Bērnu leikēmija un tās ārstēšana

Leikēmija bērnībā

Leikēmija ir visizplatītākais vēzis bērniem un pusaudžiem, kas veido gandrīz 1 no 3 vēža gadījumiem. Lielākā daļa bērnības leikēmiju ir akūta limfoleikoze (ALL) un akūta mieloleikoze (AML). Hroniskas leikēmijas bērniem ir reti sastopamas.

Bērnu akūta mieloīda leikēmija

AML (acute myeloid leukaemia) is a blood and bone marrow malignancy that affects children. AML, also known as acute myelogenous leukaemia or acute nonlymphocytic leukaemia, is a kind of leukaemia that affects the blood cells. Acute cancers usually progress swiftly if they are not treated. Chronic cancers typically worsen over time. Myeloid stem cells in AML normally grow into myeloblasts, a type of immature white blood cell (or myeloid blasts). In AML, the aberrant myeloblasts, or leukaemia cells, do not mature into healthy white blood cells. Leukemia cells can accumulate in the blood and bone marrow, making it difficult for healthy white blood cells, red blood cells, and platelets to thrive. Infection, anaemia, and simple bleeding are all possible outcomes. Outside of the blood, leukaemia cells can travel to other regions of the body, such as the central nervous system (brain and spinal cord), skin, and gums. Leukemia cells can sometimes produce a solid tumour termed a myeloid sarkoma. Granulocytic sarcoma, or chloroma, is another name for myeloid sarcoma.

Akūtas mieloleikozes ārstēšana

Ķīmijterapija lielākajai daļai bērnu ar akūtu mieloleikozi (AML) ir sadalīta divās fāzēs:

• Indukcija
• Konsolidācija (intensifikācija)

Ārstēšanas intensitātes un iespējamo nopietnu seku dēļ bērni ar AML jāārstē vēža centros vai slimnīcās, kurām ir pieredze ar šo slimību.

Indukcijas ķīmijterapija AML pacientiem

Daunorubicīns (daunomicīns) un citarabīns (ara-C), kurus abus lieto vairākas dienas pēc kārtas, ir visbiežāk lietotās ķīmijterapijas zāles AML ārstēšanai. Atkarībā no tā, cik intensīvu ārstēšanu vēlas ārsti, ārstēšanas shēmu var atkārtot pēc 10 dienām vai 2 nedēļām. Īsāki ārstēšanas intervāli var būt efektīvāki leikēmijas šūnu izskaušanā, taču tie var izraisīt arī nopietnākas nelabvēlīgas sekas. As part of their induction treatment, some children with AML may get a dose of the targeted medication gemtuzumab ozogamicin (Mylotarg) in addition to chemo. If the doctors believe the leukaemia will not react to just two chemo medications, they may add another chemo agent like etoposide or 6-thioguanine to the mix. This group includes children who have a high number of white blood cells or whose leukaemia cells have particular genetic defects. The chemo medicines are given again and again until the bone marrow reveals no more leukaemia cells. This usually happens after two or three therapy cycles. Most children with AML will also get intrathecal chemotherapy (chemotherapy delivered directly into the cerebrospinal fluid, or CSF) to help prevent leukaemia from relapsing in the brain or spinal cord. The use of brain radiation therapy is becoming less common. After induction therapy, between 85 percent to 90 percent of children with AML go into remission. This indicates that no symptoms of leukaemia have been identified using normal lab tests, but it does not necessarily imply that the leukaemia has been healed.

Konsolidācija

After the induction phase, the consolidation (intensification) phase begins. The goal is to use a more aggressive treatment to kill any remaining leukaemia cells. Some youngsters have a sibling who would be a suitable stem cell donor. Once the leukaemia is in remission, a stem cell transplant may be advised for these children, especially if the AML has some unfavourable prognostic markers. Most studies have shown that while this improves long-term survival over chemotherapy alone, it also increases the risk of significant consequences. Some clinicians may propose only delivering aggressive chemotherapy to youngsters with good prognostic criteria, and saving the stem cell transplant until if the AML relapses. Consolidation consists of heavy doses of the chemo medication cytarabine (ara-C) for most children who do not have a good stem cell donor. It’s also possible to use daunorubicin. It is normally given for a period of at least a few months. If the targeted medicine gemtuzumab ozogamicin (Mylotarg) was given during induction, it will almost certainly be given again during this stage of treatment. For as long as intensification continues, intrathecal chemo (into the CSF) is normally given every 1 to 2 months. Children with AML do not require maintenance chemotherapy (other than those with APL). Supportive care is a key element of AML treatment (proper nursing care, nutritional support, antibiotics, and blood transfusions). The aggressive therapy for AML frequently destroys much of the bone marrow, resulting in significant blood cell shortages, as well as other catastrophic consequences. The current high remission rates would not be conceivable without antibiotic treatment of infections or transfusion assistance.

Bērnības akūta limfoblastiskā leikēmija (ALL)

Acute lymphoblastic leukaemia in children (also known as ALL or acute lymphocytic leukaemia) is a blood and bone marrow malignancy. If left untreated, this type of cancer usually worsens swiftly. Too many stem cells turn into lymphoblasts, B lymphocytes, or T lymphocytes in a child with ALL. Leukemia cells are another name for these cells. These leukaemia cells do not function like normal lymphocytes and are unable to effectively fight infection. In addition, when the number of leukaemia cells in the blood and bone marrow rises, there is less room in the blood and bone marrow for healthy white blood cells, red blood cells, and platelets. Infection, anaemia, and simple bleeding are all possible outcomes.

Akūtas limfoblastiskas leikēmijas ārstēšana bērnībā

Bērni ar akūtu limfoblastisku leikēmiju var saņemt dažādas ārstēšanas metodes (ALL). Dažas ārstēšanas metodes ir vispārpieņemtas (jau tiek izmantotas), bet citām tiek veikta klīniska pārbaude. Ārstēšanas klīniskais pētījums ir pētniecisks pētījums, kura mērķis ir palīdzēt pacientiem ar vēzi uzlabot esošās ārstēšanas metodes vai uzzināt vairāk par iespējamām ārstēšanas metodēm. Ja klīniskie pētījumi pierāda, ka jauna ārstēšana ir pārāka par pašreizējo standartu, jauno ārstēšanu var pieņemt par standartu.

Ir pieejami četri dažādi ārstēšanas veidi

Chemotherapy is a cancer treatment that involves administering chemicals to cancer cells in order to limit their growth, either by killing them or preventing them from growing. Chemotherapy medications enter the bloodstream and can reach cancer cells all throughout the body when taken by mouth or injected into a vein or muscle (systemic chemotherapy). Chemotherapy that is administered directly into the cerebrospinal fluid (intrathecal), an organ, or a bodily cavity such as the abdomen targets cancer cells primarily in specific regions (regional chemotherapy). Combination chemotherapy is a type of cancer treatment that involves the use of multiple anticancer drugs. The method of chemotherapy administration is determined by the child’s risk group. Anticancer medications are given in higher doses to children with high-risk ALL than to those with standard-risk ALL. Childhood ALL that has spread or may spread to the brain and spinal cord is treated with intrathecal chemotherapy.

Staru terapija VISĀ

Staru terapija ir vēža ārstēšana, kas ietver augstas enerģijas izmantošanu rentgena stari or other forms of radiation to kill or stop cancer cells from developing. External radiation therapy involves sending radiation from a machine outside the body to the cancerous spot. Childhood VISS kas ir progresējis smadzenēs, muguras smadzenēs vai sēkliniekos, var ārstēt ar ārēju staru terapiju. To var arī izmantot, lai sagatavotu kaulu smadzenes cilmes šūnu transplantācijai.

Ķīmijterapija ar cilmes šūnu transplantāciju

Chemotherapy is a treatment that is used to kill cancer cells. Total-body irradiation is used in conjunction with chemotherapy in children aged 3 and up. The cancer treatment also kills healthy cells, including blood-forming cells. A stem cell transplant is a procedure that replaces blood-forming cells in the body. Stem cells (immature blood cells) are extracted from a donor’s blood or bone marrow, frozen, and stored. The stored stem cells are thawed and delivered to the patient via an infusion after the patient has completed chemotherapy and radiation therapy. These stem cells develop into (and replenish) blood cells in the body. For children and adolescents with ALL, stem cell transplantation is rarely used as a first-line treatment. It’s being utilized increasingly frequently as part of relapse treatment for ALL.

Mērķtiecīga terapija

Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells. Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy do. There are different types of targeted therapy: Tyrosine kinase inhibitor (TKIs) therapy: This treatment blocks the enzyme, tyrosine kinase, that causes stem cells to develop into more white blood cells than the body needs. Imatinib mesylate and dasatinib are TKIs used in the treatment of children with Philadelphia chromosome–positive ALL. Ruxolitinib is a TKI that is being studied in the treatment of newly diagnosed high-risk ALL. Monoclonal antibodies: Monoclonal antibodies are immune system proteins made in the laboratory to treat many diseases, including cancer. As a cancer treatment, these antibodies can attach to a specific target on cancer cells or other cells that may help cancer cells grow. The antibodies are then able to kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells. Blinatumomab and inotuzumab are monoclonal antibodies being studied in the treatment of refractory childhood ALL. Blinatumomab is also being studied in the treatment of standard-risk ALL.

CAR T-šūnu terapija

Imūnsistēma tiek izmantota, lai cīnītos pret vēzi CAR T šūnu terapija, jauns un revolucionārs veids, kā ārstēt akūtu limfoblastisku leikēmiju (ALL). Šajā ārstēšanā T šūnas tiek ņemtas no pacienta asinīm un ģenētiski mainītas, lai ražotu himēriskos antigēnu receptorus (CAR). Šīs CAR palīdz T šūnām atrast un uzbrukt vēža šūnām, kurām ir noteikti virsmas marķieri. Ievietojot atpakaļ pacienta ķermenī, šīs inženierijas T šūnas aug un ļoti precīzi uzbrūk vēža šūnām, kas bieži vien izraisa remisiju. CAR T šūnu ārstēšana ir daudz potenciālu, taču tam var būt tādas problēmas kā citokīnu atbrīvošanās sindroms un neirotoksicitāte. Tas parāda, cik svarīgi ir to turpināt pētīt un uzlabot.

Jūs varētu vēlēties lasīt: CAR T-Cell terapija Ķīnā

Vai bērnu leikēmijas gadījumus var nodot citiem brāļiem un māsām?

Dažiem jauniešiem ir brālis un māsa, kas būtu piemērots cilmes šūnu donors. Kad leikēmija ir remisijas stadijā, šiem bērniem var ieteikt cilmes šūnu transplantāciju, īpaši, ja AML ir daži nelabvēlīgi prognostiski marķieri. Lielākā daļa pētījumu ir parādījuši, ka, lai gan tas uzlabo ilgtermiņa dzīvildzi, salīdzinot ar ķīmijterapiju, tas arī palielina nozīmīgu seku risku. Daži ārsti var ierosināt tikai agresīvas ķīmijterapijas nodrošināšanu jauniešiem ar labiem prognostiskiem kritērijiem un cilmes šūnu transplantācijas saglabāšanu līdz AML recidīvam.

Jūs varētu vēlēties lasīt: CAR T-šūnu terapijas izmaksas Ķīnā

Kāpēc izvēlēties mūs?

Our ability to completely comprehend the biology of your child’s cancer is one of our greatest assets and sets us apart from most paediatric leukaemia programmes. We have the tools, experience, and resources to investigate the roots of your child’s illness down to the most fundamental molecules, thanks to a strong partnership between our paediatric leukaemia clinicians and researchers, the Department of Pathology, and the Pediatric Translational Medicine Program. Our staff evaluates your child’s cancer to check if there are any genetic alterations present. The results of these tests can assist us in determining the most effective treatment. We are convinced that our paediatric haematology department, which has more than 20 years of expertise treating young leukaemia cases, will handle this case and ensure that the patient is in complete remission as soon as possible. Our clinical genetics experts can help you and your family understand how genetics plays a role in your child’s leukaemia and whether any genetic alterations may affect other family members. We’ll be there for you every step of the way, from the initial consultation to the follow-up care. We provide the direction and assistance you and your family require.