How is leukemia treated?

Treatment of all leukemias can only be carried out in specialized departments using various schemes and protocols of antitumor and anti-relapse therapy.

In acute leukemia, therapy is divided into periods: remission induction, consolidation, maintenance therapy with periodic courses of active therapy (in particular, prevention of CNS lesions). There are several therapy programs that cannot be described in a textbook and which should be read about in additional literature. As an example, we provide the MB-91 protocol (Moscow-Berlin-91). The ALL-MB-91 program provides for dividing patients into two groups - standard risk (leukocytosis on admission less than 50,000 per μl; age over 1 year; no initial CNS lesion; no pre-T/T immunological subvariant and/or enlarged mediastinum) and a risk group (all other children).

Remission induction is a preliminary phase of treatment with dexamethasone for a week, then remission induction for the standard-risk patient in the form of daily dexamethasone, vincristine, rubomycin, L-asparaginase, and endolumbar methotrexate, cytosine arabinoside, and dexamethasone.

Consolidation for standard-risk patients consisted of L-asparaginase administration in parallel with 6-mercaptopurine and methotrexate administration, interrupted by vincristine + dexamethasone courses. In these patients, radiation was not used at all. Risk patients received an additional 5 rubomycin administrations and cranial irradiation.

Maintenance therapy consisted of 6-mercaptopurine, methotrexate, and reinduction courses of vincristine + dexamethasone with endolumbar administration of drugs. The total duration of therapy was 2 years.

Symptomatic treatment of leukemia. Hemotransfusions are used in agranulocytosis combined with thrombocytopenia. In these cases, blood products are transfused daily. It is optimal to select a donor based on the HLA antigen system.

Children with anemia and hemoglobin less than 70 g/l are transfused with red blood cells (approximately 4 ml per 1 kg of body weight). In case of profound thrombocytopenia (less than 10 x 10 /l) and the presence of hemorrhagic syndrome, platelet mass is transfused. Children with promyelocytic leukemia, given their tendency to DIC syndrome, are prescribed transfusions of fresh frozen plasma and heparin (200 U/kg per day, divided into 4 injections; the dose is increased as indicated) along with cytostatic therapy. Children with profound granulocytopenia and the presence of septic complications are transfused with leukocyte mass (10 leukocytes are transfused).

Infectious complications are typical for patients with acute leukemia. Optimally, children should be placed in separate boxes or wards in hospital, observing the rules of asepsis and antisepsis. Any increase in body temperature is considered a sign of infection. Antibiotics are prescribed before the pathogen is isolated based on the established factor of widespread opportunistic flora in patients. Preventive administration of systemic antibiotics is not recommended.

New methods of treating patients with acute leukemia primarily concern various aspects of bone marrow transplantation, which is especially important for patients with acute leukemia, who often develop bone marrow aplasia during treatment. Allogeneic bone marrow with removed T-lymphocytes or purified autologous bone marrow is transplanted. Allogeneic bone marrow compatible with the main HLA antigens is transplanted immediately after the first remission is achieved. The most difficult task remains the search for a donor, therefore, in recent years, umbilical cord blood transplantation is considered as an alternative source of stem cells. It contains a large number of stem cells, and after birth, there is enough of them left for transplantation to a child weighing up to 40 kg. Fetal blood does not contain active lymphocytes that can cause rejection, and is better suited for unrelated transplantation. Methods are being developed to combine chemotherapy and bone marrow transplants with preliminary administration of colony-stimulating factors - granulocyte or granulomacrophage.

The diet prescribed for patients with acute leukemia is high-calorie with one and a half times the age-appropriate amount of proteins, fortified with vitamins, and rich in minerals (table 10a). When glucocorticoids are prescribed, the diet is enriched with products containing a lot of potassium and calcium salts.

Outpatient monitoring is carried out by a hematologist of a specialized center and a local pediatrician. Considering that the patient receives cytostatic therapy almost all the time, it is necessary to do a blood test at least once every 2 weeks.

No change in climatic conditions is indicated. The child is exempt from preventive vaccinations and physical education classes. He must be protected from physical exertion, mental trauma, cooling, and infections. Classes according to the school program are not contraindicated, but it is better to study at home, since acute respiratory infections are common among children at school.

Prognosis. Unfortunately, clinically at the time of diagnosis of acute leukemia it is not always possible to speak with certainty about the prognosis. Among patients with acute lymphoblastic leukemia, a group of children of "standard risk" with a favorable prognosis, as a rule, and a group of patients of "high risk" are distinguished. The more mature cells are detected in ONLL, the worse the prognosis. At present, according to world literature, the probability of curing acute lymphoblastic leukemia is at least 50-70%, AML - 15-30%.

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