The treatment of pediatric leukemia is a special battle waged at the "starting point of life." Unlike adults, children's bodies are like saplings in the process of growth, with both immature development and extreme vulnerability. Therefore, during treatment, while eradicating cancer cells, we must also safeguard the hope of children's growth. Every decision in pediatric leukemia treatment conceals a unique "pediatric code."
Approximately 75 - 85% of newly diagnosed children have acute lymphoblastic leukemia (ALL) (according to the WHO 2022 classification criteria). These cancer cells are sensitive to chemotherapy and are as likely to "melt" as snow and ice exposed to sunlight.
Children's bone marrow and immune systems are still developing, so treatment cannot be one - size - fits - all. For example, for children with ALL, a 1 - year - old infant may need to have their medication dosage adjusted to avoid affecting bone growth, while adolescents with ALL need to have potential damage to their reproductive systems monitored during chemotherapy.
Under standardized chemotherapy, the cure rate for low - risk ALL children exceeds 90%, and that for medium - risk children is also over 80%, which is much higher than that for adults. This means that most children can win the battle against leukemia through chemotherapy without the need for a "desperate" transplant.
Every child is unique. The first step in leukemia treatment is to create a "customized battle map" for them:
Gene tests (such as the BCR - ABL fusion gene test) and chromosomal analysis can accurately determine the risk level. Children carrying high - risk genes may need to receive CAR - T therapy or transplantation earlier, while low - risk children can "go into battle lightly" with a shortened chemotherapy cycle.
Case: After a 5 - year - old child named Xiaoyu was diagnosed with ALL, gene testing showed that he had a low - risk type. The doctor decisively adopted a simplified chemotherapy plan. After 2 years of treatment, he stopped taking medicine smoothly and now attends primary school as normal.
After every 1 - 2 chemotherapy courses, minimal residual disease (MRD) in the bone marrow is detected to assess the "remaining strength" of cancer cells at any time. If the MRD remains negative, it indicates that chemotherapy is effective, and the treatment can proceed as originally planned. If it is positive, "upgrades" are needed, such as adding CAR - T therapy to clear the remaining cancer cells or preparing for transplantation in advance.
Data: A study shows that the relapse rate of children whose treatment is adjusted dynamically is 15% lower than that of those on a fixed - treatment plan.
For low - and medium - risk ALL, standardized chemotherapy (such as the VDLP regimen) is the first choice. Through 4 - 6 courses of "combination therapy," most cancer cells can be eradicated. The cost is approximately 200,000 - 300,000 yuan. With the popularization of domestic chemotherapy drugs, the financial threshold has been significantly reduced.
Key Reminder: The standardization of the first - round treatment is of great importance. Chemotherapy must strictly follow the guidelines. Arbitrarily increasing or decreasing the number of treatment courses may lead to drug resistance and even exacerbate the disease into a more severe form. For example, a primary - level hospital once reduced the dosage of anthracycline drugs for a medium - risk child due to concerns about side effects, and the child relapsed 1 year later.
After every 1 - 2 chemotherapy courses, minimal residual disease (MRD) in the bone marrow is detected to assess the "remaining strength" of cancer cells at any time. If the MRD remains negative, it indicates that chemotherapy is effective, and the treatment can proceed as originally planned. If it is positive, "upgrades" are needed, such as adding CAR - T therapy to clear the remaining cancer cells or preparing for transplantation in advance.
Data: A study shows that the relapse rate of children whose treatment is adjusted dynamically is 15% lower than that of those on a fixed - treatment plan.
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