Symptoms of leukemia in young children. Ultrasound of all organs

  - A malignant blood disease characterized by tumor proliferation of immature leukocyte progenitor cells. Clinical manifestations of leukemia in children can include swollen lymph nodes, hemorrhagic syndrome, pain in the bones and joints, hepatosplenomegaly, CNS damage, etc. Diagnosis of leukemia in children is promoted by a comprehensive blood count, sternal puncture with bone marrow examination. Treatment of leukemia in children is carried out in specialized hematological hospitals using chemotherapy, immunotherapy, substitution therapy, bone marrow transplantation.

General information

Child leukemia classification

Based on the duration of the disease, acute (up to 2 years) and chronic (more than 2 years) forms of leukemia in children are isolated. In children, in absolute majority of cases (97%), acute leukemias are found. A special form of acute leukemia in children is congenital leukemia.

Based on the morphological characteristics of tumor cells, acute leukemias in children are divided into lymphoblastic and non-lymphoblastic. Lymphoblastic leukemia develops with uncontrolled proliferation of immature lymphocytes - lymphoblasts and can be of three types: L1 - with small lymphoblasts; L2 - with large polymorphic lymphoblasts; L3 - with large polymorphic lymphoblasts with vacuolation of the cytoplasm. According to antigenic markers, 0-cell (70-80%), T-cell (15-25%) and B-cell (1-3%) acute lymphoblastic leukemias in children are distinguished. Among acute lymphoblastic leukemias in children, leukemia is more common with L1-type cells.

Among nelimfoblastnyh leukemia, depending on the preponderance of certain blast cells differentiate myeloid undifferentiated (M1), myeloblastic highly differentiated (M2), promyelocytic (M3), myelomonoblastic (M4) monoblastny (M5), erythroleukemia (M6), megakaryocytic ( M7), eosinophilic (M8), undifferentiated (M0) leukemia in children.

In the clinical course of leukemia in children, there are 3 stages, according to which the treatment tactics are built.

• I- The acute phase of leukemia in children; covers the period from the manifestation of symptoms to improve clinical and hematological parameters as a result of therapy;
• II - incomplete or complete remission. In the case of incomplete remission, hemogram and clinical parameters normalize; the number of blast cells in bone marrow punctate is not more than 20%. Complete remission is characterized by the presence of no more than 5% blast cells in the myelogram;
• III  - relapse of leukemia in children. On the background of hematological well-being, extramedullary foci of leukemic infiltration appear in the nervous system, testicles, lungs and other organs.

Symptoms of leukemia in children

In most cases, the leukemia clinic develops gradually and is characterized by nonspecific symptoms: child fatigue, sleep disturbance, loss of appetite, ossalgia and arthralgia, unmotivated fever. Sometimes leukemia in children manifests suddenly with intoxication or hemorrhagic syndrome.

In children suffering from leukemia, there is a marked paleness of the skin and mucous membranes; sometimes the skin becomes jaundiced or sallow. Due to leukemic infiltration of the mucous membranes in children, gingivitis, stomatitis and tonsillitis often occur. Leukemic hyperplasia of the lymph nodes is manifested by lymphadenopathy; salivary glands - sialadenopathy; liver and spleen - hepatosplenomegaly.

For the course of acute leukemia in children, a hemorrhagic syndrome characterized by hemorrhages in the skin and mucous membranes, hematuria, nasal, uterine, gastrointestinal, pulmonary hemorrhages, hemorrhages in the joint cavity, etc. is typical. and bleeding. The severity of anemia in children depends on the degree of proliferation of blast cells in the bone marrow.

Cardiovascular disorders in children with leukemia can be expressed by the development of tachycardia, arrhythmias, expansion of the borders of the heart (according to chest X-ray), diffuse changes in the myocardium (according to ECG), a decrease in the ejection fraction (according to EchoCG).

Intoxication syndrome that accompanies the course of leukemia in children, occurs with considerable weakness, fever, sweating, anorexia, nausea and vomiting, and hypotrophy. Manifestations of immunodeficiency syndrome in children with leukemia is the layering of infectious-inflammatory processes that can take a heavy, threatening course. The death of children suffering from leukemia is often due to severe pneumonia or sepsis.

A very dangerous complication of leukemia in children is leukemic infiltration of the brain, meninges and nerve trunks. Neuroleukemia is accompanied by dizziness, headache, nausea, diplopia, stiff neck. With the infiltration of the substance of the spinal cord may develop paraparesis of the legs, sensitivity disorders, pelvic disorders.

Diagnosis of leukemia in children

The leading role in the primary detection of leukemia in children belongs to the pediatrician; further examination and management of the child is carried out by a pediatric onco-hematologist. The basis of the diagnosis of leukemia in children is laboratory methods: the study of peripheral blood and bone marrow.

In children with acute leukemia, characteristic changes in the general blood test are revealed: anemia; thrombocytopenia, reticulocytopenia, high ESR; leukocytosis of varying degrees or leukopenia (rare), blastemia, disappearance of basophils and eosinophils. A typical sign is the phenomenon of "leukemic failure" - the absence of intermediate forms (young, stab, segmented leukocytes) between mature and blast cells.

Ultrasound of the lymph nodes, ultrasound of the salivary glands, ultrasound of the liver and spleen, ultrasound of the scrotum in boys, chest X-ray, CT scan in children (for the detection of metastases in various anatomical regions) have auxiliary diagnostic value. Differential diagnosis of leukemia in children should be carried out with a leukemia-like reaction observed in severe forms of tuberculosis, whooping cough, infectious mononucleosis, cytomegalovirus infection, sepsis and having a reversible transient nature.

Treatment of leukemia in children

Children with leukemia are hospitalized in specialized onco-hematological institutions. In order to prevent infectious complications, the child is placed in a separate box, the conditions in which are as close to sterile as possible. Much attention is paid to nutrition, which must be complete and balanced.

The basis of the treatment of leukemia in children is polychemotherapy, aimed at complete eradication of the leukemic clone. The treatment protocols used in acute lymphoblastic and myeloblastic leukemias differ by the combination of chemotherapy, their dose and route of administration. Phased treatment of acute leukemia in children involves the achievement of clinical and hematological remission, its consolidation (consolidation), supportive therapy, prevention or treatment of complications.

In addition to chemotherapy, active and passive immunotherapy can be given: introduction of leukemic cells, BCG vaccine, smallpox vaccine, interferons, immune lymphocytes, etc. Promising methods for treating leukemia in children are bone marrow, umbilical cord blood, stem cell transplantation.

Symptomatic therapy in children with leukemia includes transfusion of erythrocyte and platelet mass, conducting hemostatic therapy, antibiotic treatment of infectious complications, detoxification measures (intravenous infusions, hemosorption, plasmasorption,).

Prognosis of leukemia in children

Prospects for the development of the disease are determined by many factors: age of onset of leukemia, cytoimmunological variant, stage of diagnosis, etc. The worst prognosis should be expected in children with acute leukemia before the age of 2 years and over 10 years; having lymphadenopathy and hepatosplenomegaly, as well as neuroleukemia at the time of diagnosis; T-and B-cell variants of leukemia, blast hyperleukocytosis. Prognostically favorable factors are acute lymphoblastic leukemia L1 type, early treatment, the rapid achievement of remission, the age of children from 2 to 10 years. In girls with acute lymphoblastic leukemia, the probability of cure is somewhat higher than in boys.

The absence of specific treatment of leukemia in children is accompanied by 100% mortality. Against the background of modern chemotherapy, a five-year relapse-free course of leukemia is observed in 50-80% of children. It is possible to speak about the probable recovery after 6-7 years of no relapse. In order to avoid provocation of recurrence, physiotherapy treatment and climate change are not recommended for children. Vaccinal prophylaxis is carried out on an individual calendar, taking into account the epidemic situation.

The cells of our body are constantly updated. This means that the old cells die off, and new ones form in their place. Usually cells are formed in the same place where they should be located. But where are the blood cells formed if they circulate throughout the body?

All blood cells, and these are red blood cells, leukocytes, platelets, are formed in a special blood-forming organ - the red bone marrow. Red bone marrow is an accumulation of cells in the flat bones of our body, from which any blood cell can be formed. A red bone marrow appears still in utero. This cluster of cells is laid in the bones once and for all, and is not subject to change. Red bone marrow cells are constantly dividing, forming new blood cells.

The location of the red bone marrow inside the bones is not accidental. The cells of our body, if they very often divide, are very susceptible to variability. If, during cell division, it is influenced from outside (thermal, radioactive, vibrational, viral, bacterial), then a disruption in chromosome discrepancy may occur, and various mutations occur due to this. Nature tried to prevent the occurrence of chromosomal diseases and concluded the red bone marrow in a kind of skeleton consisting of bones, as the bone tissue does not pass radioactive radiation poorly, prevents the penetration of heat, infrared, ultraviolet radiation, smoothes out vibrations and limits the access of viruses and bacteria. However, the newly formed cells must be quickly delivered to the bloodstream, so the red bone marrow has a rich blood circulation, which promotes the penetration of pathological agents into this very important organ.

But disturbances in the process of dividing red bone marrow cells can be observed. Such disorders are most often tumorous and are called leukemias.

Leukemia is a tumor of the red inert brain that causes a disruption in the production of all the blood cells of a child. Leukemia can be primary, when tumor growths appear only in the red bone marrow, and then spread throughout the body (metastasize), and secondary, when the primary (maternal) tumor is located somewhere in the body, and only then with blood flow metastasis in red bone marrow. The course of acute leukemia (up to 2 years) and chronic (more than 2 years).

Causes of Leukemia in Children

The causes of leukemia in children are not fully understood. There are several theories of the occurrence of red bone marrow lesions.

1. Radioactive exposure. Radiation greatly affects the process of cell division, causing mutations. The radioactive background of the environment is constantly changing. Anthropogenic human exposure has led to an increase in the natural radioactive background. This made a great contribution to the testing of nuclear weapons, the accident at the Chernobyl nuclear power plant, the use of nuclear weapons in hostilities (Khorosima and Nagasaki), the accident at the Fukushima-1 nuclear power plant. The change in radioactive background led to the fact that in areas close to areas of increased radioactive emissions, the number of children with leukemia increased.

2. Viral infections. Viruses are able to penetrate inside the cell and affect the structure of DNA. Since viruses are quite small, they can penetrate almost all organs and have their effects everywhere. Having penetrated into the red bone marrow, viruses disrupt the process of chromosome division during cell multiplication, and thus lead to the formation of a tumor cell germ.

3. Deterioration of the environment. Every day a huge amount of toxic substances is dumped into the environment. Many of these substances have a carcinogenic effect (they can accumulate in the body and provoke the formation of tumors). Toxic substances enter our body with air, water, food. One of the abilities of these substances is the ability to accumulate in various organs and tissues, and to persist there for a long time, exerting its toxic effect.

4. Increased insolation. Solar radiation, as well as radiation, can cause disturbances of cell division. The air envelope of our planet protects us from this harmful effect, passing only part of the radiation. The use of chemicals, aerosols, antifreeze, aircraft flights lead to the destruction of the ozone layer of our planet. Over the large cities, ozone holes have been fixed for several years, which transmit a very large amount of solar radiation. Increased insolation causes an increase in tumor diseases among the population of large cities.

5. Bad habits. Tobacco smoke has a large carcinogenic effect. For children, it is very dangerous, especially in the sense that children are most often passive smokers (they inhale tobacco smoke from cigarettes of people smoking near them). People who smoke cigarettes are to some extent protected from the effects of smoke by a cigarette filter. Children do not have such protection and inhale "clean" tobacco smoke.

Symptoms of leukemia in children

A feature of tumor diseases is that the affected cells continue to multiply, they divide, even in larger numbers than normal ones, but at the same time lose their ability to differentiate. All the cells of our body come from a single cell - a fertilized egg. In the process of dividing cells undergo differentiation, as if "mature". Imagine that you have a flower, and depending on which part of the room you put it, either an apple, or a plum, or a potato, or a melon, or something else will form from it. Similarly, in our body, if a cell is located in a certain place, then it can result in skin or a nerve, or a heart muscle, or a white blood cell. With leukemia, the cells begin to massively divide, but they do not form full blood cells, but so-called blast cells are formed.

The manifestations of leukemia is mainly associated with impaired formation of blood cells.

1. Due to the defeat of the red hemopoietic germ, the formation of red blood cells is disturbed and hemoglobin decreases. In peripheral blood, changes characteristic of anemia are observed. Also, children will experience all the clinical manifestations of anemia: fatigue, muscle pain, dry skin, brittle hair and dull hair, dyspeptic manifestations.

2. Due to the defeat of the blood germ responsible for the formation of platelets, their decrease in peripheral blood is observed. If the number of platelets becomes less than 30x10 ^ 9 / l, the child begins to appear bleeding. Gingival bleeding is most often observed, however they can be anywhere (at the injection site, in the cavity and organs).

3. The defeat of the germ responsible for the production of white blood cells leads to a decrease in immunity. Children often get sick, long-term, very often the usual antibiotic therapy does not help. Another feature of reduced immunity is the appearance of fungal infections. Children have candidal stomatitis, vulvovaginitis, urethritis.

In addition to symptoms associated with damage to the red bone marrow itself, symptoms may be observed that are caused by other mechanisms.

1. Pain in the bones. Tumor growths fill the entire volume inside the bones, expanding them from the inside, which causes bone soreness. It also causes bone thinning due to disruption of calcification processes, which leads to increased bone fragility and the appearance of pathological fractures.

2. Metastasis. Red bone marrow is well supplied with blood, so if a small number of cells come off the tumor, they immediately enter the bloodstream and spread throughout the body. In places where these cells settle, a new tumor begins to grow. This new tumor is called metastasis. Metastases to the brain are very dangerous, since their removal is very problematic, and all brain tumors are considered malignant, due to the limited volume of the skull, which prevents the growth of the tumor. With a brain injury in a child, headaches, decreased vision, loss of consciousness may occur. In addition to brain metastases, the liver, kidneys, lungs, gastrointestinal tract, testicles, and ovaries can enter. Clinically, the defeat of these organs will manifest in the violation of their functions.

3. Swollen lymph nodes. This is due to the fact that the blast cells are retained in the lymph nodes and metastases can occur. Lymph nodes are a kind of filters that detain everything dangerous for children, preventing it from spreading to the entire body. All groups of lymph nodes increase to one extent or another. If intra-abdominal lymph nodes are affected, abdominal pain may occur. The lymph nodes of the neck and head can be felt directly through the skin.

4. In children with leukemia, there is an increase in the liver and spleen.

Examination of a child with suspected leukemia

For the diagnosis required:

1. Complete blood count, in which there is an increase in the number of leukocytes to 25x10 ^ 9 / l or more, a decrease in red blood cells, a decrease in hemoglobin, a decrease in the number of platelets. Sometimes there may be so-called aleukemic variants of the disease when a reduced number of red blood cells, platelets and white blood cells is detected in the blood.
2. Ultrasound of the internal organs. Change the size of the liver and spleen, the increase in intra-abdominal lymph nodes, metastases in internal organs.
3. Puncture red bone marrow. This study is the gold standard for setting an accurate diagnosis, allows you to determine the form of leukemia and to choose the right treatment. In this study, the sternum or the ilium is punctured with a special needle and a red bone marrow is collected with a syringe. In newborns, red bone marrow is taken from the tibia. Anesthesia is only necessary local in the place of injection, since the bones do not have nerve endings. After collecting the material, it is sent for microbiological and cytological examination.
4. Biopsy of enlarged lymph nodes.
5. Radiography of the chest, which determines the enlarged lymph nodes of the chest cavity.
6. Biochemical analysis of blood. It will reflect changes characteristic of lesions of an organ (liver, kidney, heart, lungs).
7. Puncture of the spinal cord with the study of cerebrospinal fluid, which determine the presence of tumor cells (typical for metastasis to the brain).
8. Urinalysis reveals the appearance of uraturia in the urine (excretion of urate salts with urine), which is a sign of the disintegration of the tumor.
9. Computed tomography can determine the presence of metastases in various organs.

Treatment of leukemia in children

Treatment of children with leukemia for five years. There are specially designed treatment regimens, each of which is selected individually for the child. In the treatment of leukemia, the property of tumor cells is used to rapidly divide. Drugs used in the treatment of leukemia inhibit the process of division and, thus, reduce the number of blast cells. The disadvantage of this method of treatment is that these drugs act not only on tumor cells, but also on all healthy cells of the child’s body.

There are several rules for the treatment of children with leukemia, the implementation of which improves the prognosis of the disease.

1. Children with leukemia should, while in the hospital, be treated in separate wards, best of all boxed, which eliminates the imposition of infection and infection of the child.
2. Food for children should be complete and balanced. The child should receive proteins in easily digestible form, a sufficient amount of fat, half of which should be vegetable and carbohydrates in the form of cereals, vegetables and fruits.
3. The child should receive enough water and often go to the toilet. This must be done so that the decay products of the tumor are removed from the child’s body.
4. At the first signs of a bacterial or viral infection, it is necessary to immediately begin taking antibacterial drugs, since the child’s immunity is reduced, and the body cannot fight the infection itself.
5. When platelet levels drop below 10x10 ^ 9 / l, children are shown platelet transfusions, and when hemoglobin levels fall below 90 g / l, the erythrocyte mass is transfused.
6. It is imperative that children take sulfonamides to prevent the development of pneumonia, and nystatin, to prevent the appearance of fungal diseases.
7. In severe infections and critical reduction of neutrophils in the blood, chemotherapy of leukemia is stopped until the child’s condition is normalized.

The prognosis for leukemia may be different and depends on the results of the study at the initial stages of treatment and on the response to the treatment being given. A more favorable prognosis in children from 2 to 10 years with acute leukemia, less favorable in chronic leukemia. Girls are better treated. The faster the blast cells disappear from the blood, the more favorable the prognosis.

Doctor pediatrician Litashov M.V.

Cancer of the blood is difficult to detect in the initial stages. Usually it is disguised as overwork or frequent colds. When diagnosed, parents experience shock, however, leukemia is not a sentence. Therapy for blood cancer is long, takes several years, but with the timely implementation of all the recommendations of the doctor there is hope for a cure.

What is leukemia, what are its causes in children?

Leukemia in children is a malignant disease of the circulatory system. It initially affects the bone marrow, then enters the bloodstream and spreads throughout the body.

  To the question of where the disease in children comes from, scientists still cannot find the answer. There are several factors provoking the development of the disease. These include:

1. Radiation exposure. With a dose of radiation that exceeds the permissible norms, the bone marrow is affected first. For example, after the Chernobyl accident an increase in the number of cases of leukemia.
2. Oncoviruses. Some viruses are able to alter cellular DNA and lead to cell mutations, which causes their uncontrolled growth and loss of differentiation ability.
3. Genetic predisposition and hereditary causes. Scientists have discovered a pattern in which patients with Down syndrome are 15 times more likely to become ill with leukemia than other children. The risk increases in the presence of Klinefelter syndrome, Bloom, primary immunodeficiency. The causes of leukemia in newborns can be genetic mutations.

In the modern scientific community, it is considered that the mechanism of development of leukemia is associated with mutational changes in cells. Because of the mutated DNA, the bone marrow cells responsible for blood formation lose their ability to differentiate and begin to divide uncontrollably. They remain at the level of the blasts and create their own clones.

Blasts enter the bloodstream and spread throughout the body, infecting organs. Through the blood-brain barrier, mutated blasts end up in the brain, causing neuroleukemia.

Classification and symptoms of the disease in children

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Leukemia is the common name for a whole group of malignant diseases of the circulatory system. There are several classifications depending on the form of the disease, the level of differentiation, cytogenesis. Symptoms, diagnosis and treatment of each subspecies may differ significantly from each other.

Acute and chronic forms

Depending on the degree of leakage, there are 2 forms of leukemia:

1. Acute form. Mutated blood stem cells lose maturation. There are no mature cells in the blood, which means that the circulatory system does not perform its functions. Lymph nodes, liver, spleen are enlarged. This form is diagnosed in 97% of sick children. As a rule, leukemia appears at the age of about 1 year. Life expectancy is from 2 weeks to 2-3 months.
2. Chronic form. Mutant cells gradually replace healthy blood cells. Life expectancy in chronic form can reach 2 years. The chronic form never becomes acute, and vice versa.

Symptoms are signs of lymphatic infiltration. The child affects the mucous membranes of the mouth, a rash appears, bruises are formed on the legs, even if the baby has not fallen and has not hit. External signs of the disease can be seen in the photo.

Immunity decreases, which is why the body undergoes penetration of infections of various etiologies. Body weight decreases, muscular weakness, sweating are felt, fever is observed - in the presence of such signs it is necessary to consult a doctor immediately.

Lymphoblastic and non-lymphoblastic

Acute leukemia in turn is divided into:

1. Lymphoblastic (ALL). Lymphoblasts are immature lymphocytes. With this form of leukemia, it is they who stop ripening and begin to divide uncontrollably. The lesion begins in the bone marrow, and from there the lymphoblasts enter the spleen, lymph nodes, and other parts of the body. The most common form among all leukemias. The peak incidence is 3 years for the B-cell subspecies (80% of all cases of ALL) and 15 years for the T-cell (20% of all cases of ALL). Boys are sick more often than girls in 2 times. This is probably due to genetic factors.
2. Non lymphoblastic or myeloblastic. There are 8 subspecies of myeloid leukemia. The disease begins in the myeloid process of the bone marrow. Myelocytes actively divide and gradually fill the cavity of the bone marrow. The peak incidence is 2-3 years.

Stage of the disease

Signs of blood cancer in children at the first stage are practically absent, which makes diagnosis difficult. It is possible to bring the disease into remission in the first 2 stages of oncology. Remission is the absence of oncogenic cells in the blood for 5 years. The terminal stage cannot be brought into remission.

Blood test and other diagnostic methods

From the timely diagnosis depends on the outcome of the disease. If you identify lesions in the early stages, you can achieve sustained remission. At the first changes in the child's behavior (lethargy, fatigue, weight loss) parents should consult a pediatrician. The pediatrician prescribes a complete blood count.

A general blood test can detect the presence of leukemia. Blood cancer rates:

• an increase in the number of white blood cells;
• reducing the number of red blood cells and their predecessors - reticulocytes;
• decrease in the number of platelets;
• high erythrocyte sedimentation rate;
• the presence of a large number of leukoblasts;
• lack of intermediate forms of development between leukoblasts and leukocytes.

The next stage of diagnosis for making the final diagnosis is myelogram. It is made on the basis of sternal puncture. A piece of bone marrow is taken from the sternum and examined for the number of mutated cells. If a bone marrow sample contains more than 30% of blasts, then this is an indicator of leukemia.

  To determine the presence of metastases in the organs, use hardware diagnostic methods - MRI, ultrasound, CT, x-ray. Examine the abdominal cavity - liver, spleen, lymph nodes. A dangerous manifestation of cancer is neuroleukemia, when the affected blood enters the brain. To identify metastases in the central nervous system, you need to consult a neurologist and an ophthalmologist.

Features of the treatment of leukemia in children

Blood cancer in children is a dangerous cancer that requires urgent therapy. A delay of several days is dangerous for the life of the baby. If cancer is detected at an early stage, then the treatment can give positive results; it does not occur at the terminal stage of recovery.

Chemotherapy and Immunotherapy

The goal of therapy is the complete elimination of the leukemic group of cells. The main treatment is chemotherapy. Depending on the type of cancer, various combinations of drugs are prescribed:

  Stages of chemotherapy:

• the conclusion of the disease in remission;
• maintaining remission;
• therapy of associated pathologies;
• relapse prevention.

Chemotherapy courses and their duration are always determined individually, depending on the characteristics of the disease and the children's body. In acute leukemia, chemotherapy treatment can last for 2 years. You can talk about remission if:

• the rate of blasts in the bone marrow is less than 5%;
• there are no blasts in the bloodstream;
• no metastases.

Children with leukemia have virtually no immunity. When a disease is detected, they are immediately placed in a special box of the Onco-Hematology Department, where almost sterile conditions are maintained.

Immunotherapy is performed along with chemotherapy. It includes the introduction of leukocytes, interferons into the child’s body, smallpox vaccination, and the introduction of BCG.

Symptomatic effect

With leukemia, many organs are damaged, since blood is not able to perform its main function. In addition, the mutated cells infiltrate into the tissues of the body.

Frequent infections, including fungal infections, are companions of blood cancer. Weakened immunity cannot fight viruses and bacteria, and any inflammatory process can lead to serious complications. To prevent infections, the patient is placed in a special box, but if the pathogens still penetrate inside, antibiotics are treated.

Chemotherapy has a detrimental effect on the children's body. Toxic drugs kill the leukemic colony of mutant cells, and with them healthy cells. This is a necessary measure in the fight against cancer. After the disease is in remission, doctors eliminate the effects of chemotherapy. It turns out medical support of the liver, kidneys, organs of the digestive system.

During treatment, which lasts more than one year, it is important to adhere to a balanced diet. The child should not be deficient in vitamins and microelements. He needs to drink plenty of water.

Bone marrow and stem cell transplant

When leukemia is brought into remission, but there is a high chance of relapse, a bone marrow and stem cell transplant is prescribed. It is important to have a transplant before recurrence, since conservative treatment is practically useless when returning the disease.

Parts of the bone marrow are taken from a compatible donor, which may be a relative or stranger. Of course, a relative is more likely to approach in all respects. There are several criteria by which a future donor is checked to be suitable for transplantation. Searches can be delayed for a long time, but they are facilitated by the presence of a bank of donors.

A prerequisite for transplantation is complete remission. The recipient's bone marrow must be clean so that the stem cells of the donor can fill it and start the process of healthy blood formation.

During transplantation there is a risk of rejection of the foreign organ, therefore, for the beginning, immunosuppressive therapy is carried out. Immunity is completely suppressed, making the transplant take root.

Bone marrow transplantation cannot be carried out in cases of recurrent leukemia or infectious diseases. First, you need to bring the disease into remission or treat the infection and only then transplant stem cells.

Other methods

Chemotherapy and bone marrow transplantation are not the only treatments. If blood cancer has moved to the central nervous system and has affected the brain, then radiation therapy is prescribed, in which the patient is irradiated with a certain dose of radiation.

In addition, there are special drugs cytostatics that inhibit the growth of cancer cells. They can be taken in pill form or by injection. This method of treatment is called targeted therapy. It does not affect the healthy tissues of the body, but acts on the molecules of mutated cells. This is a more benign option than chemotherapy.

Prognosis and complications in a child

The success of treatment can be judged by the duration of remission. If there is no relapse within 5 years, then we can say that the disease is in remission. The prognosis depends on the form of leukemia, as well as on the stage at which it was detected, the treatment regimen and the individual characteristics of the child.

Oncohematologists give such predictions of survival over 5 years:

• acute lymphoblastic leukemia - 85%;
• myeloblastic leukemia - 45%.

Much depends on age. Up to 15 years, the chances of recovery are high - up to 94%, after 15 years they fall to 80%. The terminal stage is practically not treatable. Doctors prescribe palliative therapy, which aims to alleviate the symptoms of the disease and ensure an acceptable quality of the last days of life.

In chronic form, the survival rate ranges from 60-80%. Among children, it is a rare form of the disease.

After the oncological disease has receded, the task of the parents is to by all means prevent the return of the cancer. First of all, it is necessary to pass tests as often as possible so as not to miss a relapse. It is not recommended to expose the child to stress, to change the climate, to make vaccinations. Even if several years have passed after the treatment, you should regularly visit the doctor and carry out the necessary examinations.

Affected cells may accumulate in different organs of the child.

Leukemia (leukemia), this type of hematopoietic dysfunction is often called "blood cancer." The bone marrow begins to produce immature blood cells in large numbers, this causes a disturbance in the normal functioning of the blood-forming organs and influences the formation of healthy blood cells.

Leukemia in children is mainly a disease of white blood (leukocytes). There is an imbalance between blood cells: when leukocytes do not mature and can not perform their functions, the red blood cells become larger. Thus, normal blood formation is disturbed.

Forms of manifestation of the disease

The specific symptoms of leukemia in children are due to the ability of tumor masses to accumulate in different organs. They can be found in the lymph nodes, spleen, liver, and other organs.

Leukemia can be:

• acute, they are distinguished by the uncontrolled growth of pathogenic blood cells; this form requires immediate treatment, is very difficult (can be lymphoblastic and myeloblastic);
• chronic, develop less rapidly, often due to an increase in the number of pathogenic cells in the blood, lymph nodes, spleen (may be lymphoblastic and myeloblastic);
• primary, with the development can metastasize throughout the body;
• secondary, metastases develop in the bone marrow.

There are types of leukemia:

The acute form of lymphoblastic leukemia in children is very severe. But, nevertheless, the prognosis in children with this form of the disease is better than in patients in older age.

The acute form of myeloblastic leukemia in children is distinguished by a rapid flow during the active production of immature blood cells in an increased amount. The prognosis of treatment can be favorable with timely, differentiated and individually selected therapy.

Causes of disease

Today, the causes of leukemia in children are not fully established.

Attention! The reason for the development of the disease becomes only one cell susceptible to mutation.

There is a rapid division of the affected cell, its reproduction. As a result, this causes healthy cells to be repressed, and leukemia develops. There are factors whose influence can trigger the development of the disease:

Signs and symptoms of leukemia

There are a number of signs of leukemia in children that can characterize the onset of the disease. So, the symptoms of acute leukemia in children include:

• significant increase in body temperature;
• general weakness;
• pains in the joints of the limbs;
• frequency of dizziness;
• heavy and frequent bleeding.

Also, with this disease, complications of an infectious nature may occur. These include necrotic tonsillitis and ulcerative stomatitis.

In chronic leukemia, the following symptoms may occur:

• constant weakness;
• fast fatiguability;
• weight loss;
• lack of appetite.

After 2 months from the onset of the disease, the first signs may appear in children. There is a rapid manifestation of signs of the disease with high fever, bleeding, general poor health, but sometimes the disease manifests itself more slowly.

But children may have symptoms caused by other processes:

• if there is a tumor inside the bone, pain will appear, and a decrease in the level of calcium can lead to fractures;
• decreased vision, loss of consciousness may be evidence of metastasis in the brain;
• an increase in the abdomen can be with an enlarged liver, spleen, which can also indicate the presence of metastases in these organs;
• as a rule, lymph nodes increase in children, as seen in the photo, due to the delay of a large number of blast cells there;
• the appearance of suffocation, coughing may be a consequence of a lesion of the thymus, which, with an increase, squeezes the trachea;
• rashes, felds and other lesions may appear on the skin due to reduced immunity.

How to make a diagnosis

To establish the diagnosis, patients are assigned a series of examinations, including:

• general and biochemical blood test;
• general urine analysis;
• Ultrasound of the digestive tract and lymph nodes;
• x-ray studies of lymph nodes and organs of the chest cavity;
• cT scan;
• lymph node biopsy.

Signs of leukemia in children, as determined by blood tests, may be as follows:

• decrease in the number of erythrocytes, platelets;
• increased ESR;
• basophils and eosinophils are absent in the peripheral blood;
• the hemoglobin index decreases, anemia develops;
• reticulocytes are usually reduced, with the acute form of erythromyelosis, their number is not more than 10-30%.

Biochemical analysis allows to determine the following blood parameters, allowing to establish leukemia in children:

• decrease in the rate of fibrinogen;
• low blood glucose;
• low albumin levels.

Elevated levels of urea, AST, LDH, bilirubin, gamma globulins, uric acid is evidence that pathogenic processes occur in a child’s body.

The definition of tumor markers will help establish a more complete and detailed picture of the disease. Such an analysis will be able to determine the type of disease, the degree of its development, indicate the presence of metastases in the organs.

Important! Only an oncologist on the basis of blood tests and bone marrow studies can diagnose leukemia.

Disease treatment

There are several methods for treating leukemia in children that are widely used to combat this disease:

Chemotherapy	Stopping the development and destruction of cancers. The principle of operation is as follows: the drug, entering the patient's body, affects the diseased cells, destroying them. Chemotherapy can be given in the form of tablets, as well as administered intravenously and intramuscularly.
Radiation therapy	An x-ray or other type of radiation course is prescribed. Exposure to rays allows you to destroy diseased cells and prevent the development of new
Stem cell transplant	Replacing diseased cells with healthy ones
Biological treatment	Based on the intake of synthesized biological substances. And the goal is to stimulate immunity to self-control against cancer cells.

In any form of leukemia in children, the following rules should be followed:

• the rest mode should be observed, overloads, stresses are not allowed;
• can not be in the sun;
• limit the consumption of animal fats in the diet, but food should include a large amount of protein (up to 120 g per day);
• abandon physiotherapy procedures.

Learn about the existence of such a terrible disease in a child, as leukemia is a real shock. Such a diagnosis can paralyze the actions and feelings of the parents.

Important! Leukemia is treated. In no case can not refuse traditional treatment.

It is necessary to clearly understand what exactly this disease is, what processes occur in the child’s body. There are many different organizations that unite parents of children with oncological diagnosis. When offices arise, parental committees, parents share their experience in forums, charitable foundations and organizations come to the rescue. It is important to understand that parents are not alone in their problem and will be able to overcome all difficulties through joint efforts.

Leukemia in children is referred to as malignant diseases. It is caused by the immaturity of leukocytes. During an illness, tumor cells are formed from pathological unhealthy tissues. Most often, the disease affects children from two to five years.

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

The treatment of leukemia is long-lasting and guarantees a good result only when a diagnosis is made in the early period.

The causes of the disease

Usually the disease progresses very quickly, and can cause it:

• Genetic disorders. These include the syndrome of Li-Fraumeni, Down syndrome, neurofibromatosis.
• Exposure to radiation in large doses. This category includes man-made accidents and explosions at a nuclear power plant.
• Defeat solar energy.
• Bad environmental situation.
• Infections of viral origin, in which the central nervous system and DNA structural tissues are affected.

In older adults, a habit can be a disease such as smoking. Children may suffer from prolonged passive smoking.

Symptoms of leukemia in children

In medicine, the disease has several classifications. The basis is taken signs of leukemia, their manifestations:

• Anemic syndrome. It is characterized by weakness, lethargy, fatigue. In addition, the child begins to turn pale skin, and from the side of the heart noise appears in the upper part. The causes of the pathology are associated with impaired red blood cell formation when the bone marrow is damaged.
• Hemorrhagic syndrome. May manifest with varying degrees of severity. Initial signs are noticeable when violet spots and large subcutaneous hemorrhages can be detected on the surface of the skin and mucous membranes. Often there are high intensity bleedings, both external and internal. The problem with this is the development of platelets. When they are missing, the brain is gradually filled with cancer cells.
• Hyperplastic syndrome. Manifested in an enlarged liver, lymph nodes, spleen, often occurs myeloid sarcoma. The child experiences pain from the bones and joints. This is due to the fact that pathology leads to the development of osteoporosis. At the same time, the lymph nodes do not hurt with an increase, but they begin to solder with the nearest tissues. Sometimes there is discomfort in the liver and spleen with a significant increase.
• Infectious infection. A child with leukemia is often diagnosed with diseases associated with fungal, viral, and bacterial infections. This is observed because the immunity weakens with a decrease in the production of white blood cells.
• Intoxication. The tumor causes a sharp increase in body temperature, weight loss, weakness, the appetite of the baby disappears. If pathogenic blood cells infect the brain, it leads to severe headache, dizziness, trembling and tension in the eyeballs, strabismus, vomiting.

When there is an increase in the thymus gland, it often begins to squeeze the superior vena cava, then swelling and clamping can cause the baby’s head to turn blue. In addition, it may be overcome by other symptoms: persistent, agonizing 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 passes into the second or third stage. Parents are alarmed when they notice the first signs of illness in a child, which manifest themselves in:

• Fatigue.
• Lack of appetite.
• Prolonged sleep disturbance.
• Periodic temperature rises, not associated with catarrhal infections or other pathologies.
• Pain in the joints and bones.
• Severe intoxication. The child is nauseous, or is constantly starting to vomit.
• Bleeding from the nose, manifested repeatedly.
• The appearance of purple spots on the skin of a child.
• Swollen lymph nodes in the neck, axilla, groin, over the collarbone.

Stage Leukemia

The disease has 3 stages:

• Initial manifestations may resemble the common cold. The child becomes sluggish, loses activity, his temperature rises. Often he complains of pain in the muscles and bones of the legs and arms. Against this background, a chronic viral or bacterial infection occurs.
• With a developed form of the disease, the symptoms begin to appear stronger. Skin rash appears, fatigue, the child becomes weak and withdrawn. At this stage, he needs urgent treatment, otherwise the diagnosis may be disappointing.
• Terminal stage. This is the last stage of the disease, when the treatment has almost no effect on the body. During this period, the baby may have virtually no hair on his head, he complains of constant pain all over his body, he becomes withdrawn and weak. During this period, there is an active metastasis of the body.

Classification and types of leukemia

Leukemia in children can be:

• Primary. When a tumor occurs in the red bone marrow and gradually spreads through the body.
• Secondary. In this case, the tumor appears in any organ and gradually through the blood enters the bone marrow.

According to the cell type, the following types of leukemia are distinguished:

• 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 causes lymphocytes. Pathology is typical for children 2-3 years and older.

By the nature of the flow is:

• Acute leukemia. It can be both myeloid and lymphoblastic. The disease in this case progresses rapidly.
• Chronic course. It has a slow spread. Lymphoblastic or myeloid forms may also be observed.

Children are most often diagnosed with an acute course of the disease. Chronic form in childhood can be observed only in the case of myeloid leukemia flowing for a long time.

Diagnosis of the disease

When parents and doctors become suspicious of leukemia in a child, he is referred for an appropriate diagnosis, which includes:

• Blood test. It is necessary to know the level of hemoglobin, leukocyte, platelet, erythrocyte blood count.
• The delivery of material for biochemical analysis of blood. Through this survey, you can determine the degree of damage to the internal organs.
• Analysis of urine. If salts appear in the sample, this indicates a 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 in the first stage, you can see an increase in lymph nodes in the chest.
• CT Necessary for the recognition of metastases in the brain.
• Puncture of the bone marrow. To do this, a puncture is made in the zone of the tibia, the sternum, after which a little of the material under investigation is collected into the syringe. The procedure is performed under anesthesia, the results are sent for examination. This manipulation can be recommended only after the confirmation of the disease by other analyzes.

Features of blood indicators in case of disease

If a child has acute leukemia, then in deciphering the indicators of a blood test can talk about:

• Anemia
• Thrombocytopenia.
• Reticulocytopenia.
• ESR elevation.
• Leukocytosis, sometimes leukopenia.
• Blastemia
• Decreases in eosinophils and basophils.

To understand how leukemia begins, it is possible by blood tests. The disease is indicated by the absence of intermediate forms of the leukemic series. Normally, they must be between the blast and mature cells, these are stab-segmented leukocytes.

After sternal puncture and myelogram in the presence of the disease, one can learn that the number of blast cells is above 30%.

It is important to note that leukocytes with leukemia are always significantly elevated. Platelets, red blood cells and hemoglobin, by contrast, are greatly reduced.

Leukemia treatment

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

• The destruction of leukemia cells.
• Strengthening and maintaining immunity.
• Protecting your baby from various infections.
• Elimination of platelet and red blood cell deficiencies.

At the same time during the treatment may be prescribed:

• Chemotherapy. Reception of special preparations of cytostatic action.
• Radiation therapy. Usually for the head.
• Immunotherapy. A sick child is gradually injected with the appropriate vaccines.
• Bone marrow transplantation and treatment with cord blood, stem cells.

Symptomatic therapy may include an infusion of platelet or erythrocyte mass, taking antibiotics, removal of intoxication with special drugs and procedures, the implementation of hemostatic therapy.

The answer to the question of whether leukemia is treated in children will sound differently for each case. Much depends on the stage of the disease, the presence of metastases, the degree of organ damage, the magnitude of the risk of recurrence.

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

• Preliminary. It begins with the preparation for the course. In this case, the child is assigned not a long-term administration of chemotherapeutic drugs.
• Inductive. The baby is given intensive therapy for a period of 1 to 2 months. This is necessary to achieve a stable remission.
• Consolidation It helps to consolidate the remission and stop the spread of metastases to the brain and spinal cord. Sometimes radiation and cytostatics are prescribed at this stage, which are injected into the canal of the spinal cord.
• Repeated induction. Potent drugs prescribed courses with certain time intervals. This helps to completely remove the blast cells. This period lasts from 2 to 8 weeks.
• Supportive Therapy At this stage, the doses of drugs are reduced, treatment is possible on an outpatient basis, the child can communicate with other people.

Forecast

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

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

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

In any form of the disease, the dangerous factor is considered to be the children's age up to 1 year. There is a low survival rate and a high risk of various complications.

Danger of relapse

Even with the onset of remission, it is likely that there will be a relapse. Parents of the child should watch out for him.

They say remission only with an increase in leukocyte and platelet numbers and a decrease in blast cells to a rate of 5-10%.

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

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

It is possible to talk about a complete recovery from the disease when the period of remission lasts at least 6-7 years. Statistics show that its term of more than 5 years is observed in 70% of children. Nevertheless, even with a relapse, you can achieve a stable remission.

When a bone marrow transplant is performed

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

Transplantation is necessary because when taking anticancer drugs, in addition to the sick, healthy cells of the body also die. By transplanting bone marrow cells, doctors do not provide a 100% guarantee of cure for leukemia.. However, if after surgery, high doses of chemotherapy are used, then the chance of recovery increases.

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

In the case when the donor is not a relative, the procedure is called allogeneic. If the material is from a twin, then this is a syngenic manipulation. When the patient himself becomes the donor, it is an autologous transplant.

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

The following methods can be used to take blood from a prospective donor:

• Biopsy with anesthesia and subsequent surgery.
• Blood sampling from a vein after the introduction of special means for the formation of an increased number of uniform blood buds.
• Extraction of the cord blood graft immediately after the birth of the 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.

Warning measures

Since the causes of the disease are different, prevention can be carried out with proper nutrition, timely treatment of all diseases of internal organs, exclusion of radioactive radiation, prevention of viral infection by performing timely vaccination, and protecting the child from passive smoking. But even compliance with all the rules does not guarantee the complete safety of the baby..

Leukemia is quite difficult to treat. But if the parents noticed the signs of this disease in their child in a timely manner, then the prognosis of life will be much more joyful. During treatment, the following factors are taken as the basis: the period of diagnosis, the individual reaction of the body to the methods of therapy and the nature of the disease.

Children aged 2 to 11 years with acute leukemia are much more likely to recover than patients of the same age criteria with the chronic form of the disease.