At the time I was in college, leukemia was still almost incurable.
A few decades further back, this was even more evident, as Mr. Lu Daopei, the father of bone marrow transplantation in Asia and a member of the Chinese Academy of Engineering, said in the preface to the first edition of Leukemia Therapeutics, which he edited: “Looking back to when I first started working in hematology 34 years ago, there were very few treatments for acute leukemia other than blood transfusions and nursing care. A very large majority of patients with acute leukemia died within six months. Therefore, my family father, —- an ophthalmologist, was strongly opposed to my pursuing leukemia research. According to him, physicians who treat leukemia can only serve as a pass for the road to ‘Hades’.”
The prognosis of leukemia patients has improved since the 1970s, when hematologists and morphologists from France, the United States, and the United Kingdom (FAB) divided acute leukemia into acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) based on the morphology of leukemia cells under the microscope, with the former divided into M1-M7 based on morphological characteristics and the latter divided into L1-L3, for different For different types of leukemia with different chemotherapy regimens, the survival of patients is prolonged and a small number of patients can be cured.
Scientists in China first treated acute promyelocytic leukemia (M3) with retinoic acid and arsenic, and have gradually identified and elaborated on the mechanism of action, and now the cure rate of M3 has reached more than 95%, and the majority of patients can continue to enjoy a good life without transplantation.
The improvement in treatment results is also due to advances in testing technology. Cytogenetics has shown that the hematopoietic cells of patients with chronic myeloid leukemia (CML, commonly known as “slow granulocytes”) have the Philadelphia chromosome (Ph chromosome), which means that part of chromosome 9 and part of chromosome 22 of the patient are ectopic, resulting in a fusion gene —-BCR/ABL, which encodes a protein with tyrosine kinase activity that prevents cell differentiation and maturation and apoptosis, resulting in a large accumulation of immature leukocytes in the body and a significantly higher white blood cell count and enlarged spleen in the patient. Scientists for this genetic abnormality research of new drugs —- Imatinib Mesylate was launched in 2001, this is the first generation of tyrosine kinase inhibitors (TKI), the treatment of slow particles is a milestone progress, since then the development of the second and third generation of TKI, now more than 80% of patients taking TKI disease can be well controlled, can work and live normally, do not have to live in the disease accelerated Now more than 80% of patients taking TKI have good control of their disease and can work and live normally without the fear of accelerated disease and rapid changes.
In recent decades, the application of MICM typing technology for accurate diagnosis and treatment of leukemia has improved the prognosis of patients and eventually cured leukemia as well as gradually become a reality.
MICM typing technology is the use of cytomorphology (M), immunology (I), cytogenetics (C), and molecular biology (M) to find out which patients have a good prognosis and which have a poor prognosis, and which factors are good prognostic factors and which are bad, based on the medical records of a large number of patients. Based on these findings, patients were distinguished as having an excellent prognosis, low-risk, intermediate-risk, and high-risk types. Patients with very good prognosis and low risk can achieve 70-80% cure rate by standard chemotherapy or chemotherapy + immunotherapy alone; patients with intermediate risk can achieve 40-50% cure rate by standard chemotherapy and 60-70% by immunotherapy, or 70-80% by allogeneic hematopoietic stem cell transplantation if there is a sibling allogeneic donor. The cure rate of high-risk patients is very low even with standardized chemotherapy + immunotherapy, even less than 10%. It is recommended that patients should standardize chemotherapy in time, and at the same time, find a donor, reserve a space and have an allogeneic HSCT as early as possible, and the cure rate of transplanted patients can reach 50-60%.
Therefore, leukemia has long been not an incurable disease!
However, we are very sorry to see that there are still many patients who cannot get proper disease assessment and standardized typing treatment, wasting a lot of treatment cost and missing the best time for treatment. Even, individual patients who originally belonged to the very good prognosis type or low-risk type did not consolidate their treatment after chemotherapy remission or switched to Chinese medicine, resulting in the relapse of leukemia, which was re-evaluated to be high-risk!
Now is the era of precision medicine, only with the correct assessment of the disease can we know ourselves and our enemy, and we will never be in danger! The means of diagnosis and treatment have become very advanced and scientific, and the efficacy of treatment is not comparable to that of yesteryear. The key is how to choose and make decisions about diagnostic and treatment strategies, and how to find experts who implement precision medicine for diagnostic and treatment.