Benign type (A) lymphocytes slightly increased in stable condition, and generally did not require chemotherapy to regularly observe the symptomatic treatment. Progressive (B to stage C) in patients with symptoms, lymph nodes and spleen gradual enlargement, should be positive chemotherapy.
The single chemotherapy ① chlorambucil as the drug of choice, the best, the remission rate of 50 to 98% of the general adult dose of 0.08 to 0.1mg/kg · d When the blood is lower than normal should disable. To maintenance therapy, the dose should be adjusted in 0.04 ~ 0.08mg / (kg · d) until remission. Literature also advocates the application of intermittent high-dose chlorambucil 0.4 ~ 0.8mg / (kg · d), and even served four days, 4 to 6 weeks of intermittent as the induction of remission, may preferably smaller doses, but should be alert to the bone marrow toxicity reaction. The ② cyclophosphamide and chlorambucil efficacy is similar, commonly used in phenylpropanoid acid nitrogen mustard sensitive and serious condition, the prolymphocytic more or thrombocytopenia. The usual dose to 3mg / (kg · d), oral or 20mg/kg, intravenously once every 2 to 3 weeks. (3) fluorine da pull Bin monophosphate (fludarabinemonophosphate), the mechanism of action related to the interference adenosine nucleoside acid metabolism, progressive CLL half effective, can be 25 to 30mg / (m2 · d), 5 days, intravenous four weeks per intermittently repeated courses. ④ 2 – chlorodeoxyadenosine (2-chlorooxyadenosine) 0.05 ~ 0.2mg/kg d × 7 continuous infusion, 55% efficiency. ⑤ deoxy intercostal neomycin (Deoxycoformycin) 25% of patients on the B-slow leaching 4mg/m2 weekly or every two weeks intravenously; refractory T-slow leaching can be 5 to 19mg / (m2 · d) 3 to 5 days, intravenous injection.
Concurrent autoimmune hemolytic anemia or thrombocytopenia purpura and are resistant to alkylating agent for the application of prednisone indications, specifically dissolve CLL lymphocytes, the usual dose of 20 to 60 mg / d, effective available intermittently maintained weekly service on the 2nd, 40 to 60 mg / d, generally not in favor of long-term application. Advocate the application of short (5 days) prednisone larger amount (80mg / d), as a combination therapy with chlorambucil.
Combination chemotherapy can try using the M2 program of the multiple myeloma, complete remission was 15%. Using anti-lymphoma cop Liepmen (1978) and other 36 patients with CLL, 16 cases of complete remission, the median survival of more than two years; CHOP regimen in the treatment the C of CLL patients, the efficiency of up to 50 to 70%, the dose Methods See related diseases.
(B) radiation therapy
There are obvious lymph nodes (including mediastinal or splenomegaly) local irradiation can be considered to alleviate the symptoms of oppression. Sparr (1974) Application the thymic irradiation treatment of 22 cases, 11 cases of complete remission, partial remission in 7 cases. Heilmann (1978) 12 cases of the application of blood cells in vitro irradiation treatment, see the significantly lower number of B lymphocytes and T lymphocytes no change, but it requires special equipment. The the radioactive 32P only chemotherapy ineffective considered, the dose should be less than other types of leukemia, each time 1 ~ 2mci (3.7 × 107 ~ 7.4 × 107Bq), week 1 or 2 times.
(3) Other treatment
Low gamma globulinemia and recurrent infections the regular intravenous gamma globulin. The adrenal glucocorticoid or spleen radiation therapy invalid, consider splenectomy. Lymphocytes accumulate significantly increased, the lymphocyte separation may also help.