncological pathology in children. The disease is based on the formation of a clone of malignant blast cells that have one common precursor cell. Blasts infiltrate primarily the bone marrow, inhibiting normal hematopoietic cells, which leads to their gradual displacement. Many types of leukemia are also characterized by blastic infiltration of internal organs. Leukemia affects predominantly children and young people.

Leukemia occurs with a frequency of 4-5 cases per 100,000 children. In childhood, the same forms of leukemia are observed as in adults, with the exception of chronic lymphocytic leukemia. At the same time, there is a significant predominance of acute leukemia: acute lymphoblastic leukemia (ALL) accounts for 76-82% of cases, acute non-lymphoblastic leukemia - 17-21%, chronic forms (chronic myeloid leukemia) - 3% of cases. The highest incidence of acute leukemia is recorded at the age of 2-4 years - the so-called “infantile peak”. During this period, boys get sick more often than girls. From 11-12 years of age, the incidence of the disease in boys and girls is approximately equal. IN last decades Significant advances have been made in the treatment of acute leukemia. The five-year survival rate for children with ALL is 70% or more.

Etiology. Leukemia is a polyetiological disease, since no unconditional cause of leukemia has been identified. Factors that may influence the occurrence of leukemia under certain conditions include:

Chemicals (benzene, alkylating compounds, cytostatics, etc.). Increased risk Children whose parents' work involves working with chemical compounds have OB development. The incidence of leukemia among patients receiving intensive therapy for lymphogranulomatosis is 290 times higher than in the population.

Ionizing radiation - the incidence of leukemia is higher in children and individuals young survivors of the bombings in Hiroshima and Nagasaki; in persons exposed to Rg irradiation (radiologists, patients after radiation therapy).

Hereditary and genetic factors - leukemia is more common in such genetic diseases as Down syndrome (AML is 20 times more common than in healthy people), Bloom's, Klinefelter's, Wiskott-Aldrich's, and Fanconi's anemia. B O The greater likelihood of developing leukemia in these diseases is associated with their characteristic chromosome instability. The incidence of leukemia in both twins is 25%. The empirical risk of developing leukemia in siblings with ALL is 4 times higher than the risk in the population.

Viruses - HTLV-I (from the English human T-cell lymphotropic virus), causing T cell leukemia in adults, HTLV-II, isolated from individuals with hairy cell leukemia, and HTLV-III, which causes AIDS, which in turn is associated with lymphomas and leukemias. The role of retroviruses in the development of leukemia is currently receiving special attention. It is believed that in the genome of carcinogenic viruses there are specific genes that are directly responsible for the transformation of a normal hematopoietic cell into a leukemic one (oncogenes). IN normal cells humans have genes homologous to viral oncogenes. They are called pro-oncogenes because. become potential oncogenes after their interaction with the virus occurs. Activation of pro-oncogenes can also occur under the influence of other carcinogens.

Pathogenesis.

According to modern concepts, leukemia cells are the offspring of one mutated hematopoietic cell (clonal origin). The primary leukemic clone has an advantage in growth, inhibits and gradually displaces the normal one. When the leukemic population reaches a certain mass, according to the feedback law, the differentiation of normal stem cells and the production of normal blood cells are inhibited. This is due to the fact that stem cells enter differentiation only after the reduction of committed (dependent) cells to a certain level, and most blasts have the properties of committed cells. The leukemic clone is characterized by a high predisposition to repeated mutations due to the instability of the cellular genome, therefore, in the future, new subclones appear, the tumor becomes polyclonal and acquires malignant features.

The results of a detailed study of the genotype of blast cells from patients with acute leukemia indicate that in many cases these cells have chromosomal rearrangements.

Formulated laws of tumor progression (A.I. Vorobyov, 1985), which characterize the stages of development of leukemia. The main ones are:

inhibition of normal hematopoietic germs

natural replacement of mature differentiated cells with blasts, which constitute the tumor substrate

loss of enzyme specificity (cells become morphologically and cytochemically undifferentiated according to belonging to a certain series of hematopoiesis)

change in cell morphology (from round to irregular with an increase in the area of the nucleus and cytoplasm)

the ability of leukemia cells to grow outside the hematopoietic organs (skin, kidneys, brain and meninges), these proliferates represent different subclones

removal of the tumor from the control of treatment (previously effective).

Classification

Leukemia is divided into acute and chronic. According to the modern scheme of hematopoiesis (Appendix No. 1), acute leukemia is united by a common feature: the substrate of the tumor is blast cells. These are either progenitor cells of classes 2 and 3 with an undifferentiated form of blasts, or cells of class 4 - morphologically recognizable blasts that begin separate series of hematopoiesis.

Forms of acute leukemia: lymphoblastic, plasmablastic, myeloblastic, myelomonoblastic, erythromyelosis, promyelocytic, undifferentiated leukemia.

Clinical stages of acute leukemia:

initial(most often placed retrospectively); lethargy, loss of appetite, fatigue, pallor, low-grade fever are detected

expanded- symptoms are associated with severe inhibition of normal hematopoietic germs and proliferative syndrome

remission- disappearance as a result of treatment clinical symptoms, blood test normalization, the number of blasts in the bone marrow is less than 5%, there are no blast cells in the cerebrospinal fluid

relapse- the appearance of clinical symptoms and/or hematological changes: aleukemic (bone marrow) - changes only in the bone marrow (blasts more than 5%), leukemic (blasts and in peripheral blood), local (extrabone marrow) - with a normal blood test and bone marrow, brain damage , testicles, liver, lungs.

terminal- characterizes the incurable stage of tumor progression and the therapeutic possibilities of modern medicine. The immediate causes of death in most cases are sepsis, cerebral hemorrhage, and massive bleeding.

Clinical picture of ALL consists of a number of syndromes.

Intoxicating- lethargy, fatigue, loss of appetite, nausea and vomiting, sweating, fever (due to the release of pyrogens by tumor cells). Hyperthermia in leukemia is temporarily relieved by the use of non-steroidal anti-inflammatory drugs and normalizes with programmatic treatment of leukemia; There is no effect from the empirical use of antibiotics, because there is no focus of infection.

Osteoarticular- ossalgia due to expansion of the hematopoietic area (flat bones), due to osteoporosis, cortical destruction, periosteal layers (tubular bones, vertebrae).

Anemic– as a result of suppression of normal hematopoiesis and bleeding - pallor, weakness, fatigue, systolic murmur at the apex of the heart; blood test shows normochromic anemia.

Hemorrhagic- as a result of secondary thrombocytopenia - petechiae, ecchymoses on the skin and mucous membranes, bleeding from the mucous membranes (microcirculatory type of bleeding).

Leukopenic- decreased immunity, frequent illnesses, infection, especially where there is a rich microbial flora - gingivitis, sore throats occur more often, a necrotic component is characteristic; severe course of infectious and inflammatory processes.

Proliferative- enlargement of the liver, spleen, lymph nodes - they are usually dense, painless (blast cells spread throughout the embryonic foci of hematopoiesis). Lymph nodes are more often enlarged in all groups, isolated appearance of conglomerates is possible, more often in the neck area. Leukemic infiltrates can also affect other organs (heart, kidneys, lungs). Leukemides on the skin in ALL in children are rare.

Special emphasis is placed on neuroleukemia– the presence of leukemic infiltration in the membranes of the brain and spinal cord, in the nerve trunks, ganglia of the autonomic nervous system. Neuroleukemia is a consequence of metastasis of blast cells in initial stage diseases. Metastasis can occur in two ways: contact (from the bones of the skull and spine to the dura mater and dural funnels of the cranial and spinal nerves) and more likely diapedetic (from the vessels of the soft shell to cerebrospinal fluid and into the brain matter). Meningeal form manifested by headaches, nausea, vomiting, hyperesthesia of the skin, positive meningeal symptoms. Encephalitic- impaired consciousness, convulsions, focal symptoms of brain damage. At meningoencephalitis the symptoms of the two previous forms are combined. Signs diencephalic syndrome There may be hyperthermia, drowsiness, bulimia, polydipsia. Less commonly, in children, damage to the nervous system occurs in the form of myelitis, epiduritis, plexitis, and polyradiculoneuritis. Lumbar puncture data for neuroleukemia - increased cerebrospinal fluid pressure, increased protein content, pleocytosis, decreased glucose levels, the presence of blast cells, positive Pandi reaction. Changes in the cerebrospinal fluid can be detected even in the absence clinical picture CNS lesions.

Diagnosis of ALL must be laboratory confirmed. For a painting peripheral blood characterized by the presence of blast cells, a decrease in the number of maturing and mature forms, a gap occurs between blasts and mature cells (leukemic window - hiatus leucemicus). Sometimes blasts do not enter the peripheral blood (aleukemic variant), and the number of lymphocytes is often increased. The number of leukocytes is very variable from deep leukopenia to severe hyperleukocytosis. The latter in acute leukemia is always associated with high blastosis. Hemoglobinopenia, erythropenia, thrombocytopenia, and increased ESR are characteristic.

Myelogram is a decisive method in making a diagnosis. Blast metaplasia of the bone marrow is combined with inhibition of normal hematopoietic germs. The number of blast cells in the bone marrow of more than 5% is considered diagnostic. However, if their number is from 5 to 30%, it is recommended not to start treatment, but to perform a repeat sternal puncture after 3-4 weeks. This is due to the fact that in children, especially young children, it can be difficult to determine the line when one can talk about leukemia with confidence. Due to the ease of return to embryonic hematopoiesis in children with sepsis, hemolytic disease of the newborn, and other severe pathologies, an increased number of blasts is determined in the peripheral blood and bone marrow (leukemoid blast-type reaction). Treatment with cytostatics and glucocorticoids can only be prescribed if a diagnosis of leukemia has been established.

To clarify the form of leukemia, they carry out morphological and cytochemical study bone marrow cells. In ALL, blasts have a high nuclear-cytoplasmic ratio, the rim of the cytoplasm is narrow, basophilic, devoid of granularity, the nucleus has a delicate chromatin network, 1-2 large nucleoli. A cytochemical feature of blasts in ALL are negative reactions to peroxidase, phospholipids, esterase (or traces of nonspecific esterase), and glycogen (CHIK reaction) is distributed in the cytoplasm around the nucleus in clumps in the form of a necklace (at least 10% of blast cells). In acute myeloid leukemia (AML), the cytoplasm of blast cells has a delicate azurophilic granularity, the nucleus is round, with smooth edges, and the nuclear-cytoplasmic ratio is low. In the nucleus, a granular arrangement of chromatin is noted, with 3-5 nucleoli; the cytoplasm often contains Auer bodies in the form of tubular structures oriented linearly. Positive reactions to peroxidase, lipids (with Sudan black), acid phosphatase, and PAS reaction in the form of weak diffuse staining of the cytoplasm are typical. The number of cells that give a positive reaction to peroxidase or lipids is always more than 5%. Depending on the type of lymphoblastic (T-, B-, etc.) and myeloblastic (M1-M7) leukemia, the result of cytochemical reactions may vary.

According to the results immune typing blast cells are classified into a typical form, T-cell, B-cell leukemia, and “null” form. The prognosis of the disease and its therapy depend on the form of leukemia. Typical shape(prognostically the most favorable) is about 70% in children (with it, blasts do not have T- or B-markers, but react with antiserum directed against them).

Morphologically There are 3 types of blast cells in ALL according to the French-American-British classification (FAB): L1 - cells with small sizes, homogeneous nuclear chromatin, regular nuclear shape, in which nucleoli are not visible or small, the amount of cytoplasm is scanty, its basophilia is weak or moderate , vacuolization of the cytoplasm is variable. This form of ALL occurs in more than half of children and only 5-10% of adults. L2 and L3 forms are distinguished by large cell sizes, chromatin, nuclear shape, the presence of nucleoli, basophilia and vacuolization of the cytoplasm.

Treatment ALL is aimed at eradicating tumor cells, for which polychemotherapy is used. The rationale for the harsh treatment tactics in which drug-induced bone marrow aplasia develops is that the sensitivity of tumor cells to cytostatics is higher than that of healthy cells. Their remaining “islands” in the bone marrow give rise to normal branches of hematopoiesis. The BFM (Berlin-Frankfurt-Münster) program, used in Russia since 1990, is the most aggressive, but allows for recovery in 70% of patients or more. The modern MB program (Moscow-Berlin) gives similar results. Most authors accept complete clinical and hematological remission for 5 years as recovery, but isolated relapses have been noted after 5, 7 and even 10 years of remission.

The development of cytostatic therapy programs is consistent with the phases of the cell cycle. Cells go through a mitotic phase (M), postmitotic (G 1), synthetic (S), premitotic (G 2). From the standpoint of cell kinetics, all chemotherapy drugs are divided into 2 groups: non-cycle-specific (act in any phase of the cell cycle) and cycle-specific. A greater cytostatic effect is achieved by combining drugs with different cycle specificities (Figure No. 1).

The main anti-leukemia drugs include:

Antimetabolites(cyclospecific, disrupt the synthesis mainly of nucleic acid precursors in leukemic cells): methotrexate- antagonist folic acid, disrupts the synthesis of purine bases; when the same dose is administered, the intracellular concentration of methotrexate is 3 times higher in lymphoblasts than in myeloblasts; 6-mercaptopurine- purine antagonist, inhibits purine synthesis, cytosar- inhibits DNA synthesis and after 24 hours 90% of blasts are synchronized in S-phase.

Alkylating compounds(non-cyclospecific) - suppress DNA and RNA synthesis: cyclophosphamide(azotiprite group) - acts cytostatically and cytolytically on cells in any phase of the mitotic cycle.

Alkaloids (vincristine)- non-cyclospecific, acts on all phases, mainly during mitosis.

Enzymes (L-asparaginase)- decomposes asparagine, which a leukemia cell cannot synthesize, and blocks the entry of cells into the period of DNA synthesis.

Antibiotics (rubomycin, daunorubicin)- non-cyclospecific, inhibit the synthesis of nucleic acids.

Hormones (preisolone, dexamethasone)- inhibit the synthesis of RNA and DNA in the cell, act cytolytically only on leukemia cells and do not cause destruction of normal lymphocytes.

Figure No. 1

Scheme of action of cytostatics on the phases of the cell cycle

G 0 – resting phase of the cell cycle

G 1 – postmitotic phase

S – synthetic phase

G 2 – premitotic phase

M – mitotic phase

P – prednisolone

L-A – L-asparaginase

R – rubomycin

Mt – methotrexate

Ts – cytosar

6-Mp – 6-mercaptopurine

Tsf - cyclophosphamide

B – vincristine

Anti-leukemia therapy is often complicated by the side effects of cytostatics. For example, rubomycin has a toxic effect on the myocardium, which is manifested by tachycardia and prolongation of electrical systole. During the administration of methotrexate, toxic damage to hepatocytes and damage to the mucous membranes is more often observed. L-asparaginase may cause allergic reactions up to anaphylactic shock. Vincristine is neurotoxic (neuritis and paralysis may develop).

When conducting chemotherapy, it is necessary to take into account that the strategy and tactics for treating ALL are conditionally distinguished.

Treatment strategy for ALL:

Induction of remission

Consolidation of remission

Treatment of the central nervous system

Maintenance therapy

Treatment tactics for ALL:

Maximum tolerated doses of drugs

Minimum interim time between individual doses

Intensive treatment side effect drugs

According to the BFM program, three protocols with the previously indicated drugs are used for the treatment of the active phase of ALL (Appendix No. 2). Induction remission is aimed at the rapid destruction of leukemia cells; resistant clones should not have time to develop. Remission should be achieved on the 33rd day of treatment, then it is consolidated (consolidation). During sternal puncture on day 15, a decrease in the number of blasts in the bone marrow by 2 times or more indicates a good response to therapy. A special feature of the intermediate protocol is the parallel administration of high-dose methotrexate intravenously and endolumbarally.

Treatment defeats CNS, i.e. Prevention of neuroleukemia begins immediately after diagnosis. Spinal taps with the introduction of cytostatics are carried out every 2 weeks, at the end of the 3rd protocol, remote gamma therapy is prescribed at a dose of 12-24 Gy (depending on the risk group).

Supportive therapy is aimed at destroying the remaining mass of leukemia cells, carried out for 2 years using 6-mercaptopurine and methotrexate.

The development of the Moscow-Berlin protocol by domestic specialists was associated with the difficulties of implementing the BFM program in Russia (the severity of side effects required high-quality and expensive accompanying therapy, which is not always available in practice). The main idea of this chemotherapy program was the idea of the key role of neuroleukemia in the occurrence of relapses and, consequently, failures in the treatment of ALL in children. In this regard, prednisolone was replaced by dexamethasone, and a regimen was introduced long-term use asparaginase and local chemoprophylaxis of neuroleukemia with three drugs during 1 year of therapy.

The differences between the MB-91 program and the BFM-90 program were:

refusal to use high-dose intensive chemotherapy

reducing the need for accompanying therapy and transfusions of blood components

refusal of cranial irradiation in most patients

preferential treatment of patients on an outpatient basis

Accompanying (auxiliary) therapy for acute inflammation: holding symptomatic therapy due to the presence of a progressive malignant leukemic process, cytostatic therapy with severe toxic effect, a profound disruption of normal hematopoiesis.

Supportive therapy includes transfusion replacement therapy, detoxification treatment, immunotherapy, prevention and treatment of infectious and other complications.

Transfusion therapy involves replacement treatment with transfusions of missing blood components. With a progressive decrease in hemoglobin content, transfusions of red blood cells are indicated, with deep thrombocytopenia and the development of hemorrhagic syndrome - transfusion of platelet concentrate.

One of the effective ways to remove a patient from a state of deep myelodepression due to powerful cytostatic therapy and radiation is a bone marrow transplant from a healthy donor compatible with the recipient for HLA antigens. Bone marrow is injected intravenously after the complete destruction of its hematopoietic cells, otherwise the transplant will be displaced. For widespread transplantation, a large donor bank is required; in addition, it has been shown that bone marrow transplantation is not always effective.

When treating patients with leukemia, compliance with the rules of deontology is of particular importance. Considering the rigidity modern circuits treatment, parents and child must be prepared for them. Parents should only be told the diagnosis if the doctor is already sure of it. Both the severity of modern treatment regimens and the likelihood of its complications, as well as the increased opportunities for recovery, are explained. Informed consent of the parents, and after 15 years of age, of the patient himself, is required to conduct program therapy.

Forecast.

One of the most difficult to cure pathologies in children today is leukemia. The disease is characterized by a disruption of the process of hematopoiesis in bone marrow cells and the replacement of healthy cells with immature blasts (sick cells) from a number of leukocyte cells. The percentage of children with cancer (leukemia, leukemia) is about 35%. Oncological damage to the blood most often occurs in children under five years of age and older than two. Currently, there is a trend towards an increase in the number of children developing blood cancer.

In children weak immunity, and they are more susceptible to negative factors:

toxic chemicals, such as formaldehyde, found in furniture varnishes;
radiation exposure;
electromagnetic radiation, for example, during long stay near computers or computer devices;
frequent relapses infectious diseases, capable of causing mutational changes in the child’s body;
genetic disorders, including Down's disease;
potent drugs that provoke changes in the condition of bone tissue in children.

These are the main suspected causes of leukemia in children. A mutation occurring in the bone marrow causes development and division cancer cells, which are called blasts. Then a repeated mutation of the cells may occur, causing the irreversible development of tumor cells and malignant neoplasms.

The rapid division of pathological cells affects the state of leukocytes, and a person’s immunity sharply decreases. Cancer cells enter all lymph nodes and organs, which causes changes normal condition health.

Types and degrees of leukemia

According to the form of the disease in a child, acute and chronic courses are distinguished. pathological process. The acute process very quickly exhausts children, and their condition worsens sharply. The chronic course of the disease can last for several years, and this form of the disease is more often characteristic of adults.

Based on changes in the structure of leukocytes, they are distinguished: lymphoblastic (leukocyte) leukemia, in which leukocytes are directly affected, myeloid leukemia, characterized by changes in granulocytes (leukocyte fraction) and erythroblastic.

Blood diagram healthy child and a leukemia patient

In some in rare cases there is a congenital disease. Children under 15 years of age are most often affected.

According to the course of the disease, there are three stages, according to which the treatment regimen is built:

complete or incomplete remission;
relapse of the disease in a child.

Rarely, secondary leukemia occurs due to the use of potent drugs, chemotherapy or radiation.

Symptoms

Healthy white blood cells are replaced by altered cells, immunity decreases, the body weakens and cannot fight infections. The lifespan of blast cells increases, and leukocytes practically cease to function.

In children, leukemia manifests itself with nonspecific symptoms:

fast fatiguability;
disruption of normal sleep;
decreased appetite, up to absence;
unreasonable temperature fluctuations;
headaches often (small children cannot tell and cry constantly);
less often, nausea and vomiting for no reason;
uneven enlargement of nodes of the lymphatic system;
severe sweating of the baby at night;
swelling of the joints and aching pain in them.

In rare cases, the first symptoms of leukemia in children manifest themselves as intoxication or hemorrhagic syndrome.

Symptoms of leukemia in a child

Other signs of the disease include the following symptoms:

tonsillitis (inflammation of the pharyngeal tonsils);
stomatitis (more about stomatitis);
pallor of the skin and mucous membranes;
gingivitis;
yellowish or grayish skin color;
splenomegaly (enlarged spleen);
hepatopathy (pain in the liver and increase in size);
lymphadenopathy.

Similar manifestations in children with acute leukemia:

hemorrhages (in the form of stars) in the skin or mucous membranes;
hematuria (blood in the urine);
accumulations of blood can penetrate into the joint cavities;
bleeding in the stomach, uterus, lungs, nose.

Diagnostic procedures

When a child shows the first signs of illness, parents often confuse them with colds or they blame it on the baby’s fatigue after playing or studying. Such conditions of children cannot be ignored; you should immediately contact a pediatrician.

To find out the cause of the child’s unhealthy condition, it is recommended to undergo a preventive examination:

examination by a pediatrician;
taking an anamnesis (history of development pathological condition person);
ECG (electrocardiography);
Ultrasound ( ultrasonography) abdominal organs;
clinical blood test with a detailed leukocyte formula;
in severe cases that are difficult to diagnose, a bone marrow puncture is prescribed;
blood test for sugar;
clinical urine analysis;
stool analysis for worm eggs (about worms).

This is necessary to differentiate the diagnosis. Very often, the symptoms of leukemia are similar to the condition of anemia. In advanced cases, additional or repeated studies are prescribed to monitor the dynamics of the disease.

In order to correctly and timely prescribe a course of treatment, it is very important to establish the cause of the disease.

The slightest changes in the baby’s health condition cannot be ignored; you should immediately seek advice from a pediatrician if you discover even some mild symptoms. With this pathology, an early diagnosis is important. The disease progresses rapidly.

Therapeutic measures

When children are diagnosed initial signs leukemia is primarily prescribed diagnostic examination and symptomatic treatment. After an accurate diagnosis is made, treatment is carried out in a specialized children's hospital.

For treatment, the following are used: chemotherapy, radiotherapeutic methods, bone marrow transplantation, and very rarely, medicine is injected into the canal with the cerebrospinal fluid. Drug treatment is prescribed according to the degree and type of lesion circulatory system, and also use hormonal therapy to stimulate the immune system.

Leukemia in children, if detected early, can be cured in 85% of cases. Every year, new technologies and treatment methods make it possible to heal more patients and prevent the relapse of the disease.

Leukemia in children is classified as malignant diseases. It is caused by the immaturity of leukocytes. In case of illness, tumor cells are formed from pathological unhealthy tissues. Most often, the disease affects children between two and five years of age.

The first symptoms are usually enlarged lymph nodes, pain in joints and bones, hemorrhagic syndrome, hepatosplenomegaly, and damage to the central nervous system. To diagnose blood cancer, a general puncture of the bone marrow is performed. instrumental examinations such as CT and MRI.

Treatment for leukemia is long-term and guarantees good result only when diagnosed early.

Causes of the disease

Usually the disease progresses very quickly, and it can be caused by:

Genetic disorders. These include Li-Fraumeni syndrome, Down syndrome, and neurofibromatosis.
Exposure to radiation in high doses. This category includes man-made accidents and explosions at a nuclear power plant.
Solar energy damage.
Poor environmental situation.
Infections of viral origin that affect the central nervous system and structural DNA tissues.

In older age it can cause the disease bad habit, such as smoking. Children may be harmed by prolonged exposure to secondhand smoke.

Symptoms of leukemia in children

In medicine, the disease has several classifications. The signs of leukemia and their manifestations are taken as a basis:

Anemic syndrome. It is characterized by weakness, lethargy, and fatigue. In addition, the child’s skin begins to turn pale, and heart murmurs appear in the upper part. The causes of the pathology are associated with impaired formation of red blood cells due to bone marrow damage.
Hemorrhagic syndrome. May appear with to varying degrees gravity. Initial signs are noticeable when purple spots and large subcutaneous hemorrhages can be found on the surface of the skin and mucous membranes. Bleeding of great intensity is often observed - both external and internal. The problem with this is the production of platelets. When there are not enough of them, the brain gradually fills with cancer cells.
Hyperplastic syndrome. Manifests itself in liver enlargement, lymph nodes, spleen, myeloid sarcoma often occurs. The child feels pain from the bones and joints. This is observed due to the fact that the pathology leads to the development of osteoporosis. In this case, the lymph nodes do not hurt when enlarged, but they begin to adhere to nearby tissues. Sometimes there is discomfort in the liver and spleen when they are significantly enlarged.
Infectious infection. A child with leukemia is often diagnosed with diseases associated with fungal, viral, bacterial infections. This is observed because immunity weakens when the production of white blood cells decreases.
Intoxication. The tumor causes a sharp increase in body temperature, weight loss, weakness, and the baby loses appetite. If pathogenic blood cells affect the brain, this leads to severe headache, dizziness, trembling and straining of the eyeballs, strabismus, and vomiting.

When the thymus gland enlarges, it often begins to compress the superior vena cava, then swelling and compression can cause the baby’s head to turn blue. In addition, he may be overcome by other symptoms: constant painful cough and shortness of breath.

The first signs of pathology

Many symptoms of the disease do not appear immediately, but only when the body is affected by metastases and the disease enters the second or third stage. Parents should sound the alarm when they notice the first signs of illness in a child, which manifest themselves in:

Fatigue.
Lack of appetite.
Long-term sleep disturbance.
Periodic rises in temperature not associated with colds or other pathologies.
Painful sensations in joints and bones.
Severe intoxication. The child feels sick or starts vomiting continuously.
Bleeding from the nose, appearing repeatedly.
The appearance of purple spots on the child’s skin.
Enlarged lymph nodes in the neck area, armpits, in the groin, above the collarbones.

Stages of leukemia

The disease has 3 stages:

Initial symptoms may resemble a common cold. The child becomes lethargic, loses activity, and develops a fever. He often complains about painful sensations in the muscles and bones of the legs and arms. Against this background, a chronic viral or bacterial infection occurs.
With the advanced form of the disease, symptoms begin to appear more severe. A skin rash and fatigue appear, the child becomes weak and withdrawn. At this stage, he needs urgent treatment, otherwise the diagnosis may be disappointing.
Terminal stage. This final stage diseases when treatment has practically no effect on the body. During this period, the baby may have virtually no hair on his head, he complains of constant pain throughout the body, becomes withdrawn and weak. During this period, active metastasis of the body occurs.

Classification and types of leukemia

Leukemia in children can be:

Primary. When a tumor arises in the red bone marrow and gradually spreads throughout the body.
Secondary. In this case, the tumor appears in any organ and gradually penetrates through the blood into the bone marrow.

Based on cell type, they are classified the following types leukemia:

Myeloid type. The source of pathology are monocytes or granulocytes. Basically, it can be diagnosed in infants and in the first years of a child’s life.
Lymphoblastic type. The disease is caused by lymphocytes. The pathology is typical for children 2-3 years old and older.

According to the nature of the flow there is:

Acute leukemia. It can be either myeloid or lymphoblastic. The disease in this case progresses rapidly.
Chronic course. Differs in slow spread. A lymphoblastic or myeloid form may also be observed.

Children are most often diagnosed with an acute course of the disease. Chronic appearance in childhood can be observed only in the case of long-term myeloid leukemia.

Diagnosis of the disease

When parents and doctors suspect leukemia in a child, he is referred for appropriate diagnostics, which includes:

Blood analysis. It is necessary to find out the level of hemoglobin, leukocyte, platelet, erythrocyte blood count.
Submitting material for a biochemical blood test. Thanks to this examination, it is possible to determine the extent of damage to internal organs.
Analysis of urine. If salts appear in the sample, this indicates the breakdown of cancer cells.
Ultrasound. It reveals the spread of metastases throughout the body, an increase in the size of the spleen and liver.
X-ray. Even at the first stage, you can see an enlargement of the lymph nodes in the chest.
CT. Necessary for recognizing metastases in the brain.
Bone marrow puncture. To do this, a puncture is made in the large area tibia, sternum, after which a little test material is drawn into the syringe. The procedure is performed under anesthesia, and the results are sent for examination. This manipulation can only be recommended after the disease has been confirmed by other tests.

Features of blood parameters in the disease

If a child has acute leukemia, then the blood test results may indicate:

You can understand how leukemia begins using blood tests. The disease is indicated by the absence of intermediate forms of the leukemic series. Normally, they should be located between blast and mature cells; these are band segmented leukocytes.

After a sternal puncture and a myelogram, if the disease is present, you can find out that the number of blast cells is above 30%.

It is important to note that leukocytes in leukemia are always significantly elevated. Platelets, red blood cells and hemoglobin, on the contrary, are greatly reduced.

Treatment of leukemia

When an accurate diagnosis is made based on the results of tests and diagnostic measures, the child is immediately hospitalized in the hematology or oncology department. Clinical guidelines include placing the baby in a sterile box and giving him special diet. Nutrition should be balanced and complete. The goal of therapy is:

Destruction of leukemia cells.
Strengthening and maintaining immunity.
Protecting the baby from various infections.
Elimination of platelet and red blood cell deficiency.

In this case, during treatment the following may be prescribed:

Chemotherapy. Taking special drugs with cytostatic action.
Radiation therapy. Usually for the head.
Immunotherapy. The sick child is gradually injected with appropriate vaccines.
Bone marrow transplantation and treatment with cord blood and stem cells.

Symptomatic therapy may include infusion of platelets or red blood cells, taking antibiotics, removing intoxication with special drugs and procedures, and performing hemostatic therapy.

The answer to the question of whether leukemia can be treated in children will be different for each case. Much depends on the stage of the disease, the presence of metastases, the degree of organ damage, and the magnitude of the risk of relapse.

In general, the treatment is quite lengthy, is prescribed purely individually and has many stages according to the protocol:

Preliminary. It begins with preparation for the course. In this case, the child is prescribed short-term chemotherapy drugs.
Inductive. Conducts the baby intensive care for a period of 1 to 2 months. This is necessary to achieve stable remission.
Consolidation. Helps to consolidate remission and stop the spread of metastases in the brain and spinal cord. Sometimes radiation and cytostatics are prescribed at this stage, which are injected into the spinal cord canal.
Repeated induction. Potent drugs are prescribed in courses at certain time intervals. This helps to completely remove blast cells. This period lasts from 2 to 8 weeks.
Maintenance therapy. At this stage, the dosage of medications is reduced, treatment is possible on an outpatient basis, and the child can communicate with other people.

Forecast

The chance of full recovery and prognosis largely depend on the initial indicator of disease damage and the possibility of relapse. Thus, with low risk with lymphoblastic leukemia, the life prognosis is comforting (85-95% survival rate), with a standard course the figure is slightly lower (from 65 to 85%).

With a high risk of relapse, the survival rate is 60-65%.

If acute myeloid leukemia is diagnosed, the prognosis for the future is much worse. So, with standard therapy the chances are 40-50%, if a bone marrow transplant was done, then the survival rate is 55-60%.

For any form of the disease, children under 1 year of age are considered a dangerous factor. There is a low survival rate and a high risk of various complications.

Danger of relapse

Even when remission occurs, there is a high probability that a relapse will occur. The child's parents should keep a vigilant eye on him.

Remission is spoken of only when the leukocyte and platelet numbers increase and blast cells decrease to normal 5-10%.

The duration of treatment for each patient is individual, therapy is carried out according to a special protocol. For acute lymphoblastic leukemia, Vincristine and Prednisolone are usually prescribed; these drugs help achieve remission in approximately 5-6 months.

At this stage, in order to consolidate the effect, it is necessary to take cytostatics: Cyclophosphamide, Mercaptopurine, Methotrexate.

We can talk about a complete cure for the disease when the period of remission lasts at least 6-7 years. Statistics show that it lasts more than 5 years in 70% of children. However, even with relapse, stable remission can be achieved.

When is a bone marrow transplant performed?

The procedure can be performed for acute myeloid leukemia or relapse of acute leukemia. Before the manipulation, the patient undergoes chemotherapy, sometimes it is combined with radiation treatment, this helps to completely remove leukemia cells.

The transplant is necessary because when taking anticancer drugs, in addition to patients, people also die healthy cells body. When transplanting bone marrow cells, doctors do not provide a 100% guarantee of a cure for leukemia.. However, if after surgical intervention apply high doses chemotherapy, the chance of recovery increases.

The source of material for transplantation can be either an identical twin or close relative or the patient himself.

When the donor is not a relative, the procedure is called allogeneic. If the material is from a twin, then this is syngeneic manipulation. When the patient himself becomes the donor, this is an autologous transplantation.

The finished material is infused intravenously with a dropper. This operation is simple and takes place without anesthesia. The most dangerous period is the first month after the procedure, as rejection of foreign cells may occur. During this period, you need to monitor the condition of the patient's body.

To collect blood from a prospective donor, the following methods can be used:

Biopsy with anesthesia and subsequent surgery.
Taking blood from a vein after administration special means to form increased amount formed blood buds.
Extraction of a graft from umbilical cord blood immediately after the birth of a child, followed by freezing and storage.

If the first method is chosen, then the material is mainly taken from the flat bones of the pelvis.

Preventive measures

Since the causes of the disease are different, its prevention can be carried out proper nutrition, timely treatment of all diseases of internal organs, excluding radioactive radiation, preventing viral infection through timely vaccination, protecting the child from passive smoking. But even following all the rules does not guarantee the baby’s complete safety..

Leukemia is quite difficult to treat. But if parents notice signs of this disease in their child in a timely manner, then the prognosis for life will be much happier. Treatment is based on the following factors: the timing of diagnosis, the body’s individual response to therapy methods and the nature of the disease.

Children aged 2 to 11 years with acute leukemia have a much better chance of recovery than patients with the same disease age criteria With chronic form diseases.