LEUKAEMIA IN CHILDHOOD

Leukaemia in Childhood

Leukaemia in Childhood

Introduction

Leukaemia is defined by a clonal proliferation (of a sort) of a precursor of blood cells in the marrow. An international classification defines different types according to cytological cell line in question: lymphoid or myeloid lineage. These diseases are serious. However, treatment advances are spectacular. The first prolonged remissions date from the late 1960s. The advances of the 1980s are a better approach to care (widespread use of central lines, wide use of powerful antibiotics, and better use of analgesics) and high-dose chemotherapy (use of treatment intensification, better control of allogeneic bone marrow transplantation). Understanding of Leukaemia has been greatly improved in recent years by molecular biology.

Acute Leukaemia is the most common childhood cancer, representing one third of cancers in children, with an annual incidence of 4/100 000. Acute Leukaemia is 20 times more common in children with trisomy. Leukaemia results in the replacement of normal blood cells in bone marrow by cancer cells. These abnormal cells on the one hand prevent marrow to produce normal cells and also will infiltrate various organs.

The spontaneous evolution was rapidly fatal in arrays of severe infections or major bleeding. Currently, modern therapeutic result in remission in 95% of cases of acute lymphoblastic Leukaemia.

Causes and risk factors

The application of molecular biology techniques to the fields of Leukaemia improves understanding of these diseases. Recent work concerned with early events, molecular, responsible for leukaemogenesis. Now, these techniques improve identification of disease by allowing the definition of fusion transcript and description of rearrangements of immunoglobulin genes between receivers or T.

The contributions of these techniques are twofold: better knowledge on the molecular definition of disease and possible follow-up of residual disease. We must point out the interest of testing techniques in vitro antileukaemic activity of different drugs. There are few studies on the physiology of leukemic cells, with the exception of studies of angio-genetic

Complications

Before modern treatment, children with Leukaemia died quickly. Currently, various therapeutic developed in recent years allow obtaining remissions of longer or shorter. There is talk of forgiveness when a complete cure lasts five years. A "remission" is defined by the disappearance of clinical signs and hematological cell lines with the reappearance of normal marrow in the bone. Several complications can occur:

Bone marrow suppression is caused by the treatment that heals somewhat but Leukaemia causes severe infections or severe bleeding. The various treatments have an immunosuppressive effect and make it very sensitive children with viral infections (chickenpox, measles etc.)

Localized leukemic infiltrations may reach the meninges (meningitis Leukaemia). These meningeal relapses were responsible hematological relapse early during the first year of treatment. Preventive treatment is now routinely performed. The testicular damage is relatively common and requires regular review of the external genitalia (painless and gradual increase in the volume of a testicle). When the disease no longer responds to treatment maintenance or re induction, the disease often progresses to death from a plastic anemia.

Treatment

Central catheters

Several types exist - simple percutaneous catheters, catheters with sleeves or room - the choice is related ...