Help my dad! (paraphrased)

Enhance the confidence of patients to overcome the disease, go to a regular hospital and come up with a systematic treatment plan. If you are ill, never go to see a doctor. The economic problem is also a very important issue that needs comprehensive consideration.

Some of the information provided below is for reference only. If you use it, you must find an expert in a regular hospital to see if it is suitable for patients. I wish the patient a speedy recovery.

Treatment is divided into three stages: induced remission, consolidated remission and maintenance remission.

1) induced remission

At present, the international standard VDLP regimen is mostly adopted: vincristine (VCR)2mg, intravenous injection, 1 8, 15, 22 days. Dnr 40 ~ 60 mg/(m2 d), intravenous drip, day 1 ~ 3. L-asparaginase 6000 u/(m2 d), intravenous drip, day 17 ~ 28. Pred 30 ~ 40 mg/(m2 d), oral, 1 ~ 28 days. Bone marrow puncture was conducted on day 14. If there are still many leukemia cells and bone marrow hyperplasia is active, DNR 40 ~ 60 mg/(m2 d) should be added intravenously, bone marrow puncture should be performed on day 15 ~ 16, and bone marrow puncture should be performed on day 28. If there is still no remission, bone marrow puncture will be carried out intermittently on day 10.

2) Consolidation therapy

1, 3, 5 and 7 were treated with the following regimen: VCR 2mg, intravenous injection, 1, 8 days. Dnr 40 ~ 60 mg/(m2 d), intravenous drip, day 1 ~ 2. L-ASP12000u/(m2 d), intravenous drip, 2nd, 4th, 7th, 9th, 1 1,14th day. Pred 30 ~ 40 mg/(m2 d), oral, 1 ~ 14 days.

In the 2nd, 4th, 6th and 8th courses of treatment, teniposide (VM26) 1 65mg/(m2 d), intravenous drip,1,4, 8,1kloc-0/day was adopted. Cytarabine 300 mg/(m2 d), intravenous drip, on the 65438th day +0, 4, 8, 1 1.

The ninth course of treatment: methotrexate (MTX)690mg/m2, intravenous drip, intramuscular injection of calcium formyltetrahydrofolate 15mg, q6h, *** 12 times. Measures such as alkalization, hydration, protecting liver and benefiting gallbladder were added two days before treatment.

3) Maintenance treatment

Commonly used drugs are MTX 20mg/m2, taken orally, 65438 0 times a week. 6- mercaptopurine (6-MP)75mg/m2, oral, one day 1 time. Cyclophosphamide 50mg/m2, oral, daily 1 time, 5 ~ 7 days per month. Progress in treatment of acute lymphoblastic leukemia

The application of high-dose chemotherapy makes 80% ~ 85% of adult patients with acute lymphoblastic leukemia get complete remission. Allograft BMT is still the main treatment for patients who have failed conventional chemotherapy. Targeted therapy is another new treatment for acute lymphoma.

chemotherapy

Due to the application of high-dose chemotherapy, especially the use of high-dose methotrexate (MTX) and cytarabine (cytarabine), 80% ~ 85% of adult acute lymphoblastic leukemia? All patients were in complete remission, and the long-term disease-free survival rate (DFS) reached 30% ~ 40%. 75% of children were cured. The most common drugs in the induced remission scheme are prednisone, vincristine, anthracyclines (mostly daunorubicin) and L-asparaginase, and they can also be combined with cyclophosphamide, cytarabine (regular dose or large dose), 6-mercaptopurine or other drugs for early intensive treatment. Dexamethasone has high concentration in cerebrospinal fluid and strong anti-leukemia effect, so it replaces prednisone in many schemes. The results of MRCALL 97/99 study showed that compared with prednisolone, the recurrence rate of patients with central nervous system leukemia treated with dexamethasone was significantly reduced, and the 3-year disease-free survival time was 87% to 79% respectively.

stem cell transplantation

AlloBMT is still the main treatment for patients who have failed conventional chemotherapy, and this treatment can cure 10% ~ 20% of patients with primary drug resistance; 10% ~ 25% patients with secondary recurrence have long-term disease-free survival; 30% ~ 56% of patients in the second remission stage have long-term disease-free survival, while the chemotherapy maintenance control group is only 17% ~ 23%. Therefore, once these patients are diagnosed, most of them should consider AlloBMT treatment. For patients with the first relapse, whether to transplant immediately or induce chemotherapy again is still a problem. Hematopoietic stem cell transplantation after the first remission has no obvious advantage for standard risk patients, but it is superior to simple chemotherapy for high-risk patients, especially pH+All patients.

For patients who cannot receive conventional transplantation due to old age or other reasons, non-myeloablative hematopoietic stem cell transplantation can be accepted, but it cannot be evaluated because of the small number of cases.

For patients without HLA-matched family members, unrelated donors are another choice, but the transplant-related mortality is higher. Kiehl's Center in Germany reviewed and analyzed the efficacy of adult ALL patients receiving BMT from unrelated matched donors (MUD) or semi-matched family members. The results showed that 82 of 220 patients survived, the median survival time was 269 days, and the transplant-related mortality rate was 57%.

Autologous hematopoietic stem cell transplantation (ABMT) has the same effect as chemotherapy. GOELAM study showed that patients with low-risk T-All received ABMT and chemotherapy at random, and there was no significant difference in overall survival rate and DFS between the two groups. Lala-94 study showed that patients with high-risk ALL were randomly treated with ABMT or chemotherapy alone, with a median DFS of 65,438 03.7 months and 65,438 02.7 months respectively, but the late recurrence rate in chemotherapy group was high (3-year DFS was 36% and 265,438 0% respectively).

Targeted therapy

Targeted therapy is another new treatment for acute lymphoma. The preliminary phase II clinical study showed that imatinib mesylate (STI-57 1) can completely relieve 29% of patients with pH+All, especially those with recurrence after hematopoietic stem cell transplantation. Combined with chemotherapy can improve the curative effect and possibly reduce minimal residual disease (MRD). Thomas et al. used STI-57 1 combined with CVAD regimen (cyclophosphamide, vincristine, epirubicin, azepamide) to treat relapsed or unresponsive patients with pH+All. CR, 4/ 1 1 case BCR/ABL turned negative, but more time is needed to observe the effect of STI-57 1 on MRD.

Many antigens such as CD 19, CD20, CD22 and CD52 are expressed on the surface of all primitive cells, and these antigens can be the targets of monoclonal antibodies. At present, anti-CD20 monoclonal antibodies on the market can completely relieve 93% of pre-B-All and mature B-All patients, and the 1 year survival rate is 86%. Thomas et al. used anti-CD20 monoclonal antibody plus CVAD to treat L3 and Burkitt lymphoma, and 35% of the patients were over 60 years old. The results showed that 1 year CR was 89%, DFS was 86%, and there was no treatment-related death. In addition, anti-CD 19 monoclonal antibody and anti-CD52 monoclonal antibody have also been used in human body. Seibel et al. compared the efficacy of chemotherapy alone with chemotherapy plus anti-CD 19 monoclonal antibody in the treatment of primary ALL. The results showed that the complete remission rate was only 43% in the simple chemotherapy group and 93% in the combined chemotherapy group. Faderl used anti-CD52 monoclonal antibody to treat 5 cases of acute lymphoma, and no curative effect was found. Because these research samples are small, further observation is needed. Effect of anti-CD22 monoclonal antibody on MDR- 1 (multidrug resistance gene) positive Burkitt lymphoma cell line and BCP-ALL cell line? EU- 1 has obvious killing effect. With the application of new drugs, all treatments will be greatly improved.

Treatment of leukemia with traditional Chinese medicine

For all types of leukemia with mild symptoms, one of Xiao Ping Pill, Bujin Pill, Shenlou Pill, Shenshu Pill and Shen Chong Pill can be taken orally together with Fan Dan Powder (the above prescriptions are all from Oncology of Traditional Chinese Medicine), and other drugs can be added according to the principle of syndrome differentiation (refer to 7.6-7. 165438+). Please also note that the prescription containing realgar.