1. What kind of disease is leukemia?
A: Leukemia is a malignant tumor of the hematopoietic system. First of all, we have to figure out what is the hematopoietic system, so let me explain the hematopoietic system. Ordinary people know that our human body has eight systems, such as the digestive system, respiratory, cardiovascular, neurological, endocrine, urinary, reproductive and motor systems, but know little about the hematopoietic system and immune system, in fact, the hematopoietic system is also a major system of the human body, it is also called the blood system, including the bone marrow, the liver, the The hematopoietic system, also known as the blood system, includes the bone marrow, liver, spleen and other hematopoietic tissues and all the blood in the body. Blood has always been regarded as the “river of life”, is composed of formed fraction and invisible components, namely plasma, the so-called formed fraction refers to white blood cells, red blood cells and platelets, collectively known as blood cells, three kinds of blood cells have a certain number and function, for example, the normal number of human white blood cells is 4,000 to 10,000 (4-10 × 109/L), it mainly plays the body’s anti-infection function. It mainly performs the body’s function of fighting infection, the red blood cell count is 3.5 to 5.5 million (3.5 to 5.5 x 1012/L), whose role is to transport oxygen, and the platelet count is 100,000 to 300,000 (100 to 300 x 109/L), which plays the role of stopping bleeding.
Leukemia is the cancer of the hematopoietic system, also known as blood cancer by the people. As a cancer, leukemia also has the common characteristics of other systemic cancers such as liver cancer, such as the progressive and uncontrolled abnormal proliferation of cancer cells, therefore, leukemia is the progressive and uncontrolled abnormal proliferation of abnormal cancer cells in hematopoietic tissues such as bone marrow, and “almost simultaneously” from hematopoietic Of course, the function of the blood system itself is also impaired DD leukemia cells proliferate abnormally and inhibit the production of normal blood cells, so the number of three normal blood cells such as white blood cells in the blood decreases, thus producing the corresponding clinical manifestations. produce the corresponding clinical manifestations.
2. How is leukemia discovered and named?
A: Leukemia was first reported by a French doctor in 1827, when he described a 63-year-old florist with clinical manifestations of fever, fatigue, urinary calculi, and enlarged liver and spleen. The term “leukemia” (leukemia) was first coined in 1847 by a famous German pathologist named Rudolf Weilzau to refer to this disease, which means “white blood disease”. It is known that the color of human blood is red (this is the color of red blood cells, because the number of red blood cells in the three blood cells is much more than the other two cells), but the blood of such patients can be found after centrifugation and precipitation, there is a white sediment at the bottom of the tube, “looks like a sticky pus”, and even some patients’ blood does not precipitate, the color also looks white. This is due to the increase in abnormal white blood cells that are themselves “white” in color.
In fact, modern medical research shows that not all patients with “leukemia” have an increase in abnormal peripheral blood leukemia cells at the time of initial diagnosis, and about 10% of patients have only a few leukemia cells in their blood, called subleukemic leukemia; or even no leukemia cells, called non-leukemic leukemia. Of course, sub (non-) leukemic leukemia can change to a so-called classic leukemia with increased white blood cell counts as the disease progresses. Therefore, the name “leukemia” does not describe all patients with this disease, and strictly speaking, the name “leukemia” is not accurate.
Nowadays, people are afraid of talking about cancer and know that cancer is malignant and “nine out of ten cancers are fatal”. In medicine, there is an accepted naming principle for neoplasm, that is, benign tumors are called “tumor” and generally named by “site or organ or tissue + tumor”, such as lipoma. As for malignant tumors, those originating from epithelial tissues are collectively called “carcinoma” and are named by “site or organ or tissue + cancer”, such as gastric cancer, squamous cell carcinoma, adenocarcinoma; those originating from mesenchymal tissues are called “sarcoma” (sarcoma). “sarcoma” (sarcoma), such as smooth muscle sarcoma, fibrosarcoma. Hematopoietic tissue belongs to mesenchymal tissue, according to the above naming principle, malignant tumor of hematopoietic system or hematopoietic tissue should be called “hematopoietic sarcoma” or “leukocytic sarcoma”, but leukemia, as a malignant tumor from mesenchymal tissue, is not named according to this However, leukemia, as a malignant tumor of mesenchymal tissue origin, is not named according to this principle, but because of the customary name, doctors are used to the word “leukemia” and do not change it. However, in special cases, leukemia cells sometimes form “tumor masses”, which are greenish in color and are commonly known as “chloroma” or “chloroleukemia”. This is commonly known as “chloroma” or “chloroleukemia”. However, it also has a formal name “myeloid sarcoma” or simply “granulocytic sarcoma”, the latter two being its proper names. In addition, incidentally, there are several hematologic malignancies, such as lymphoma, multiple myeloma, and myelodysplastic syndrome, which are not named according to the above nomenclature principles. This is a more specific aspect of hematologic diseases as far as nomenclature is concerned.
3. What is the incidence of leukemia?
A: Leukemia is one of the top ten cancers that Chinese people are susceptible to, with men ranking 6th and women ranking 8th. However, it is especially important to emphasize that the incidence of leukemia is at the top of childhood cancers. According to the epidemiological survey in China in the 1980s, the annual incidence rate of leukemia in China was 3 per 100,000, with more than 40,000 new leukemia patients each year, of which children accounted for 50%, with children aged 2 to 7 years old being the majority. The current incidence of leukemia in China is certainly higher than this figure. Generally speaking, the incidence of leukemia in developed countries is higher than in less developed countries, for example, the United States reported more than 30,000 and 800 new cases of leukemia in 2000, while in 2008 there were more than 44,000 new cases of leukemia, considering that the population of the United States did not exceed 300 million in 2000, so the annual incidence of leukemia in the United States is much higher than in China, up to 10 per 100,000, and it is also rising. The incidence is higher in urban than in rural areas, and the incidence is significantly higher in oil fields and polluted areas. In addition, the incidence of leukemia also tends to increase with age. The peak age of onset of most leukemia types is after 50 years of age, except for acute lymphoblastic leukemia, which has a high incidence before the age of 10, especially in children aged 2-7 years.
4. What are the causes of leukemia?
A: “Doctor, what causes this disease in me?” This is one of the most common questions asked by patients, and also the most difficult for doctors to answer, but also the most important problem that medical doctors want to figure out, and also the most important problem that academics have invested in human and material resources to solve, because as long as we know the cause of a disease, we can start to prevent it, “the doctor does not treat the disease to cure the disease”. When it comes to the cause of leukemia, “the cause of leukemia is not known” is how medical textbooks have traditionally started, but the authors believe that this statement may be true for some specific patients, because some factors have been found to definitely cause leukemia, which are called risk factors in etiology. factor, and the risk factors associated with the development of leukemia include biological, physical, chemical, genetic, and immunological. Please listen to my detailed explanation.
First, biological factors. It is the virus. In addition to humans, some animals such as chickens, cats, cows and mice get leukemia, and the virus that causes leukemia can be isolated from leukemic tissue in these animals. In humans, it is now certain that a virus called human T-cell leukemia virus-1 (HTLV-1) can cause adult T-cell leukemia (ATL).
Second, physical factors. That is ionizing radiation, including alpha, beta, gamma and x-rays and neutrons. Let me give a few examples. The atomic bombing of Hiroshima, Japan, resulted in a significant increase in the incidence of leukemia among the local population. One study found that the incidence of leukemia was also high among radiologists when protection was previously poor. In the early 1990s the UK and Germany reported frequent leukemia in children around nuclear power plants. Patients receiving radiation therapy, such as a rheumatoid disease DD ankylosing spondylitis, had an increased incidence of leukemia after receiving radiation therapy.
Therefore, the radiation mentioned above is identified as a class I carcinogen by the International Agency for Research on Cancer (IARC), which is affiliated with the World Health Organization (WHO), and can certainly cause leukemia, but only up to a certain dose, and it varies from person to person as to how much dose will cause leukemia. The general public may be very concerned about whether the diagnostic irradiation that we do during hospital checkups, such as taking chest X-ray and CT, can cause leukemia. My answer is that there is no clear evidence to confirm that taking a single film increases the chance of getting leukemia, but I would suggest that such tests be done as little as possible and not at all if you can.
Third, chemical factors. This includes chemicals and poisons. First is benzene and its derivatives. Benzene is also classified by IARC as a class I carcinogen and can certainly cause leukemia. Benzene is widely used in a variety of industries, it is a basic petrochemical raw material and an organic solvent, light tar produced during coal coking contains large amounts of benzene, benzene is used as a gasoline additive, benzene is contained in decoration materials and hair dyes, and benzene is also present in cigarette smoke. In nature, even volcanic eruptions and forest fire hazards can produce benzene. It can be said that benzene is everywhere, just how much is different.
Next is formaldehyde, which is often referred to as formalin. formaldehyde was designated as a class I carcinogen by IARC in 2004 and can cause leukemia. The National Cancer Institute (NCI) reported in 2008 that funeral home employees, anatomists, and pathologists are susceptible to leukemia because they have to be exposed to formalin for long periods of time. Decoration materials also contain formaldehyde, and many children with leukemia occur as a result of home renovations.
Once again, alkylating agents and cytotoxic drugs, that is, chemotherapy drugs, such as the alkylating agent cyclophosphamide is the main drug of chemotherapy for breast cancer, and breast cancer patients have an increased incidence of leukemia after chemotherapy. I have seen many patients with breast cancer chemotherapy followed by secondary leukemia. Patients with Hodgkin’s lymphoma (HL) treated with alkylating agent nitrogen mustard chemotherapy have an exponentially increased chance of developing secondary leukemia. Patients with cancer treated with cisplatin and onychotoxins such as etoposide also have an increased chance of developing leukemia. In addition, chemotherapeutic agents that can cause secondary leukemia include alkylating agents such as mafenamic acid and anthracyclines
There are also drugs for psoriasis such as etidiumorphine that can also lead to leukemia.
Fourth, genetic factors. It can be said that leukemia is not a genetic disease and will not be inherited. However, in the case of monozygotic twins, if one person has leukemia, the chance of the other person having leukemia can be as high as 20 percent. Certain hereditary diseases have a higher chance of developing leukemia than normal people, such as congenital stupidity, a genetic disease better known to the general public, are prone to leukemia.
Fifth, the immune factor. It is a person’s immune status that determines his or her susceptibility to leukemia. You may ask why some people in the same environmental conditions suffer from leukemia while others do not. this involves a person’s resistance to disease, in layman’s terms, a person’s physical quality. the IARC has classified immunosuppressants such as cyclosporine A and azathioprine as a class of carcinogens, a class of drugs that can damage the body’s immune system and lead to a decline in immune function. Philosophically speaking, external factors work through internal factors, so the external factors that cause disease can only play their disease-causing role if the internal factors are damaged and it has a weakness to take advantage of. This coincides with the Chinese medicine that “the righteousness of the internal, the evil can not dry”. Therefore, I believe that the high pressure of people’s survival today, the body is often overdrawn, resulting in a decline in the body’s immunity, the “righteousness” is damaged, which is one of the important reasons for the increased incidence of leukemia. For this reason, we need to change our bad lifestyle, quit smoking and limit alcohol, strengthen exercise, and improve our physical quality.
The immune system has been mentioned twice before, so I will briefly talk about it in this paragraph. The body’s immune system, commonly known as the “body’s defense system”, is a major system of the human body that is relatively unknown to the general public, just like the “hematopoietic system”. In fact, the development of immunology has witnessed the rapid development of medical science, and many scientists were awarded the Nobel Prize in Physiology and Medicine for their research on the immune system, and the breakthroughs in the study of the immune system have led to many medical revolutions. Leukemia patients can now be cured by bone marrow transplantation thanks to innovative discoveries and continuous progress in the field of immunology research on “human leukocyte antigens”. Whether it is the composition and function of the hematopoietic system and the immune system, or their pathology, disease and disease diagnosis and treatment, the two systems are inextricably intertwined and overlapping. Therefore, hematologists must have knowledge of immunology. The importance of the human immune system should also be fully appreciated by physicians, normal people and leukemia patients alike.
In conclusion, leukemia is the result of a combination of causes, and it is difficult to determine what the exact cause of each case of leukemia is. However, I need to emphasize that with the industrialization of China, various kinds of pollution such as food pollution, decoration pollution, environmental pollution including water and air pollution are not unrelated to the current increase in the incidence of leukemia and deserve the attention of all parties.
Moreover, I would like to advise smokers especially solemnly: “Smoking can certainly lead to leukemia” “Smoking has a hundred harms but no benefit”; for the sake of your own health and the health of others, please be sure to quit smoking from now on! Nowadays, the environment around us has deteriorated to the extent that we are suffocating, are you still complaining about the deterioration of the environment while you continue to “smoke”? Do not give yourself and others a fresh environment!
In clinical care, I have seen many families of leukemia patients who are suffering from the disease because their sons, daughters, fathers or mothers are in pain, hoping for the early recovery of their loved ones, but they themselves are “relaxed” in the ward or wherever they are, swallowing fumes, not knowing that “quitting smoking and stopping passive Smoking is better than a panacea”. You know, you quit smoking, persuade your family or others to quit smoking, is our own ability and merit of good deeds, in today’s China’s tobacco era, can also be a feat. About the relationship between tobacco and leukemia or even blood diseases, I will introduce in another article.
5. What are the clinical manifestations of leukemia?
A: I have already said, leukemia is a cancer of the hematopoietic system, is the hematopoietic cells in the bone marrow and other hematopoietic tissues have become malignant, into leukemia cells, progressive, uncontrolled abnormal proliferation, leukemia cells first in the hematopoietic system, with the blood circulation and then rapidly diffuse to various organs throughout the body, the body’s immune system and other eight system function is impaired, the relevant leukemia Clinical manifestations.
First of all, in the blood system itself, the leukemia cells, as cancer cells, are taking advantage of the body’s nutrition and have the advantage of proliferation, thus inhibiting the production of normal blood cells and reducing the number of the three types of normal blood cells in the blood. Because leukocytes are responsible for the body’s resistance to infection, the patient’s resistance to infection decreases after leukopenia, and as a result, the patient develops various infections, viral, bacterial, and even mycotic infections, which manifest as fever and symptoms of infections in various areas such as the respiratory tract. Red blood cell reduction can lead to anemia and pallor in patients because red blood cells are for transporting oxygen and as a result, patients will experience symptoms of oxygen deficiency such as dizziness, panic, shortness of breath, lack of energy, and fatigue. Because platelets are hemostatic, thrombocytopenia can cause patients to bleed in various ways, such as skin bleeding spots, nose bleeding, gum bleeding, etc.
Secondly, the blood circulation of human body can make leukemia cells spread rapidly to all major systems and various organs of the body, which is medically known as the infiltration manifestation of leukemia, such as enlarged liver and spleen, enlarged lymph nodes, which can lead to abnormal liver function and reduced immune function; infiltration into the nervous system can cause headache, neck straightness, even limb paralysis and other neurological manifestations; infiltration into the bone and joint system can lead to bone pain, joint pain, and misdiagnosis as rheumatism; misdiagnosis as rheumatism; misdiagnosis as rheumatism. Infiltration into the respiratory, digestive and urinary systems may cause diffuse or nodular changes in the lungs, pleural effusion, digestive disorders, proteinuria and hematuria; infiltration into the reproductive system may cause swollen and painful testicles in men and amenorrhea or excessive menstruation in women; infiltration into the skin, orbit, lacrimal gland and fundus of the eye may cause skin nodules, lumps, maculopapular rash and eye Patients may develop skin nodules, lumps, maculopapular rash, and symptoms such as protrusion of the eye and loss of vision.
Thus, infection, anemia, hemorrhage, and infiltration are the “four clinical manifestations” of leukemia. However, the clinical manifestations of leukemia can vary widely depending on the individual patient.
6. How is leukemia diagnosed?
A: The diagnosis and subsequent treatment of leukemia should be made by a hematologist in a hematology specialty. Based on the above-mentioned manifestations, after the consultation and physical examination, the doctor will first test the patient’s blood, and if changes in the number of three blood cells are found, further blood tests will be conducted and bone marrow tests will be drawn. Finally, when all kinds of data, especially the bone marrow test results, are analyzed together, a diagnosis of leukemia can be made as long as the leukemic cells account for 20% or more of the nucleated cells in the bone marrow.
There are two points that I would like to emphasize here. Routine blood tests (blood analysis by automated blood cell analyzer) can show the number of the three types of blood cells, red blood cells and platelets are generally reduced in patients with acute leukemia, but the number of white blood cells is increased in most patients and reduced in only a few patients because the leukemia cells are divided by the machine inside the white blood cell count. Another point is that some friends are afraid of bone marrow aspiration, thinking that it will “hurt” and be harmful to the body. Just think, bone marrow donors even have to donate hundreds of milliliters of bone marrow to others, and so far there have been no reports of sequelae, but the ordinary bone marrow examination only takes a few milliliters of marrow smear, so this examination is a routine examination in the hematology department, just like the ultrasound examination in the liver and gallbladder department, and it is absolutely harmless to the body.
7. How is leukemia classified?
A: Since leukemia was first reported in 1827, medical doctors have been studying leukemia for nearly two hundred years and have been trying to reveal the nature of leukemia, and have put forward various classifications. It is a heterogeneous group of diseases that includes many subclasses and subtypes. It can be said that each time a new classification is proposed, it is a further insight into the nature of leukemia as a disease. Since this is a general introduction for the general public, I will mention here only four simpler classifications.
First, leukemia can be divided into acute leukemia and chronic leukemia. This is based on the course of leukemia, that is, leukemia patients who do not receive any treatment, generally within 6 months of death is called acute leukemia, if you can live more than 6 months is chronic leukemia, as you can see, this is the earliest classification proposed at the beginning of leukemia research. As you can see, this was the first classification proposed at the beginning of leukemia research. Later studies found that the tumor cells of acute leukemia were poorly differentiated, while the cells of chronic leukemia were relatively highly differentiated, so the classification reflected the nature of the disease and was therefore retained.
Second, acute leukemia can be divided into acute lymphoblastic leukemia (ALL) and acute non-lymphoblastic leukemia (AML). In children, acute lymphoblastic leukemia is prevalent, with common enlargement of the liver and spleen, lymph nodes, and painful bone and joint swelling.
Third, it was first proposed by French, American, and British hematologists in 1976 and subsequently revised several times, and is called the FAB classification. This classification divides acute lymphoblastic leukemia into three subtypes, L1, L2 and L3, and acute non-lymphoblastic leukemia into M0, M1, all the way to M7, for a total of eight subtypes.
Fourth, leukemia is divided into primary and secondary leukemia according to whether it has a clear cause.
The so-called primary leukemia means that the cause of the disease is unknown, which contains two meanings: first, the cause cannot really be found; second, although the cause is unknown, there is actually a cause, but it is difficult to find out the cause retrospectively, and it should be said that the majority of primary leukemia belongs to the latter type.
Secondary leukemias are those that have a clear cause or antecedent, and include at least three types of cases: first, those caused by chemotherapy drugs such as cyclophosphamide, which I mentioned earlier; second, those that occur after radiation therapy; and third, those caused by myelodysplastic syndrome (MDS), a malignant condition once called “pre-leukemia” (preleukemia). preleukemia), and myeloproliferative neoplasms (MPN) such as primary thrombocythemia (ET). In general, the elderly are more prone to secondary leukemias, which have a worse prognosis than primary leukemias. Of course, the WHO classification is more complex (requiring MICM testing for clarity, as detailed below) and is now becoming accepted by a wide range of hematologists worldwide.
The leukemia classification is an important foundation and basis for the treatment of leukemia. When leukemia patients first develop, they must be examined as comprehensively as possible for MICM classification, meaning that blood bone marrow cytology (including histochemistry, the first M), immunophenotyping (I), cytogenetics (i.e. chromosome examination, C) and molecular biology (the second M), also known as stratified diagnosis, should be performed to allow for individualized treatment later.
For example, a more precise assessment of AML risk and prognosis based on cytogenetic (C) and genetic mutation (second M) profiles, divides AML risk into three groups: low, intermediate and high risk, with different molecular genetic profiles, respectively. low risk group: karyotype inv(16), t(8;21) without 9q- or complex karyotype and t(16;16), molecular mutation with normal karyotype with NPM1 mutation alone. Intermediate risk group: normal karyotype, +8, -Y, t(9;11) and other karyotype bad and poor groups (<3 abnormalities) with molecular mutations as c-kit mutations in t(8;21) or inv(16). High-risk group: -5/5q- or -7/7 q-, t(8;21) with 9q- or complex karyotype, inv(3q), 11q23 abnormalities, 20q, 21q, 9q-, t(6;9), t(9;22), 17p abnormalities and complex karyotype (≥3 aberrations) with molecular mutations as normal karyotype with separate FLT3 mutations.
The clinical prognosis of patients in the low-risk, intermediate-risk and high-risk groups differed significantly, and individualized treatment based on the above risk stratification could avoid under- or over-treatment.
For patients in the low-risk group, high-dose cytarabine-based intensive chemotherapy or autologous stem cell transplantation can be used after induction of remission to improve relapse-free survival and mortality. Sibling-to-sibling stem cell transplantation can also be performed for low-risk patients if a fully compatible sibling donor is available.
For intermediate-risk and high-risk patients, due to the presence of residual leukemia cells in the body after remission, it is best to perform allogeneic stem cell transplantation after induction of remission, with allogeneic stem cell sources available: sibling allogeneic bone marrow, unrelated donor stem cells (from Chinese bone marrow bank or Taiwan bone marrow bank), umbilical cord blood stem cells (single or double), semi-identical related stem cells (parents, children or siblings), and for some intermediate-risk patients who really cannot find a donor High-dose chemotherapy plus autologous stem cell transplantation is also possible for some patients in the intermediate risk group for whom no donor can be found. However, for patients in the high-risk group who are prone to relapse, it is best to implement allogeneic stem cell transplantation as soon as possible after remission.
8. How is leukemia treated?
A: As the general public knows, cancer treatment includes surgery, chemotherapy and radiotherapy. For example, for gastric cancer, surgery is considered first to remove it, and if it is early, it can be cured by surgery alone. So is the treatment for leukemia as cancer the same? I say that there is also a special place for the treatment of leukemia. Since the hematopoietic system consists of hematopoietic tissues such as bone marrow and the blood that circulates throughout the body all the time, cancer cells in hematopoietic tissues appear in the blood circulation almost simultaneously, plus only after three kinds of normal blood cells are reduced to a certain level, patients show physical symptoms and seek medical treatment, and at that time the leukemia cells in the patient’s body are usually as high as 1012 (100 billion, about 1 kilogram in weight), therefore Generally speaking, leukemia patients are already at an advanced stage when they are found, so in medicine, there is no distinction between early and late stages of leukemia, which is also called “liquid tumor” to distinguish it from other systems of “solid tumor” that are confined to one organ tissue at an early stage. It is also known as “liquid tumor” to distinguish it from other systemic “solid tumors” that are confined to one organ tissue in early stages.
It is clear from the above that leukemia cannot be treated surgically. However, leukemia cells are sensitive to chemotherapy, which circulates throughout the body after administration and kills leukemia cells everywhere, so chemotherapy, referred to as chemotherapy, is one of the main treatments for leukemia. In general, even bone marrow transplants are administered after the patient has achieved “complete remission” (CR) through chemotherapy. Leukemia cells are also sensitive to radiation, and radiation therapy, referred to as radiotherapy, is generally used for bone marrow transplantation and less often alone because leukemia is a systemic disease (in addition, radiotherapy is only used in conjunction with chemotherapy to treat specific areas of leukemia, such as cerebral white, testicular white, and the green tumors mentioned above).
I mentioned above the concept of “complete remission” (CR), which means that the percentage of leukemic cells has dropped to less than 5% of the nucleated cells in the bone marrow, the patient has recovered three normal blood cells, and the infection, anemia, bleeding, and However, the number of leukemia cells in the patient’s body at this time is still 108 (100 million), so the patient still needs to undergo a longer period of post-remission chemotherapy, each course of which kills part of the cancer cells and, as the patient’s immune function recovers, relies on the body itself to clear the residual cancer cells, and if chemotherapy is stopped in the middle, the patient will relapse at any time, so that the previous treatment is abandoned.
Chemotherapy for leukemia must be administered with a variety of different drugs in accordance with certain rules, called “combination chemotherapy”. For example, acute non-lymphoblastic leukemia is usually treated with a short course of two or three drugs, while acute lymphocytic leukemia is treated with a long course of four or five drugs.
Chemotherapy drugs do not have long eyes, it can kill cancer cells, but also can harm normal blood cells and other cells, so leukemia chemotherapy has considerable side effects, such as vomiting, there are now Western drugs with strong antiemetic effect, so Western medicine has better solved this problem, but, as I have said, the reason why leukemia patients suffer from leukemia, a patient’s own problem is a low immune system, coupled with chemotherapy In addition, chemotherapy can cause further damage to the patient’s immune function, in this regard, we have the theory and practice of “supporting the righteous and dispelling the evil” in Chinese medicine, that is, while “dispelling the evil”, the patient as a whole, to support their “righteousness “to improve their immunity. In addition, Chinese medicine has various roles in the treatment of leukemia.
(1) Some herbal medicines can promote the transformation of leukemia cells to normal cells, that is to say, make the leukemia cells change from evil to righteous, thus making the treatment of leukemia achieve a good efficacy.
(2) Discriminatory use of herbal medicines can counteract other side effects of chemotherapy, promote the recovery of cell functions of mucous membrane cells of the digestive tract, heart, liver, kidney and other organs damaged by chemotherapy, protect hair follicle cells and reduce hair loss.
(3) It protects bone marrow to restore normal hematopoietic function, prevents severe bone marrow suppression caused by chemotherapy drugs, reduces blood transfusion and alleviates bleeding.
(4) Chinese medicine with chemotherapy can increase chemotherapy sensitivity.
(5) Reversing drug resistance and restoring the sensitivity of leukemia cells to chemotherapeutic drugs.
(6) Chinese herbal medicine can also play an important role in combating microscopic residual disease. To eliminate residual leukemia cells, it is necessary to use a combination of herbs that improve the body’s immunity and anti-leukemia, because the body’s normal immune function can control or eliminate residual leukemia cells when the total number of leukemia cells is below 106 (million).
It can be seen that the use of combined Chinese and Western medicine in the treatment of leukemia can give full play to the respective advantages of Chinese medicine and Western medicine, complementing each other’s strengths to achieve better clinical efficacy.
It is because chemotherapy is not specific for killing leukemia cells that a large number of new specific therapies have emerged in the field of Western medicine so far, such as Gleevec (imatinib mesylate, tyrosine kinase inhibitor) targeted therapy for chronic granulocytic leukemia (CML), Meroval (rituximab, anti-CD20) immunotherapy for chronic lymphocytic leukemia (CLL), Campas (alemtuzumab, anti-CD52 ) immunotherapy for B-cell CLL (B-CLL) and T-cell lymphocytic leukemia (T-PLL), among others.
The place of hematopoietic stem cell transplantation in the treatment of leukemia is unquestionable. Even with Gleevec and second and third generation tyrosine kinase inhibitors for targeted specific therapy, allogeneic transplantation is still the only recognized cure for chronic granulocytic leukemia. Hematopoietic stem cell transplantation has been perfected and is a systematic project that organically integrates the above-mentioned chemotherapy, radiotherapy and immunotherapy techniques.
9. How is leukemia monitored and followed up?
A: As leukemia treatment becomes more and more effective and long-term survivors become more and more numerous, monitoring and follow-up of leukemia patients becomes more and more important, which is an area that needs to be improved in the current hematology community and is also an area that is easily overlooked by the families of leukemia patients. Here, I would like to remind that when leukemia patients are first diagnosed, they should be examined as comprehensively as possible to achieve MICM classification and capture specific markers (specific markers) of abnormal leukemia cells for later monitoring of micro residual disease (MRD) using flow cytometry and molecular biology techniques for timely management and prevention of recurrence. In general, leukemia patients need to be followed up for 3 to 5 years, and if they have not relapsed for 5 years, they can be said to be cured.
10. What is the prognosis of leukemia?
A: Before answering this question, please allow me to talk about my own personal experience. Once I was traveling on a train, and as a stranger in the carriage, I happened to overhear a conversation between two adult passengers whom I did not know, one of whom said, “I had leukemia when I was a child,” and the other immediately responded that he also had leukemia when he was a child. The other one immediately responded that he also had leukemia as a child, and of course both of them have been cured of their leukemia. It is clear that although leukemia is a malignant disease of blood-forming tissue, it is by no means an incurable disease! Due to the development of medical technology and the gradual increase in remission rates, leukemia has become a treatable disease and is not terrible. Through aggressive chemotherapy, Chinese herbal medicine, hematopoietic stem cell transplantation (radiotherapy), targeted therapy, immunotherapy and other comprehensive treatments, it has been possible to prolong the survival of more than 70% of patients, and 40% to 60% of patients can be cured.
The clinical prognosis of patients in the low-risk, intermediate-risk and high-risk groups is significantly different, and individualized treatment based on the above risk stratification can avoid under- or over-treatment.
For patients in the low-risk group, high-dose cytarabine-based intensive chemotherapy or autologous stem cell transplantation can be used after induction of remission to improve relapse-free survival and mortality. Sibling-to-sibling stem cell transplantation can also be performed for low-risk patients if a fully compatible sibling donor is available.
For intermediate-risk and high-risk patients, due to the presence of residual leukemia cells in the body after remission, it is best to perform allogeneic stem cell transplantation after induction of remission, with allogeneic stem cell sources available: sibling allogeneic bone marrow, unrelated donor stem cells (from Chinese bone marrow bank or Taiwan bone marrow bank), umbilical cord blood stem cells (single or double), semi-identical related stem cells (parents, children or siblings), and for some intermediate-risk patients who really cannot find a donor High-dose chemotherapy plus autologous stem cell transplantation is also possible for some patients in the intermediate risk group for whom no donor can be found. However, patients in the high-risk group are prone to relapse and it is best to perform allogeneic stem cell transplantation as soon as possible after remission.