How is leukemia treated?

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

In acute leukemia, therapy is divided into periods: induction of remission, consolidation, supporting treatment with periodic courses of active therapy (in particular, prevention of CNS lesions). There are several therapy programs, which can not be described in the textbook, and which should be read in additional literature. As an example, we give the MB-91 protocol (Moscow-Berlin-91). The ALL-MB-91 program provides for the distribution of patients into two groups - standard risk (leukocytosis at admission of less than 50 000 in μL, age over 1 year, absence of initial CNS lesion, absence of pre-T / T immunological sub-variant and / or mediastinum increase) and a risk group (all other children).

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

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

Supportive therapy consisted of taking 6-mercaptopurine, administering methotrexate, re-induction of vincristine + dexamethasone, and endolumbal administration of drugs. The total duration of therapy was 2 years.

Symptomatic treatment of leukemia. Blood transfusion is used for agranulocytosis, combined with thrombocytopenia. In these cases, blood products are poured daily. It is optimal to select a donor for the antigenic HLA system.

Children with anemia and hemoglobin less than 70 g / l are transfused with erythrocyte mass (approximately 4 ml per 1 kg of body weight). With deep thrombocytopenia (less than 10 x 10 / L) and the presence of hemorrhagic syndrome, the platelet mass is transfused. Children with promyelocytic leukemia, taking into account their propensity for DIC syndrome, along with cytostatic therapy, are prescribed transfusions of fresh frozen plasma, heparin (200 units / kg per day, divided into 4 injections, as indicated by a dose increase). Children with deep granulocytopenia and the presence of septic complications are transfused with leukocyte mass (10 leukocytes infuse).

Infectious complications are typical for patients with acute leukemia. Optimum in a hospital it is necessary to place children in separate boxes or chambers at observance of rules of asepsis and antiseptics. Any increase in body temperature is considered a sign of infection. Antibiotics before allocation of the pathogen are appointed proceeding from the established factor of wide distribution in patients of conditionally pathogenic flora. Prophylactic use of systemic antibiotics is not recommended.

The new methods of treating patients with acute leukemia primarily concern various aspects of bone marrow transplantation, which is especially important for patients with OnLL, who often develop bone marrow aplasia during treatment. Transplanted allogeneic bone marrow with removed T-lymphocytes or purified autologous bone marrow. 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 studies, cord blood transplantation is considered as an alternative source of stem cells. It contains a large number of stem cells, after birth there is enough of them, sufficient for a transplant 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 transplantation with the preliminary introduction of colony-stimulating factors - granulocyte or granulomacrofagal.

The diet of patients with acute leukemia is prescribed a high-calorie diet with a one and a half amount of proteins, compared with age norms, vitaminized, rich in mineral substances (table 10a). With the appointment of glucocorticoids, the ration is enriched with products containing many salts of potassium and calcium.

The dispensary observation is carried out by the hematologist of the specialized center and the district pediatrician. Given that the patient almost always receives cytostatic therapy, it is necessary at least 1 time in 2 weeks to do a blood test.

The change in climatic conditions is not shown. The child is freed from preventive vaccinations, physical education. It must be protected from physical exertion, mental trauma, cooling, infections. Classes for the school curriculum are not contraindicated, but it is better to study at home, since in school there are frequent ARD among children.

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

[1], [2], [3], [4], [5], [6], [7]