tag:blogger.com,1999:blog-91606888730977470742011-11-27T17:23:17.603-08:00let's fight leukemia together so that no child has to suffer anymoredr.ahmed.ezznoreply@blogger.comBlogger551100tag:blogger.com,1999:blog-9160688873097747074.post-89765601298373782712009-03-30T09:29:00.001-07:002009-03-30T09:29:50.489-07:00

A protocol is a written plan for treating a disease. Just like a recipe for baking a cake,it has a list of ingredients, the amounts to use, and the order to use them so the recipehas the best chance for success. The protocol document lists the drugs, dosages, andtests for each segment of treatment and follow-up. It usually also contains a diagram(called a roadmap) that shows when each drug

dr.ahmed.ezznoreply@blogger.comtag:blogger.com,1999:blog-9160688873097747074.post-27276064114466701872009-03-30T09:27:00.000-07:002009-03-30T09:29:01.727-07:00

To fully understand the clinical trial that has been proposed, here are some impor-tant questions to ask the oncologist:• What is the purpose of the study?• Who is sponsoring the study? Who reviews it? How often is it reviewed? Whomonitors patient safety?• What tests and treatments will be done during the study? How do these differfrom standard treatment?• Why is it thought

dr.ahmed.ezznoreply@blogger.comtag:blogger.com,1999:blog-9160688873097747074.post-28705280318679526532009-03-30T09:26:00.004-07:002009-03-30T09:27:27.877-07:00

There used to be four primary pediatric cancer research groups in North America:Children’s Cancer Group (CCG), Pediatric Oncology Group (POG), National Wilms’Tumor Study Group (NWTSG), and Intergroup Rhabdomyosarcoma Study Group(IRSG). In July 1998, the four groups decided to form a single pediatric cancer clinicaltrials organization. The groups officially merged in 2000

dr.ahmed.ezznoreply@blogger.comtag:blogger.com,1999:blog-9160688873097747074.post-21596768113355866072009-03-30T09:26:00.003-07:002009-03-30T09:26:46.097-07:00

Some scientific studies require a process called randomization. This means that afterparents agree to enroll their child in a clinical trial, a computer will randomly assignthe child to one arm of the study. If there are three arms, the parents will not knowwhich of the three (one standard, two experimental) their child will receive until thecomputer assigns one. The purpose of computer assignment

dr.ahmed.ezznoreply@blogger.comtag:blogger.com,1999:blog-9160688873097747074.post-78046344549072922422009-03-30T09:26:00.001-07:002009-03-30T09:26:21.683-07:00

There are three main types of clinical trials.• Phase I. These clinical trials are designed to determine the maximum tolerateddoses (MTD) of a new drug and to evaluate the side effects. The dose of a newdrug is gradually increased in small groups of children until unacceptable toxic-ity or side effects are seen. This means that one small group of children gets alow dose. The next

dr.ahmed.ezznoreply@blogger.comtag:blogger.com,1999:blog-9160688873097747074.post-53709726108622019422009-03-30T09:25:00.003-07:002009-03-30T09:25:59.248-07:00

Standard treatment is the best known treatment for a specific type of cancer. Forinstance, in 2002, the standard treatment for intermediate-risk ALL is combinationchemotherapy for two to three years. The standard treatment for high-risk ALLincludes more drugs and may include cranial radiation and/or stem cell transplantfor very high-risk groups.As results

dr.ahmed.ezznoreply@blogger.comtag:blogger.com,1999:blog-9160688873097747074.post-13415106156903063082009-03-30T09:25:00.001-07:002009-03-30T09:25:30.748-07:00

The challenge in pediatric oncology remains clear: to strivefor the cure and health of all children through thedevelopment of more effective yet less damaging treatmentfor our young patients.—Daniel M. Green, MD and Giulio J. D’Angio, MDLate Effects of Treatment for Childhood CancerWITHIN DAYS OF ARRIVING at a major pediatric medical center with a child newly diag-nosed with leukemia, parents are

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X-rays, a type of electromagnetic radiation, provide the doctor with a quick andsimple method of viewing organs and structures inside your child’s body. Pictures aretaken and then displayed on a film or a computer screen. X-rays are performed formany reasons during a child’s treatment for leukemia. Some of the most commonreasons for taking x-rays are:• Needed before

dr.ahmed.ezznoreply@blogger.comtag:blogger.com,1999:blog-9160688873097747074.post-15692543812067413742009-03-30T09:24:00.001-07:002009-03-30T09:24:43.151-07:00

Timed urine collections are sometimes needed at various times during your child’streatment. Such collections are useful in evaluating your child’s kidney function priorto receiving chemotherapy drugs that can cause damage to the kidneys or to measurecertain substances in the urine. If your child is toilet trained, the collection is doneby saving all the urine your child produces

dr.ahmed.ezznoreply@blogger.comtag:blogger.com,1999:blog-9160688873097747074.post-16581018773086297432009-03-30T09:23:00.002-07:002009-03-30T09:24:12.932-07:00

During the period in which your child is undergoing treatment, fever becomes anenemy because it is often the first sign of infection. Parents take hundreds of temper-atures, especially when their child is not feeling well. Temperatures can be takenunder the tongue, under the arm, or in the ear using a special type of thermometer.Rectal temperatures are not recommended due to

dr.ahmed.ezznoreply@blogger.comtag:blogger.com,1999:blog-9160688873097747074.post-71282035614299835322009-03-30T09:23:00.001-07:002009-03-30T09:23:48.033-07:00

Over the course of your child’s treatment, it will be necessary to administer pills and/or liquid medications on a regular basis. When giving oral medications, it is essentialto get off to a good start and establish cooperation early.To teach Brent (6 years old) to swallow pills, when we were eating cornfor dinner I encouraged him to swallow one kernel whole. Luckily, it wentright down and he got

dr.ahmed.ezznoreply@blogger.comtag:blogger.com,1999:blog-9160688873097747074.post-28689125090766857522009-03-30T09:22:00.002-07:002009-03-30T09:23:02.047-07:00

Some children require medications given by subcutaneous injection (shot under theskin) during their treatment. For example, Neupogen (G-CSF), a colony-stimulatingfactor that is often used to boost the white blood cell count, and methotrexate areusually given by injection.We found that giving 4-year-old Joseph as much power in the processas possible really helped. The shots themselves are

dr.ahmed.ezznoreply@blogger.comtag:blogger.com,1999:blog-9160688873097747074.post-62674881205913029082009-03-30T09:22:00.001-07:002009-03-30T09:22:36.559-07:00

Most pediatric hospitals have teams of technicians who specialize in starting IVs anddrawing blood. The IV technician will generally use a vein in the lower arm or hand.First, a constricting band is put above the site to make the veins larger and easier tosee and feel. The vein is felt by the technician, the area is cleaned, and the needle isinserted. Sometimes a needle is left in place and

dr.ahmed.ezznoreply@blogger.comtag:blogger.com,1999:blog-9160688873097747074.post-54537836685641172832009-03-30T09:21:00.004-07:002009-03-30T09:22:12.190-07:00

Due to the blood-brain barrier, systemic chemotherapy usually cannot destroy anyblasts in the central nervous system (brain and spinal cord). Chemotherapy drugsmust be directly injected into the cerebrospinal fluid to kill any blasts present andprevent a possible central nervous system relapse. The drugs most commonly usedintrathecally are methotrexate, ARA-C, and

dr.ahmed.ezznoreply@blogger.comtag:blogger.com,1999:blog-9160688873097747074.post-10633421634661610042009-03-30T09:21:00.003-07:002009-03-30T09:21:37.272-07:00

Platelets are an important component of the blood. They help form clots and stopbleeding by repairing breaks in the walls of blood vessels. A normal platelet count fora healthy child is 150,000/mm3 to 420,000/mm3. Chemotherapy can severely depressthe platelet count for some children. If a transfusion is not given when counts arevery low, uncontrollable bleeding can result.

dr.ahmed.ezznoreply@blogger.comtag:blogger.com,1999:blog-9160688873097747074.post-34484899854410347882009-03-30T09:21:00.001-07:002009-03-30T09:21:19.262-07:00

A multiple-gated acquisition (MUGA) scan tests cardiac function. It is more sensitivethan an echocardiogram. Prior to having a MUGA scan, children are sometimes givena sedative to help them relax and stay perfectly still for the fifteen- to twenty-minutetest. An injection of red cells or proteins tagged with a mildly radioactive substance(called technetium) is given through an IV. The

dr.ahmed.ezznoreply@blogger.comtag:blogger.com,1999:blog-9160688873097747074.post-3658889881008075302009-03-30T09:20:00.003-07:002009-03-30T09:20:57.749-07:00

Finger pokes are different from blood draws in several ways. First, EMLA can be usedsuccessfully. Put a blob of EMLA on the tip of the middle finger. Cover the fingertipwith plastic wrap, and tape it on the finger. Another method is to buy long, thinballoons with a diameter a bit wider than the child’s finger. Cut off the open end,leaving only enough balloon to cover the finger up

dr.ahmed.ezznoreply@blogger.comtag:blogger.com,1999:blog-9160688873097747074.post-91037324996211878932009-03-30T09:20:00.001-07:002009-03-30T09:20:41.157-07:00

Several drugs used to treat CNS tumors can damage the muscle of the heart, decreas-ing its ability to contract effectively. Many protocols require a baseline echocardiogramto measure the heart’s ability to pump before any chemotherapy drugs are given.Echocardiograms are then given periodically during and after treatment to check forheart muscle damage.An echocardiogram uses

dr.ahmed.ezznoreply@blogger.comtag:blogger.com,1999:blog-9160688873097747074.post-26344933523205437492009-03-30T09:19:00.004-07:002009-03-30T09:20:16.037-07:00

Protocols for children with leukemia require bone marrow aspirations, a process bywhich bone marrow is sucked out with a needle. The purpose of the first, or diag-nostic, bone marrow aspiration is to see what percentage of the cells in the marroware abnormal blasts. Then these cells are analyzed microscopically to determinewhich type of leukemia is present. The next bone

dr.ahmed.ezznoreply@blogger.comtag:blogger.com,1999:blog-9160688873097747074.post-38925973413194447042009-03-30T09:19:00.003-07:002009-03-30T09:19:40.145-07:00

Treatment for leukemia can cause severe anemia (a low number of oxygen-carrying redcells). The normal life of a red cell is three to four months and, as old cells die, thediseased (or suppressed by treatment) marrow cannot replace them. Many childrenrequire transfusions of red cells when first admitted and periodically throughouttreatment.Whenever my son needed a

dr.ahmed.ezznoreply@blogger.comtag:blogger.com,1999:blog-9160688873097747074.post-57401141082163387972009-03-30T09:19:00.001-07:002009-03-30T09:19:16.411-07:00

Frequent blood samples are a part of life during leukemia treatment. A complete bloodcount (CBC) tells the physician how effective the drugs are and helps determine thechild’s susceptibility to infection. It is important to measure blood chemistries tomake sure that the liver and kidneys are not being damaged by treatment. (For a listof normal blood counts, see Appendix B, Blood

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Understanding what will occur during a procedure and what other parents do to prepare their children will arm you with essential information. Knowing what to expecwill lower the anxiety level of both you and your child and lay the foundation foyears of tolerable tests. The descriptions of procedures in the rest of the chapter manot exactly mirror your experience. Practices vary by

dr.ahmed.ezznoreply@blogger.comtag:blogger.com,1999:blog-9160688873097747074.post-49652225223791421632009-03-30T09:17:00.000-07:002009-03-30T09:18:28.833-07:00

The goal of pediatric pain management should be to minimize discomfort whileperforming the procedure. The two methods to achieve this goal are psychological(using the mind) and pharmacological (using drugs). These two methods can be usedtogether to provide an integrated mind/body approach.Psychological methodPreparation for every procedure is essential. Unexpected

dr.ahmed.ezznoreply@blogger.comtag:blogger.com,1999:blog-9160688873097747074.post-80219581567149460492009-03-30T09:16:00.002-07:002009-03-30T09:17:23.826-07:00

Mommy, I didn’t cry but my eyes got bright.—Four-year-old with ALLTHE PURPOSE OF THIS CHAPTER IS TO PREPARE both child and parent for several commonprocedures by providing detailed descriptions of each. Since almost all procedures arerepeated frequently during the long treatment for childhood leukemia, it is importantto establish a routine that is comfortable for you and your child. The procedure

dr.ahmed.ezznoreply@blogger.comtag:blogger.com,1999:blog-9160688873097747074.post-86942835040068992362009-03-30T09:16:00.001-07:002009-03-30T09:16:35.955-07:00

Children need to be told that they are seriously ill, that they will be spending sometime in the hospital, that the treatment will last for a long time and is sometimespainful, that the treatments are usually successful, and that the doctors and nursesare experts and will provide the very best care available. Depending on the child’sage, this could vary from

dr.ahmed.ezznoreply@blogger.comtag:blogger.com,1999:blog-9160688873097747074.post-76073865665224843962009-03-30T09:15:00.001-07:002009-03-30T09:16:07.808-07:00

In the first harrowing days after a diagnosis of leukemia, parents must decide whenand what to tell their children. Because parents are coping with a bewildering arrayof emotions themselves, sharing information and providing reassurance and hopemay be difficult. In the past, shielding children from the painful reality was the norm.Most experts now agree that children feel less

dr.ahmed.ezznoreply@blogger.comtag:blogger.com,1999:blog-9160688873097747074.post-69545805954736868142009-03-30T09:14:00.002-07:002009-03-30T09:15:19.972-07:00

Juvenile myelomonocytic leukemia (JMML) accounts for less than one percent ofchildhood leukemias. It is usually diagnosed in children under two years of age andis more common in boys than in girls. Children with neurofibromatosis 1 (NF 1) areat increased risk of developing JMML.The symptoms of JMML are similar to those of the acute leukemias: pale skin, fever,headaches, sweating, and

dr.ahmed.ezznoreply@blogger.comtag:blogger.com,1999:blog-9160688873097747074.post-42378659524112349272009-03-30T09:14:00.001-07:002009-03-30T09:14:53.268-07:00

success rate (20 to 40 percent) is lower than for children who are transplanted in thechronic phase of their disease.During the blast phase, white blood cells fail to mature and the immature cells floodthe bloodstream. The blasts may have characteristics of AML (70 percent) or ALL (30percent). Children in this phase respond poorly to standard chemotherapy for acuteleukemias. Stem cell

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CML is rare in children, accounting for less than 5 percent of all childhood leukemias.It is characterized by a very large spleen, high white count of mostly neutrophils andother types of granulocytes, and a high platelet count. Other symptoms of CML arefatigue, weakness, headaches, irritability, fevers, night sweats, and bone pain. Somechildren have no symptoms and the cancer is

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induction, children with AML receive further intensive treatment with an allogeneicbone marrow transplant (if a matched sibling donor is available) or more chemo-therapy, called postremission therapy.Postremission chemotherapy may include: cytosine arabinoside (in high or standarddoses), etoposide, an anthracycline (doxorubicin, daunorubicin or idarubicin),thioguanine,

dr.ahmed.ezznoreply@blogger.comtag:blogger.com,1999:blog-9160688873097747074.post-47533306351415953242009-03-30T09:12:00.002-07:002009-03-30T09:13:23.117-07:00

transplantation (see Chapter 20) is frequently used to treat childhood AML in first orsecond remission.Certain groups of children with AML (those with Down syndrome and those withM3 t(15;17) APL) are treated on different protocols to address their unique disease.Children with subtype M3 are given all-trans-retinoic acid (ATRA) in addition tochemotherapy.For most children,

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AML (also called acute myelogenous leukemia, acute nonlymphocytic leukemia, orANLL) is cancer of the blood cells. The cancer cells are those that would otherwisedevelop into granulocytes and monocytes. Because treatments for AML and ALL arevery different, it is crucial that sophisticated laboratory studies are performed on thebone marrow samples to determine whether your child has AML

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Because a blood-brain barrier exists that prevents most chemotherapy drugs fromcrossing into the CNS to destroy leukemic cells, chemotherapy drugs are injecteddirectly into the cerebrospinal fluid (called intrathecal medication) during spinal taps.Intrathecal medication is given periodically throughout treatment. Five to 10 percentof children experience seizures from

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Approximately 15 percent of children with ALL have T-cell ALL. T-cell ALL has oneor more of the following antigens on the surface of the cancer cells: CD2, CD7, CD5,CD8, or CD3. Often, children with T-cell ALL are male, have high WBC counts, havemasses in their chests at diagnosis, and are over 10 years old. T-cell ALL requiresmore intensive therapy, but outcomes after intensive

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Seventy-five percent of all children with leukemia have ALL. It is caused by a rapidproliferation of immature lymphocytes (lymphoblasts), which would normally havedeveloped into mature T cells or B cells. There are several subgroups of ALL based onwhether the cancer cells developed from precursors of B cells or T cells, or whetherthey display characteristics of both.The first sample of bone

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The two broad classifications of leukemia are acute (rapid progression) and chronic(slow progression). The acute leukemias are characterized by abnormal numbers ofimmature white cells (blasts). In chronic leukemia, mature white cells predominate.Acute leukemia is the most common type of cancer found in children. The two mostcommon types of acute leukemia are acute lymphoblastic leukemia (

dr.ahmed.ezznoreply@blogger.comtag:blogger.com,1999:blog-9160688873097747074.post-84255594511638156842009-03-30T09:09:00.001-07:002009-03-30T09:09:46.955-07:00

At diagnosis, many parents do not know how to find the best doctors and treatmentsfor their child. State-of-the-art care is available from physicians who participate in theChildren’s Oncology Group (COG). This study group, composed of pediatric surgeonsand oncologists, neurologists, radiation oncologists, researchers, and nurses, providesthe best possible current treatments for leukemia and

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A tentative diagnosis of leukemia is made after a physical examination of the child andmicroscopic analysis of a blood sample have been conducted. Physical findings mayinclude pale skin; bruising or unusual bleeding; enlarged liver, spleen, or lymph nodes;weakness; and fever (with or without a specific site of infection). Parents or childrenmay describe irritability, night sweats,

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Acute leukemia is the most common childhood cancer. Often thought of as strictly achildhood disease, leukemia actually afflicts many more adults than children. Eachyear in the United States, approximately 3,500 children are diagnosed with acuteleukemia.Childhood leukemia is most commonly diagnosed at ages two to seven, with thehighest incidence at approximately three years of

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Blood is a vital liquid that carries oxygen, food, hormones, and other necessarychemicals to all of the body’s cells. It also removes toxins and other waste productsfrom the cells. Blood helps the lymph system fight infection and carries the cellsnecessary for repairing injuries. Blood also contains important clotting factors.Whole blood is made up of plasma, which

dr.ahmed.ezznoreply@blogger.comtag:blogger.com,1999:blog-9160688873097747074.post-12250886887047999722009-03-30T09:07:00.001-07:002009-03-30T09:07:38.519-07:00

The world breaks everyoneand afterward many are strongat the broken places.—Ernest HemingwayA Farewell to ArmsTHE WORD LEUKEMIA literally means “white blood.” Leukemia is the term used todescribe cancer of the blood-forming tissues known as bone marrow. This spongymaterial fills the long bones in the body and produces blood cells. In leukemia, thebone marrow creates an

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It is important for you to know that you are not alone. Many have traveled this pathbefore you. Although it is sad to know that others are forced into this terrifyingjourney, you can take some small solace from knowing that you are not the onlyparents to experience these feelings. You can call upon other parents as resources andfountains of support.The next several

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Parents feel an acute sense of loss when their child is diagnosed with leukemia. Theyfeel unprepared to cope with the possibility of death, and fear that they may simplynot be able to deal with the enormity of the problems facing the family. Parentsdescribe feeling engulfed by sadness. Grieving for the child is common, even whenthe prognosis is good. Parents grieve the loss of

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Parents sometimes feel overwhelmed by the sudden loss of control after their child isdiagnosed with a tumor. This is especially true for parents who are used to having ameasure of power and authority in the workplace or the home.My husband had a difficult time after our son was diagnosed. We havea traditional marriage, and he was used to his role as provider andprotector for the family. It was

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Anger is a common response to the diagnosis of life-threatening illness. It is nobody’sfault that children are stricken with cancer. Since parents cannot direct their anger atthe cancer, they target doctors, nurses, spouses, siblings, and sometimes even the illchild. Because anger directed at other people can be very destructive, it is necessaryto devise ways to express the anger.We were sent

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A diagnosis of leukemia strips parents of control over their child’s daily life. Previ-ously, parents established routines and rules which defined family life. Children wokeup, washed and dressed, ate breakfast, perhaps attended day care or school, playedwith friends, and performed chores. Life was predictable. Suddenly, the family isthrust into a new world populated

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Guilt is a common and normal reaction to childhood leukemia. Parents feel that theyhave failed to protect their child, and blame themselves. It is especially difficult becausethe cause of their child’s cancer cannot be explained. There are questions: How couldwe have prevented this? What did we do wrong? How did we miss the signs? Whydidn’t we bring her to the doctor sooner? Why

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In the first few days after diagnosis, many parents use denial to shield themselvesfrom the terrifying situation. They simply cannot believe that their child has a life-threatening illness. Denial may serve as a useful method to survive the first few daysafter diagnosis, but a gradual acceptance must occur so that the family can begin tomake the necessary adjustments to

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After a tentative diagnosis of leukemia, most physicians refer the family for furthertests and treatment to the closest major medical center with expertise in treatingchildren with cancer. It is very important that the child with leukemia be treated at afacility that uses a team approach, including pediatric oncologists, oncology nurses,specialized surgeons and pathologists,

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Leukemia is cancer of the blood-forming tissues that make up the bone marrowinside large bones. The diseased bone marrow floods the body with abnormal whitecells. These cells do not perform the infection-fighting functions of healthy, maturewhite cells. In addition, production of red cells, which carry oxygen, and platelets,which help prevent bleeding, is decreased. Chapter

dr.ahmed.ezznoreply@blogger.comtag:blogger.com,1999:blog-9160688873097747074.post-47585569373414233942009-03-30T09:02:00.001-07:002009-03-30T09:02:21.935-07:00

A journey of a thousand leagues begins with a single step.—Lao-tzu“WE HAVE THE RESULTS of the blood work back. I’m afraid it’s bad news. Your child hasleukemia.” For every parent who has heard those words, it is a moment frozen intime. In one shattering instant, life forever changes. Many parents equate cancer withdeath and are staggered by the thought of losing their beloved child.

dr.ahmed.ezznoreply@blogger.comtag:blogger.com,1999:blog-9160688873097747074.post-36079193306112693312009-03-30T09:01:00.001-07:002009-03-30T09:01:50.100-07:00

xviiWe are all in the same boat, in a stormy sea, and weowe each other a terrible loyalty.—G. K. ChestertonMY LIFE ABRUPTLY CHANGED on Valentine’s Day, 1992, when my 3-year-old daughterwas diagnosed with acute lymphoblastic leukemia (high-risk). At the time, I was thefull-time mother of two small daughters, Katy, 3 years old, and Alison, 18 months.The phone call from my pediatrician

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EVERY YEAR IN THE UNITED STATES approximately 12,000 children and adolescents underthe age of twenty years are diagnosed with cancer. Of these children, approximately2,500 will be afflicted with acute lymphoblastic leukemia and 500 with other types ofchildhood leukemia. Significant progress has been made in the treatment of childhoodcancer over the past four decades,

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In the first post we talked about cancers generally and what it means for you and also about blood elements and what they are supposed to do and how they malfunction leading to cancer,this time we talk more about leukemia basics and i will do my best to make it very simple for you.What are the types of leukemia? The types of leukemia are grouped by how quickly the disease develops

dr.ahmed.ezznoreply@blogger.comtag:blogger.com,1999:blog-9160688873097747074.post-22866277659270294432009-03-15T12:13:00.000-07:002009-03-15T13:10:10.685-07:00

Leukemia is a CANCER which is no different than any other cancers u might have heard off but this one is a little different that is it considered the number one cancer in children .All sure heard the word cancer many times and may know a relative or a close one who suffered from it but what exactly the word means is a mystery to non medically oriented people .Cancer is a group of many related

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