leukaemia
It can be said that it is the most familiar blood tumor for us
People's fear of it is comparable to that of cancer
And we often say adult leukemia
80% are acute myeloid leukemia
Unfortunately this is the most common leukemia in adults
For nearly 50 years, the internationally accepted "3+7" chemotherapy regimen has been used
Mitigation rate
5-year survival rate<30%
This data is cold and desperate for patients
For this reason, researchers "want to break their heads"
Want to find a better chemotherapy regimen
Benefits for patients with acute myeloid leukemia
Hematologists from the First Affiliated Hospital of Zhejiang University School of Medicine
An article published in Lancet Haematology
Good news:
They created a new DAV solution
One induction course of complete relief can reach 91%
That is, after the diagnosis of acute myeloid leukemia
Chemotherapy is only needed for 11 days
Complete disappearance of signs and symptoms of leukemia can reach a 91% success rate
This greatly exceeds the full response rate of previous gold-standard chemotherapy regimens
Survival rate is expected to be improved!
Acute leukemia
How to cure it?
Leukemia is a malignant tumor disease of the hematopoietic system, acute myeloid leukemia (AML) is the most common type of leukemia in adults, China's new patients > 100,000 per year, how to treat this leukemia? Professor Honghu, the chief of the Department of Hematology of the First Hospital of Zhejiang University, said that assuming that there are 100 patients with acute myeloid leukemia, due to the average age of such groups is about 68 years old and the basic physical conditions are not good, only about 10-20 patients can be transplanted in the end, and most patients still choose chemotherapy.
"Although genetic testing can now be relied upon to find mutation targets and use targeted drug therapy, targeted drugs are too few, the number of targeted populations is small, and the treatment cost is expensive." Professor Honghu said frankly that at present, the specific gene mutation acute myeloid leukemia targeted by targeted drugs needs to pay 30,000-400,000 yuan a month, and ordinary families simply can't eat it.
Although there is a new targeted drug on the market - Venequera Venetocalx (remember this targeted drug, it has a big effect later), but this drug is currently mainly used in elderly patients over 75 years old or patients who cannot tolerate chemotherapy, and for adult patients under 60 years of age, there are no indications for medication.
"So, in addition to the patients who can be transplanted, most of these 100 patients with acute myeloid leukemia still need to rely on chemotherapy." Professor Honghu stressed that chemotherapy treatment is the mainstream treatment plan for acute myeloid leukemia.
Speaking of which, let's first popularize the chemotherapy steps of acute myeloid leukemia, first induction therapy and then consolidation therapy, and some patients may also undergo maintenance therapy. The most critical and important of these steps is induction therapy, which we can think of as using some chemotherapy drugs to quickly kill the leukemia process, otherwise normal cells can not return to normal, and they can not get relief.
"Only when induction therapy is effective will there be consolidation chemotherapy later." Professor Honghu made an analogy, induction therapy is like a runner in the high jump competition, if the runner is not successful, the "high jump" competition between people and leukemia is doomed to failure.
Therefore, if you want to improve the survival rate of patients with acute myeloid leukemia, how to efficiently "help run" has become the key.
Half a century of unchanged "running" method
This team broke through
"Since 1971, the internationally used induction scheme is DA, and half a century has passed, and the current gold standard induction treatment is still DA." The DA mentioned by Professor Honghu is the use of daunorubicin (referred to as D, with 3 days) and cytarabine (referred to as A, with 7 days), which is the internationally renowned "3 + 7" induction chemotherapy program.
Currently using the DA regimen, the complete response rate for one course of treatment in young patients () is about 64%, the complete response rate in elderly patients (≥ 60 years) is about 40%, and the 5-year survival rate is in young patients.
"So, we've been thinking about how to explore new induction regimens to improve patient outcomes based on the DA protocols that have been the international gold standard." As an internationally renowned hematologist, Professor Honghu has been paying attention to the most cutting-edge related research in the world, and he found that the famous cancer centers in the United States are exploring more efficient induction chemotherapy regimens such as FLAG-IDA or CLIA in combination with the targeted drugs we mentioned earlier, Venequera Venetocalx, "The concept of this regimen is correct, but the 'bold' dose and excessively long course of treatment they use are more toxic to patients." Professor Honghu said that the early data of the study in the United States showed that many patients had severe toxicity, and even 2 cases of early death in 12 patients, "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 based on the joint short-course Venequera, we named it DAV scheme, which is an original induction scheme, and we wanted to find the most appropriate dosage to reflect the optimization of this scheme." Between January 2021 and July 2021, the research team recruited a total of 36 adult patients with primary acute myeloid leukemia.
After much research and discussion, the team finally found the optimal solution. Of the 33 patients who could be evaluated, the median age was 40 years, 76% were at high risk in cytogenetics, and the complete response rate after a cycle of the DAV regimen developed by the team was 91%, which means that none of the patients died early after 11 days of DAV chemotherapy. There were also no patients who needed to adjust the dose or discontinued due to drug-related toxicity.
This result shows that Professor Jin Jie and Professor Honghu of the Department of Hematology of the First Hospital of Zhejiang University have established an original new DAV protocol, which has made the remission rate of acute myeloid leukemia reach the highest international record, and has also completed the enrollment of the new DAV protocol and the prospective randomized controlled study of gold standard DA, which is expected to provide higher evidence-level data and lay the foundation for DAV to enter the international leukemia guidelines.
How much does the new DAV plan cost?
Experts say "not expensive"
Since the DAV program uses venequera targeted drugs, as mentioned above, this targeted drug is about 4,000 boxes of self-funded drugs, and many people are worried that this solution will be much more expensive than the previous DA program. After all, the DA program itself only needs a few hundred yuan per month after medical reimbursement.
"The overall cost of hospitalization is similar, but the difference in efficacy is very large." Professor Honghu said that although the DAV program uses one more targeted drug, because the remission rate of this program is much higher than that of the old program, the patients have reduced treatments such as blood transfusions, and the number of hospital stays has also been reduced by 5-7 days than usual, and the cost has been reduced from another aspect, so patients do not have to worry about costs at all.
"Because the new DAV program has a very good effect, there are fewer and fewer patients who do not alleviate, and clinicians have also experienced the sense of achievement of the new technology, and more and more patients with acute leukemia have come to the Hematology Department of the First Hospital of Zhejiang University for treatment."
This article is the original of the First Hospital of Zhejiang University
Image source network