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Leukemia is one of the most common malignancies in children. They include a wide group of neoplasms of the white blood cell system. The disease affects people of all age groups. In children, it occurs with the frequency of about 3 out of 100 and accounts for 30% of all malignant neoplasms in this group. The peak incidence of leukemia is between the ages of 2 and 5.
The starting point of leukemia cells is the bone marrow, in which, under normal conditions, in the process of multiple divisions and differentiation, blood cells are formed: erythrocytes, leukocytes and platelets. If there is an abnormal transformation of the cell, leukemia cells, the so-called blastic cells. They divide quickly and uncontrollably. Moreover, it does not fulfill its immune function because they have a disturbed structure. The abnormal leukemia cells dominate the bone marrow replacing other normal cell lines, enter the bloodstream and infiltrate various organs of the body.
At the moment, we do not know the cause of leukemia. Factors that increase the likelihood of developing the disease include: diseases caused by chromosomal disorders, e.g. Down syndrome, exposure to ionizing radiation, some chemicals, including drugs, and infection with viruses, e.g. Ebstein-Barr virus.
Acute leukemias predominate in children, including acute lymphoblastic leukemiawhich occurs in approximately 80% of young leukemia patients up to 15 years of age. Much less often children suffer from acute myeloid leukemia and chronic myeloid leukemia. Acute leukemia is characterized by a rapid course and a short medical history. Symptoms typically last 2-6 weeks until the baby is hospitalized and diagnosed.
The symptoms of the disease are most often very nonspecificie, they are common to many different diseases. Belong to them:
- weakness, listlessness, excessive sleepiness, pale skin due to a reduced number of red blood cells
- Unexplained fever
- petechiae on the skin and oral mucosa, easy bruising, bleeding caused by low blood platelets
- bone pain, which is a symptom of bone marrow dominance by cancer cells and infiltration of the periosteum. They most often appear at night, in bed, after the limb has warmed up, not related to the injury.
- recurring infections, e.g. inflammation of the throat, ear or lungs. They result from a defective immune system and should alert you when prolonged antibiotic treatment does not improve
- enlargement of lymph nodes in various locations
- abdominal pain caused by a tumor in the abdomen
- headache, vomiting as a symptom of tumor involvement of the brain
- enlargement of the testicles
Early diagnosis = better chances of recovery
If disturbing symptoms are present, the child should have a blood count with a smear. In leukemia, the levels of white blood cells can be elevated or lowered. However, if their number is significantly above the norm in the presence of other abnormalities, such as anemia, such as a drop in red blood cells or a reduced number of platelets, leukemia should be excluded first.
The examination that determines the diagnosis of this disease is the examination of the bone marrow and the presence of leukemic cells in it. Imaging tests that are performed next depend on the symptoms and include: X-ray of the chest or long bones, ultrasound of the abdominal cavity, ECHO examination of the heart and others.
Extremely important are cytogenetic and molecular tests of leukemia cells, on the basis of which the subtype of leukemia is determined, which allows for more accurate diagnosis and better classification to risk groups.
Treatment is long and multi-stage
When the disease is diagnosed, its type should be determined, the patient should be classified as at risk, its general condition assessed and treatment initiated. It is multi-stage, long, planned according to a specific scheme, and its aim is to cure the child.
Treatment stages:
1. Induction of remission
It involves the use of chemotherapy to achieve complete remission, i.e. the absence of blasts in the blood. It usually takes 4-6 weeks.
2. Consolidation of remissions
During the several-month period of treatment with chemotherapy pulses, the aim is to remove the so-called residual disease, i.e. cancer cells remaining in the body.
3. Post-consolidation treatment
At this stage, the goal of therapy is to maintain remission and prevent relapse.
Depending on the patient’s condition and risk group, it is also possible to perform bone marrow transplantation, maintenance therapy or experimental treatment with monoclonal antibodies.
During treatment, the patient is cared for against infections that pose a great threat to him in the state of reduced immunity. In addition, it is important to properly plan proper nutrition in order to provide the necessary amount of calories. An equally important sphere of a child’s life during treatment is his / her psychological comfort, which, apart from the closest relatives, is ensured by a qualified team of psychologists.
The cure rate of leukemia is increasing, currently it amounts to approx. 80% in children.
In the case of leukemia, a cure is defined as a period of time equal to or greater than 5 years during which the patient has no symptoms of the disease.
The most important element of cancer prevention is oncological vigilancewhich applies to people who have contact with the child, starting from parents, through guardians, teachers and ending with doctors. All disturbing changes in the child’s behavior, the way he functions at home or at school, and any complaints reported by the child should be reported to the doctor, which will enable faster diagnosis of the disease and increase the chance of recovery.
Text: lek. Jagoda Kumik
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