Leukemia is a malignant blood system disease when a large number of defective and/or immature leukocytes (white blood cells) are formed in the bone marrow. At the same time, the bone marrow gradually loses its ability to produce normal blood cells and a number of symptoms associated with life-threatening pancytopenia (decrease of all blood cells in blood – leukocytes, erythrocytes, platelets) appear.
About 300,000 people die from leukemia every year. This accounts for 3% of all cancer deaths. It is also worth to remember that leukemia is the most common malignant disease among children and the number one cause of premature death in children. Young children experience the disease especially hard.
All these principles of working with children in Hematology Oncology Department took over the specialists of Maimonides Medical Center. We work on the model of the best Israeli clinics and under the direct supervision of Israeli doctors. In our clinic the Pediatric Hematology project is managed by Professor Amos Toren (the head of the Pediatric Hemato-Oncology and BMT department at the Haim Sheba Israel Medical Center)
Modern pediatric hematology is at a high level of porgress, and this area of practical medicine is developing particularly well in Israel. Every day in Israeli clinics, leading hematologists save hundreds of children's lives, making the disease go away and never come back. All thanks to a modern and comprehensive approach to the treatment of malignant hematological diseases:
- High qualification of doctors working with children. During training and internship, specialists achieve not only skills in the field of medicine, but also learn to quickly establish contact with small children in order to avoid the slightest psychological discomfort or fear on their side.
- High level of comfort in children's hospitals and departments of multidisciplinary medical centers. The wards have all the necessary conditions for a comfortable stay not only for children, but also for their parents or custodians. Game rooms, cafeterias, training programs and courses are available there.
- Treatment based only on modern recommendations, application of innovative equipment for fast and high-quality diagnosis, appointment of therapy courses taking into account the individual characteristics of each child and possible side effects of prescribed drugs and procedures. All therapy is planned individually, while its safety and effectiveness are constantly monitored. All treatment regimens are built on the basis of modern global treatment protocols in accordance with the principles of evidence-based medicine.
- Multidisciplinary team work. A whole team of specialists provide the recovery of one child, which may include not only pediatric oncology hematologists, but also pediatricians, radiation therapists, chemotherapists, diagnosticians, psychologists, infectious disease specialists, rehabilitators, transfusion specialists, and others. This ensures continuity of medical services. That is, within the walls of one institution, you can get all the necessary help, starting with diagnosis, ending with rehabilitation and further outpatient follow-up.
Types and causes of leukemia in children
The main types of leukemia are distinguished:
- Acute myeloblastic leukemia (33%).
- Acute lymphoblastic leukemia (10%).
- Chronic myeloid leukemia (14%).
- Chronic lymphocytic leukemia (35%).
- Other types of leukemia (8%).
Acute lymphoblastic leukemia is the most common among children.
What are the different types of leukemia? The difference is in which blood cells they originate. Acute leukemias develop from immature poorly differentiated cells (blasts – lymphoblasts, myeloblasts), chronic – from more mature blood cells.
Unfortunately, the direct cause, that leads to leukemia’s appearance is unknown. There are some following risk factors:
- Exposure to ionizing radiation or certain chemicals presence in the anamnesis.
- Certain anticancer drugs treatment in the past.
- Infection with some types of viruses – human T-lymphotropic virus, Ebstein-Barr virus.
- Genetic predisposition.
Symptoms of leukemia
As you know, early and correct diagnosis is more than a half of success of any disease treatment. This is especially relevant for the field of Pediatric Onco-hematology. Unfortunately, there are no reliable signs of leukemia. But the following symptoms will help to suspect something wrong with the child's health:
- frequent bruises occurrence on the child's skin for no apparent reason;
- painful pallor of the skin;
- refractory (resistant) to standard treatment anemia;
- unmotivated weight loss;
- lag in the child's physical development;
- liver and spleen enlargement according to ultrasound data;
- frequent infectious diseases;
- an increase in peripheral lymph nodes for no apparent reason;
- prolonged fever that cannot be explained by other causes;
- recurrent aphthous stomatitis;
- joints and bones pain.
If you have noticed several of described symptoms in your child, do not waste time, seek help from the specialists of the Maimonides Multidisciplinary Medical Center. The specialists of our clinic will ьфлу a plan for rapid diagnosis and dismiss your doubts about the child's health. And in case of a real problem, they will provide a detailed consultation based on the practice of the best Israeli children's hematology centers. Then they will give step-by-step instructions on how to act in such a situation.
Modern approaches to the leukemia diagnosis in children at the Maimonides Medical Center
As a rule, the diagnosis of leukemia does not cause difficulties. You can suspect the disease on the basis of a routine blood test. If you received pathological results of a general blood test, a more detailed diagnosis is recommended. The Israeli model of medical care precisely involves accurate diagnosis using modern methods and equipment, which our doctors have successfully inharited and practiced.
Modern methods of leukemia diagnosis are:
- Laboratory blood tests: in case of hematology oncology diseases, standard blood tests indicators change significantly. This is the primary stage of diagnosis, from which the entire program of additional examination methods is subsequently built.
- Myelocytogram: is a type of biopsy in which a portion of the bone marrow is taken from inside bones such as the breastbone or pelvis. Then, this fragment of bone marrow is viewed under a microscope and it is determined which cells it consists of. In this way, you can diagnose leukemia and determine its type. The invasiveness of this study is its peculiarity. It mean that it causes significant pain, therefore, in Maimonides Clinic, it is prov only under general anesthesia in children. Due to this children do not feel any pain or other psychological discomfort during the procedure.
- Modern medical imaging techniques are used to detect possible metastases in distant organs. Such methods as MRI, CT, MSCT, PET-CT are actively explore. This makes it possible to determine the stage of the disease and make a prognosis regarding the treatment program.
It is important to know, to know that all the cytological and histological material that we receive during the examination of small patients with the help of biopsy is sent for revision to the best pathohistological laboratories in Israel, the USA, and Germany. Thanks to such "molecular checks", we are absolutely sure of the diagnosis correctness and prescribed treatment scheme adequacy.
If required narrow specialist or diagnostic equipment is not available in our clinic, the patient is referred to subsidiary medical centers or Israeli Maimonides partner clinics.
The latest and most effective treatment of leukemia in children
Despite the fact that leukemia is a very serious disease, modern medicine has learned to fight it effectively and not only in terms of patient survival, but also to provide them with an excellent quality of life after the disease.
The Pediatric Hematology Oncology Department is well-deservedly respected among colleagues and patients. The best specialists with leukemia treatment experience in young patients practice here. At the same time, they use world leukemia treatment standards and use an individual approach to every child and his clinical situation. That means that medicine approach is personalized, not clichéd, when one treatment protocol is used for all patients.
The main method of leukemia treating is chemotherapy. Medicines used in the children’s treatment are produced only by leading pharmaceutical companies, all of them have been tested for effectiveness and safety. The basis of chemotherapy is the systemic drugs application that block the reproduction of malignant cells. Depending on the type of disease and the patient characteristics various chemotherapy regimens are provide in leukemia treatment. Our departments are equipped with modern wards for chemotherapy, which makes staying in them very comfortable.
Radiation therapy can also be explored in leukemia treatment. In this case, remote radiation therapy is used with the help of modern and completely safe devices. They named linear accelerators
Today the most effective method of leukemia treating is bone marrow transplantation. The bone marrow is a "cradle" for all blood cells that gradually mature and leave it in the peripheral blood to perform their functions. In the case of leukemia, at a certain level of blood cells maturation in the bone marrow a "breakdown" is observed. That’s why bone marrow transplantation on a new and healthy one solves the problem fundamentally.
Unfortunately, everything is so simple only in theory. In fact, the bone marrow transplantation procedure is very complicated and expensive, it requires the selection of an ideal donor according to many parameters, devising, the most technically complex transplant procedure execution, struggle with all possible complications (from infections to rejection syndrome) and long recovery.
Therefore, bone marrow transplantation should be provided only by qualified and experienced specialists. The department should be equipped with modern equipment and comply with strict infection control conditions in order not to expose patients to danger after the procedure.
There are several types of bone marrow transplantation:
- Autologous - hematopoietic cells transplantation of the patient himself, which were previously taken from him. This procedure is provided for certain diseases that do not have a genetic factor at their core. For example, before a course of chemotherapy, stem cells from the patient's bone marrow are collected, and when the course of chemotherapy is completed, they are injected back into the body. Thanks to this the normal production of blood cells is restored. It is almost never used for leukemia.
- Allogeneic – this type of transplantation consists of hematopoietic stem cells introduction taken from a suitable donor into the patient. This is the best treatment method of the blood system malignant tumors. Especially those caused genetically, like leukemia.
Before the bone marrow transplantation, the patient must undergo chemotherapy chemotherapy is often used to destroy all malignant cells. This treatment characterized by a large dose of drugs that kill not only all malignant cells, but also healthy bone marrow cells. Therefore, during this period (between chemotherapy and bone marrow transplantation procedure), the body becomes completely defenseless against any infection. That is why it is so important to follow all the rules of infection control, and to minimize the risk of infection. The patient is placed in a sterile box during this period.
Modern treatment methods in children with leukemia are also used before bone marrow transplantation. For example, target therapy and immunotherapy (biological). This treatment execute in order to obtain the best long-term results of the procedure and prevent recurrence.
Targeted drugs purposefully destroy only malignant cells (they block the function of mutant genes or the synthesis of certain proteins that these cells need for life). Thus, targeted drugs destroy only tumor cells without harming healthy surrounding cellular elements. As a result we receive significantly fewer side effects than with classical chemotherapy. This type of treatment is also called molecular therapy.
Targeted drugs are chosen depending on the main diagnosis, the tumor process stage, the presence of specific targets identified during immunohistochemical and molecular genetic analysis of malignant cells. For example, drugs that block abnormal proteins FLT3, IDH1, IDH2 (low-molecular-weight inhibitors) are used for complex treatment of acute myeloblastic leukemia. These are: imatinib, dabrafenib, sunitinib, erlotinib, gefitinib.
Monoclonal antibodies are another group of drugs in targeted therapy. They influence on the surface of a malignant cell, blocking its receptors for growth factors. Producing of such drugs is a high-tech, expensive and complex process, but we try to provide all the necessary drugs for small patients with leukemia. Example of monoclonal antibodies are: cetuximab, panitumumab, trastuzumab, bevacizumab, ramucirumab.
CART therapy (immunotherapy) is a treatment method of blood system malignant diseases. Such as acute lymphoblastic leukemia. The essence of the technique is the T-lymphocyte cells extraction from the patient's bloodstream and their modification ("training"). After this, modified cells can find and destroy malignant cells. This is an innovative treatment method, that all our patients have access to.
After treatment, the little patient and his parents can receive all the necessary psychological help, as well as the entire complex of rehabilitation measures. Such a comprehensive approach significantly improves prognosis and reduces the likelihood of long-term side effects from treatment.