What method treats leukemia?

1. Chemotherapy methods Acute leukemia chemotherapy can be divided into two stages: ① Induction remission stage: that is, leukemia cells decrease to a certain extent, normal hematopoietic function is restored, and patients' symptoms disappear. Leukemia cells can't be found in blood films. Drugs used for induction are required to be sensitive to leukemia cells, which can kill a large number of leukemia cells in a short time (1 ~ 2 courses of treatment) and restore normal bone marrow stem cells at the same time. Therefore, induced remission drugs not only require specific anti-leukemia cell efficacy, but also have a killing effect on non-proliferative cells, and will not produce drug resistance in a short time. At present, vincristine plus prednisone is an induction and remission drug for acute lymphocytic diseases, and cytarabine plus daunorubicin or cephalotaxine is the basic scheme for acute non-lymphocytic diseases. At present, it is advocated to strive for early induction, pay special attention to the initial treatment effect, make a quick decision, and relieve after 1 ~ 2 courses, which not only has a high remission rate, but also has a long survival period. Leukemia can be treated with a small amount of chemotherapy, such as cytarabine or Cephalotaxus fortunei combined with adrenocortical hormone, and then treated according to the general chemotherapy scheme after the hemogram rises slightly. For such patients, it is necessary to repeatedly check the bone marrow and adjust the dose. ② Continue treatment after remission: After the above treatment, although the disease has entered remission stage, there are still a certain number of leukemia cells in the body. Therefore, we must continue to use anti-leukemia drugs and adopt large doses of consolidation and reinforcement to eliminate leukemia cells as much as possible in order to achieve a long-term disease-free survival. Drug resistance in remission stage is slow, and there is no cross-resistance with induced remission drugs. At present, there is no unified opinion on the time of continuous treatment. Most of them advocate stopping taking drugs for 6 ~ 8 months after complete remission. Patients with acute lymphoblastic leukemia still need to maintain treatment for 3 years after consolidation and intensification. At present, the commonly used method in China is to consolidate 2 ~ 4 courses of treatment with the original induced remission scheme after acute lymphocyte remission, and then maintain it with 6- mercaptopurine and methotrexate for a long time; After remission, cyclophosphamide (200 ~ 300 ml/m2) can be added once a week, and the combination chemotherapy can be strengthened once every 2 ~ 3 months. Various induction chemotherapy methods can also be used alternately every month in 1 year. For relapsed or drug-resistant cases, high-dose or medium-dose cytarabine plus other chemotherapy can significantly improve the complete remission rate and survival rate. (1) Several combined chemotherapy schemes for inducing remission of acute leukemia ① VP scheme for initial treatment of acute lymphoblastic leukemia: vincristine 1.4mg/m2, intravenous injection, 1 time/week; Prednisone 40 ~ 60 mg/m2 d, orally, 1 ~ 14 days. Once every 4 weeks, or until complete remission. VDP regimen: vincristine 1.4mg/m2, intravenous injection, weekly 1 time; Prednisone 40 ~ 60 mg/m2 d, orally, 1 ~ 14 days. Daunorubicin 30 ~ 50 mg/m2, intravenous injection, 65438 0 times a week. Generally 4 weeks is a course of treatment. VDCP regimen: vincristine 1.4mg/m2, intravenous injection, weekly 1 time; Prednisone 40 ~ 60 mg/m2 d, orally, 1 ~ 14 days. The course of treatment is 28 days; Daunorubicin 30 ~ 40 mg/m2, intravenous injection, 1 ~ 3 days, 15 ~ 17 days; Cyclophosphamide 600 ~ 800 mg/m2, intravenous injection, day 1 and 15. VDLP regimen: On the basis of VDP regimen, L-asparaginase was injected intravenously at 17 ~ 28 days, once a day. The whole course of treatment is 28 days. ② The initial treatment of acute non-lymphoblastic leukemia with DA regimen: daunorubicin 30 ~ 70 mg/m2, intravenous injection, 1 ~ 3 days; Cytarabine 100 ~ 150 mg/m2, continuous intravenous drip or intravenous drip twice in the morning and evening, the first 1 ~ 7 days. HA regimen: harringtonine 3 ~ 4 mg/m2, intravenous drip, 1 ~ 7 days; Cytarabine100 ~150mg/m2 d, continuous intravenous drip or intravenous drip twice in the morning and evening, the first 1 ~ 7 days. LD-ARA-C regimen: cytarabine 100 ~ mg/m2 once every 12 hours, and intravenous or subcutaneous injection of 15 ~ 2 1 day is a course of treatment. Retinoic acid 30 ~1.20 mg/m2 d was taken orally for 3 ~ 4 times until complete remission. It is mainly suitable for variant acute non-lymphocytic leukemia (M3) and also effective for a few non-variant acute leukemia (non-M3). ③ Treatment of Refractory and Recurrent Leukemia Some acute leukemia can't achieve complete remission after standard first-line chemotherapy, which is called primary drug resistance. Most of the patients with acute leukemia who have achieved complete remission will eventually change their cell characteristics due to drug treatment, leading to drug resistance, that is, leukemia cells are insensitive to chemotherapy drugs, which is proportional to the recurrence of the disease and offset by secondary drug resistance. Another kind of acute leukemia is cytotoxic drug, which can kill a large number of leukemia cells, that is, leukemia cells are sensitive to chemotherapy. After a course of treatment, leukemia cells regenerate rapidly, leading to treatment failure and becoming regenerative drug resistance or biological drug resistance. The resistance of leukemia cells to chemotherapy drugs is the biggest obstacle to cure leukemia. Refractory acute non-lymphocytic leukemia is defined as: ① initial treatment cases are ineffective for first-line induction therapy; ② Recurrence within 6 months after the first remission; ③ Although it recurred 6 months after the first remission, it failed to induce again according to the original plan; (4) Recurrence for the second time or above. The treatment principles of refractory or recurrent acute leukemia are as follows: (1) Choose drugs without cross-resistance to form a new scheme; (2) using increased doses of conventional drugs; ③ The use of new anti-leukemia drugs with different mechanisms of action from those commonly used at present. Adding cyclosporine or verapamil to drug-resistant patients on the basis of chemotherapy can reverse drug resistance. In general, the original effective induction scheme is used for patients with recurrence. If relapse or primary or primary induction is ineffective during treatment, acute lymphoblastic leukemia can choose the following regimen: MOAD regimen: methotrexate 100mg/m2, intravenous drip, 1 day; L-asparaginase 1 500U/m2, intravenous drip, the next day; Vincristine 1.5mg/m2, dropped in a small pot, the next day; Dexamethasone 6mg/m2, taken orally from 1 to 10 days. Every 10 day is a course of treatment. According to the degree of bone marrow hyperplasia, it can be used continuously for 3~4 courses. However, the dose of methotrexate increased by 50% every 10 day, until it reached 225 mg/m2 d. This regimen had mild bone marrow suppression, and after remission, strong chemotherapy regimen was used. HD-MTX regimen: methotrexate 1~3g/m2, in which the dosage of 1/3 was intravenously infused within 30 minutes, intrathecally injected methotrexate 10 mg/m2, and the remaining 2/3 doses were continuously intravenously infused for 24 hours. Calcium folinate was administered 12 hours after instillation. The total dose was calculated as 10% of methotrexate dose, and it was injected in 8 times with an interval of 6 hours each time. HD-Ara-C scheme: cytarabine 0.5~3g/m2, once every 12 hours, ***8~ 12 times. One of the following drugs can be appropriately added, such as second-line chemotherapy drugs such as etoposide, teniposide, mitoxantrone, 4- nordaunorubicin or L-asparaginase. For acute lymphoblastic leukemia, the following regimen can also be selected: MV regimen: mitoxantrone 7.5 mg/m2, intravenous drip, 1 ~ 3 days; Etoposide 75 mg/m2, intravenous drip for 5 ~ 7 days. IA regimen: 4- nordaunorubicin 8 mg/m2, intravenous injection, day 1 ~ 3; Cytarabine 100 ~ 150 mg/m2 was administered intravenously for 7 days. For regenerative resistance, retinoic acid and interferon can be used in the interval of chemotherapy, which may improve the therapeutic effect, because in vivo studies have found that these two drugs can slow down the proliferation of acute lymphoblastic leukemia cells. (2) The purpose of chemotherapy after remission of acute leukemia is to further reduce the residual leukemia cells, which is very necessary to prolong the disease-free survival of patients. ① For acute lymphoblastic leukemia, the following schemes can be adopted: a. The original induction scheme can be adopted; B.VA regimen: teniposide 100 ~ 150 mg, intravenous injection, 2 ~ 3 times a week; Cytarabine100 ~ 200mg/m2 d was injected intravenously twice in the morning and evening for 1 ~ 7 days. C MD-MTX regimen: methotrexate 1 ~ 3g/m2, continuous intravenous drip for 24 hours. Three chemotherapy schemes were alternately strengthened for 9 courses, and then oral methotrexate 20 mg/ week and 6- mercaptopurine 75 mg/m2 d were taken for maintenance treatment. During this period, the dose of intrathecal methotrexate should be 7.5 mg/m2, weekly 1 time, lasting for more than 4 weeks, in order to prevent central nervous system leukemia. ② For acute non-lymphocytic leukemia, DA regimen (DNR 40 mg/m2, intravenous injection, day 1~3; Ara-C 150~200 mg/d, intravenous injection twice, once every 12h, on1~ 7th day), HA scheme (homoharringtonine 4~6 mg/d, intravenous injection, on1~ 2nd day). Ara-C 150~200 mg/d, twice, once every12h, on the 7th day of 1 ~) and MD-Ara-C(0.5~ 1.0 g/m2) every/kloc. There is no need to maintain chemotherapy. 2. Differentiation-inducing therapy (1) Low-dose cytarabine: The commonly used low-dose cytarabine is 10~20 mg/m2, once every 12 hours, and subcutaneous injection of 15~2 1 day is a course of treatment. At present, it is considered that low-dose cytarabine is suitable for: ① elderly patients with acute non-lymphocytic leukemia; ② Myelodysplastic Syndrome transformed into acute leukemia; ③ Secondary acute leukemia. Low dose cytarabine is considered as an inducer.

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