Leukemia is a malignant blood disease in which a certain blood cell system in the hematopoietic tissue overproliferates and infiltrates into various tissues and organs, thus causing a series of clinical manifestations.
According to the survey, the incidence of pediatric leukemia in <10 years old is 3/100,000-4/100,000, which accounts for about 35% of the survey on the prevalence composition of malignant tumors in <15 years old, it is the most common pediatric malignancy.
The incidence is higher in males than females. Acute leukemia accounts for 90%-95%, while chronic leukemia accounts for only 3%-5%.
How Leukemia is Caused
The exact cause of leukemia is still unknown. Many factors are thought to be involved in the development of leukemia. Viruses are probably the main factor. In addition, there are also genetic factors, radiation, chemical toxins or drugs.
Many years of research have long demonstrated that retroviruses, which are RNA viruses, can cause human T-lymphocytic leukemia. The relationship between other viruses and leukemia has also attracted attention.
2. Hereditary Quality
Leukemia is not a hereditary disease, but there can be multiple malignancies in the family; a few children may suffer from other hereditary diseases, such as trisomy 21, congenital testicular hypoplasia, congenital aplastic anemia with multiple malformations, congenital distal capillary dilated erythroderma, and severe combined immunodeficiency disease, etc. The incidence of leukemia in children with these diseases is higher than that of the average The incidence of leukemia in children with these disorders is significantly higher than in the general population.
In addition, the incidence of acute leukemia in one identical twin is 20%, which is 12 times higher than the incidence of dizygotic twins. All these phenomena suggest that the occurrence of leukemia is related to genetic quality.
3. Radiological Factors
Ionizing radiation has a leukemogenic effect, and its effect is related to the size of the radiation dose and radiation site. A larger dose (1-9Gy) or multiple small doses have leukemogenic effects. In children with thymic hypertrophy treated with radiation, the incidence of leukemia is 10 times higher than in normal children. After irradiating the abdomen of pregnant women, the incidence of leukemia in their newborns is 17.4 times higher than that of unirradiated ones.
4. Chemical Factors
Leukemia can be induced by benzene and its derivatives, chloramphenicol, pautazone, etanercept, alkylating agents and cytotoxic drugs. Breast cancer, ovarian cancer and lung cancer are also prone to secondary leukemia after chemotherapy. In recent years, there are many reports that indoor decoration and furniture, toy pollution is a major cause of the rising incidence of leukemia in urban children.
Early Symptoms of Leukemia
Most children and adolescents with leukemia have an acute onset. Early symptoms of leukemia include pallor, depression, fatigue, low appetite, nasal bleeding or gum bleeding; a few children have fever and bone and joint pain similar to rheumatic fever as the first symptoms.
The symptoms of leukemia are mainly related to the destruction of hematopoietic function in the bone marrow. Since white blood cells have the ability to penetrate into tissues, some of the symptoms are also related to this property.
1. Symptoms caused by destruction of the hematopoietic function of the bone marrow
- Bruising and spotting: lack of platelets due to a decrease in platelet-producing megakaryocytes.
- Anemia: a lack of red blood cells due to a decrease in the mother cells that make red blood cells. Tendency to shortness of breath and dizziness when walking, or exercising.
- Persistent fever and long-lasting infection: Most of the white blood cells are blood cancer cells without normal function, resulting in decreased immunity and susceptibility to infection.
2. Symptoms caused by penetration of blood cancer cells into the tissue
- Enlarged lymph nodes.
- Bone pain or joint pain: caused by the massive proliferation of blood cancer cells in the bone marrow. Tapping the sternum of patients with acute lymphoblastic leukemia often causes severe pain.
- Swollen gums.
- Enlargement of the liver and spleen.
- Headache and vomiting: signs of penetration of blood cancer cells into the central nervous system.
- hard lumps in the skin: also known as green tumors because of their slightly greenish appearance.
- Pericardial or cribriform fluid accumulation.
3. Special manifestations of various types of leukemia
- Acute promyelocytic leukemia: diffuse bleeding.
- Chronic myelogenous leukemia: most patients have increased platelet count and splenomegaly.
- Acute lymphoid leukemia: If it leads to enlargement of the lymph glands in the mid-thoracic diaphragm, it often compresses the trachea, leading to shortness of breath and cough.
- Adult T-cell lymphoid leukemia: Because of high calcium ions in the blood, it leads to dehydration, unconsciousness, and coma.
Tests for Leukemia
1. Decreased hemoglobin and platelet count.
The total leukocyte count varies, generally ranging from 20.0-50.0 × 109/L, with a few higher than 100 × 109 or lower than 10.0 × 109/L. A large number (sometimes up to 90%) of abnormal primitive leukocytes are seen in the peripheral blood picture in more than half of the patients.
Blood cell chemistry staining methods can determine the type of acute leukemia. About 45% of cases have chromosomal abnormalities, including haploid, hyperdiploid and various marker chromosomes.
2. Blood biochemical tests.
- Terminal deoxynucleotidyl transferase (TDT): increased activity in ALL, but no activity in ANLL.
- Alkaline phosphatase (AKP): significantly in ALL and significantly lower in AML.
- Lactate dehydrogenase (LDH): significantly increased in ALL. In addition, serum uric acid concentration is increased, and urinary uric acid excretion is increased, more so when treated with cytotoxic drugs.
3. Active bone marrow proliferation, significantly active or extremely active, dominated by leukemic cells.
- Primitive cells >6% in the bone marrow is suspicious, more than 30% is a more certain diagnosis, and primitive cells + early (young) cells ≥50% can confirm the diagnosis.
- In the whole bone marrow, the red lineage and megakaryocytes are highly reduced.
- When blood and bone marrow images are not sufficient to confirm acute leukemia, lymph node puncture fluid smear and specific skin lesion print examination can be applied to find the corresponding leukemia fine combined with pathological prints, which can help the diagnosis.
Treatment of Leukemia
In the current clinical treatment of leukemia, Western medicine mainly adopts chemotherapy to kill leukemia cells, but it is impossible to completely kill 100% of the bad cells at high doses, so the residual leukemia cells are the root cause of recurrence.
The treatment of acute leukemia is mainly a combination of chemotherapy-based therapy, the principles of which are: early diagnosis and early treatment, the type of leukemia of the child should be strictly distinguished, and different chemotherapy drugs and corresponding drug doses should be selected according to the type of combined therapy, the policy of early continuous moderate chemotherapy and phased long-term standardized treatment should be adopted.
At the same time, early prevention and treatment of central nervous system leukemia and testicular leukemia should be carried out, and chemotherapy should be accompanied by active supportive treatment. Patients with acute lymphoblastic leukemia are given maintenance therapy after complete remission for a total duration of 2.5-3.5 years, children with acute non-lymphoblastic leukemia are treated with a short course of high-intensity chemotherapy without maintenance therapy; the total duration of treatment is approximately 6-8 months.
In early stage leukemia, a combination of treatment methods is advocated, among which chemotherapy is the mainstay and can be combined with Chinese herbal medicine to reduce toxicity and increase effectiveness; for patients with intermediate and late stage leukemia, it mainly depends on the appropriateness of the treatment method and the patient’s physical condition.
The common treatments for intermediate and advanced leukemia include chemotherapy, bone marrow transplantation, biomodulator therapy and Chinese medicine. Bone marrow transplantation is the most effective treatment for intermediate to advanced leukemia, and about 50% of patients can survive long-term after receiving a bone marrow transplant, but it has the disadvantage of being expensive and having few bone marrow sources.
Chemotherapy is also an important treatment for intermediate and late stage leukemia, which can effectively relieve the symptoms and prolong the survival period.
Can Leukemia be Cured?
In the past 10 years, due to the continuous improvement of chemotherapy, acute lymphoblastic leukemia is no longer considered “incurable”, with a 5-year disease-free survival rate of 75%-88%, and the primary complete remission rate of acute non-lymphoblastic leukemia has reached 80%, with a 5-year disease-free survival rate of about 40%-60%.
The Cost of Leukemia Treatment
The treatment of leukemia is a comprehensive treatment that includes multiple aspects, such as infection prevention, supportive therapy, immunotherapy, radiation therapy, Chinese medicine, and nursing care. For pediatric leukemia, the most prominent treatment is chemotherapy. Most pediatric leukemia patients can be cured with chemotherapy alone, while a few poorly treated types require chemotherapy followed by hematopoietic stem cell transplantation. Leukemia patients require extensive, ongoing treatment, the cost of which is not a small sum. The cost of treatment is directly related to the type of treatment the patient chooses, so it should be discussed on a case-by-case basis.
The cost of a course of treatment can range from a few thousand to tens of thousands of dollars. This treatment method effectively kills leukemia cells while the body’s normal hematopoietic system such as the normal red blood cells and platelets have a harmful effect on the white blood cells, and over a period of time there will be damage to other organs of the body, and the relapse rate is high.
2. Bone marrow transplantation.
The cost is about 300,000, but the treatment effect is good, and bone marrow transplantation is considered to be the ideal means to cure leukemia.
3. Biological therapy.
A course of treatment is about 20-30,000.
The cost of leukemia treatment, in addition to the method chosen by the individual patient, also has an important relationship with the time of discovery and treatment of the disease, usually, the earlier the discovery and start of treatment, the lower the cost of disease treatment.
Effects of Leukemia
1.Heart damage: It is not uncommon for leukemia to occur with cardiac changes, most of which manifest as myocardial leukemic cell infiltration, hemorrhage and epicardial bleeding, and pericardial effusion. However, those with clinical symptoms are rare, and a few cases may have systolic murmur in the precordial region and arrhythmia.
2. Lung and pleural damage: leukemia pulmonary infiltration has few clinical manifestations, mainly infiltrating the alveolar wall, but also infiltrating the bronchi, pleura, blood vessel wall, etc.. The X-ray manifestation of pulmonary infiltration is atypical and cannot be easily distinguished from pulmonary infection and bleeding. Pleural infiltration is often accompanied by pleural effusion, which is common in acute lymphocytic leukemia.
3. Kidney damage: leukemia has kidney lesions in up to 40% or more, but those with clinical symptoms are rare. A few cases may show increased protein in the urine, microscopic leukocytes, red blood cells, etc. Renal meningo-nephritis and kidney stones are rare, and occasionally death from uremia.
4. Gastrointestinal system damage: leukemic cell infiltration of the gastrointestinal tract is mostly manifested as nausea, vomiting, loss of appetite, abdominal distension, diarrhea, etc.. Necrotic perforation due to leukemic infiltration of the gastrointestinal tract is rare, but bleeding from the gastrointestinal tract is more common, and massive vomiting of blood and black stools can occur.
How Long Can You Live With Leukemia?
The length of life in leukemia depends on the appropriate treatment and the patient’s physical function. For example, chronic myeloid leukemia is the most common of the leukemia classifications, and this disease eventually leads to death from a combination of myelofibrosis, acute leukemia and multiple organ failure, complicated by infections, bleeding and other serious complications. The duration of chronic gonorrhea varies from 1-2 years to 5-10 years or even 20 years.
The duration of the disease is related to the urgency of the disease, systemic symptoms, hepatosplenomegaly, and changes in blood and bone marrow images. Acute leukemia is a dangerous disease, and without special treatment, the average survival period is only about 3 months, while infection and intracranial hemorrhage are important causes of death in acute leukemia.
In recent years, due to the strengthening of various measures, the mortality rate due to infection has been significantly reduced, while intracranial hemorrhage has become an important cause of death in acute leukemia, especially early death.
Leukemia patients and their families should learn more about the treatment of leukemia and communicate more with their primary care physicians to help prolong the survival of leukemia patients.
The best results are achieved if the treatment is carried out in the early stages of leukemia. For patients with mid- to late-stage leukemia, it depends mainly on the appropriateness of the treatment and the patient’s physical condition.
Common treatments for intermediate to advanced leukemia include bone marrow transplantation, chemotherapy, biomodulator therapy and Chinese medicine. Bone marrow transplantation is the most effective treatment for intermediate to advanced leukemia, and about 50% of patients who receive bone marrow transplantation can survive for a long time, but it also has the disadvantage of being expensive and having few bone marrow sources. Chemotherapy is also an important treatment for intermediate and late stage leukemia, which can effectively relieve symptoms and prolong survival, and it is also a necessary step before bone marrow transplantation.
As you can see, how long a leukemia patient can live is related to many factors, such as the patient’s physical condition, whether the leukemia is in the early or late stage, and whether the treatment is appropriate. Leukemia patients are generally effective after treatment, so patients must not give up on treatment, which will cut off their hopes.
Is Leukemia Contagious?
Leukemia is not contagious. The main factors that contribute to the development of leukemia are the mutation of leukemia in individuals with potential genetic defects and repeated exposure to carcinogenic substances in the environment.
The etiology of its development is multifaceted. There is no possibility of transmission, regardless of the analysis of genetic, lifestyle and chemically toxic substances. Isolation is mainly for the protection of the patient, who has no resistance and is very susceptible to infection, and is very dangerous if infected.
Is Leukemia Hereditary?
Leukemia is not a hereditary disease, but multiple malignancies can run in families, a small number of children may have other hereditary diseases, such as trisomy 21, congenital testicular hypoplasia, congenital aplastic anemia with multiple malformations, congenital distal capillary dilated erythroderma, and severe combined immunodeficiency disease, and the incidence of leukemia in children with these diseases is significantly higher than in the general pediatric population.
How to Prevent Leukemia
- Do not abuse drugs. Be careful when using drugs such as chloramphenicol, cytotoxic anticancer drugs and immunosuppressants, which must be guided by a doctor, and do not use or abuse them for a long time. In addition, use hair dyes sparingly or not at all. American researchers have found that women who use hair dyes (especially in large quantities) have 3.8 times the risk of developing leukemia than the general population. Hairdressers, beauticians and plastic surgeons who are often exposed to hair dyes are also potentially harmful.
- Pay attention to dietary hygiene. Because vegetables and fruits containing chemical fertilizers, pesticides and other food, after consumption, digestion and absorption into the blood, easy to destroy the normal hematopoietic function of the bone marrow, and thus the onset of disease. Therefore, vegetables and fruits should be cleaned before consumption to reduce the residues of chemical fertilizers and pesticides to a minimum.
- People at high risk of leukemia should do a good job of regular screening, paying special attention to leukemia warning signs and early symptoms.
- Avoid contact with certain carcinogenic substances and do a good job in occupational protection and monitoring: for example, in the production of phenol, chlorobenzene, nitrobenzene, spices, drugs, pesticides, synthetic fibers, synthetic rubber, plastics, dyes, etc., pay attention to avoid contact with harmful and toxic substances.
- To avoid excessive exposure to X-rays and other harmful radiation, the personnel engaged in radiation work need to do a good job of personal protection, pregnant women and infants should pay particular attention to avoid exposure to radiation.
- Prevention and control of various infections, especially viral infections: such as C-type RNA virus.
- The best way to decorate homes to meet the environmental requirements of harmless materials, it is best to open the windows and ventilation for more than a week before moving in, ask the indoor environmental monitoring department to monitor, qualified before moving in, once the unexplained bleeding, low fever, joint pain, dizziness and other symptoms to the hospital for examination.
- Eat more high-protein stuff, this is because the leukemia blood cells have been pathologically changed due to the consumption of protein in the body of such patients is much greater than normal people, only supplemented with a large amount of quality protein to maintain the function of the tissues and organs.
In addition, various antibodies in the body are also composed of proteins, which have the function of protecting the body from bacteria and viruses and improving the body’s resistance. Therefore, leukemia patients should consume a high-protein diet, especially the use of some good quality, high digestion and absorption rate of animal protein and legume protein, such as poultry eggs, dairy, fish and shrimp, lean meat, animal blood, animal offal, tofu, soy milk, etc..
In addition, liver also contains more nucleic acid, which plays a potential role in cancer prevention. It is beneficial for leukemia patients to eat some animal liver regularly in their daily diet.
- More intake of iron-rich food. According to clinical data, it is proved that about 70%-90% of malignant tumor patients have different degrees of vitamin deficiency in their bodies, so they should eat more iron-rich foods.
- Adjust the diet according to the disease. Patients may have poor appetite and indigestion due to their disease, so they can be supplied with semi-liquid or soft rice, such as two rice porridge, liver porridge, steamed egg custard, yogurt, tofu brain, small dumplings, etc.
- less food and more meals, easy to digest. Because leukemia patients are already quite weak, plus the side effects of chemotherapy and other treatments lead to symptoms such as nausea, vomiting, bloating, diarrhea, etc., at this time, you can adopt the method of eating less and more meals.