Leukemia
It is arguably the most familiar hematological tumor
It is as feared as cancer
And what we often call adult leukemia
80% have acute myeloid leukemia
Unfortunately, the most common form of leukemia in adults
Over the past 50 years by using the internationally accepted “3+7” chemotherapy regimen
Remission rate
Five-year survival rate <30%
This data is cold and hopeless for patients
For this reason, researchers “want to break their heads”
Want to find a better chemotherapy regimen
Benefits patients with acute myeloid leukemia
Hematology experts at the First Affiliated Hospital of Zhejiang University School of Medicine
An article published in Lancet Haematology
Brings good news:
Their new DAV solution
91% complete remission with one induction course
That is, after a diagnosis of acute myeloid leukemia
Only 11 days of chemotherapy required
Complete disappearance of signs and symptoms of leukemia with a 91% success rate
This greatly exceeds the complete response rate of previous gold standard chemotherapy regimens
Survival rates are expected to improve!
Acute myeloid leukemia
How to treat it?
Leukemia is a malignant tumor of the hematopoietic system. Acute myeloid leukemia (AML) is the most common type of leukemia in adults, with new cases in China every year> 100,000, how to treat this kind of leukemia? Professor Honghu, head of the Department of Hematology at the First Hospital of Zhejiang University, said that assuming that there are 100 patients with acute myeloid leukemia, because the average age of this group is about 68 years old, and the basic physical conditions are not good, they can eventually be transplanted. There are only about 10-20 patients. For most patients, chemotherapy is still the main choice.
“Although it is now possible to rely on genetic testing to find mutation targets and use targeted drugs for treatment, there are too few targeted drugs, a small number of people targeted, and high treatment costs.” Professor Honghu said frankly, Currently targeted drugs for specific gene mutation acute myeloid leukemia need to pay 30,000 to 400,000 yuan per month, and ordinary families simply cannot afford it.
Although there is a new targeted drug on the market, Venetocalx (remember this targeted drug, it has a great effect later), this drug is currently mainly It is used for elderly patients over 75 years old or those who cannot tolerate chemotherapy, and there are no indications for adult patients under 60 years old.
“So, except for patients who can be transplanted, most of the 100 patients with acute myeloid leukemia still need to rely on chemotherapy.” Professor Zhu Honghu emphasized that chemotherapy treatment is the only cause of acute myeloid leukemia. Mainstream treatment options.
Speaking of which, let’s first introduce the chemotherapy steps of acute myeloid leukemia. First, induction therapy and then consolidation therapy. Some patients may also need maintenance therapy. In these steps, the most important and most important is induction therapy, we can regard this process as the process of using some chemotherapy drugs to kill leukemia quickly, otherwise normal cells will not be able to return to normal, and they will not be able to obtain ease.
“Consolidation chemotherapy will follow if the induction therapy is effective.” Professor Zhu Honghu made an analogy, induction therapy is like the run-up in a high jump competition. Without success, the “high jump” competition between people and leukemia is doomed to fail.
Therefore, if we want to improve the survival rate of acute myeloid leukemia patients, how to “run” efficiently becomes the key.
A half-century-old “run-up” approach
This team broke through
“The internationally used induction regimen has been DA since 1971. Half a century later, the current gold standard induction therapy is DA.” Prof. Zhu Honghu The so-called DA is the use of daunorubicin (referred to as D, for 3 days) and cytarabine (referred to as A, for 7 days), which is the internationally famous “3+7” induction chemotherapy regimen.
Currently using the DA regimen, the complete remission rate of one course of treatment in young patients () is about 64%, and in elderly patients (≥60 years old) ), the complete response rate is about about 40%, and the 5-year survival rate is in younger patients.
“So, we have been thinking about how to explore a new induction scheme to improve the prognosis of patients on the basis of the international gold standard DA scheme.” Professor Zhu Honghu, an internationally renowned hematologist, He has been paying attention to the most cutting-edge related research in the world. He found that the famous cancer center in the United States is exploring the combination of the targeted drug we mentioned in the previous article on the basis of more efficient induction chemotherapy regimens such as FLAG-IDA or CLIA-Venecla Venetocalx, “The concept of the regimen is correct, but with the ‘bold’ doses they use and the long course of treatment there is increased toxicity for the patient.” Professor Honghu Zhu said early data from the US study It showed that many patients had severe toxicity, and even 2 of 12 patients died early, “This result is obviously contrary to the purpose of our exploration.”
“Under the leadership of Professor Jin Jie, our team adopted the international gold standard DA scheme combined with the short-range Venekla, and we named it DAV scheme strong>, This is an original induction regimen, and we want to find the most appropriate dose to reflect the optimization of this regimen.” The research team recruited a total of 36 adult patients with primary acute myeloid leukemia.
After extensive research and discussion, the team finally found the best solution. Among the 33 patients with evaluable efficacy, the median age was 40 years old, and 76% of the cytogenetically high-risk patients accounted for 76%. None of the patients experienced early death after 11 days of chemotherapy with DAV regimen. No patient required dose adjustment or discontinuation due to drug-related toxicity.
This result shows that the team of Professor Jin Jie and Professor Zhu Honghu of the Department of Hematology of Zhejiang University First Hospital established an original new DAV program, which has made the remission rate of acute myeloid leukemia reach the highest international record , and has also completed the enrollment of the prospective randomized controlled study of the new DAV regimen and the gold standard DA, which is expected to provide data with a higher level of evidence and lay the foundation for DAV to enter the international leukemia guidelines.
How much does the new DAV plan cost?
Experts say “inexpensive”
Due to the use of veneclax targeted drugs in the DAV program, the targeted drug mentioned above is probably more than 4,000 boxes of self-funded drugs. Many people worry about whether this program will be more effective than before. Is the DA plan much more expensive? After all, the DA program itself only costs a few hundred yuan per month after medical reimbursement.
“The overall hospitalization costs of the two are similar, but the efficacy is very different.” Professor Zhu Honghu said that although the DAV program uses one more targeted drug, Because the remission rate of this scheme is much higher than that of the old scheme, the patients have reduced blood transfusion and other treatments, and the length of hospital stay is also reduced by 5-7 days than usual. In general, the cost is reduced from another aspect, so the patient does not have to worry about the cost at all.
“Due to the excellent efficacy of the new DAV regimen, fewer and fewer patients do not remission, and clinicians also experience the sense of achievement of the new technology, and more and more acute leukemia patients are attracted He came to the Hematology Department of the First Hospital of Zhejiang University for treatment.”
This article is original by the First Academy of Zhejiang University
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