根据自然病程及细胞成熟程度急性白血病AcuteLeukemia慢性.PPT

* * * * * * * * * * * * * * * * * * * * the drug should work in all period of cell cycle the dosage should be full the regimen would be used repeatedly why full ? Killing the cells in all period of cell cycle repeatedly could make G0→ cycle control the source of relapse use Combination regimen of these drugs which have different action, typing and toxicity to increase curative effect and decrease toxicity why combine ? end cell apoptosis Go (source of relapse) sensitive insensitive G1 S G2 M Cell cycle and chemotherapy Interval for 3~4 weeks before next therapy Leukemia cell normal cell when get disease the greater part of cells hyperplasia is inhibited is not in G0 period easily killed by chemotherapy in G0 period or not? doubling time long short recover in interval not easy to recover easy to recover why interval ? remission consolidation maintenance induction 1012 109 104（MRD） prevent CNS leukemia 6 cycles 3～5years Reduce MRD step by step Keep the DFS for long time why by stages? (2) 化疗策略: ① 诱导缓解: 白血病确诊后, 经化疗取得完全缓解 (complete remission, CR)的治疗阶段。 症状和体征消失。 血 象：Hb≥100g/L或90g/L；N≥1.5×109/L； PLT≥100×109/L；无白血病细胞。 骨髓象：原早幼（粒/单/淋巴）细胞 ≤5％，红系及巨核 系正常。 ② 缓解后治疗: 目的是最大限度杀灭残余的白血 病细胞. 包括巩固、强化及维持治疗。 (3) 急性淋巴细胞白血病的化疗: ① 诱导缓解: VDLP方案, CR率70-90%, 化疗间歇期2周； VCR 1.4mg/m2, 静注, 第1. 8. 15. 22天 DNR 30-45mg/ m2, 静注, 第1. 2. 3, 15.16. 17天 L-