The following are the symptoms of acute leukemia:
· Tiredness.
· Bleeding after slight injury.
· Frequent infections.
· Lump in the abdomen which is found out to be the spleen.
· Discomfort or pain over the bones.
· Loss of weight.
· Diminished appetite.
· The onset is after abrupt with flu-like symptoms and fatigue.
· There may be fever, malaise and a rapidly progressive anaemia.
· Bleeding from the nose (epistaxis), bleeding from the gums or bleeding patches in the skin called purpura, are common and are due largely to reduction in platelet count in the blood (thrombocytopenia). Sore throat and ulcers in the mouth or pharynx are frequent, due to reduction in normal polymor; ho-nuclear leukocytes.
Diagnosis
Routine:
Blood: RBC counts and Hb are low, TLC counts are high, and there are immature white cells in the blood.
ESR is raised.
Platelet counts are diminished.
Special:
Bone marrow biopsy and histological examination of the same helps in establishing the diagnosis.
Additional:
X-ray of the chest indicates if the lungs have been involved in the leukaemic process.
Treatment
Surgery: It is not indicated.
Radiation: Only indicated if the leukaemic deposits develop in the coverings of the brain (meninges), the brain and the spinal cord.
Chemotherapy: It intends to eliminate by killing, the leukaemic cells in the bone marrow and the blood and allow the formation of normal blood cells. Commonly used drugs are:
· Adriamycin
· Cyclophosphamide
· Vincristine
· Methotrexate
· Bleomycin Prednisolone
These drugs axe given in various combinations, depending upon the severity of the disease and the condition of the patient. The treatment is given in phases. In the first phase, the patient is admitted in the ward. Vincristine and prednisolone arc the ideal drugs for killing all the leukaemic cells.
Patient is liable to infection of various sorts and bleeding from different sources during the course of chemotherapy. Care is taken to treat them by blood transfusions, antibiotics, platelet transfusions wherever needed. Chemotherapy also worsens the symptoms already present such as weakness, vomiting, loss of appetite. They are treated symptomatically.
Over 90 per cent of the children get into remission within a month. This means that all or almost all cancer cells in the blood have been killed. Those patients who do not go into complete remission, in them further chemotherapy is given.
Even in the stage of complete remission, patients can develop Leukemia spread and deposits in the meninges, brain and the spinal cord. Radiation over the head, and chemotherapy with methotrexate in the cerebrospinal fluid by injection around the spinal cord (intrathecal) is given.
After this initial phase, even though there are no leukaemic ceils in the blood, there may be a few in the bone marrow. To kill them, higher dose of chemotherapy is given. At this stage, the therapy is tolerated better by the patient than it was at the initial phase.
After the disease has been brought under remission and control, maintenance therapy is given in moderate doses so as to kill the remaining collections of leukaemic cells anywhere in the body. This treatment is continued on for about two years, and if the patient suffers no relapse then the treatment is stopped.
If relapse of the disease occurs, it is treated again by chemotherapy. After a relapse, unfortunately, the period of remission becomes less and the prognosis worse.
Prognosis
About half of all children patients having acute lymphatic Leukemia can be cured with the current methods of treatment. The risk of relapse is the greatest in the first two years of treatment, after that it gets progressively less.
Early Detection – Signs & Symptoms:
· Tiredness in a child without any cause.
· Bleeding from gums or other places after slight injury.
· Frequent fever.
· Enlargement of lymph glands.
· Discomfort or pain over the bones.
· Anemia.
Investigations:
· High TLC with immature white blood cells.
· Bone marrow biopsy examination.