Leukemia In Children

Leukemia in children

Leukemia accounts for around a third of all cancers in childhood and adolescence. They arise in the bone marrow, the place where blood is formed. From the beginning, leukemia cells are distributed throughout the body via the blood. They are therefore counted among the so-called systemic tumor diseases. In many cases, those affected can be completely cured.

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• What types of leukemia are there in children and adolescents?
• What are the causes of leukemia?
• What are the symptoms?
• How is the diagnosis made?
• How is leukemia treated?
• Whom can I ask?
• How are the costs going to be covered?

In the bone marrow, blood cells and platelets develop from common progenitor cells. There is already an early breakdown into two rows of blood cells:

• Stem cells of the myeloid cell series: The red blood cells (transport of oxygen), the blood platelets (blood clotting) and some of the white blood cells (granulocytes and monocytes - non-specific defense cells) develop from this in several intermediate stages.
• Stem cells of the lymphatic cell series: they give rise to the lymphocytes (specific defense cells), which are a subgroup of white blood cells.

The bone marrow is constantly producing supplies so that the blood can fulfill its vital functions. Normally, all blood cells multiply and renew themselves in a harmonious equilibrium and go through a maturation process. This maturation process gets out of control in leukemia: the white blood cells (leukocytes) no longer mature into functional cells, but multiply quickly and uncontrollably. As a result, they increasingly displace normal blood formation - as a result, too few healthy blood cells and platelets are produced.

What types of leukemia are there in children and adolescents?

A distinction is made between acute (rapidly progressing) and chronic (insidiously progressing) and, depending on which blood cell line is affected, lymphatic and myeloid leukemia. In childhood, chronic lymphocytic leukemia does not occur and chronic myeloid leukemia very rarely occurs. In the case of cancers, which are usually acute, the symptoms usually develop within a few weeks.

• Acute lymphoblastic leukemia (ALL): It is the most common cancer in children and, at 80 percent, the most common form of leukemia in children and adolescents. It occurs predominantly between the ages of one and six. The disease arises from the malignant change in an immature precursor cell of the lymphocytes.
• Acute myeloid leukemia (AML): It accounts for 15 to 20 percent of leukemias in children and adolescents. Infants and small children in the first years of life are particularly affected. The disease arises from the malignant changes in immature myeloid cells, mostly around progenitor cells of white blood cells.

What are the causes of leukemia?

Leukemia is associated with changes in the genome of the affected cells. Usually the causes remain unexplained. Theoretically, external influences can also play a role in the development of leukemia, for example:

• radioactive beams,
• chemical substances,
• Medication,
• Viruses.

However, as a rule, no increased exposure can be demonstrated in the patient's history. Family accumulation is also not the case, with a few exceptions. In identical twins, however, about a third of the siblings develop the same leukemia. Children with Down syndrome are at increased risk of developing leukemia.

What are the symptoms?

Symptoms of the disease usually develop within a few weeks and are individually very different. Many complaints can be traced back to a lack of normal blood cells: Decreased red blood cells (anemia), blood platelets (tendency to bleed) and normal immune cells (infections, fever) are the cause of the symptoms. The following complaints can occur, among others, according to the frequency of occurrence:

• Tiredness, general exhaustion and listlessness, feeling of illness;
• Pallor of the skin and mucous membrane;
• Fever;
• increased susceptibility to infection;
• Bleeding tendency with little or no external influence, eg nose or gum bleeding, bruises without a corresponding external cause, punctiform skin bleeding;
• Bone and joint pain.;
• swollen, non-painful lymph nodes;
• Abdominal pain and loss of appetite (due to enlarged spleen and / or liver).

How is the diagnosis made?

If there is evidence of acute leukemia in the medical history or a physical examination, a comprehensive blood test is carried out. If the suspicion is confirmed, further examinations are carried out in a hospital specializing in cancer and blood diseases in children and adolescents, for example:

• Taking a bone marrow sample from the iliac crest and a sample of the cerebrospinal fluid (liquor) from the lower spinal canal (bone marrow and lumbar puncture),
• Ultrasound,
• Lung x-ray.

Depending on the symptoms and subtype of lymphoblastic leukemia, other imaging methods such as magnetic resonance tomography, computed tomography or skeletal scintigraphy can be used.

How is leukemia treated?

The aim is to destroy the tumor cells as completely as possible so that the bone marrow can resume its function as a blood-forming organ. For this purpose, a complex drug therapy is carried out, which largely consists of classic chemotherapy. Treatment takes about two years. Hospitalization is required for certain phases of therapy, especially at the beginning of treatment, while others can take place at home.

The disease always affects the whole body. Since the cerebral spaces and membranes are difficult to reach with drugs that are administered into the blood or swallowed, a needle puncture (lumbar puncture) carried out in the lower back requires direct medication into the cerebral fluid (liquor) located there. In some cases, the head is also irradiated. In rare, persistent cases, a bone marrow transplant (stem cell transplant) may be required.

forecast

With early, individually tailored therapy in a children's oncology treatment facility, the majority of those affected are completely cured. Around half of all patients who do not respond adequately to the treatment from the start or who suffer a relapse of the disease can still be cured thanks to appropriate therapies.

Whom can I ask?

The first point of contact is a doctor specializing in paediatrics.

Detailed information for patients and parents can be found on the website of the German-Austrian Society for Pediatric Oncology and Hematology (GPOH).

How are the costs going to be covered?

The e-card is your personal key to the benefits of the statutory health insurance. All necessary and appropriate diagnostic and therapeutic measures are taken over by your responsible social insurance agency. A deductible or contribution to costs may apply for certain services. You can obtain detailed information from your social security agency. Further information can also be found at:

• Right to treatment
• Visit to the doctor: costs and deductibles
• What does the hospital stay cost?
• Prescription fee: This is how drug costs are covered
• Medical aids & aids
• Health Professions AZ
• and via the online guide to reimbursement of social insurance costs.