1. Is the incidence of M3 leukemia high?
A: The incidence rate is not high, accounting for about 10% of acute myeloid leukemia, with about 3 people per 1 million population.
2.Is M3 leukemia hereditary and contagious?
A: No, it is not hereditary and not contagious.
3.Can M3 leukemia be cured?
A: M3 is the best of all leukemias and can be cured without bone marrow transplantation, with a cure rate of over 90%. The recurrence rate is about 5-8%. Central nervous system leukemia (leukemia cells invading the brain) is the main cause of relapse.
4.What is the basis for risk classification of M3 leukemia?
According to the onset (when there is no treatment) leukocytes and platelets are classified as low risk, intermediate risk and high risk.
High risk: white blood cells greater than 10,000
Intermediate risk: white blood cells less than 10,000 and platelets less than 40,000
Low risk: white blood cells less than 10,000 and platelets greater than 40,000
5.What are the differences in treatment methods and efficacy for M3 patients with different risk levels?
A: Treatment plan for high-risk patients: induction regimen of retinoic acid + chemotherapy (foreign), or retinoic acid + arsenic + chemotherapy (domestic); more than 90% of patients achieve complete remission in about 1 month (mortality rate of 5-10% in 1 month). Afterwards, they receive 3 courses of consolidation chemotherapy, and then enter a 1-2 year maintenance phase of treatment. Eradication rates for these regimens range from 85-90%.
Regimens for intermediate-risk and low-risk patients.
Preferred: induction regimen vincristine + arsenic (without chemotherapy) (foreign and domestic), with approximately 97% or more patients achieving complete remission in about 1 month (mortality rate of approximately 3% within 1 month), followed by 7 months of consolidation therapy (vincristine taken for 2 weeks every month for 7 months; arsenic 10 mg/day for 4 weeks with 4 weeks off (equivalent to 28 days every other month, 4 times). The total duration of treatment was 8 months at the end. The eradication rate of this regimen is over 95%.
There are also options: induction retinoic acid + chemotherapy (foreign and domestic); or retinoic acid + arsenic + chemotherapy (domestic); followed by 3 courses of consolidation chemotherapy and then a 1-2 year maintenance treatment phase. The eradication rate of these programs is around 95%.
6.Can oral arsenic (compound Huang Dai tablets) replace intravenous arsenious acid?
A: Yes, with the same efficacy and lower toxicity. In October 2007, the Institute of Hematology of Peking University organized a multicenter prospective randomized controlled trial of oral arsenic (Huang Dai Tablets) and intravenous arsenic (arsenious acid) in the treatment of acute promyelocytic leukemia in 7 hematology centers across China. Patients were randomly assigned (1:1) to receive either oral cotrimoxazole tablets (60 mg/kg) or intravenous arsenious acid (0.16 mg/kg) in combination with retinoic acid (25 mg/m2) during induction therapy. After achieving complete remission (CR), all patients received three courses of consolidation chemotherapy followed by 2 years of sequential maintenance treatment with vincristine and either cotrimoxazole or arsenious acid. The median follow-up period of the study was 39 months. There were no significant differences in remission rates (99.1% and 97.2%) or 3-year overall survival rates (99.1% and 96.6%) between the oral and intravenous arsenic groups. The incidence of adverse events was similar in both groups. CONCLUSION: Oral arsenic in combination with retinoic acid is not inferior to intravenous arsenic in combination with retinoic acid regimens for the first-line treatment of patients with APL, and therefore can be considered as a routine treatment for applicable patients.
7. Is there any regimen that does not require chemotherapy, no infusion, no hospitalization, less costly and highly effective?
This is the most desired treatment for all patients and doctors, and currently only Dr. Hongwan, the main doctor of Peking University People’s Hospital, has conducted research in this field internationally. This study was published in the New England Journal of Medicine, the highest international medical journal, and it is the second research article published in this journal in the history of hematology in mainland China (the first one also had Hongwan as the first author). For low to intermediate risk M3 patients, only two oral drugs (retinoic acid and compound huangdai tablets) were used and the treatment course ended in 8 months without lumbar puncture. 20 consecutive patients were treated from 2013 to 2014, 10 patients were not hospitalized (closely observed in outpatient follow-up) and all patients reached complete remission in 1 month and the treatment ended in 8 months. All patients were monitored for PML-RARA, a leukemia-specific gene, and turned negative. All patients are now alive and the average cost of all treatment is more than $50,000 (the first case cost at least $20,000, when the compound Huang Dai tablets were $580/box). Since 2014, we have added 112 patients to our observation at various centers within the United Nations, and so far, there have been 3 early deaths and all other patients have achieved remission, genetic conversion, and no genetic conversions or hematological relapses. Further validation of our earlier findings. It is a very promising new program, but because the observation time is not too long, we need to observe for about 1-2 years before we can draw a conclusion.
8. Why is the “new M3 regimen with no chemotherapy, no infusion, and only two oral drugs for 8 months” not popular?
A new regimen must stand the test of time, and we cannot draw a final conclusion until we have observed it for more than 2 years, although the results are very good now and we are still closely observing it. The biggest advantage of this program is the convenience, after 1 month of treatment you can work, study and live normally, without the need for hospitalization with infusion and family members, and the total cost of more than 50,000 yuan on average is significantly lower than other programs, even if the out-of-pocket expenses are not reimbursed the average family can afford to pay. This treatment method is ideal for an average family. In the future, this program will gradually spread.
9. Which patients need allogeneic transplantation?
A. The following cases can be considered.
1. standard regular treatment (those who have not discontinued drugs on their own) with ≥ 2 hematological relapses.
2, the standard regular treatment (no self-discontinued) hematological relapse ≥ 1, after the autologous transplantation of molecular conversion of positive
10.Is the incidence of “brain white” high? Is it easy to treat?
”It is basically very rare when you first get the disease, but about 1/3-1/2 of the relapsed patients are relapsed cerebral white, once it happens, you have to lumbar puncture intrathecal injection of chemotherapy drugs, which must be eradicated, otherwise it will be very difficult to treat repeated relapses. For the lumbar puncture intrathecal injection of chemotherapy drugs is not effective, radiation therapy can be carried out. Now there is a new method, the efficacy is very good. It is retinoic acid + mannitol (arsenious acid before infusion) + arsenious acid, mannitol can make the arsenic agent into the brain drug volume increased significantly, the efficacy is very significant.