Follow up of children with leukemia
Patients who go into remission continue to be examined regularly by the doctor. Once the remission is induced and the therapy after it is completed, it is necessary to continue with a careful periodic evaluation of the patient's health status, make cell counts blood and, if necessary, bone marrow transplants. With the passage of time, the Evaluations can be made more spaced but should continue indefinitely.
While current therapy for acute lymphocytic leukemia can cure most children, the therapy can have long-term consequences, including effects on growth, psychological development and others. Because of these conceivable reactions, it is essential proceed long haul development and with long-term medical advice. Careful monitoring of children with known genetic abnormalities is important can increase your risk of developing leukemia, of those who have been treated by another type of cancer with chemotherapy, or with joined chemotherapy and radiotherapy, and the individuals who have gotten organ transplants and are taking suppressive medications of the immune system.
In pediatric patients with ALL in total abatement, a case-control ponder was directed to think about clinical and cost results between two medicines bone marrow transplantation 2. Utilization of fringe blood forebear cells (10 microgame/kg day for 4 back to back days. The clinical factors of result results were the quantity of passings, sickness free period at 100 days, 1 and 2 years and other antagonistic therapeutic results for the treatment; the result factors of the expenses were connected with the expense of anti-infection agents, transfusions of blood items, parenteral nourishment, research center examinations and x-beams, hospitalization time and others. The clinical finishes of the investigation were that treatment with fringe blood begetter cells is as sheltered as bone marrow transplant treatment and that patients who were treated with cells Peripheral blood ancestors recouped quicker and the restorative arrangements did not were more terrible than those treated with bone marrow transplant; The completions of the costs all around terms was that the cost of treatment with fringe blood forebear cells was superior to the treatment with bone marrow transplantation. (Madero L, 2000)
The utilization of granulocyte animating component to lessen the seriousness of neutropenia in kids who have gotten treatment with bone marrow transplant so as to diminish the danger of nosocomial contaminations. There are a couple of examinations that demonstrate the reasonability of the usage of the consider stimulant of granulocytes reestablishing neutrophil levels in grown-up patients. With this reason a non-randomized preliminary was directed with recorded controls to assess the adequacy of the utilization of granulocyte incitement factor in pediatric patients who had gotten 22 bone marrow transplant, one gathering got the granulocyte invigorating component and the control aggregate got standard consideration barring the granulocyte animating element. The factors of The outcome was the recuperation rate of neutrophils and the nonattendance of contaminations intrahospitalarias and tasteful high. The clinical ends were that there was no distinction in the outcomes in the two gatherings.
The authors concluded that there is no difference in the costs of treatment in the two groups, but the children who benefited from the stimulant factor got better quality of life for having achieved recover in less time neutrifilo levels what allowed these children to be removed earlier from isolation environments. (Duncan N, 1997)
Leukemia is characterized by having a clonal, autonomous and abnormal of the cells that give origin to the rest of the normal cells of the blood (tumor behavior in general). This implies that a cell early undergoes a genetic change that will cause an uncontrolled abnormal clone of itself. The cells abnormal multiply in image and likeness of themselves, so that occupy space gradually of normal bone marrow and cause Progressive anemia, abnormal bleeding and predisposition to infections. When abnormal cells invade other tissues, failure of the functioning of the organ that is occupied, for example, the infiltration to the system central nervous system that occurs in leukemia acute lymphoblastic could manifest with headache, seizures, alterations focused motor vehicles, increased intracranial pressure.
The cure of the condition will depend on the elimination of all existing malignant cells in the patient. In general, some of the leukemias can be susceptible to healing with chemotherapy only, but today it should be given much importance to the so-called prognostic factors that are based on mathematical models that allow locate patients in the degree of prognosis they have.
The alterations of the laboratory that force a special review include: 1. Anemia (any degree). 2. Leukopenia or leukocytosis (predominance of a Cellphone line). 3. Thrombocytopenia. 4. Combinations: bicytopenia or pancytopenia. Special care should be taken when the laboratory reports the presence of leukocytes or atypical lymphocytes (these may be leukemic blasts). It is advisable to request the review of an expert (figure 2). Bone marrow aspirate is essential for the diagnosis (figure 3) and the minimum of 20% of blasto to establish the criterion of acute leukemia in any of its variety. In the same procedure, samples should be obtained for the final classification of the condition and request karyotype and immunophenotype, since currently the cytomorphological criterion is Of vital importance but it is not enough anymore. In (Table 2) lists the current and current classification of malignant blood diseases.
The treatment is directed towards 2 important aspects: the first one is the specific anti-leukemia and is based on the use of drugs of chemical origin that are known with the name of chemotherapy, whose main objective is to eradicate, that is, eliminate all leukemic cells of the organism. The second aspect of the treatment is the support for the complications that patients usually present in their hospitalization, such as: