Leukemia is a malignant disease of blood system in which a large number of defective and/or immature leukocytes (white blood cells) are formed in bone marrow. In this case, bone marrow gradually loses the ability to produce normal blood cells and a number of symptoms associated with life-threatening pancytopenia (a decrease in blood of all blood cells – leukocytes, red blood cells, platelets) arise.
Every year, about 300 thousand people die worldwide as a result of leukemia. This accounts for 3% of deaths from all cancers. It is also worth remembering 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.
Modern pediatric hematology is at a high level of development, and this area of practical medicine is developing especially well in Israel. Every day in Israeli clinics, leading Hematology Oncologists save hundreds of children’s lives, causing the disease to recede and never return. All thanks to a modern and comprehensive approach to treatment of malignant hematological diseases.
Tel Aviv Medical Clinic has a modern Pediatric Hematology Oncology Department. All our doctors are highly qualified and have unique practical experience. During their training and internship in the best children’s hospitals in the world, doctors acquire not only skills in the field of medicine, but also learn to quickly establish contact with young children in order to avoid the slightest psychological discomfort on their part or fear.
Important! All therapy is planned individually, its safety and effectiveness are constantly monitored. All treatment regimens are based on modern world treatment protocols in accordance with the basics of evidence-based medicine.
A whole team of specialists is working on the recovery of one child, which may include not only pediatric hematology oncologists, but also pediatricians, radiation therapists, chemotherapists, diagnosticians, psychologists, infectious disease specialists, rehabilitation specialists, transfusiologists, etc. 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 subsequent outpatient care.
Causes of acute lymphocytic leukemia
Acute lymphoblastic leukemia is the most common disease among children. How do different types of leukemia differ from each other? The difference is what blood cells they come from. Acute leukemias develop from immature, low-differentiated cells (blasts – lymphoblasts, myeloblasts), chronic leukemias – from more mature blood cells.
Unfortunately, the immediate cause leading to leukemia appearance is unknown. But there are the following risk factors:
- A history of exposure to ionizing radiation or certain chemicals.
- Previous treatment with certain anticancer drugs.
- Infection with certain viruses – human T-lymphotropic virus, Epstein-Barr virus.
- Genetic predisposition.
Symptoms of acute lymphoblastic leukemia
As you know, early and correct diagnostics is more than half of success in treatment of any disease. This is especially true for the field of Pediatric Hematology Oncology. Unfortunately, there are no reliable signs of leukemia. But the following symptoms will help you to suspect something is wrong with your child’s health:
- frequent occurrence of bruises on child’s skin for no apparent reason;
- painful pallor of skin;
- refractory (resistant) anemia to standard treatment;
- unmotivated weight loss;
- delay in physical development of child;
- enlarged liver and spleen according to ultrasound;
- frequent infectious diseases;
- enlargement of peripheral lymph nodes for no apparent reason;
- prolonged fever that cannot be explained by other causes;
- recurrent aphthous stomatitis;
- pain in joints and bones.
If you notice several of described symptoms in your child, do not waste time, seek help from specialists of Pediatric Hematology Oncology Department of TAMC. Our clinic’s specialists will develop a quick diagnostic plan and cast aside your doubts about the child’s health, and if there is a real problem, they will provide detailed consultation and step-by-step instructions on how to act in such a situation, based on practice of the best Israeli pediatric hematology centers.
Modern diagnostic methods
As a rule, leukemia diagnosing is not difficult. The disease can be suspected based on a routine blood test. If you receive pathological results of a general blood test, a more detailed diagnostics is recommended.
Modern methods for leukemia diagnosing:
- Laboratory blood tests – in case of hematology oncology diseases, the indicators of standard blood tests change significantly. This is the initial stage of diagnostics, from which the entire program of additional examination methods is subsequently built.
- A myelocytogram is a type of biopsy that removes part of bone marrow from inside of such bones as sternum or pelvis. Subsequently, this fragment of bone marrow is viewed under a microscope and it is determined what cells it consists of. Thus, it is possible to diagnose leukemia and determine its type. The peculiarity of this study is its invasiveness; it causes significant pain, therefore in TAMC it is carried out only under general anesthesia in children, so that children do not experience any pain or other psychological discomfort during the procedure.
- Modern medical imaging techniques are used to identify possible metastases to distant organs. Such techniques as MRI, CT, MSCT, PET-CT, PET-MRI are actively used. This makes it possible to determine the stage of the disease and make a prognosis, as well as a treatment program.
It is important to know that all cytological and histological material obtained during examination of small patients using biopsy is sent for revision to the best pathohistological laboratories in Israel. Thanks to such checks, we are absolutely sure of diagnosis correctness and adequacy of prescribed treatment regimen.
Prognosis for acute lymphoblastic leukemia in children
About 98% of children with ALL achieve remission within a few weeks of starting complex and modern treatment. More than 90% of patients with ALL can make a full recovery.
If a child is diagnosed with resistant (not responding to standard treatment) or relapsing form of acute lymphoblastic leukemia, doctors discuss further treatment options.
Modern treatment of ALL in children
Despite the fact that acute lymphoblastic leukemia is a very serious disease, modern medicine has learned to deal with it effectively, not only in terms of patient survival, but also to provide them with a good quality of life after illness.
Pediatric Hematology Oncology Department at TAMC deservedly enjoys authority among colleagues and patients. After all, the best specialists in the field of helping young patients with leukemia work here. In their practice, they simultaneously use world standards in treatment of leukemia and practice an individual approach to each child and his clinical situation. That is, medicine is personalized, and not stereotypical, when one treatment protocol is used for all patients.
The main treatment for leukemia is chemotherapy. Drugs used in the treatment of children in Pediatric Hematology Oncology Department of TAMC are produced only by leading pharmaceutical companies, all of which have been tested for effectiveness and safety. Chemotherapy is based on systemic application of drugs that block the proliferation of malignant cells. In ALL treatment, various chemotherapy regimens are used depending on the type of disease and patient’s characteristics. The departments are equipped with modern chemotherapy wards, which makes staying in them very comfortable.
Radiation therapy may also be used to treat leukemia in a comprehensive care program. In this case, external radiation therapy is used with the help of modern and completely safe devices – linear accelerators.
Today the most effective treatment for ALL in children is bone marrow transplantation. The bone marrow is the “cradle” for all blood cells that gradually mature and exit into peripheral blood, where they directly perform their functions. In case of leukemia, “breakdown” is observed at a certain level of blood cells maturation in bone marrow, so replacing it with a new and healthy one solves the problem radically.
Unfortunately, everything is so simple only in theory. In fact, the bone marrow transplantation procedure is very complicated, requiring the selection of an ideal donor based on many parameters, preparatory measures, production of this technically complicated transplantation procedure, dealing with all possible complications (from infections to rejection syndrome) and long-term recovery.
Therefore, bone marrow transplantation should be performed only by qualified and experienced specialists, and the department should be equipped with modern equipment and strict infection control conditions, so as not to endanger patients after the procedure. These are the conditions available to patients in our department.
There are several types of bone marrow transplantation:
- Autologous – transplantation of patient’s own hematopoietic cells, which were previously selected from him. This procedure is used for certain diseases that are not based on a genetic factor. For example, before a course of chemotherapy, bone marrow stem cells are collected from a patient, and after the course of chemotherapy is completed, they are reintroduced into the body, thereby restoring normal blood cell production. It is almost never used for leukemia.
- Allogeneic – such a transplantation consists of injecting the patient with hematopoietic stem cells selected from appropriate donor. This is the best method in malignant tumors of blood system treatment, especially those caused by genetics, in particular acute lymphoblastic leukemia.
Before a bone marrow transplantation, patient must undergo chemotherapy to destroy all malignant cells.
A feature of this treatment is a large dose of medications, which kill not only all malignant cells, but also healthy bone marrow cells. Therefore, during this period (between chemotherapy, actual grafting procedure and engraftment time of the new bone marrow), the body becomes absolutely defenseless against any infection. That is why it is so important to follow all the rules of anti-infection control, and in order to minimize the risks of infection, patient is placed in a sterile box during this period.
In treatment of children with leukemia before bone marrow transplantation, modern techniques are also used, such as targeted therapy and immunotherapy (biological), in order to obtain the best long-term results of the procedure and prevent relapse development.
Targeted drugs specifically destroy only malignant cells (they block the function of mutant genes or synthesis of certain proteins necessary for these cells to live). Thus, targeted drug destroys only tumor cells, without causing harm to healthy surrounding cellular elements, which leads to significantly fewer side effects than with classical chemotherapy. This type of treatment is also called molecular therapy.
Targeted drugs are selected depending on the main diagnosis, stage of tumor process, and the presence of specific targets identified during immunohistochemical and molecular genetic analysis of particular patient malignant cells (personalized oncology approach). For example, for complex treatment of acute lymphoblastic leukemia, drugs that block abnormal proteins FLT3, IDH1, IDH2 (low molecular weight inhibitors) are used. For example, these are the following drugs: imatinib, dobrofenib, sunnitin, erlotinib, gefitinib.
Another group of targeted drugs are monoclonal antibodies. They act on the surface of malignant cell, blocking its receptors for growth factors. Creating such a medicine is a high-tech, expensive and complex process, but for treatment of small patients with leukemia, we are trying to provide all the necessary medicines. Example of monoclonal antibodies: cetuximab, panitumumab, trastuzumab, bevacizumab, ramucirumab.
CAR-T therapy is a method of treating blood system malignant diseases, in particular acute lymphoblastic leukemia. The essence of the technique is to extract T-lymphocyte cells from patient’s bloodstream and then modify them (“train”) so that in future they can find and destroy malignant cells. This is an innovative treatment method that all our patients have access to.
After treatment, little patient and his parents can receive all the necessary psychological help, as well as the full range of rehabilitation measures. This comprehensive approach significantly improves the prognosis and reduces the likelihood of long-term side effects of treatment.
