Leukemia is a malignant tumor of the hematological system with an incidence of about 3-4/100,000 population, and pediatric leukemia ranks first among all kinds of pediatric malignancies. The age of prevalence ranges from birth to 14 years and affects the entire pediatric age range, but is more common in children aged 2-5 years. It is one of the leading causes of death in children under 15 years of age. It is generally classified into acute and chronic according to the urgency of onset, clinical, hematological and bone marrow manifestations. Among them, acute leukemia predominates, accounting for 97% of all pediatric leukemias. Acute leukemia can be divided into acute lymphoblastic leukemia and acute non-lymphoblastic leukemia, with the former accounting for 70-85%. In the last decade or so, the efficacy of pediatric leukemia has been improving due to the application of many new drugs and the continuous enhancement of chemotherapy regimens. Currently, pediatric acute lymphoblastic leukemia is not an incurable disease, and 70-80% of children can be cured and return to normal school and life. However, there is a lack of awareness about childhood leukemia, from the parents of the sick children to the whole society, and even some doctors have misconceptions about the disease, which is considered incurable and can only prolong life for a few years with a lot of money. At present, there are about 16,000-20,000 new children with childhood leukemia in China each year, and less than 20% of them receive regular treatment. Many children with hope for a cure lose their hope for survival, not least for economic reasons, but mainly because of misconceptions about the disease.
Childhood leukemia is not an incurable disease
Childhood leukemia, especially acute lymphoblastic leukemia, is very sensitive to common chemotherapeutic drugs, therefore, using a combination of drugs for chemotherapy is the best way to treat this childhood leukemia. After years of practice, an effective method has been developed for the treatment of acute leukemia in children in China. After regular treatment, more than 90% of children can achieve complete remission. After 2-3 years of consolidation treatment, 70-80% of children with acute lymphoblastic leukemia and 40% of children with acute non-lymphoblastic leukemia can be cured, which can neither affect their life and work, generally without sequelae, and is affordable for some families. Coupled with the increasing sophistication of the social security system, it is important not to give up treatment at will.
Once childhood leukemia is diagnosed, it is important to go to a regular hospital to receive standardized treatment. Random chemotherapy may achieve temporary results, but it is very likely to lead to relapse and drug resistance, which will have a negative impact on future consolidation.
Chemotherapy is preferred over bone marrow transplantation for childhood leukemia
Bone marrow transplantation is one of the methods of treating childhood leukemia, and it cannot be said in general whether it is the best method of treating childhood leukemia, which depends on the specific condition of the patient. At present, it is recognized at home and abroad that chemotherapy for acute lymphoblastic leukemia in children is more effective, with a 5-year survival rate of 70-80% or more. Therefore, bone marrow transplantation is not advocated for pediatric acute lymphoblastic leukemia patients in their first bone marrow remission, while bone marrow transplantation is advocated for acute lymphoblastic leukemia and acute non-lymphoblastic leukemia with high-risk factors in their first complete remission. The cost of bone marrow transplantation treatment is approximately $200,000 or more, and about 50% of those who achieve 5-year survival are currently living at home and abroad. Bone marrow transplantation is far more costly mentally, emotionally, organically, and cost-wise than chemotherapy.
It is undeniable that the current news coverage of bone marrow transplantation and cord blood transplantation is somewhat overheated and misrepresented, as if a panacea for all diseases has been found. For childhood leukemia only those high-risk and relapsed refractory cases are indications for bone marrow transplantation.
Childhood leukemia requires standardized treatment
Treatment options for pediatric leukemia are different from those for adults and are significantly more effective than those for adult leukemia. Treatment of pediatric leukemia mainly includes chemotherapy, radiation therapy, intrathecal drug injections and various stem cell transplants. Chemotherapy and intrathecal injections are the mainstay. Chemotherapy is generally divided into induction remission therapy, consolidation intensive therapy, extramedullary leukemia control, re-induction therapy and maintenance therapy.
Induction remission therapy is the key to the long-term survival of the child, and is often a combination of multiple drugs in high doses, which can reduce the leukemia cells in the body by 99%, make the anemia, bleeding and infiltration symptoms disappear clinically, restore normal blood tests, reduce the leukemia cells in the bone marrow by less than 5%, and eliminate the tumor cells in the cerebrospinal fluid, which means complete remission. This stage of treatment often requires hospitalization. Induction of remission is only the beginning of success; intensive consolidation therapy after remission is still needed to further kill residual leukemic cells. Otherwise, these leukemic cells can lead to relapse after a period of proliferation. The first six months to one year is strong chemotherapy, and thereafter maintenance therapy, which is generally a weaker maintenance regimen. Maintenance therapy can be administered at home,. The total course of treatment in this way is about 2.5-3 years, and can be discontinued for observation.
Childhood leukemia can be prevented
The etiology of leukemia is still not fully understood. Viruses are the main causative agent. However, many other factors such as radiation, chemical toxins or drugs, and genetic qualities may be cofactors in the pathogenesis, and changes in genetic structure within the chromosomes directly cause malignant changes in the cells. Reduced immune function favors the development of the disease. As with other cancers, although leukemia cannot be completely prevented, relative prevention can be achieved by targeting a number of pathogenic factors.
First of all, do not have too much exposure to X-rays and other harmful radiations. Infants and pregnant women are more sensitive and vulnerable to radiation, and women should avoid excessive exposure to radiation during pregnancy, otherwise the incidence of fetal leukemia is higher. However, occasional, medical x-rays in small doses will basically have no effect on the body.
Second, do not abuse drugs. Be careful when using drugs such as chloramphenicol, cytotoxic anticancer drugs, immunosuppressants, etc. You must have a doctor’s guidance, and do not use or abuse them for a long time.
Third, to reduce exposure to benzene, chronic benzene poisoning mainly damages the human hematopoietic system, causing a reduction in the number of human white blood cells, platelets induced leukemia. Therefore, when decorating a house, we should choose the decoration materials that are harmless to humans and open the windows fully before moving in.
Early detection and timely treatment of childhood leukemia
(1) Unexplained fever, anemia, bleeding, enlargement of liver, spleen and lymph nodes, muscle and joint pain or sternal pressure pain, swollen gums that do not heal for a long time, purpura and bruises on the skin, epistaxis.
(2) Unexplained leukopenia of all lineages that is ineffective for a long time; unexplained leukocytosis with an increased percentage of monocytes.
(3) Severe anemia in pediatric patients with significant effect of treatment with corticosteroids.
(4) Unexplained leukocytosis, especially if accompanied by immature leukocytosis.
Anyone who finds any of the above abnormalities should seek early medical attention and have a comprehensive examination.
Modern chemotherapy for leukemia has a history of more than 100 years, but the real rapid development is still after the 1970s, on the one hand, because of the development of research in basic related disciplines, so that we have a more profound understanding of the nature of leukemia; on the other hand, because of the success of bone marrow transplantation methods, the accumulation of strong chemotherapy experience, the emergence of new effective drugs, gene therapy, prompting clinical treatment Children’s leukemia has made great progress, China has a large number of professional pediatric hematologists, and a large national collaboration, with the further advancement of medical science, people’s awareness of the disease continues to improve, the cause of childhood leukemia treatment in China is bound to make rapid progress.