Patient: I would like to ask, the patient has already done a course of chemotherapy, in preparation for the second chemotherapy, the doctor said the patient is in remission and does not need to do chemotherapy, it was said that it takes 4-5 times to be in remission, but now it is in remission in one time, I would like to ask, is there a mistake or what! What should we do next? The doctor suggested a transplant, but the family doesn’t have enough money, is there any other way besides a transplant?
Liu Jiajun, Department of Hematology, The Third Affiliated Hospital of Sun Yat-sen University: The patient’s disease is acute myeloid leukemia (AML-M1), after a course of remission (is it complete remission?) This is a very good chemotherapy effect. However, chemotherapy must be adhered to because even after complete remission, there are still a large number of leukemia cells (8-9 times 10) in the patient’s body, which are called residual leukemia and cannot be detected by conventional tests (e.g., blood tests, bone marrow, etc.), so chemotherapy must be adhered to to prevent relapse. If you have the conditions, you can undergo 2-3 intensive consolidation treatments after complete remission, followed by hematopoietic stem cell transplantation. If economic conditions do not allow, you must have chemotherapy (generally speaking, within the first year, chemotherapy is given once a month or so). As for the cost, because the price of drugs is not exactly the same for different programs, general programs such as HA, DA, etc. do not cost much if there are no complications such as infections. In addition, there is no herbal medicine found to be effective in treating M1.
Patient: Dr. Liu, hello, today my mother went to the laboratory, this is a doctor said remission of bone penetration report, we also can not read, and now the platelets rose so high, I would like to ask you to see, is it really remission. 1, there is nucleated cell proliferation is obviously active. The first is that the number of people who have been in remission is very high. Mature erythrocytes were of varying sizes, slightly underfilled with color, and triangular and polygonal were rare.4 The lymphocyte ratio and morphology were generally normal.4 No blood parasites or other special cells were seen.7 More than 1,000 megakaryocytes were seen in one myelogram, and platelets were scattered in piles.
Liu Jiajun, Department of Hematology, The Third Affiliated Hospital of Sun Yat-sen University: Simply put, complete remission (CR) means that the primitive cells in the bone marrow are less than 5%, the white blood cells in the peripheral blood and the classification are normal, and the hemoglobin and platelets are basically normal. From the information you provided, the granulocyte-red ratio is reduced (normal is 2-4:1) and the proliferation of granulocyte system is suppressed, which may be post-chemotherapy bone marrow suppression. Since the patient has acute granulocytic leukemia, this is theoretically a good thing. As for platelets, they all recover very slowly after chemotherapy. Elevated platelets are one of the manifestations of bone marrow hematopoietic recovery after chemotherapy, and under normal circumstances, a bone marrow slice can usually see 7-35 megakaryocytes, and if more than 1000 megakaryocytes are seen, this is rarely the case (is it 100?) . Currently, most routine blood tests are operated by machines, and the machines for blood cell tests generally count the smallest cell components in the blood as platelets (sometimes some cell fragments, etc., may also be recognized as platelets by the machine), so it is recommended that you do manual platelet counts. In addition, the chromosome test will not affect chemotherapy. The chromosome test can determine the disease and prognosis, and help in the selection of clinical treatment plan, etc.