Leukemia treatment options

Because leukemia classification and prognosis stratification are complex, there is no one-size-fits-all treatment method, and it is necessary to combine careful classification and prognosis stratification to formulate treatment plans. At present, there are mainly the following types of treatment methods: chemotherapy, radiotherapy, targeted therapy, immunotherapy, stem cell transplantation, etc.

Through reasonable comprehensive treatment, the prognosis of leukemia has been greatly improved. A considerable number of patients can be cured or long-term stable. The era of leukemia as an “incurable disease” has passed.

It is usually necessary to first carry out combination chemotherapy, so-called “induction chemotherapy”, commonly used DA (3 + 7) scheme. After induction therapy, if remission is achieved, further intensive consolidation chemotherapy or stem cell transplantation procedures can be continued according to the prognostic stratification arrangement. After consolidation treatment, maintenance treatment is usually not performed at present, and the drug can be stopped for observation and regularly followed up.

Due to the success of targeted therapy and induced apoptosis therapy, PML-RARα positive acute promyelocytic leukemia (M3) has become the best prognostic type in the entire AML. More and more studies have shown that all-trans retinoic acid combined with arsenic treatment can cure most patients with M3. The treatment needs to be carried out strictly according to the course of treatment, and the length of the maintenance treatment in the later period is mainly determined by the residual condition of the fusion gene.

Induction chemotherapy is usually performed first, and there are differences in the commonly used schemes between adults and children. However, in recent years, studies have suggested that the results of using children’s regimens to treat adult patients may be better than traditional adult regimens. After remission, it is necessary to insist on consolidation and maintenance treatment. High-risk patients have the conditions to do stem cell transplantation. Patients with Ph1 chromosome positive are recommended for treatment with tyrosine kinase inhibitors.

In the chronic phase, tyrosine kinase inhibitors (such as imatinib) are the preferred treatment. It is recommended to treat them as soon as possible and in sufficient amounts. Delayed use and irregular use can easily lead to drug resistance. Therefore, if you decide to use imatinib, first of all, do not delay, and secondly, you must insist on long-term use (close to life), and do not arbitrarily reduce the amount or stop taking it during taking it, otherwise it will easily lead to drug resistance. The accelerated phase and the acute phase usually require targeted therapy (imatinib uptake or the use of second-generation drugs). If possible, allogeneic transplantation or timely combination therapy can be accepted.

Early asymptomatic patients usually do not need treatment, and in the late stage, they can choose a variety of chemotherapy options, such as Liu Keran monotherapy, fludarabine, cyclophosphamide combined with merova, and other chemotherapy. Bendamustine and anti-CD52 monoclonal antibodies are also effective. In recent years, it has been found that targeted therapy of BCR pathway inhibitors may have a significant effect. Patients with refractory conditions can consider allograft therapy.

Although the types of M4 and M5 in ALL and AML are often combined with CNSL, other acute leukemias can also occur. Because commonly used drugs are difficult to penetrate the blood-brain barrier, these patients usually need lumbar puncture to prevent and treat CNSL. Some refractory patients may require whole-brain spinal cord radiotherapy.

Except for a few special patients who may benefit from autologous transplantation (the autologous transplantation recurrence rate is very high), the vast majority of leukemia patients should choose xenotransplantation for transplantation.　　

In summary, the general first-line treatment of leukemia is not transplantation. Although transplantation can obtain a better survival effect, complications such as recurrence rate and graft-versus-host disease may seriously affect the quality of life of patients. Treatment after relapse will be more difficult. Therefore, transplantation is generally the last step of choice.