The treatment of leukemia includes chemotherapy, targeted therapy and hematopoietic stem cell transplantation. When regular chemotherapy is ineffective and targeted therapy fails, we consider this type of leukemia as relapsed refractory leukemia, and only allogeneic hematopoietic stem cell transplantation is the only possible cure for leukemia. However! The pressure and challenges faced by both the patient and the family and the transplant surgeon at this time are enormous.
The first is the psychological effect.
Patients and families at this point are often very knowledgeable about leukemia, knowledge that comes from the doctors he comes in contact with, and currently a part of the doctors believe that leukemia only has hope for transplantation after complete remission, and that transplantation cannot be done without remission, so patients and families think so too, and in this way they walk into a dead end, relapsed refractory leukemia = not in remission = not transplantable = death. Patients who think this way can only go to the end of their lives in confusion and despair.
The second reason is economic.
Patients who have reached this stage often undergo a lot of chemotherapy, mostly accompanied by infection, which consumes a lot of money, and transplantation in such patients costs more than doing A transplant in remission, so some patients would love to do a transplant, but no longer have the cost of transplantation.
The third is the pressure faced by the transplant surgeon.
1, the risk of transplantation increases, relapsed refractory patients experience a lot of chemotherapy, the organs function poorly, often accompanied by varying degrees of infection, so that during the transplantation process prone to organ failure and serious infection. Therefore, transplantation in relapsed refractory patients requires more effort and experience in dealing with various adverse events.
2. The risk of relapse after transplantation, the malignancy of relapsed refractory leukemia is very high, so it is easy to relapse after transplantation, which gives rise to two contradictions: (1) too strong pretreatment is prone to organ toxicity, while weak pretreatment is prone to relapse after transplantation; (2) too strong immunotherapy after transplantation can lead to life-threatening aggravation of graft-versus-host disease, while no immunotherapy or weak immunotherapy after transplantation may lead to relapse.
Therefore, allogeneic HSCT for relapsed refractory leukemia is a systemic project involving various aspects, and it is also the treatment that best reflects the transplantation technology and level. At present, allogeneic HSCT for relapsed refractory leukemia is still in the exploratory stage, but the only promising means to save patients’ lives!