..Central catheters

Several types exist. simple percutaneous catheters, to muffs or catheters to room. whose choice is bound to every team's practice. They permit to manage the medicines cytostatiques in good conditions of security. in particular without risk of extravasation. and to achieve the withdrawals of surveillance without too important hindrance for the child. Their use requires some rigorous conditions of asepsis. They expose to the risk of infectious contaminations nevertheless, in particular to germs of types staphylococci épidermidis.

  ..Chemotherapy by general way

The treatment takes place in rule according to therapeutic protocols including for a part a drawing, in the setting of the Huriet law. Such protocols require to be put in work by networks of specialized physicians in the domain. For France, two groups cooperators exist:  the Fralle group and the EORTC group.

The general structures of the French protocols or the western countries are today very similar. They include all one intensive initial period lasting about 6 months, and a period of maintenance treatment lasting about 2 years and half to 3 years. In the initial treatment, one distinguishes 3 periods:  the induction, the funding, and the intensification.

The objective of the induction is to get a complete remission (RC), that means a reduction of the tumorous mass on this side of the level of detection by the cytological methods (the complete remission is defined by a number of abnormal cells lower to 5% on the myélogramme).

This period is crucial. On the one hand, it is about controling in the best possible conditions the illness while mastering the tumorous lyse and the infectious complications. On the other hand, it is about appreciating the answer of the illness to the therapeutic. Two medicines seem determining at the time of this period:  the corticostéroïdes and the vincristine (or another poison of the spindle as the vindésine). To them only, these medicines permit to get a complete remission at 90% of the patients. Other medicines seem useful to this stage, in individuals the antracyclines (adriamycine, daunorubicine.) and the asparaginase. The rate of complete remission gotten with these 4 medicines is from 95 to 98%.

This treatment provokes a clinical and hematological obvious recovery. He/it destroys a very big number of cancerous cells but in leash unfortunately to persist some. Thus, at a child weighing 20 kg, one estimates to 1 kg the weight of his/her/its leukemic cells. After the induction, one considers that he/it remains about 1 g of cancerous cells, too weak number to be discovered on a myélogramme. These obstinate cells have the risk of relapse run. It is the reason for which of other treatments are necessary.

At the time of the funding, that lasts about 12 weeks, several other medicines cytostatiques is introduced:  the VP 16, the méthotrexate, the aracytine, the anti-métabolites (6 mercaptopurine or 6 thioguanine).

Occurs then the intensification where medicines similar to those of the induction are managed. The interest of this second intensive chemotherapy cure, 12 to 18 weeks after the induction, has been demonstrated by the German physicians and made it adopt by the different international teams.

A maintenance treatment is managed for a length of 2 to 3 years. He rests on the continuous administration of two medicines by oral way:  the méthotrexate and the 6 mercaptopurine. At the time of the first year of this maintenance treatment, of the monthly "réinductions" (injection of vincristine and takes corticostéroïdes) are associated.

These medicines are very toxic, dangerous to manipulate and require a perfectly broken in team, informed the complications, the secondary effects and the necessary surveillance.

  ..All these treatments entail the complications that it is necessary to warn:

    * Of the infectious complications: