How quickly does leukemia develop in a child? Leukemia in children

Acute leukemia – cancer hematopoietic system. The tumor substrate in leukemia is blast cells.

All blood cells come from one source - stem cells. Normally, they mature, undergoing differentiation and developing along the path of myelopoiesis (leads to the formation of red blood cells, leukocytes, platelets) or lymphopoiesis (leads to the formation of lymphocytes). In leukemia, the blood stem cell mutates in the bone marrow at the early stages of differentiation and subsequently cannot complete development according to one of physiological pathways. It begins to divide uncontrollably and forms a tumor. Over time, abnormal immature cells replace normal blood cells.

Study of red bone marrow- the most important and exact method diagnosis of acute leukemia. The disease is characterized by a specific picture - an increase in the level of blast cells and inhibition of the formation of red blood cells.

Synonyms: acute leukemia, blood cancer, leukemia.

Causes and risk factors

The exact causes of leukemia are not known, but a number of factors have been identified that contribute to its development:

• radiotherapy, radiation exposure (this is evidenced by the massive increase in leukemia in areas where nuclear weapons were tested or in places of man-made nuclear disasters);
• viral infections that suppress immune system(T-lymphotropic virus, Epstein-Barr virus, etc.);
• influence of aggressive chemical compounds and some medicines;
• smoking;
• hereditary predisposition (if one of the family members suffers from an acute form of leukemia, the risk of its manifestation in loved ones increases);
• unfavorable environmental conditions.

Forms of the disease

Depending on the rate of proliferation of malignant cells, leukemia is classified into acute and chronic. Unlike other diseases, acute and chronic are different types leukemia and do not pass from one to another (i.e. chronic leukemia not a continuation of the acute, but separate species diseases).

Acute leukemia is divided according to type cancer cells into two large groups: lymphoblastic and non-lymphoblastic (myeloid), which are further divided into subgroups.

Lymphoblastic leukemia primarily affects the bone marrow, then The lymph nodes, thymus gland, lymph nodes and spleen.

Depending on which lymphopoiesis precursor cells predominate, acute lymphoblastic leukemia can have the following forms:

• pre-B-shape– B-lymphoblast precursors predominate;
• B-shape– B-lymphoblasts predominate;
• pre-T-shape– T-lymphoblast precursors predominate;
• T-shape– T-lymphoblasts predominate.

Average duration of treatment for acute leukemia is two years.

With non-lymphoblastic leukemia, the prognosis is more favorable than with lymphoblastic leukemia. Malignant cells also first affect the bone marrow, and only in later stages affect the spleen, liver and lymph nodes. Often, with this form of leukemia, the mucous membrane also suffers. gastrointestinal tract, that leads to serious complications up to ulcerative lesions.

Acute non-lymphoblastic or, as they are also called, myeloid leukemias are divided into the following forms:

• acute myeloblastic leukemia– the appearance of a large number of granulocyte precursors is characteristic;
• acute monoblastic and acute myelomonoblastic leukemia– it is based on the active reproduction of monoblasts;
• acute erythroblastic leukemia– characterized by an increase in the level of erythroblasts;
• acute megakaryoblastic leukemia– develops due to the active proliferation of platelet precursors (megakaryocytes).

Acute undifferentiated leukemias are classified into a separate group.

Stages of the disease

Clinical manifestations are preceded by a primary (latent) period. During this period, leukemia, as a rule, proceeds unnoticed by the patient, without pronounced symptoms. The primary period can last from several months to several years. During this time, the first degenerated cell multiplies to such a volume that it inhibits normal hematopoiesis.

With the appearance of the first clinical manifestations, the disease enters the initial stage. Its symptoms are not specific. At this stage, a bone marrow examination is more informative than a blood test. increased level blast cells.

At the stage of advanced clinical manifestations, true symptoms diseases that are caused by inhibition of hematopoiesis and the appearance in peripheral blood a large number of immature cells.

Modern chemotherapy treatment provides 5 years without relapse in children in 50–80% of cases. If there is no relapse within 7 years, there is a chance of complete recovery.

At this stage, the following variants of the course of the disease are distinguished:

• the patient has no complaints, severe symptoms absent, but a blood test reveals signs of leukemia;
• the patient experiences a significant deterioration in health, but there are no pronounced changes in the peripheral blood;
• Both the symptoms and the blood picture indicate acute leukemia.

Remission (the period of subsidence of exacerbation) can be complete or incomplete. We can talk about complete remission in the absence of symptoms of acute leukemia and blast cells in the blood. The level of blast cells in the bone marrow should not exceed 5%.

In case of incomplete remission, the symptoms temporarily subside, but the level of blast cells in the bone marrow does not decrease.

Relapses of acute leukemia can occur both in the bone marrow and outside it.

The last, most severe stage of acute leukemia is terminal. It is characterized by a large number of immature leukocytes in the peripheral blood and is accompanied by inhibition of the functions of all vital important organs. At this stage, the disease is practically incurable and most often ends in death.

Symptoms of acute leukemia

Symptoms of acute leukemia are manifested by anemic, hemorrhagic, infectious-toxic and lymphoproliferative syndromes. Each form of the disease has its own characteristics.

Acute myeloblastic leukemia

Acute myeloblastic leukemia is characterized by a slight enlargement of the spleen, damage to the internal organs of the body and elevated temperature bodies.

With the development of leukemic pneumonitis, the focus of inflammation is in the lungs, the main symptoms in this case are cough, shortness of breath and fever. A quarter of patients with myeloblastic leukemia experience leukemic meningitis with fever, headache and chills.

According to statistics, disease-free survival after bone marrow transplantation ranges from 29 to 67%, depending on the type of leukemia and some other factors.

At a later stage, renal failure may develop, up to complete urinary retention. In the terminal stage of the disease, pink or light brown formations appear on the skin - leukemids (leukemia of the skin), and the liver becomes denser and enlarges. If leukemia has affected the organs of the gastrointestinal tract, severe abdominal pain, bloating and loose stool. Ulcers may form.

Acute lymphoblastic leukemia

The lymphoblastic form of acute leukemia is characterized by a significant enlargement of the spleen and lymph nodes. Enlarged lymph nodes become noticeable in the supraclavicular region, first on one side, and then on both. Lymph nodes become denser and do not cause painful sensations, but may affect neighboring organs.

When the lymph nodes located in the lung area become enlarged, coughing and shortness of breath appear. Involvement of the mesenteric lymph nodes in the abdomen can cause severe abdominal pain. Women may experience thickening and pain in the ovaries, usually on one side.

In acute erythromyeloid leukemia, anemic syndrome comes first, which is characterized by a decrease in hemoglobin and red blood cells in the blood, as well as increased fatigue, pallor and weakness.

Features of the course of acute leukemia in children

In children, acute leukemias account for 50% of all malignant diseases, and they are the most common cause infant mortality.

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The prognosis of acute leukemia in children depends on several factors:

• the age of the child at the time of the onset of leukemia (the most favorable in children from two to ten years old);
• stage of the disease at the time of diagnosis;
• form of leukemia;
• gender of the child (girls have a more favorable prognosis).

In children, the prognosis for acute leukemia is more favorable than in adults, which is confirmed by statistical data.

If the child does not receive specific treatment, probable death. Modern chemotherapy treatment provides 5 years without relapse in children in 50–80% of cases. If there is no relapse within 7 years, there is a chance of complete recovery.

To prevent relapse, it is not advisable for children with acute leukemia to undergo physiotherapeutic procedures, be exposed to intense insolation and change climatic conditions accommodation.

Diagnosis of acute leukemia

Acute leukemia is often detected based on the results of a blood test when a patient visits for another reason - in leukocyte formula a so-called blast crisis, or leukocyte failure (lack of intermediate cell forms), is detected. Changes in peripheral blood are also observed: in most cases, patients with acute leukemia develop anemia with a sharp indicator decrease in red blood cells and hemoglobin. There is a drop in platelet levels.

As for leukocytes, two options can be observed here: both leukopenia (decrease in the level of leukocytes in the peripheral blood) and leukocytosis (increase in the level of these cells). As a rule, pathological immature cells are also found in the blood, but they may be absent; their absence cannot be a reason to exclude the diagnosis of acute leukemia. Leukemia, in which it is detected in the blood a large number of blast cells is called leukemic, and leukemia with the absence of blast cells is called aleukemic.

Red bone marrow examination is the most important and accurate method for diagnosing acute leukemia. The disease is characterized by a specific picture - an increase in the level of blast cells and inhibition of the formation of red blood cells.

Unlike other diseases, acute and chronic are different types of leukemia and do not transform into one another (i.e., chronic leukemia is not a continuation of acute, but a separate type of disease).

Another important diagnostic method is bone biopsy. Bone sections are sent for a biopsy, which reveals blastic hyperplasia of the red bone marrow and thus confirms the disease.

Treatment of acute leukemia

Treatment of acute leukemia depends on several criteria: the patient’s age, his condition, and the stage of the disease. The treatment plan is drawn up for each patient individually.

The disease is mainly treated with chemotherapy. If it is ineffective, they resort to bone marrow transplantation.

Chemotherapy consists of two sequential steps:

• remission induction stage– achieve a reduction in blast cells in the blood;
• consolidation stage– necessary to destroy remaining cancer cells.

The average duration of treatment for acute leukemia is two years.

A bone marrow transplant provides the patient with healthy stem cells. Transplantation consists of several stages.

1. Search for a compatible donor, bone marrow collection.
2. Patient preparation. During the preparation they carry out immunosuppressive therapy. Its goal is to destroy leukemia cells and suppress protective forces body so that the risk of transplant rejection is minimal.
3. The actual transplant. The procedure is similar to a blood transfusion.
4. Bone marrow engraftment.

It takes about a year for the transplanted bone marrow to fully take root and begin to perform all its functions.

According to statistics, disease-free survival after bone marrow transplantation ranges from 29 to 67%, depending on the type of leukemia and some other factors.

Possible complications and consequences

Acute leukemia can provoke the growth of cancerous tumors in places where lymph nodes accumulate, hemorrhagic syndrome and anemia. Complications of acute leukemia can be dangerous and often fatal.

Prognosis for acute leukemia

In children, the prognosis for acute leukemia is more favorable than in adults, which is confirmed by statistical data.

With non-lymphoblastic leukemia, the prognosis is more favorable than with lymphoblastic leukemia.

With lymphoblastic leukemia, the five-year survival rate in children is 65–85%, in adults – from 20 to 40%.

Acute myeloid leukemia is more dangerous, with a five-year survival rate of 40–60% in younger patients and only 20% in adults.

Prevention

For acute leukemia there is no specific prevention. It is necessary to visit a doctor regularly and undergo all medical procedures in a timely manner. necessary examinations in case of suspicious symptoms.

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Acute leukemia is malignant tumors, which arise from hematopoietic cells. The incidence is 3-4 patients per 100,000 children.

Acute leukemia in children- polyetiological disease. Causal factors may be chemicals (endogenous - for example, metabolites of tryptophan and tyrosine, and exogenous - for example, benzene), physical factors(ionizing radiation), viruses, genetic factors. Acute blood leukemia in children often occurs under the influence of immune drugs that are used without medical supervision.

Classification. The classification of acute leukemia is based on the principle of functional histogenesis, which assumes that in malignantly transformed cells the main phenotypic traits, which are inherent in the original normal cells.

Acute leukemia symptoms

Acute leukemia often begins to show symptoms at a fairly advanced stage of the disease. This complicates the further course of the disease and the use adequate therapy and requires a lot of effort to achieve a positive result. Parents should remember that in most cases, acute leukemia in children can produce symptoms on their own. early stage. But they often go unnoticed. Clinical manifestations are determined by the degree of bone marrow infiltration by blasts and extramedullary spread of the process.

The earliest symptom of acute leukemia in children is pain in the bones and joints. In typical cases of severe anemic syndrome (pallor of the skin and mucous membranes, tachycardia, shortness of breath, systolic murmur above the apex of the heart) hemorrhagic syndrome: polymorphic hemorrhagic syndrome leads to large hemorrhages, bleeding from the mucous membranes; proliferative (enlargement of peripheral groups of lymph nodes, liver, spleen, ostalgia and arthralgia, tumor formations under the skin, in areas of the bones of the skull, face, ribs), sometimes simultaneous enlargement of the parotid glands - Mikulicz, damage to the nervous system and its membranes, etc.) and intoxication syndromes (fatigue, weakness, lethargy, fever, headache).

Damage to the nervous system (neuroleukemia) is characterized by cerebral and meningeal symptoms: tension occipital muscles, Kernig's symptom, less often Brudzinsky's, there may be convulsions of a clonic-tonic nature. Damage to the hypothalamic region of the brain stem manifests itself in the form of diencephalic syndrome (thirst, polyuria, obesity, hyperthermia).

The diagnosis of acute leukemia is confirmed by the presence of normochromic, hyporegenerative, thrombocytopenia, leukocytosis with the presence of blast cells and leukemic failure in the peripheral blood. In cases of aleukemic blood picture, the number of leukocytes in the blood is normal or reduced, the leukocyte formula shows neutropenia, absolute lymphocytosis, and accelerated ESR. The main criterion for the diagnosis of acute leukemia is the presence of more than 30% blast cells in the bone marrow.

To clarify the variant of acute leukemia, cytochemical reactions are carried out (in myeloid cells, a positive reaction to peroxidase, lipids; in lymphoid cells - glycogen (RAS or CHIC reaction), reaction to nonspecific esterases and monoblasts).

Acute leukemia treatment

Acute leukemia is not always a death sentence: treatment of hematological malignancies is carried out in specialized hematology departments. Main direction modern treatment acute leukemia is the maximum destruction (eradication) of leukemic cells. When acute leukemia is diagnosed, treatment is carried out according to protocols of intensive (total) chemotherapy, which consists of using combinations of chemotherapy drugs to achieve remission (remission induction, consolidation), prevention of neuroleukemia, long-term anti-relapse (maintenance) treatment during the remission period.

In the treatment of acute leukemia, the following antitumor drugs are most often used:

• Alkylating agents(cyclophosphamide, endoxan, ifosfamide).
• Antimetabolites- antagonists folic acid(methotrexate, amethopterin); purine antagonists (mercaptopurine, cytarabine, cytosar, Alexan).
• Antitumor antibiotics(actinomycin).
• Anthracyclines(rubomycin, adriamycin, Farmorubicin).
• Drugs plant origin(alkaloids) - vincristine, oncovin, andesine.
• Epidofolotoxins(etoposide, teniposide).
• Enzyme preparations(asparaginase, krasnitin, leynase).

After completion of treatment according to the protocol, the child receives maintenance therapy (mercaptopurine daily and methotrexate once a week) for 2 years under the control of peripheral blood tests.

Patients with an unfavorable prognosis (presence of unfavorable chromosomal abnormalities, a combination of prognostically threatening factors: poor response to the initial prednisolone prophase, poor response to the chemotherapy protocol), allogeneic bone marrow transplantation is indicated in the first remission. Alternative source stem cells can be umbilical cord blood.

Acute leukemia prognosis for a child's life

For lymphoblastic acute leukemia, the 5-year survival prognosis in most clinics is 80-86%, for myeloblastic leukemia - 13-30%.

Types of leukemia: chronic myeloid leukemia

Chronic myeloid leukemia(HML)- myeloproliferative diseases, in which the morphological substrate is predominantly maturing and mature granulocytes, mainly neutrophils. Chronic myeloid leukemia occurs in childhood rare and accounts for 2-5% of cases of leukemia in children.

Highlight adult And juvenile type of chronic myeloid leukemia.

Juvenile type occurs in children under 4 years of age and is characterized by the presence of anemic, hemorrhagic, intoxication and proliferative syndromes. Sometimes an eczematous type is noted. Blood tests show anemia, thrombocytopenia, leukocytosis with a shift to o-myelocytes, sometimes to myeloblasts, acceleration of ESR. In cell culture it is determined high level fetal hemoglobin.

Adult type It proceeds subclinically for a long time; an enlarged spleen or hyperleukocytosis is sometimes detected only during routine examinations. The course of mass CML has three phases: slow, chronic (lasts about 3 years), acceleration (lasts about 1-1.5 years, with treatment you can return to the chronic phase). The development of blast crisis is observed during terminal exacerbation.

During the acceleration period, a detailed picture of the disease. There is weakness, increased fatigue, general malaise, increased abdominal size, pain in the left hypochondrium, palpation of the spleen big size. Lymph nodes are slightly enlarged. A blood test reveals hyperleukocytosis with a shift to myeloblasts (no leukemic failure), eosinophilic-basophilic association (moderate increase in the number of eosinophils and basophils), lymphopenia, accelerated ESR. A myelocytic reaction is also expressed in the bone marrow. In 95% of patients, an additional chromosome is detected in the group of the 22nd pair (Philadelphia chromosome-RP1 chromosome). When material is translocated between the 9th and 22nd chromosomes, a proto-oncogene is transferred; It is believed that it is this gene that causes the development of CML.

Treatment is carried out with chemotherapy drugs (hydrea, busulfan, myelosan, myelobromol, Gleevec, etc.), Interferon. The adult type has more long course. In case of blast crisis development, therapy is carried out according to the protocols for the treatment of acute leukemia. After bone marrow transplantation and radiation therapy for CML, recovery is possible. Allogeneic bone marrow transplantation from a compatible donor is performed in the chronic phase of chronic myeloid leukemia.

Children are joy and hope. They force parents to believe in the future and strive for it. They inspire you to conquer peaks and rise if you suddenly fall. And there is nothing sadder and more tragic than the illness of family members. Then it seems that the world has turned upside down. Of course, everyone can say that children do not grow up without illnesses, but illnesses and illnesses are different. Leukemia is one of those diseases that forces you to always be on guard. This problem is very serious. The future of the child depends on how timely the diagnosis of leukemia is carried out.

A little about the problem

Leukemia is a disease circulatory system. It is considered malignant. Reproduction and increase in leukocytes in the blood, bone marrow, during internal organs uncontrollable. Initially, the tumor grows in the bone marrow, and then begins to “attack” the blood circulation.

As the disease progresses, it entails the appearance of other ailments associated with increased bleeding, internal hemorrhages, weakened immunity, and infectious complications.

In children, this disease is considered from the point of view of mutation healthy cells into pathological ones. Every day there are more and more of them. Patients may develop different variants lack of any blood cells.

Types of leukemia

Depending on the degree of the disease, the symptoms of leukemia in children manifest differently. That is why, first of all, we will consider the possible types of the disease.

1. According to the degree of cell maturity, leukemia is:

• acute (its sign is the presence of young cells (blasts), which form the basis of the disease)
• chronic.

Types tumor cells can also be different:

• erythroblasts;
• myeloblasts;
• lymphoblasts.

Previously, it was believed that acute leukemia in children and adults is characterized by a rapid course. There was not even any talk about the patient’s survival. But thanks to the introduction of new methods used in treatment, the number of survivors has now increased by an order of magnitude, and every year there are more and more of them.

The chronic form of leukemia is quite rare.

Why does a person have a problem?

Currently exact reasons emergence of this disease not yet installed. And it is unlikely that in the future it will be possible to describe them in detail. But still, there are some factors that contribute to the appearance of the disease in question:

• radiation;
• constant contact with chemicals;
• heredity;
• treatment with chemotherapy;
• inflammatory diseases;
• blood diseases;
• Down's disease.

How does the disease manifest itself?

Symptoms of leukemia in children and adults, as mentioned above, depend on the form of the disease, but they still have something in common:

• lymph nodes enlarge;
• body temperature periodically rises for no reason;
• if tissue is damaged, there may be increased bleeding;
• constant weakness;
• pain in the liver area;
• always want to sleep;
• shortness of breath and sweating;
• loss of appetite;
• weight loss;
• joint pain;
• susceptibility to infections.

Development of the disease in a child

It should be said right away that the signs of leukemia appear gradually. They make themselves felt approximately a month and a half after the onset of the disease. This is exactly the time that is enough for pathological cells to accumulate and for the problem to begin to signal its existence.

If you take a close look at the child at the very beginning of the disease, parents should be wary of the following:

• the baby has changed his behavior: he is often capricious, refuses to eat, does not take part in games, feels tired;
• began to suffer from colds and infectious diseases;
• his body temperature periodically rises for no apparent reason.

If you notice such symptoms, you should immediately consult a doctor. He may not make the correct diagnosis, but he will send the child for a blood test. With leukemia, certain changes will be detected in it, which will force a specialist and parents to monitor the baby.

Time is danger

If you do not contact a specialist with your child, noticing the above symptoms, or if the doctor does not pay due attention to the baby, more serious signs leukemia:

These signs prove one thing - the child has leukemia. Symptoms and blood tests indicate this disease.

Details about the disease

What happens to the blood during leukemia? The number of white blood cells may be much less than expected or, conversely, significantly more. There are cases when the level of white blood cells is very high.

The dominant form of leukocytes in the blood is paraleukoblast. This is an immature cell, pathologically altered, it is lymphoid or myeloid in nature, inside it there is a huge nucleus, which can sometimes be irregular shape. There is no transition between mature and immature forms of the cell. There are very few mature components, and the number of platelets is also low. The bone marrow has almost no normal cells.

Due to monocytic and lymphocytic reactions, a blood test for leukemia in children can be identical to that for a disease such as aplastic anemia. This is the difficulty of making a diagnosis.

Acute leukemia

Sometimes leukemia in children appears suddenly with a characteristic intoxication or hemorrhagic syndrome.

Enlarged lymph nodes manifest as lymphadenopathy, proliferation salivary glands is sialadenopathy, and hyperplasia of the liver and spleen is hepatosplenomegaly.

Acute lymphoblastic leukemia in children is characterized by:

1. Hemorrhagic syndrome. Its symptoms are as follows:

• hemorrhage into the skin and mucous membranes;
• bleeding;
• hemorrhages into the joint cavity;

2. Anemic syndrome. Its symptoms are:

• inhibition of erythropoiesis;
• bleeding.

In addition to the above symptoms, lymphoblastic leukemia in children is characterized by cardiovascular changes. The child develops arrhythmia, develops tachycardia, and increases the size of the heart muscle.

1. Intoxication syndrome is accompanied by:

• fever;
• weakness;
• nausea;
• vomiting;
• malnutrition.

2. Immunodeficiency syndrome causes the appearance of infectious and inflammatory processes.

The most dangerous complication of the disease in question is leukemic infiltration of the brain, nerve trunks and meninges. At this complication Symptoms of leukemia in children manifest themselves as follows:

• sensitivity is impaired;
• there are complaints of dizziness;
• paraparesis of the legs and stiff neck develops.

Stages of acute leukemia

There are only three of them:

1. Initial stage. During this period everything biochemical parameters blood levels may be normal or slightly different. A slight weakness appears, chronic diseases, bacterial and viral infections return.
2. Expanded stage. During this period, with a disease such as blood leukemia, the symptoms are pronounced. There are two options for getting out of this situation: there is an exacerbation of the disease or remission. During an exacerbation, a transition to the terminal stage occurs; during remission, it is necessary to wait time. Only after five years or more can we talk about a complete cure.
3. Terminal stage. The hematopoietic system is completely suppressed, and Great chance lethal outcome.

Chronic leukemia

With this type of disease, blood cells have time to grow, but cannot fully perform their functions. A blood test shows the presence of a high number of white blood cells, but these cells cannot protect the child’s body from infections. After some time, there are so many granule cells that normal blood flow is disrupted.

Symptoms of leukemia in children do not appear when it is chronic. This disease may be discovered completely by accident laboratory research blood for another disease.

Chronic leukemia stages have the following:

1. Monoclonal. Only one clone of pathological cells is present. This phase can last quite a long time, for many years, and is characterized as benign.
2. Polyclonal. At this stage, secondary clones appear. It is characterized by a fast flow. A large number of blasts are formed, and a crisis ensues. It is at this moment that more than eighty percent of patients die.

Features of the disease

As mentioned above, there are two forms of leukemia: acute (the disease is up to two years old) and chronic (the disease is more than two years old). Most often in children, this disease is expressed in an acute form, represented by congenital leukemia.

Acute leukemias are divided into:

• lymphoblastic;
• non-lymphoblastic.

Acute lymphoblastic leukemia in children occurs when the proliferation of immature lymphocytes occurs without any control. There are two types of this disease:

• with small lymphoblasts;
• with large polymorphic lymphoblasts.

Acute nonlymphoblastic leukemia in children has several varieties. It depends on which blast cells predominate:

Three stages of the disease:

1. acute phase;
2. complete or incomplete remission;
3. relapse.

Diagnostics

Preliminary diagnosis on which depends further treatment, should be diagnosed by a pediatrician. At the first slightest suspicion of leukemia, the child is transferred to the hands of a pediatric oncohematologist. The diagnosis is made based on laboratory methods: bone marrow and peripheral blood studies.

At the first stage of a disease such as blood leukemia, the symptoms are not yet so pronounced, but a general blood test may already raise suspicion: high ESR, leukocytosis, anemia, absence of basophils and esinophils.

The next step that is taken is a sternal puncture, a myelogram study. If the blast cell content is more than thirty percent, then the disease progresses. If clear data could not be obtained, then a puncture is taken from the ilium.

In addition, for staging correct diagnosis immunological, cytochemical, cytogenetic studies are used.

A consultation with a pediatric neurologist and ophthalmologist is required. Thus, such a problem as neuroleukemia is confirmed or refuted. In addition, it is taken lumbar puncture, a study of cerebrospinal fluid, ophthalmoscopy, and radiography of the skull are performed.

Ancillary measures include ultrasound of the lymph nodes, salivary glands, liver and spleen. In boys, an ultrasound of the scrotum is performed.

Differential diagnosis of leukemia is carried out using a leukemia-like reaction.

This is how a diagnosis of “blood leukemia” is made, the symptoms of which are not yet clearly expressed only at the very beginning. Only after spending necessary research, you can start treatment on time.

Therapy

If a child has leukemia, he must be immediately hospitalized in the oncohematology department. To prevent the baby from catching an infection, he is placed in a box. The conditions are almost sterile. Nutrition should be balanced and complete. This is how treatment for leukemia in children begins. Otherwise, it is based on polychemotherapy, which is aimed at completely eliminating the disease.

Treatment methods for acute leukemia differ from each other in the combination of drugs used, their dose and methods of application. They are divided into several stages:

• achieving remission;
• its consolidation;
• maintenance therapy;
• prevention;
• treatment of complications if they suddenly arise.

In addition to chemotherapy, immunotherapy is also performed. The following are introduced into the child’s body:

• leukemia cells;
• vaccines:
• interferons;
• immune lymphocytes and other drugs.

Promising methods include transplantation of bone marrow, blood from the umbilical cord, and stem cells.

Symptomatic therapy includes transfusion of platelets and red blood cells, hemostatic therapy.

What are the prognosis for further development of the disease?

This point depends on many factors:

• from age;
• depending on the type of illness;
• from the stage at which the disease was discovered.

The worst outcome is expected if acute lymphoblastic leukemia (symptoms described above) is found in children under two years of age and over ten years of age. Its characteristics: lymphadenopathy, hepatosplenomegaly, neuroleukemia.

The most favorable option is acute lymphoblastic leukemia with small lymphoblasts, treatment at an early stage, the child’s age is from two to ten years. The percentage of girls cured is slightly higher than boys.

Full recovery occurs only after seven years of no relapse. But at this time the child should be almost in ideal conditions. Only loving parents will be able to provide this for him. But how much joy there will be if the doctor says that everything is in order!

Conclusion

Only when early diagnosis disease, one can hope for complete victory over the disease. That’s why, at the first suspicion of leukemia, consult a doctor immediately. The specialist will conduct a study, prescribe treatment, and the child will be under constant supervision. As a result, not a single leukemia cell will remain in the baby’s body. Well, if everything happens like this, you should always hope for it. After all, hope means a lot in our lives, only it helps us live and believe.

Oncological blood disease is difficult to detect initial stages. Usually it is disguised as overwork or frequent colds. When the diagnosis is made, parents experience shock, however, leukemia is not a death sentence. Therapy for blood cancer is long-term, taking several years, but if all the doctor’s recommendations are followed in a timely manner, there is hope for a cure.

What is leukemia, what are the reasons for its appearance in children?

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

Scientists still cannot find an answer to the question of where the disease comes from in children. There are several factors that provoke the development of the disease. These include:

1. Radiation exposure. With a radiation dose exceeding acceptable standards, the bone marrow is primarily affected. For example, after the Chernobyl accident, the number of cases of leukemia increased.
2. Oncoviruses. Some viruses are capable of changing cellular DNA and leading 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 develop leukemia than other children. The risk increases in the presence of Klinefelter's, Bloom's, primary immunodeficiency. Genetic mutations can cause leukemia in newborns.

In the modern scientific community, it is generally accepted that the mechanism of development of leukemia is associated with mutational changes in cells. Due to mutated DNA, bone marrow cells responsible for hematopoiesis lose their ability to differentiate and begin to divide uncontrollably. They remain at the blast level 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 common name for the whole group malignant diseases circulatory system. There are several classifications depending on the form of the disease, the level of differentiation, and cytogenesis. The symptoms, diagnosis and treatment of each subtype can differ significantly from each other.

Acute and chronic forms

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

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

Symptoms are signs of lymphatic infiltration. The child's mucous membranes are affected oral cavity, a rash appears, bruises form on the legs, even if the baby did not fall or hit himself. External signs of the disease can be seen in the photo.

Immunity decreases, making the body susceptible to infections of various etiologies. Body weight decreases, you feel muscle weakness, sweating, elevated temperature is observed - if such signs are present, you should immediately consult a doctor.

Lymphoblastic and non-lymphoblastic

Acute leukemia is in turn divided into:

1. Lymphoblastic (ALL). Lymphoblasts are immature lymphocytes. In this form of leukemia, it is they who stop maturing 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 occurs at 3 years for the B-cell subtype (80% of all cases of ALL) and at 15 years for the T-cell subtype (20% of all cases of ALL). Boys get sick 2 times more often than girls. This is probably due to genetic factors.
2. Non-lymphoblastic, or myeloblastic. There are 8 subspecies myeloid leukemia. The disease begins in the myeloid blood cell of the bone marrow. Myelocytes actively divide and gradually fill the bone marrow cavity. The peak incidence occurs at 2-3 years.

Stages of the disease

Signs of blood cancer in children at the first stage are practically absent, which makes diagnosis difficult. It is possible to put the disease into remission in the first 2 stages of oncology. Remission is the absence of oncogenic cells in the blood for 5 years. It is impossible to put the terminal stage into remission.

Blood tests and other diagnostic methods

From timely diagnosis depends on the outcome of the disease. If lesions are detected early, sustained remission can be achieved. At the first changes in the child’s behavior (lethargy, increased fatigue, weight loss), parents should contact their pediatrician. Children's doctor prescribes a general blood test.

By general analysis blood can detect the presence of leukemia. Blood cancer indicators:

• an increase in the number of white blood cells;
• reduction in the number of red blood cells and their precursors - reticulocytes;
• decreased platelet count;
• high erythrocyte sedimentation rate;
• Availability large number leukoblasts;
• absence of intermediate forms of development between leukoblasts and leukocytes.

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

To determine the presence of metastases in organs, hardware diagnostic methods are used - MRI, ultrasound, CT, and x-ray. Explore abdominal cavity- liver, spleen, lymph nodes. A dangerous manifestation Cancer is neuroleukemia, when the affected blood enters the brain. To identify metastases in the central nervous system, consultation with a neurologist and ophthalmologist is necessary.

Features of treatment of leukemia in children

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

Chemotherapy and immunotherapy

The goal of therapy is to completely eliminate the leukemia cell group. The main treatment method is chemotherapy. Depending on the type of cancer, various combinations of drugs are prescribed:

Stages of chemotherapy:

• bringing the disease into remission;
• maintaining remission;
• therapy of concomitant pathologies;
• relapse prevention.

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

• the blast rate 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 in the oncohematology department, where almost sterile conditions are maintained.

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

Symptomatic impact

With leukemia, many organs are damaged, because the blood is not able to perform its main function. In addition, infiltration of mutated cells into the body tissue occurs.

Frequent infections, including fungal infections, are companions of blood cancer. A weakened immune system is unable to fight viruses and bacteria, and any inflammatory process can lead to severe complications. To prevent infections, the patient is placed in a special box, but if pathogens do get inside, they are treated with antibiotics.

Chemotherapy has a detrimental effect on 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 goes into remission, doctors eliminate the effects of chemotherapy. It provides medicinal support for the liver, kidneys, and digestive system.

During treatment, which lasts more than one year, it is important to adhere to balanced diet nutrition. The child should not experience a deficiency of vitamins and microelements. He needs to drink a lot of water.

Bone marrow and stem cell transplant

When leukemia is put into remission, but there is a high chance of relapse, a bone marrow and stem cell transplant is prescribed. It is important to perform transplantation before relapse, because if the disease returns conservative methods treatments are practically useless.

Bone marrow parts are taken from a compatible donor, who may be a relative or by a stranger. Of course, a relative has a better chance of being suitable in all respects. There are several criteria by which a future donor is checked to ensure that he is suitable for a transplant. The search may take a long time, but it is 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 donor's stem cells can fill it and start the process of healthy hematopoiesis.

When undergoing a transplant, there is a risk of rejection of the foreign organ, so immunosuppressive therapy is first administered. The immune system is completely suppressed, allowing the graft to take root.

Bone marrow transplantation cannot be performed in cases of relapse of leukemia or infectious diseases. First, it is necessary to put the disease into remission or treat the infection and only then transplant stem cells.

Other methods

Chemotherapy and bone marrow transplant are not the only ways treatment. If blood cancer has spread to the central nervous system and 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 cytostatic drugs that suppress the growth of cancer cells. They can be taken in tablet form or injected. This type of treatment is called targeted therapy. It does not affect healthy tissues of the body, but acts specifically on the molecules of mutated cells. This is a gentler option than chemotherapy.

Prognosis and complications in the 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 has gone into remission. The prognosis depends on the form of leukemia, as well as the stage at which it was detected, the treatment regimen and the individual characteristics of the child.

Oncohematologists give the following predictions for survival over 5 years:

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

Much depends on age. Before the age of 15, the chances of recovery are high - up to 94%, after 15 years they drop to 80%. The terminal stage is practically untreatable. Doctors prescribe palliative therapy, which is aimed at relieving the symptoms of the disease and ensuring acceptable quality last days life.

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

After the cancer has subsided, the parents’ task is to do their best to prevent the cancer from returning. First of all, it is necessary to get tested as often as possible so as not to miss a relapse. It is not recommended to expose a child to stress, climate change, or vaccinations. Even if several years have passed after treatment, it is necessary to regularly visit the doctor and carry out the necessary examinations.

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 lesion 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 prolonged stay near computers or computer devices;
• frequent relapses of infectious diseases that can cause 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 that occurs in the bone marrow causes cancer cells called blasts to develop and divide. 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. Chronic course 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 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 attribute them to the child being tired 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, they are prescribed additional research or repeated to monitor the dynamics of the disease.

To correctly and timely assign treatment course, it is very important to establish what the cause of the disease is.

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

Therapeutic measures

When initial signs of leukemia are detected in children, the first step is to prescribe diagnostic examination And symptomatic treatment. After production accurate diagnosis treatment is carried out in a specialized children's hospital.

For treatment, the following are used: chemotherapy, radiotherapeutic methods, bone marrow transplantation; very rarely, medicine is injected into the canal with cerebrospinal fluid. Drug treatment is prescribed according to the degree and type of damage to the circulatory system, and is also used hormone 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 large quantity patients and prevent relapse of the disease.