Based on the results of long-term studies abroad and our own treatment experience, we found that repeated bone and lumbar punctures during the maintenance period and after drug discontinuation do not comprehensively monitor and predict the recurrence of leukemia, so we have recently adjusted the content of regular review of leukemia maintenance and after drug discontinuation, especially invasive punctures such as bone and lumbar punctures have been greatly reduced, which not only reduces the long-distance travel of parents and children in the field, but more importantly This not only reduces the distance traveled by parents and children in the field, but more importantly, is conducive to the healthy growth and development of the child.
The following is an introduction to parents about the regular review of children with leukemia during the maintenance period and after drug discontinuation: I. Bone puncture examination 1.
2. After discontinuation of medication: 3 months after discontinuation of medication (maximum 6 months), children should come to the hospital for review, and have a comprehensive physical examination, blood routine and bone aspiration. If the bone puncture examination is basically normal, no further bone puncture examination will be performed in the future.
Second, lumbar puncture examination 1, maintenance period: after finishing the last intrathecal injection of chemotherapeutic drugs, cerebrospinal fluid examination (empty sheath) will be performed after 6 months for children on 03 regimen, and after 4 months for children on 08 regimen. If this test is normal, no more lumbar puncture cerebrospinal fluid examination will be done after discontinuation of the drug.
2.After discontinuation of the drug: Generally, lumbar puncture cerebrospinal fluid examination is no longer done, unless the child is still doing intrathecal chemotherapy injection at the time of discontinuation evaluation. In this case, cerebrospinal fluid examination is required 3 months after drug discontinuation, and if this examination is normal, cerebrospinal fluid examination will not be done thereafter.
Follow-up after drug discontinuation 1. The first year of drug discontinuation: routine blood examination and comprehensive physical examination should be performed every 1-2 months, with emphasis on lymph nodes, liver, spleen and testicles. If the immune function is restored, no further immune function examination will be performed in the future, and the recovered children can be vaccinated.
2. The second year of drug discontinuation: routine blood tests and comprehensive physical examination every 2-3 months, with emphasis on lymph nodes, liver and spleen and testicles. When the drug has been stopped for two years, it is recommended to perform chest X-ray, abdominal ultrasound or immune function examination.
3. The third year of drug discontinuation: routine blood examination and comprehensive physical examination will be performed every three months, with emphasis on lymph nodes, liver, spleen and testicles. When the drug is stopped for three years, chest X-ray, abdominal ultrasound or immune function examination is recommended.
Parents are recommended to bring their children to Beijing Children’s Hospital for follow-up 1-2 times a year, and to follow up locally at other times.
4. Highly endangered relapsed patients are followed up with bone and lumbar puncture and prognosis according to medical advice.