What happens in the bone marrow
Due to acquired genetic damage, the lymphocyte precursor cell loses the ability to mature, but retains the ability to divide. This creates a clone of blasts that fills the bone marrow. There is no room left for normal hematopoietic growths: red blood cells decrease, which leads to anemia, platelets, which leads to bleeding, and mature neutrophils, which is why the child begins to get sick often and seriously. Blasts enter the blood and settle in the lymph nodes, liver, spleen, meninges and, in boys, the testicles. Therefore, treatment always affects the nervous system.
- Stopping the maturation of lymphocyte precursors
- Displacement of normal hematopoiesis
- Anemia, bleeding and infections at the same time
- Spread of blasts to lymph nodes, liver and spleen
- Possible damage to the meninges and testicles
Causes and risk factors
In the vast majority of cases, it is impossible to name a specific reason, and it is important for parents to understand: neither nutrition, nor upbringing, nor previous colds are to blame. It is believed that the first genetic damage often occurs in utero, and then a second event is required for the disease to develop. Ionizing radiation, previous chemotherapy and a number of hereditary syndromes, primarily Down syndrome, significantly increase the risk. Leukemia is not contagious and cannot be passed on to other children, and the likelihood of a repeat case in the family is extremely low.
- In most cases the cause is unknown
- Ionizing radiation
- Received chemotherapy for another reason
- Down syndrome and other hereditary syndromes
- The disease is not contagious and is not associated with child care
First signs
The onset is often disguised as a protracted viral infection, and this is what makes early diagnosis difficult. The child becomes lethargic, gets tired quickly, stops playing as before, and turns pale. Bruises appear in unusual places, pinpoint rashes on the shins, bleeding gums, nosebleeds. The temperature lasts for weeks and does not drop well. A very characteristic symptom for children is pain in the legs and back due to stretching of the bone marrow, which is why the baby refuses to walk or asks to be held. During examination, enlarged lymph nodes, liver and spleen are often found.
- Pale, lethargic, loss of interest in games
- Bruises and pinpoint rashes without injury
- Prolonged fever and frequent infections
- Pain in bones, legs, refusal to walk
- Enlarged lymph nodes, liver and spleen
- Decreased appetite and weight
- Headache and vomiting due to damage to the membranes of the brain
Diagnostics
The first step is a general blood test with a mandatory leukocyte count: the combination of anemia, low platelets and the appearance of blast cells forces action immediately. However, the white blood cell count may be normal or low, so bone marrow testing is critical. In the punctate, the proportion of blasts is determined, immunophenotyping is performed to distinguish lymphoblastic leukemia from myeloid and to determine the subtype, as well as cytogenetic and molecular studies, which determine the risk group. A lumbar puncture is required to evaluate the cerebrospinal fluid.
- General blood test with leukemia formula
- Bone marrow puncture and blast count
- Immunophenotyping
- Cytogenetics and molecular markers
- Lumbar puncture
- Ultrasound of lymph nodes, liver, spleen and testicles
- LDH, uric acid, blood biochemistry
Treatment and family support
Treatment is carried out according to international protocols and consists of several stages: induction of remission, consolidation and long-term maintenance therapy, which lasts about two years. An obligatory part is the prevention of damage to the nervous system by administering drugs into the spinal canal, since conventional drugs almost do not penetrate there. The intensity of treatment is determined by the risk group and the response to the first weeks of therapy. Bone marrow transplantation is used in cases of high risk or relapse. It is important for parents to strictly follow the schedule, protect the child from infections and immediately report the temperature.
- Multi-stage chemotherapy protocol
- Injection of drugs into the spinal canal
- Maintenance therapy for about two years
- Bone marrow transplantation at high risk
- Immediate treatment for fever during treatment
- Infection prevention and special hygiene
- Live vaccines are not used during treatment
