What is Leukaemia?
Cancer in children makes them weak – but knowledge is power. Know the signs and symptoms.
Leukaemia is a kind of cancer that affects the blood. It is the most common cancer in children, and according to the Childhood Cancer Foundation of South Africa (CHOC), it accounts for 27% of all childhood cancers.

In total, there are three types of blood cells: white blood cells – T- and B-cells (for fighting infections), red blood cells (for carrying oxygen), and platelets (to aid clotting and control bleeding). In leukaemia, one of the types of blood cells mutates into a cancerous cell and is no longer under the body’s control. These abnormal cells multiply and take over the bone marrow before spreading out into the blood, lymph glands and rest of the body.
There are two types of leukaemia: Acute Lymphoblastic Leukaemia (ALL), which can have a T-cell or a B-cell lineage, and Acute Myeloid Leukemia, which can affect any of the above mentioned types of blood cells.

Most common symptoms of leukaemia in children
•    Lots of infections. The reduction in normal white blood cells results in a weakened immune system.
•    Frequent bruising and even bleeding, especially the nose and gums due to the platelet count falling.
•    Anaemia develops from the decrease in the red blood cell count.
•    Feeling unwell, weak and listless is common.
•    A child will complain of aches and pains in the limbs since the bone marrow will be stretched.
•    Because the liver, spleen and nodes will become full of cells, the child could also complain of pain in the abdomen.
Ordinarily, the symptoms are only noticed after about 12 weeks, by which time, the child will be reasonably pale and anaemic.

Treatment of Acute Lymphoblastic Leukaemia (ALL) of the early Pre-B or common type
According to Prof. Janet E. Poole, Principal Paediatrician and Head of Paediatric Haematology/Oncology for Johannesburg Hospital, there are 5 phases in the treatment protocol of CALL:
•    Phase I: Trying to kill the leukaemia cells and to get the patient into remission (induction). Remission means that the remaining leukaemia is undetectable available tests. By day 33 of Induction the patient should be in remission.
•    Phase II:  Is a four-week period which consolidates the remission.
•    Phase III CNS prophylaxis: The brain has a natural barrier where chemotherapy cannot cross into the brain. As leukaemia cells can “hide” in the fluid that surrounds the brain and spinal cord, it is necessary to stop this from happening to prevent a relapse. Chemotherapy is injected via a lumbar puncture needle directly into the fluid. A very high dose of a certain chemotherapy which can cross onto the brain is also administered.
•    Phase IV: At Re-Induction and Re-Consolidation, delayed intensity of chemotherapy has been shown to improve the cure rate.
•    Phase V: A period of maintenance lasts for two and a half years (a total of three years from diagnosis). This is to prevent recurrence of the disease and consists of continuous oral chemotherapy and pulses of intravenous chemotherapy.

Dr Poole explains that the cure rate of ALL stands at an impressive 80% to 85% with current treatment protocols.

The cure rate of leukaemia depends on:
1.    The age of the patient at diagnosis (best between two and ten years)
2.    The white cell count at diagnosis. The lower the better
3.    How big the liver and spleen and lymph nodes are at diagnosis
4.    The sex of the child – girls do slightly better
5.    The sub-type of the leukaemia (common ALL has the best cure rate)
6.    What the chromosomes of the leukaemia are. For example, if there are many extra chromosomes, then this is a favourable feature
7.    How rapidly the patient goes into remission – it's good if the blood is cleared of leukaemia cells by the end of the first week of treatment

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