Leukemia is a malignancy of blood cells derived from bone marrow, characterized by the proliferation of white blood cells, with the addition of the manifestation of abnormal cells in the peripheral blood. This disease needs to get attention because leukemia is a malignancy of the largest at the children, all over the world to reach 30-40% of all malignancies of children.
Each established a new diagnosis of leukemia in a patient, will bring a lot of impact issues, including the readiness of mental / psychological, financial, maintenance of the old, the concern can not be cured, and complications of illness or treatment. These impacts not only to be faced parents / family of sufferers, but also by the medical officers / paramedical, hospital and other parties involved, so that the necessary efforts to overcome these problems.
Epidemiology.
Leukemia incidence varies from country to country, this is related to how the diagnosis and reporting. Incidence of leukemia each year about 3.5 cases of 100,000 children under 15 years old.
Acute leukemia in children reaches 97% of all leukemia in children, and consists of 2 types namely: Limfoblastik Acute Leukemia (ALL) 82% and Leukemia Mieloblastik (LMA) 18%. This is different from leukemia in adults, is ALL 15% and 85% LMA. Chronic Leukemia reach 3% of all leukemia in children.
The peak incidence of ALL at age 2-5 years and increased again after age 65 years, while LMA of all age groups, but incidence increases with age. Comparison of patients with male and female was 1.3: 15.
Etiology
The cause of leukemia is not known, but several factors associated with the onset of leukemia. These factors are ionizing radiation, chemicals, drugs, family (genetic), viral infections, immunodeficiency.
Increased incidence of leukemia in people exposed to radiation as happened in Hiroshima and Nagasaki after the atomic bomb. While medicine is a group alkylation (sitostatica), chloramphenicol, phenylbutazone, heksaklorosiklokeksan. According to Leiss and Savitz (1995), the use of pesticides in the home associated with the incidence of malignancy in children.
Family factors (genetic) associated with the occurrence of leukemia because of the identical twins where one twin suffering from leukemia, the risk of suffering from leukemia is also within 5 years, and the incidence of leukemia in siblings increased 4 times when one brother suffering from leukemia. Leukemia more common in children who suffer from chromosomal abnormalities like Down Sandroma, and other genetic diseases. Experiments on animals showed that the viral infection ribonucleic acid (RNA) to contribute to the emergence of leukemia, but in humans still needs further investigation.
Some conditions perinatal risk factors of leukemia in children, as reported by Cnattingis et al (1995). These factors are renal disease in the mother, the use of oxygen supplementation, post partum asphyxia, birth weight> 4500 grams, and hypertension during pregnancy. While Shu DAA (1996) reported that pregnant women who consume alcohol increase the risk of leukemia in infants, especially the LMA.
Pathogenesis
Acute leukemia is a disease with malignant transformation and expansion of clones hematopoietic cells are inhibited at the level of differentiation and can not develop into a more mature form. Blood cells derived from pluripotent stem cells hematopoesis which then differentiate into lymphoid stem and stem mieloid (non-lymphoid) multipotent. Lymphoid stem cells will form the T cells and B cells, stem cells will differentiate into cells mieloid erythrocytes, granulocytes, monocytes and megakariosit. At each stage of differentiation can occur leukemic changes into a clone of unknown cause. When this happens maturation may be disrupted, so the young will increase the number of cells and suppress the formation of normal blood cells in bone marrow. Tues leukemic can enter the blood circulation which then infiltrate the organs of the body thereby causing disruption of cell metabolism and organ function. Death in patients with acute leukemia is generally caused by rapid bone marrow suppression, and great, but can also be caused by leukemic cell infiltration into the patient’s body organs.
COMPLAINTS AND SYMPTOMS Leukemia
Gum hypertrophy mainly occurs in LMA. Infiltration into the skin, which can occur in standard and high-risk groups, often occur in the scalp, and can be an early symptom of leukemia. In boys, testicular infiltration to cause enlargement of the testicles that are not pain in one or both testicles, this will affect the prognosis for causing a relapse. Generally the symptoms in children who suffer from LMA was the result of bone marrow disorders, such as in ALL, and infiltration of organs. Swelling in the orbital soft tissues and gums are more prominent.
DIAGNOSIS
Clinical symptoms and complete blood tests to diagnose leukemia. However, to be sure to do the examination of bone marrow aspiration, and furnished with chest radiographic examination, cerebrospinal fluid, and some other investigation. This method can diagnose about 90% of cases, while the rest require further examination, namely sitokimia, immunology, cytogenetics and molecular biology.
At the time of diagnosis of leukemia is established will cause a few problems, both because of the actions invasive or psychological condition of parents and family. Bone marrow aspiration and lumbar puncture can cause pain and fear in children as well as concerns in the elderly, so we need an explanation with education, sedation and psychological approaches. Such actions are also needed when evaluating the development of disease / treatment progress, according to a predetermined schedule of education and mentoring of parents at the time of the action of bone marrow aspiration and lumbar puncture is a step that aims to reduce pain and improve patient confidence.
THERAPY
Treatment of leukemia include curative and supportive. Treatment includes supportive treatment of other diseases that accompany leukemia, complications and action to promote healing, including psychological treatment. Supportive treatments include transfusions of blood / platelets, giving antibiotics to the infection / sepsis, anti-fungal drug, providing good nutrition and psychosocial aspects of the approach.
Curative therapy / specific aims to cure patients. The general strategy of acute leukemia included induction chemotherapy remission, intensification (CNS prophylaxis) and continued. Classification of standard risk and high risk, determine the protocol chemotherapy. In the remission induction chemotherapy is given the maximum that can be tolerated and the maximum supportive care. Possible results achieved complete remission, partial remission or failed. Intensification is an additional intensive chemotherapy after complete remission and for prophylaxis occurred leukemia in the central nerve channel. The expected result is an extension of the achievement of remission and improve healing. Treatment continued until about 2 years, is expected to achieve an extension of remission and may survive.
Sitostatica used at each stage of leukemia treatment is a combination of various sitostatica. Treatment with granulocyte-colony stimulating factor (G-CSF) is useful to overcome the decline sitistatika granulocytes as side effects, but does not reduce the length of hospital care.
Patients expressed complete remission if no complaints and are free of symptoms of leukemia, the bone marrow aspirate obtained cellular normal and the number of blast cells <5% of the core cell, hemoglobin> 12 g / dL without transfusion, leukocyte cell count> 3000/μl, with the count types of normal leukocytes, the number of granulocytes> 2000 / mL, platelet count> 100,000 / mL, and normal serebropinal fluid examination.
The problem faced in handling patients with leukemia is an expensive drug, the availability of drugs that do not necessarily complete, and the presence of side effects, and care of the old. Drug for leukemia considered expensive for most patients especially the days of the current crisis, addition to the many kinds of drugs, also increase the duration of treatment costs for drug procurement. Side effects sitostatica diverse as anemia, pedarahan, hair loss, granulositopenia (ease of infection), nausea / vomiting, stomatitis, myocarditis, and so forth. Patients with granulositopenia should be treated in isolation rooms. To overcome the boredom for a long treatment is necessary to provide space to play and psychological services. Patients who had complete remission and treatment of conditions such as healthy child will recover. Problem during treatment is the occurrence relap (relapse). Relapse is a bad omen for the disease. Basically there are 3 step relapse:
Intramedular (bone marrow)
Ekstramedular (composition of the central nervous system, testis, iris)
Intra-and extra-medullary.
Relapses can occur in early relapse (early relapse) that occur during treatment or within 6 months of treatment and late relapse (late relapse), which occurred more than 6 months after treatment.
Prognosis
ALL normal risk prognosis is better than high risk. Unfavorable prognostic factors include: age less than 2 years, more than 10 years of age, the number of leukocytes (white blood cells) at the beginning of more than 50×109 / L, platelet count (platelets) less than 100×109 / L, there is the mediastinum , black race, male, no enlargement of lymph nodes, liver enlargement of more than 3 cm, L2 or L3 limfoblas type, and the presence of CNS disease at diagnosis. Viana et al (1994) found, patients with malnutrition (according to standard height / age) the risk of recurrence is higher than the nutritional well. In Singapore, although there is no improvement, 30% -40% of patients experienced a relapse, and this group good prognosis. The development and success of preventive treatment for leukemia die followed by systemic chemotherapy progressively improve ALL cure rates in children. 5-year survival rate around 66-67% ALL. In the LMA, a high leukocyte count (> 100.000/μL), black race, abnormal coagulation prognosis ugly.

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