Similar to antineoplastic drugs, antileukemic drugs can be divided into alkylating agents, antimetabolites, anthracyclines (antibiotics), alkaloids, hormones, and others, for a total of six categories.
1. Alkylating agents
Alkylating agents include cyclophosphamide, carmustine, and others. Cyclophosphamide is mostly used in post-remission treatment of acute lymphoblastic leukemia, but is often used as the primary pretreatment drug in bone marrow transplantation for leukemia. The main toxic effects are myelosuppression, alopecia, hepatic impairment, and hemorrhagic cystitis.
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2. Antimetabolites
- Mercaptopurine is mainly used in the maintenance treatment of acute lymphoblastic leukemia, with the main side effects being bone marrow suppression and liver damage. Combination with adriamycin may also increase toxicity to the liver.
- Thiopurine This drug is now used sparingly for post-remission treatment of acute lymphoblastic leukemia and also for the treatment of acute myeloid leukemia. Toxic effects are the same as those of mercaptopurine.
- Algocytidine One of the most important drugs in the treatment of acute leukemia, usually administered at the time of induction of remission, this drug crosses the blood-brain barrier and can also be administered intrathecally. Side effects are oral ulcers, alopecia, bone marrow suppression, and megaloblastic changes.
- Methotrexate One of the main drugs for the treatment of acute lymphoblastic leukemia, especially for central nervous system leukemia. Side effects are the same as those of cytarabine, but nephrotoxicity may occur at high doses, so serum methotrexate concentrations need to be monitored.
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3. Anthracycline antibiotics
The main drugs used to treat acute leukemia are erythromycin, doxorubicin, mitoxantrone, and aclarubicin, which are commonly used. The main side effect is cardiotoxicity.
Can manifest in two types:
- Dose-independent cardiac rhythm disturbances;
- Dose-related cardiomyopathy, characterized by low voltage and eventually leading to intractable low output cardiac failure.
4. Alkaloids
- Vincristine class Vincristine and vincristine are commonly used to treat acute lymphoblastic leukemia to induce remission. Vincristine must be administered intravenously, and spillage has strong tissue irritation. Toxic effects are mainly neurotoxic and can manifest as numbness in the hands and feet, especially sensory numbness at the fingertips.
- Triptansine is an important anti-leukemia drug first used in China, mainly for the treatment of acute myeloid leukemia. This drug has some cardiotoxicity, such as sinus tachycardia, myocardial damage, and complete right bundle branch conduction block can occur.
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5. Hormones
In the treatment of acute leukemia, the main applications are prednisone and dexamethasone in glucocorticoids. The main side effects are Cushing-like syndrome, hypertension, and diabetes mellitus.
6. Other
- Mentholatase Clinically used as an important drug in the treatment of acute lymphoblastic leukemia. This drug is toxic and can also increase blood ammonia, so it is contraindicated in people with poor liver function. A skin test must be done before application to prevent allergic reactions.
- Epigallocatechin includes etoposide (VP-16) and teniposide (VM-26), and the main side effects are bone marrow suppression and loss of appetite.
- Hydroxyurea In acute leukemia, it is mainly used in acute myeloid leukemia with abnormally high leukemic cells. In addition it is commonly used in the treatment of chronic granulocytic leukemia.