I. The main treatment for leukemia
The main treatments for leukemia are chemotherapy and stem cell transplantation.
Chemotherapy: It can make some of the acute leukemia patients obtain more than 3 years long-term survival rate, and part of the leukemia can be cured by chemotherapy. However, transplantation may currently be the only means of cure for most leukemias.
Hematopoietic stem cell transplantation (usually called bone marrow transplantation): there are autologous stem cell transplantation and allogeneic stem cell transplantation, of which allogeneic stem cell transplantation is the only way to cure leukemia.
How does chemotherapy for acute leukemia work? Is it very dangerous?
It is true that many people think chemotherapy is a very scary thing, but in fact, chemotherapy is administered by intravenous drip or intravenous injection, just like conventional medication. Unlike other tumors, chemotherapy for acute leukemia is risky because chemotherapy drugs kill leukemia cells as well as normal blood cells, so the period during and 3 weeks after chemotherapy is a dangerous period where patients may have infections, bleeding, anemia and even organ failure.
For example, to reduce the risk of infection, there are sterile laminar flow wards, broad-spectrum antimicrobials, etc. For anemia and bleeding, component blood transfusions can be given, etc. Therefore, the mortality rate associated with chemotherapy is currently reduced to less than 5%, and once the patient has passed the dangerous period, some patients can achieve remission and will be like normal people, so that life can be extended.
Third, how long does chemotherapy for acute leukemia take?
This is also a concern for patients and their families. If chemotherapy is chosen without transplantation, it usually takes 1-3 years (depending on the patient’s leukemia type, risk level, treatment, chromosomal and genetic alterations).
After diagnosis, 1-2 courses of induction remission chemotherapy are first given to achieve hematologic remission, followed by 3-4 courses of consolidation intensive therapy to achieve molecular genetic remission. The above is basically 1 at 4-week intervals, and later maintenance therapy is required for patients with acute lymphoblastic leukemia and some acute promyelocytic leukemia.
IV. Hematopoietic stem cell transplantation for acute leukemia?
People are not unfamiliar with bone marrow transplantation for leukemia from TV or newspaper reports, but furthermore, they do not understand it. Let me briefly discuss: bone marrow transplantation or hematopoietic stem cell transplantation is simply divided into autologous stem cell transplantation and allogeneic stem cell transplantation. The former is to isolate the patient’s own stem cells and transfuse them back to the patient after high-dose chemotherapy pre-treatment;
Allogeneic transplantation is the isolation of stem cells from other normal individuals, i.e., donors, and intravenous infusion to patients who have received high-dose chemotherapy pretreatment.
For most acute leukemias, allogeneic stem cell transplantation is the only possible cure; whereas autologous transplantation can only be used as a supportive therapy for high-dose chemotherapy for leukemia, and is curable for patients with standard or low risk.
V. Allogeneic stem cell transplantation What are the conditions required for treatment?
1.Firstly, it is clear that it is an indication for transplantation treatment, which is determined by the doctor according to the patient’s risk group, age and physical condition, generally the age limit is below 55 years old (there are also those who are a little older to do transplantation), and the organ function is normal.
2.A suitable stem cell donor is required.
3.Have a certain economic base.
4.Be psychologically prepared to take risks.
VI. Donor for allogeneic stem cell transplantation
The patient and the donor need to have their blood drawn for human leukocyte antigen or HLA antigen matching test, which is the key to successful transplantation because the difference of HLA antigen leads to immune rejection and graft-versus-host disease. Usually 6 loci of HLA are tested, and a match of 6 loci is considered a full match, while a mismatch of 1-3 loci is called a hemi-match.
The best preferred donor for allogeneic transplantation for leukemia is a sibling donor who is fully compatible with HLA antigens, and the chance of such a match is 1/4; the second choice is a non-related fully compatible donor, which requires a search for a donor in the bone marrow bank, but the chance is only 1/100,000. At present, there are more than 1 million voluntary donors in the bone marrow bank in China.
The development of allogeneic allogeneic transplantation is limited by the availability of donors, especially in the modern one-child era, where there are no siblings, and the chances of finding a donor in the bone marrow bank are low. Therefore, in recent years semi-compatible transplantation has been carried out both nationally and internationally, where each individual is HLA semi-compatible with his or her parents and children. Compared with full-phase transplantation, hemiphasic transplantation has heavy complications, slightly higher transplantation mortality and failure rate, but people are trying to study various improvement methods, because hemiphasic transplantation is compatible with our national conditions. With the continuous progress of medical science, I believe there will be more means of leukemia treatment and better efficacy. I hope that the majority of leukemia patients can get good treatment and very good results.