When a child visits the doctor with unexplained persistent or recurrent fever, anemia, cachexia, bleeding tendency, enlarged liver, spleen and lymph nodes, skeletal pain or pressure pain in the sternum, unexplained weight loss and gradual loss of physical strength, be on high alert and consider the presence of leukemia.
Leukemia is a malignant neoplastic disease of hematopoietic origin, characterized by uncontrolled proliferation of a series or series of blood cells in the hematopoietic tissue and infiltration of other tissues, with primitive and early infantile cells predominating in the bone marrow and peripheral blood, with common clinical manifestations such as anemia, fever and enlargement of liver, spleen and lymph nodes.
Etiology.
1.Ionizing radiation.
2, chemical factors.
3.Viruses.
4.Genetic factors
Leukemia is divided into acute leukemia and chronic leukemia according to the maturation disorder of leukemic cells and how quickly the disease progresses. Acute leukemia is divided into acute lymphoblastic leukemia and acute non-lymphoblastic leukemia. The typing of acute leukemia has evolved from a single FAB morphological typing method in the past to morphological, immunological, cytogenetic, and molecular biology (MICM) typing methods.
To diagnose leukemia, routine blood tests are essential and often reveal primitive or naive cells, or a significant increase or decrease in a particular type of cell. When leukemia is highly suspected, bone marrow aspiration is performed first and foremost. Bone marrow examination is the main method for diagnosing leukemia and also plays an important role in the observation of therapeutic effects and determination of prognosis. Acute leukemia is diagnosed when the bone marrow has ≥ 20% primitive granulocytes or primitive (mono, germinal) + naïve (mono, germinal) cells.
Overview of childhood leukemia
Since the first reported case of leukemia in 1827.
the recognition of leukemia as a new class of disease in 1845.
The understanding of leukemia has gone through several stages. The actual cure rate in the 19th century was only 3-5%. Until the early 1970s, there was still no major breakthrough; in 1962, the Stjude Children’s Institute was established in the United States, which made a significant contribution to childhood acute leukemia; in December 1967, a new round of chemotherapy was introduced: the intensity of maintenance chemotherapy drugs was increased, and higher doses of cranial radiotherapy and intrathecal methotrexate were used to prevent and treat meningeal leukemia. In 1982, it was demonstrated that the combination of three intrathecal drugs, repeated regularly, was as effective as cranial radiotherapy, thus avoiding the sequelae of poor response to cranial and spinal radiotherapy in most cases. Childhood leukemia became a “curable disease”.
The application of morphological, immunological, cytogenetic, and molecular biology (MICM) typing methods in the diagnosis, typing, and guiding the selection of treatment regimens for childhood acute leukemia, as well as the tracking of micro residual lesions (MRD), the study of pharmacokinetics and pharmacodynamics of commonly used chemotherapeutic drugs, and the study of the metabolic characteristics of chemotherapeutic drugs in children with different types of leukemia and different individuals, the cure rate of acute leukemia has The cure rate of acute leukemia has been further improved.
The development of hematopoietic stem cell transplantation and targeted gene therapy has provided new hope for some children with refractory and relapsed acute leukemia.
In the 1980s and 1990s, the cure rate of acute gonorrhea in children has increased from 20% 20 years ago to more than 80%. The treatment effect of childhood acute myeloid leukemia (AML) is not as remarkable as that of LL, but the 5-year disease-free survival rate has also increased from 25% to about 30%-49% in 20 years. The 5-year disease-free survival rate of ALL has reached 74.6% to 80.0%, and the 10-year disease-free survival rate of AML is 27%. .
This is mainly attributed to: the accumulation of clinical experience, the increase in the number of medical and nursing staff specializing in hematology and oncology, better infection control measures and supportive therapies, the development of medical insurance business; the discovery and application of new anti-leukemia drugs, such as: cytarabine, levomucoidase, and onychotoxins; changes in the drug regimen, the
e.g., high-dose methotrexate-tetrahydrofolate relief, application of high-dose cytarabine.
There are two main reasons for leukemia treatment failure, firstly, non-remission or relapse due to insensitivity of tumor cells to chemotherapeutic drugs and death from the primary disease; secondly, death from treatment combination, such as severe infection, drug-induced organ insufficiency, etc. It is very important to grasp the appropriate intensity of chemotherapy and treatment duration. Internationally, the current treatment time for ALL is 2-3 years and for ANLL is 6-12 months, and most medical centers in China extend it by 1 year accordingly.
Leukemia is a curable disease
Leukemia is the most common malignancy in childhood and is not incurable today after the efforts of the past decades. The disease-free survival and cure rates for acute childhood gonorrhea have achieved remarkable and steady growth. Leukemia treatment is a very delicate process that may present with many different complications. We need to continuously summarize, reflect on and emphasize treatment strategies with the aim of further improving the long-term disease-free survival rate of childhood leukemia and improving the quality of their survival so that these children can live, learn, work and grow like everyone else. We need to continuously improve the MICM staging diagnosis, select strategic individualized protocols, strengthen the management and follow-up of leukemia patients, and ensure that patients are treated systematically and reviewed regularly.
As medical staff, in addition to our skill and experience, we must also have a high sense of responsibility and make it a stated goal of our work to achieve long-term sustained remission from the beginning of treatment, and never be satisfied with just the induction of remission at the beginning or short-term success. Any interruption or omission of treatment can lead to relapse or treatment failure of the patient. Therefore, we should help patients to persevere through all treatment sessions, ensure adequate treatment periods, and make every effort to carry the course of treatment to the end.
Life is the most precious, and human life is only once; life is also the most beautiful, and one more life is one more beauty. One more life is one more hope. Although leukemia is very dangerous, we have to face it bravely. During the long days of treating the disease, we will encounter many difficulties, such as economic pressure, social pressure, family pressure and psychological pressure, etc. We have to be brave to face these difficulties and setbacks! We also need to arouse the attention of the society and hope that the whole society will give understanding, support and help!
New therapies are emerging, such as peripheral blood hematopoietic stem cell transplantation, cord blood hematopoietic stem cell transplantation and gene therapy. Although some methods are not mature enough now, the prospect of these therapies is vast! It is believed that in the near future, more drugs will be available and more effective therapies will emerge, which will eventually cure leukemia completely. Let’s work hand in hand and shoulder to shoulder to beat leukemia!