Eight percent of childhood leukemias are “acute” and standardized chemotherapy is significantly more effective than bone marrow transplantation.
Children may not be treated with chemotherapy according to adult protocols, and bone marrow transplants may face problems such as inability to have children.
In recent years, news of children with leukemia looking for bone marrow donor volunteers or seeking help from the community for huge transplant costs has been in the press from time to time. Many parents fall into endless despair once they learn that their child’s bone marrow transplant match has failed, or that they cannot raise up to hundreds of thousands of dollars for the transplant. However, in interviews, reporters found that most children do not actually need a bone marrow transplant, and some children mistakenly use adult treatment options, making it difficult to get better or eventually relapse.
Several experts in pediatric leukemia treatment said that for most children with acute lymphoblastic leukemia, bone marrow transplantation is not only not the only way, but also not the preferred treatment option. Compared to adult patients, the results of standardized chemotherapy for children with leukemia are significantly better than bone marrow transplantation, with clinical cure rates reaching 80%. At the same time, children with bone marrow transplantation are likely to face problems such as inability to have children and long-term complications such as secondary tumors, which does not mean that they will not relapse in the future. What are the trade-offs? Parents must be careful.
Bone marrow transplantation is not a one-time event, and there are two main long-term effects.
Many parents mistakenly believe that “chemotherapy is time-consuming and prone to relapse” and costs more in time and money, while a bone marrow transplant can be a once-and-for-all solution. “In fact, this is a wrong view; bone marrow transplantation is not a once-and-for-all solution.” Several experts point out that the cure rate for bone marrow transplantation is only 50-60 percent and is not the optimal choice for pediatric patients. Experts point out that the international consensus is that children who are considered to have less than a 40-50 percent chance of being cured by chemotherapy through a rigorous assessment by their doctors need a bone marrow transplant. In these high-risk patients, the leukemia cells are difficult to be removed and the intensity of chemotherapy needs to be increased to overcome the drug-resistant cancer cells, but too intense chemotherapy can simultaneously destroy the normal hematopoietic cells of the bone marrow and destroy the hematopoietic function.
In the past, few children had bone marrow transplants and few samples were studied, but now it has been found that the problems after bone marrow transplantation are not small. Long-term problems are often overlooked compared to immediate problems such as rejection.
Difficulty in having children as adults.
The first is the inability to have children. “Many people who receive bone marrow transplants are not able to have children.” Experts say this is because the process of bone marrow transplantation, including alkylating agents and other high-dose chemotherapy in addition to killing leukemia cells, but also indiscriminately kill spermatozoa cells. There are children who have received bone marrow transplants who have reached the stage of love and do not know that they cannot have children. Parents are also very conflicted about whether they should tell the truth to their child’s lover.
High risk of secondary tumors.
Second, it has been clinically found that children who receive bone marrow transplants have a higher risk of secondary tumors, such as lymphoma, than the average child.
The drugs used in chemotherapy may also have an effect on fertility, but much less than a bone marrow transplant, experts say. It is important to emphasize that all drugs used to treat leukemia have side effects, including those used in chemotherapy and bone marrow transplants, and it is only the lesser of two evils whether chemotherapy or transplantation is used, given that saving lives is the first priority.
In recent years, treatment options for childhood leukemia have been improving and side effects have been greatly reduced. Twenty years ago, radiation therapy was commonly used, but follow-up found that it resulted in children not growing taller and having a high incidence of secondary tumors. Today, radiotherapy is only used for a small number of high-risk cases and at reduced doses. At the same time, studies are underway to reduce the side effects of bone marrow transplantation.
About 10% of children with acute childhood gonorrhea requiring transplantation.
Each year, 30,000 to 40,000 new pediatric malignancy patients are diagnosed in China, one third of which are leukemia. Some hospitals today do not have a pediatric hematology ward and admit children to the internal medicine hematology department, where they are treated according to adult protocols or unregulated pediatric protocols. In fact, pediatric leukemia is so different from adult leukemia that treatment according to adult protocols can do more harm than good.
Experts point out that acute childhood leukemia is divided into two main categories, namely acute lymphoblastic leukemia (acute gonorrhea) and acute myelogenous leukemia. Of these, acute gonorrhea accounts for about 80% and acute myeloid leukemia accounts for 20%.
Leukemia is treated by risk stratification, and can be classified as standard-risk, intermediate-risk and high-risk based on indicators such as leukemia cell genetic analysis, immunophenotype, blood picture and treatment response. Lin GuiDeng said that in children with acute gonorrhea, for example, 35%, 50% and 15% of patients are standard-risk, intermediate-risk and high-risk, respectively, and only some high-risk patients usually require bone marrow transplantation. “That is, more than 85 or even 90 percent of pediatric patients with acute gonorrhea do not need a bone marrow transplant.”
”But most adult patients with acute gonorrhea need a bone marrow transplant to be cured.” Experts say that when public opinion focuses on leukemia, it often fails to understand the different characteristics of adult and pediatric leukemia and the differences in treatment options, mistaking adult-suitable bone marrow transplants as the only “lifesaver” for children. Some parents feel afraid to bring their children for treatment because they do not have enough money for the transplant, resulting in delayed treatment.
However, unlike childhood acute myeloid leukemia, more than half of the children have a poor prognosis and are indicated for bone marrow transplantation, although this is not the only way out, studies have shown that many children can still be cured by chemotherapy.
Treatment of “late adolescence” patients is recommended according to the pediatric protocol.
Many people are very vague about the concept of “curing leukemia” and often mistake the medical term “5-year survival rate” or “10-year survival rate” for only 5 or 10 years of life. Luo Xuequn explained: In fact, if acute leukemia continues to remit for 5 years after treatment, that is, if it achieves 5 years of disease-free survival, there is little chance of relapse; if it can continue to remit for 8-10 years, it can be considered as a cure, while acute myeloid leukemia can continue to remit for 5 years is considered as a cure.
Experts point out that the clinical cure rates for children under 14 years of age with acute gonorrhea at high, intermediate, and standard risk have reached 50%, 70%-80%, and over 80%, respectively, with standard pediatric regimens of chemotherapy.
Only 20% of adult patients with acute gonorrhea can be clinically cured with chemotherapy, which is four times worse than children. Why is there such a big difference between adult and pediatric patients with the same leukemia? Luo Xuequn pointed out, “There are significant differences in immunophenotypes and leukemia genes between children and adults with acute gonorrhea, and the proportion of adult patients with high-risk leukemia is high.”
Another important reason for the low cure rate of chemotherapy in adult patients is that adults, especially those of advanced age, tolerate chemotherapy poorly and therefore cannot be treated with too strong a drug. Children, on the other hand, have a strong regenerative capacity and can easily recover from chemotherapy, so they can be treated “aggressively”, which is naturally effective. Thus, we can understand that the effect of adult chemotherapy in pediatric patients is much worse than that of pediatric regimens. Some pediatric patients who are initially treated with adult regimens and later wish to switch to pediatric regimens have missed the opportunity to do so, and inappropriate treatment at the early stage may make it impossible to treat them in a hierarchical manner according to pediatric regimens, making treatment very difficult. Therefore, it is important to seek treatment from a pediatric hematology specialist who is familiar with the characteristics of children and their treatment options.
For “late adolescent” leukemia patients aged 16-20 years, a large number of clinical practices and studies have confirmed that treatment with pediatric regimens is more effective because their characteristics are similar to those of children and they tolerate strong chemotherapy better.
Experts warn that standard chemotherapy should last at least six to seven months.
Parents are often reluctant to undergo chemotherapy for fear that “their children will not be able to tolerate the pain of chemotherapy. Luo Xuequn said, compared with adults, children are in a growth spurt and are more tolerant of chemotherapy, and they are more likely to recover from common complications of chemotherapy, such as hair loss and organ damage.
Experts emphasize that standardized chemotherapy is about phased and hierarchical treatment, with standard, intermediate and high-risk stratification based on chromosomal and genetic characteristics, age and leukocyte base at the time of initiation to select the appropriate treatment plan. In children, for example, clear stratification is generally available on day 33 after the start of treatment. It should be emphasized that chemotherapy must be administered in its entirety, but in some children, treatment is intermittent, which tends to cause leukemia cells to be resistant and insensitive to chemotherapy drugs.
Primary chemotherapy for children with acute gonorrhea labeled critical and intermediate risk is completed in about six to seven months, after which they can take the drugs home for about a year and a half of maintenance treatment. “The more critical the condition, the more expensive the chemotherapy.” In general, it costs about $220,000 for a high-risk child, $150,000 for a medium-risk child and $100,000 to $120,000 for a standard-risk child, Lin GuiDeng said.