Leukemia in children
The content of the article:
- Causes of leukemia in children and risk factors
- Forms of the disease
- Disease stages
- Symptoms of leukemia in children
- Diagnostics
- Treatment of leukemia in children
- Potential consequences and complications
- Forecast
- Prevention
Leukemia in children is a systemic blood disease characterized by the replacement of normal bone marrow hematopoiesis by proliferation of less functionally active and differentiated cells - early precursors of leukocyte cells.
In the general structure of cancer incidence in children and adolescents, leukemia accounts for 30 to 50%. The disease occurs with a frequency of 4-5 cases per 100,000 children. Most often, leukemia affects children aged 2–5 years.
In recent years, there has been a steady trend towards an increase in the incidence of leukemia in children.
Causes of leukemia in children and risk factors
The exact mechanism of development of leukemia in children remains unclear until the end. It has been proven that the following factors play a role in increasing the risk of developing the disease:
- immune and hormonal disorders in the child's body;
- hereditary predisposition;
- infection with oncogenic strains of viruses, for example, the Epstein-Barr virus;
- ionizing radiation;
- intoxication with chemicals, heavy metal salts;
- contact with industrial toxins.
Children who have undergone radiation or chemotherapy for any other cancer may develop secondary leukemia in the future.
Most experts consider the causes of leukemia in children from the point of view of the clonal concept and mutational theory. Under the influence of risk factors, a mutation in the DNA of a hematopoietic cell can occur in a child. As a result, its genetic code is disrupted, which becomes the cause of uncontrolled growth and impaired differentiation. In fact, leukemic cells are clones of a mutated hematopoietic cell, which are not only incapable of differentiation and further maturation, but also suppress the germs of normal hematopoiesis.
Blast (leukemic) cells enter the systemic circulation and are carried throughout the body, leading to leukemic infiltration of internal organs and tissues. They can also overcome the blood-brain barrier, contributing to the development of neuroleukemia, a pathological condition associated with leukemic infiltration of the substance and the meninges of the brain.
An increased risk of developing leukemia is observed in children with the following diseases:
- Down's disease;
- Fanconi anemia;
- Bloom's syndrome;
- Wiskott-Aldrich syndrome;
- Klinefelter's syndrome;
- Lee-Fraumeni syndrome;
- primary immunodeficiencies (Louis-Barr ataxia-telangiectasia, X-linked agammaglobulinemia);
- polycythemia.
Forms of the disease
Depending on the duration of the disease, leukemia in children is divided into acute (less than two years) and chronic (over two years) forms. The vast majority of children have acute leukemia. The chronic form of the disease is diagnosed in no more than 3% of all cases. Congenital leukemia in children is considered as a special form.
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Acute leukemias, depending on the morphological characteristics of tumor cells, are divided into two types.
- Lymphoblastic. Its development is caused by uncontrolled division of lymphoblasts - immature lymphocytes. In turn, it is divided into three types: with small lymphoblasts (L1), with large polymorphic lymphoblasts (L2) and with polymorphic large lymphoblasts with vacuolization of the cytoplasm (L3). According to antigenic markers, acute lymphoblastic leukemias in children are divided into B-cell (1-3%), T-cell (15-25%) and O-cell (70-80%). In pediatric practice, lymphoblastic leukemia L is most often observed;
- Non-lymphoblastic. This form of leukemia in children, depending on the predominance of a certain type of blast cells, is subdivided into poorly differentiated myeloblastic (M1), highly differentiated myeloblastic (M2), promyelocytic (M3), myelomonoblastic (M4), monoblastic (M5), erythromyeloid (M7)), eosinophilic (M8), undifferentiated (M0) forms.
Disease stages
There are three stages of leukemia in children.
- Sharp. It starts from the moment the first clinical signs of leukemia appear in children and continues until the improvement of clinical and hematological parameters during therapy.
- Incomplete or complete remission. When complete remission is achieved, less than 5% of blast cells are detected in the punctate of the red bone marrow. Incomplete remission is characterized by the normalization of clinical parameters and hemogram, the content of blast cells in the bone marrow from 5 to 20%.
- Relapse. Against the background of a favorable blood picture, leukemic infiltration of the tissue of the lungs, testicles, nervous system and other organs occurs.
Symptoms of leukemia in children
The clinical picture of leukemia in children usually develops gradually, with a predominance of nonspecific symptoms:
- increased fatigue;
- sleep disorders;
- pain in bones and joints;
- decreased appetite;
- increased body temperature.
In rare cases, leukemia in children is acutely manifested with severe hemorrhagic or intoxication syndrome.
Over time, children develop a pronounced pallor of the mucous membranes and skin. In the future, the skin acquires an earthy or icteric hue. Leukemic infiltration of mucous membranes contributes to frequent tonsillitis, stomatitis, gingivitis. Infiltration of spleen and liver blast cells is clinically manifested by the development of hepatosplenomegaly, the salivary glands - sialadenopathy, and lymph nodes - lymphadenopathy.
The suppression of normal bone marrow hematopoiesis leads to the appearance of a number of syndromes:
- anemic (myelophthisic anemia) - its development is associated with a violation of the maturation of erythrocytes, as well as frequent bleeding;
- hemorrhagic - due to a reduced content of platelets in the blood, manifested by skin hemorrhages (petechiae, ecchymosis), nasal, uterine, pulmonary, gastrointestinal bleeding;
- infectious - due to a violation of the formation of mature leukocytes, the body is defenseless against infections. Frequent infectious and inflammatory diseases take on a severe course, often develop into sepsis and cause the death of the patient;
- intoxication - manifested by a decrease in body weight, hyperhidrosis, fever, severe general weakness, nausea and vomiting, anorexia, malnutrition.
Leukemia in children is usually accompanied by the development of cardiovascular disorders, the signs of which are:
- decreased cardiac output (according to echocardiography);
- diffuse changes in the myocardium (according to ECG data);
- expansion of the boundaries of the heart (according to X-ray examination of the chest organs);
- arrhythmias;
- tachycardia.
Diagnostics
If leukemia is suspected, children are referred to a pediatric oncohematologist. To confirm the diagnosis, a laboratory study of the picture of peripheral blood and punctate of the red bone marrow is carried out.
In acute leukemia in children, the general blood test reveals the following changes:
- anemia;
- reticulocytopenia;
- thrombocytopenia;
- leukocytosis (much less often leukopenia);
- increased ESR;
- basophilopenia;
- eosinophilopenia;
- blastemia.
One of the main laboratory signs of leukemia in children (acute form) is the absence between blast and mature cells of intermediate forms of leukocytes (young, stab).
If leukemia is suspected, children must undergo sternal puncture, followed by laboratory examination of the resulting punctate (myelogram). The diagnosis is considered confirmed when the content of blast cells is more than 30%.
Until a definitive diagnosis is made, children should not be given glucocorticoids, which destroy blast cells, which can complicate the diagnostic process.
If laboratory data do not allow a clear and unambiguous diagnosis, a puncture of the ilium (trepanobiopsy) is indicated.
In order to determine the various forms of leukemia in children, various types of cytogenetic, immunological and cytochemical studies are performed.
Biochemical blood test for leukemia in children is of secondary importance. It reveals:
- hypofibrinogenemia - occurs as a result of the concomitant disseminated intravascular coagulation syndrome;
- hyperuricemia - due to a shortened cell life cycle.
To identify possible metastases in different anatomical areas, instrumental diagnostics are performed:
- chest x-ray;
- Ultrasound of the scrotum (in boys);
- Ultrasound of the abdominal organs;
- Ultrasound of the salivary glands;
- Ultrasound of lymph nodes;
- computer and magnetic resonance imaging of the head, thoracic and abdominal cavity, small pelvis.
If you suspect the development of neuroleukemia, the child should be referred for consultation with a pediatric neurologist. To confirm the diagnosis, it is necessary to perform ophthalmoscopy, X-ray of the skull, examination of the cerebrospinal fluid obtained during the lumbar puncture.
Leukemia in children requires differential diagnosis with a leukemia-like reaction of the body of a transient nature, which can occur against the background of sepsis, cytomegalovirus infection, infectious mononucleosis, whooping cough and tuberculosis.
Treatment of leukemia in children
The goal of treating leukemia in children is to achieve complete remission. The child is hospitalized in an oncological clinic and placed in a sterile box to prevent infectious complications.
Source: malysh-ma.ru
To destroy the leukemic clone, polychemotherapy is performed. The choice of a treatment regimen is carried out taking into account the form and stage of the disease, the general condition of the child, the presence or absence of concomitant pathology, and age.
With relapses of acute leukemia in children, the issue of the need for bone marrow transplantation is decided. If it is advisable, with the help of radiation therapy or chemotherapy in ultrahigh doses, leukemia cells are completely destroyed, after which transplantation is performed. After this procedure, a child with severe leukemia is more likely to survive.
Symptomatic treatment is also carried out, which includes:
- transfusion of erythrocyte and platelet mass;
- antibiotic therapy;
- hemostatic therapy;
- detoxification therapy.
Potential consequences and complications
Leukemia in children can lead to the development of a formidable complication - neuroleukemia associated with leukemic infiltration of the nerve trunks, substance and membranes of the brain and spinal cord. The clinical manifestations of neuroleukemia are:
- headache, dizziness;
- nausea, vomiting;
- stiff neck;
- diplopia (double vision);
- paresis of the limbs;
- disorders of skin sensitivity;
- disorder of the functions of the pelvic organs.
Forecast
The prognosis for leukemia in children depends on many factors (stage at the time of diagnosis, age of the child, cytoimmunological variant, presence or absence of concomitant pathology). The factors aggravating the prognosis are:
- age under two or over eleven;
- lymphadenopathy and / or hepatosplenomegaly;
- neuroleukemia;
- B- or T-cell variant of the disease;
- blast hyperleukocytosis.
Factors that improve the prognosis:
- starting treatment at an early stage of leukemia;
- the child's age is from 2 to 11 years old;
- female;
- lymphoblastic acute leukemia type L
Leukemia in children in the absence of specific treatment is fatal in 100% of cases. Modern polychemotherapy makes it possible to achieve stable remission of the disease in 50–90% of children. It is possible to speak of complete recovery only if the duration of remission is over 6-7 years.
With relapse, in most cases, chemotherapy allows you to achieve a second remission. Children in second remission are the main candidates for bone marrow transplantation.
During remission, to prevent the recurrence of leukemia, physiotherapy and a sharp change in climatic conditions are contraindicated in children.
Prevention
Specific prevention of leukemia has not been developed.
Source: o-krohe.ru
The following activities play a certain role in the prevention of possible mutations in the DNA of hematopoietic cells:
- limiting the exposure of the child to ionizing radiation - children should have clear indications for an X-ray examination;
- preventing children from coming into contact with products containing benzene (gasoline, pesticides, lubricants);
- prevention of secondhand smoke by a child;
- proper nutrition of children, fully corresponding to their age needs;
- active lifestyle (regular walks in the fresh air, playing sports);
- compliance with the daily routine.
To identify leukemia at an early stage, when treatment is most effective, it is necessary to carefully monitor the health of children. You should regularly undergo preventive examinations, including donating blood for analysis. If a child develops general weakness, sweating, fever, pain in joints and bones, it is imperative to consult a doctor and conduct a study of the composition of peripheral blood.
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Elena Minkina Doctor anesthesiologist-resuscitator About the author
Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.
Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
