1. Similar of chemotherapy chemotherapy principle with ALL, divided into ① remission induction therapy; ② consolidation therapy; ③ maintenance treatment; ④ shelter prevention.
ANLL chemotherapy has greatly improved, but the treatment effect is far better than ALL. The treatment programs are not uniform, quite different. Is generally believed that the good effect of the program is a combination of anthracycline and Ara-C. The other commonly used drugs three harringtonine ,6-TG Adriamycin (Adr), Accra neomycin (ACR) to methoxy daunorubicin (IDA), mitoxantrone (NVT), Table ghost acetabular class (VP16, VM26), Dapsone acridine (AMSA), and the like.
(1) induction of remission program: ① DA program: DNR40mg / (m2 · d), intravenous injection of 1 to 3 days; Ara-C100 to 200mg / (m2 · d), intravenous or intramuscular injection, 12 hour time, 1 to 7 days. ② HA program: H (high school tip ester base) 4 to 6mg / (m2 · d), intravenous, 1 to 7 days; usage of Ara-C program with the DA. ③ DAT (HAT) program :6-TG75mg / (m2 · d), oral, 1 to 7 days; DA (HA) program. ④ DAE program: DNR20mg / (m2 · d), intravenous injection of 1 to 4 days and 15 to 18 days; Ara the-C150mg / (m2 · d), intramuscular injection, 12 hours time, 1 to 4 days and 15 to 18 days; of VP16100 ~ 150mg / (m2 · d), intravenous injection of 1 to 4 and 15 to 18 days. ⑤ HOAP program: Middle School harringtonine 4 to 6mg / (m2 · d), intravenous injection of 1 to 7 days the; VCR2mg/m2, intravenous injection, the first day; the Ara-C100mg / (m2 · d), intramuscular 12 hours, 1 to 5 days; prednisone 40mg / (m2 · d), oral, twice daily, 1 to 7 days.
Generally preferred DA program, the majority of patients with a course of treatment to obtain relief. M4, M5 may be preferred DAE program. Chemotherapy, bone marrow aspiration 10 to 14 days. Such as the original plus promyelocytic cells ≥ 20%, bone marrow hyperplasia, you can start a second course of treatment. Two treatment interval of 2 to 3 weeks. If the application of the two courses original plus promyelocytic cells still ≥ 20%, other solutions should be replaced.
M3 induced differentiation of treatment-induced differentiation therapy refers to the application can promote the differentiation of leukemia cells mature or be able to adjust the leukemia cell phenotype in order to enhance its sensitivity to drug-induced differentiation agent. The most effective treatment of acute promyelocytic leukemia (M3 type) with all-trans retinoic acid (RA), RA has become the drug of choice for induction of remission in M3 leukemia. Usage is 45 ~ 80mg/m2/d, oral, until remission. The CR rate can reach 80%. Combination chemotherapy must be added with ease after further intensive treatment, or RA and chemotherapy alternately applications until withdrawal, or risk factors.
(2) consolidation therapy is that early intensive use of larger doses of the new drug application in patients with previously unused remission after treatment. The main method is high-dose Ara-C (HD-Ara-C2g/m2/d, intravenous) combined anthracycline amine benzene the acridine piperidine, mitoxantrone, table podophylloxin drug the strong sequential therapy, or alternatively effective induction programs, each course of four weeks, a total of six courses (six months).
(3) maintenance treatment selection COAP three programs in the HA, DA, TA, sequential therapy on a regular basis. The first year of a course of treatment every two months, every three months of the second year of a course of treatment. Withdrawal to 2 to 21/2 years. Or with consolidation therapy programs to maintain 1 to 2 years.
(4) shelter prevention see ALL.
(5) refractory to treatment with relapse despite the AN-LL chemotherapy in recent years, great progress, but the relapse rate is still very high, and long-term disease-free survival rate of only about 35%, the majority of patients eventually die of drug-resistant leukemia.
May be due to resistant leukemia produced: (1) primary resistance to that originally present in the body’s resistance cell subsets sensitive cells selectively kill emerged; ② secondary resistance, that is due to the change in medication-induced cell characteristics , resulting in the emergence of drug resistance. Currently, most scholars believe, relapse of leukemia is caused mainly by primary resistant leukemia cell subsets.
More treatment options, treatment principles: ① applications and commonly used drugs different mechanism of action of the new anti-leukemia drug. Such as mitoxantrone, 5 – azacytidine, go idarubicin, etc.; ② increase the dose; ③ The application no cross-resistance to existing drugs in new combinations. Can still use the original treatment plan for withdrawal relapse.
2. The bone marrow transplant of ANLL recurrence rate, so most people should advocate if the conditions for bone marrow transplantation in first remission (CR1). BMT cure rate at this time, a lower recurrence rate; physical condition was acceptable, tolerated, died of complications less, BMT allogeneic bone marrow transplantation (allogeneic BMT, allo-BMT) works best. CR1 carried allo-BMT, the 5-year disease-free survival rate of up to about 50%, the second remission (CR2) after BMT, the 5-year disease-free survival rate can reach 30%. Allo-BMT by HLA typing constraints, it is difficult to find the right for the marrow. Especially in our country is difficult to carry out extensive. Autologous bone marrow transplantation (autologous BMT, auto-BMT) for children not suitable HLA matching for the marrow collected bone marrow remission in children, and in vitro purification, cold storage, pre-treatment of children, the best possible destruction in vivo MRLC, then the collection of bone marrow infusion to the children. auto-BMT higher recurrence rate. See bone marrow transplantation chapter.
Prognosis is worse than ALL. In general, the WBC count <20 × 109 / L with good prognosis. Younger than 1 year of age, especially combined congenital malformations or genetic diseases and more poor prognosis. Merger CNSL mostly poor prognosis. Prognosis subtype M3 type of prognosis is better, M5, M6, M-type secondary MDS those poor prognosis.