Farewell to the era of "incurable disease", new treatments are giving new life to children with leukemia
Acute lymphoblastic leukemia in children is the most common malignant tumor in children in my country.
Is leukemia incurable?
What kind of treatment can a child with the disease choose at home, and what should be paid attention to in daily life?
In this issue of the big coffee health class, Fang Yongjun, director of the Department of Hematology and Oncology of Nanjing Children's Hospital, came to bring everyone to know this childhood leukemia commonly known as "blood cancer".
Correspondent Wu Yeqing
Yangzi Evening News/Ziniu News trainee reporter Lu Yanlin filmed by Fang Hao
1
Cause is not clear
Chemical pollution may become an "accomplice"
"Acute leukemia is the most common malignant tumor in childhood." Fang Yongjun told reporters that with the development of social economy and the effective control of infectious diseases, the incidence of malignant tumors, including leukemia, is on the rise, and the country and society There is a high degree of attention to the disease, and the recognition and judgment of the early symptoms of acute leukemia have also been significantly improved. In recent years, the diagnosis rate and cure rate have been significantly improved.
Why do children get leukemia?
Why does leukemia "attack" on my children?
Can leukemia be prevented?
"In fact, the real cause of the disease is not clear." Fang Yongjun explained that for children, genetic factors do play a role in the pathogenesis of leukemia.
"This genetic factor is not a simple genetic disease, but refers to a disease that interacts between heredity and the environment. In the genetic process, certain genetic mutations can lead to susceptibility to tumors, such as Bloom syndrome. , Down syndrome, neurofibromatosis, etc., are all high-risk factors.”
Fang Yongjun told reporters that environmental factors also played a big role in the pathogenic process.
"At present, the environmental adverse factors we know are mainly environmental pollution, that is, chemical pollution. This includes decoration, inhalable organic matter, exposure to X-rays, etc." At the same time, parents' drinking and smoking have become "potential murderers." one.
"In addition, improper diet is also leading to a high incidence of some childhood leukemia. Our previous research also found that some parents work outside, and children brought by their grandparents may have an increased risk of developing the disease due to poor eating habits and other reasons."
2
acute lymphoblastic leukemia
Long-term survival rate of more than 90%
方拥军介绍，儿童急性白血病的发病高峰通常在2岁到6岁之间，该病也是目前治疗效果最好的儿童恶性肿瘤。“在国内，对于急性淋巴细胞白血病治疗后长期生存率能够达到90%以上。而髓系白血病治疗水平也能达到长期生存率60%-70%的水平。” 记者了解到，目前白血病的治疗方法基本以化疗为主。“但是髓系白血病与急性淋巴细胞白血病的化疗并不一样。”方拥军表示，急性淋巴细胞白血病讲究的是两年多时间的诱导、强化、巩固与维持治疗，总体无病生存率能达85%以上。另一方面，低危髓系白血病的治疗方法仍以化疗为主，但对于中高危髓系白血病来说，异体造血干细胞移植则成为较为合适的选择。“随着这几年造血干细胞移植技术一直在不断地进步，抗排异、营养支持及靶向治疗药物的应用，异体造血干细胞移植的水平也明显地提高，移植相关死亡率已经小于10%。虽然急性髓系白血病的总体治疗效果相对急性淋巴细胞白血病要低一些，但通过化疗加造血干细胞移植也能够达到60%~70%的长期无病生存。”
3
小分子靶向等新疗法
赋予患儿新生机
In Fang Yongjun's team, about 150-200 patients with acute lymphoblastic leukemia are treated every year, and about 30-40 patients with newly diagnosed myeloid leukemia, although the current treatment for nearly 200 patients is chemotherapy. Lord, but Fang Yongjun and his team have always been actively exploring.
"Our team's specialty is cord blood-based transplantation for high-risk acute lymphoblastic leukemia." Fang Yongjun introduced that this is because the children are usually younger, and the long-term treatment effect of cord blood is good, and the recurrence rate is relatively low.
"In addition, we carried out bone marrow transplantation through donations from some volunteers of the China Marrow Bank. Even when the epidemic situation in Nanjing was tense last year, the donor stem cell specimens could not be shipped to Nanjing. Hefei will pick it up from the airport.” It is understood that, at the same time, for high-risk acute lymphocytes, in addition to the Chinese bone marrow bank and cord blood bank, family members, i.e., haploidentical sibs, can also be used for transplantation.
For myeloid leukemia with relatively high degree of malignancy and high recurrence rate, Fang Yongjun introduced that the classification method based on MICM (morphology, immunology and molecular genetics) is generally used.
"Our team has a dedicated MICM laboratory platform, and stronger induction therapy methods are often used for middle- and high-risk patients." At the same time, Fang Yongjun said that with the advancement of molecular biotechnology, some small molecule targeted therapies, Car- T (cellular immunity) and monoclonal antibodies have been maturely applied.
Fang Yongjun bluntly said that these new treatments have given new life to patients, especially those with high risk of relapse. The era when most leukemias were considered "incurable" has passed.
4
family with small children
Remember that eating clean is the most important thing
Suffering from leukemia, can I still eat normally?
Is it no longer possible to eat "hair stuff"?
These questions are often the most perplexing parents of sick children.
Fang Yongjun emphasized that children with leukemia can eat normally, but they must be clean and stay away from junk food.
Especially during chemotherapy, when the white blood cells are very low, the food must be boiled, cooked, and thoroughly cooked.
"If you eat fruit, you should eat peeled fruit, and you can't eat blueberries, strawberries and other fruits that are easily contaminated, to prevent the bacterial content from being too high and causing the infection to aggravate." For example, small roosters are "hair" and can't be eaten. Fang Yongjun also explained, "Actually, children with leukemia don't need to avoid too many mouths. There is no medical statement that 'fat' cannot be eaten. It is better to have sufficient high-quality protein and a balanced combination of meat and vegetables. You don’t have to take supplements like stews, either.”
Big coffee and small biography
Fang Yongjun, Chief Physician, Professor and Doctoral Supervisor of the Department of Hematology and Oncology, Children's Hospital Affiliated to Nanjing Medical University.
Engaged in basic research and clinical work of childhood leukemia for 30 years.
Key talents for women and children in Jiangsu Province, member of the National Health Commission Pediatric Solid Tumor Expert Committee, national member of the Hematology Group of the Pediatric Branch of the Chinese Medical Association, deputy head of the palliative care subspecialty group, head of the Pediatric Hematology Group of the Pediatric Branch of the Jiangsu Medical Association, National member of the Pediatric Oncology Professional Committee of the Chinese Anti-Cancer Association, editorial board member of the Chinese Journal of Pediatric Hematology and Oncology, editorial board member of the Chinese Journal of Cancer Metastasis, Lymphoma Professional Committee of the Jiangsu Research Hospital Association, Vice Chairman of the Coagulation Committee, Nanjing Medical Association Blood He is a member of the disease specialist branch and a member of the standing committee of the China Rare Disease Alliance Hemophilia Committee.
The first author and corresponding author published 40 SCI papers.