"Slow-granule" patients are expected to achieve "cure" withdrawal

"Slow-granule" patients are expected to achieve "cure" withdrawal

October 16, 2017 Source: Xinhuanet

Leukemia is one of the most terminally ill-advised ones, but when it comes to it, people always subconsciously associate with a very high fatality rate. The only hope for cure is hematopoietic stem cell transplantation. In fact, due to the advancement of medicine and the continuous innovation of drug research and development, chronic myeloid leukemia (referred to as "slow granule") has become a "chronic disease" that can be controlled and controlled. "Like diabetes and high blood pressure, patients can even achieve 'no treatment relief' until they reach clinical 'cure' through standardized treatment," said Professor Liu Xiaoli, chief physician of the Department of Hematology, Southern Hospital of Southern Medical University.

Early detection:

Check the blood routine to find the abnormality

"Slow granules" account for about 15% of adult leukemia, and the annual global incidence rate is 1.6 to 2/100,000. The male incidence rate is slightly higher than that of women. In China, the annual incidence of “slow granules” is 0.39~0.55/100,000. The Chinese patients with chronic granules are younger than the western ones. The median age of onset is 45-50 years old, while the average Western country is 67 years old.

Liu Xiaoli introduced that the course of “slow granules” can be divided into chronic phase, accelerated phase and blast phase. About 90% of patients are diagnosed as chronic during medical treatment. At present, about 3% to 4% of chronic patients progress to blast phase every year. . "The early symptoms of 'slow granules' are not typical, often manifested as fatigue, fever, swelling of the abdomen or mass, which is not easy to attract people's attention. Many patients are diagnosed because of the large spleen." Concealed symptoms do not mean I can't find it early. Liu Xiaoli said that the white blood cells of patients with "slow granules" were significantly higher, and the most basic blood tests could reflect abnormalities. After excluding the common infection factors, such as the digestive tract, respiratory tract, urinary system and other parts of the inflammation, patients need to go to the Department of Hematology, do some targeted professional examinations to confirm whether they have "slow granules".

Standard treatment:

"Slow grain" is expected to achieve no treatment relief

The medical community generally believes that patients with leukemia who have acquired "slow granules" can be regarded as "a great fortunes in misfortune." In the past, hematopoietic stem cell transplantation was considered to be the only cure for leukemia. However, clinical data show that for patients with chronic phase of "slow-grain", the risk of surgery is still large, and the effect of transplantation is still not satisfactory.

Fortunately, in the past 10 years, the medical industry has developed a significant therapeutic effect on the precise inhibition of abnormal genes in the development and clinical application of targeted drugs for “slow-grain”. The long-term survival rate and quality of life of patients have been improved. .

"However, long-term medication also brings psychological and economic burden to patients. They hope that they can stop the drug and cure it as soon as possible." Liu Xiaoli said that the patient's desire is expected to be through long-term standardized treatment and monitoring, and achieve "no. Treatment relief is achieved.

To achieve no treatment remission, doctors are first required to perform diagnostic stratification, develop treatment plans, and closely monitor follow-up. Liu Xiaoli said that reaching deep molecular mitigation (MR4.5) is the threshold for entering the treatment-free mitigation study. MR4.5 means that the existing technology has been unable to detect the existence of "slow granules". On this basis, patients need to continue taking the drug for 2 years, confirming that this deep molecular mitigation state continues to be maintained before attempting to stop the drug. A number of international studies have shown that there is still a recurrence rate of about 50% under this condition. Therefore, it is necessary to be cautious when stopping drugs.

Fight against "slow grain":

Need patient strict self-management

Fighting "slow grain" is like a long-distance marathon, which requires the challenge of resistance and requires strict self-management.

Liu Xiaoli introduced: "Taking the first generation of targeted drugs as an example, the South Hospital has long-term follow-up of 'slow-grain' disease with two or three hundred cases, the current resistance rate has been nearly 20%, including primary and secondary factors The ABL kinase region gene mutation. At this time, the doctor will recommend the patient to switch to the second generation of drugs, if the T315I mutation occurs, you need to switch to the third generation of drugs and prepare for hematopoietic stem cell transplantation." Liu Xiaoli said that some old drugs are taken all the year round. Susceptible to take it lightly, feel that the physical condition is getting better, do not take the medicine and review in time, arbitrarily reduce or even stop the drug, resulting in a stable blood concentration, which is very easy to lead to drug resistance, and ultimately can not reach deep level Molecular mitigation. Liu Xiaoli reminded that patients with chronic granules must be prescribed medications and regular examinations.

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