Chronic lymphocytic leukemia treatment

Benign Type (A) lymphocytes mildly increased, stable conditions, the general without chemotherapy for the periodic observation, mainly symptomatic treatment. Right progress (B to C) in patients with symptoms, lymph nodes and spleen were enlarged gradually, it should be positive chemotherapy. (A) Chemical treatment 1. Single chemotherapy ?٠chlorambucil as preferred drugs, the most effective, the remission rate of 50 ~ 98% of the general adult dose of 0.1mg/kg 0.08 ~ d, when the blood out to be lower than normal. To maintain treatment, dose adjustment to the 0.04-0.08mg / (kg · d), until the mitigation. Literature also advocated high-dose intermittent chlorambucil 0.4-0.8mg / (kg · d), even serving four days, intermittent 4 to 6 weeks, as the induction of remission, are likely to be smaller dose better, but should guard against bone marrow toxicity. ?ڠcyclophosphamide with chlorambucil efficacy similar to that used in phenylpropionate not sensitive to nitrogen mustard, and the illness was serious, David lymphocytes decreased platelet or more persons. A common dose ~ 3 mg / (kg · d), 20mg/kg or oral, intravenous, every two to three weeks time. ?۠fluoride clatter Rafah foreshore single phosphate (fludarabinemonophosphate), interference with the mechanism of nuclear adenosine effect acid metabolism, and the progress of slow leaching half-effective, can be 25 to 30 mg / (m2 d), 5 days, intravenous infusion every four weeks of intermittent treatment was repeated. ?ܠ2-chlorodeoxyadenosine (2-chlorooxyadenosine) by 0.05 ~ 3.2 × 7 d, continuous infusion, efficiency 55%. ?ݠintercostal deoxy - adriamycin (Deoxycoformycin) 25% effective in patients with the B - chronic lymphocytic leukemia, 4mg/m2 weekly or every two weeks, iv; Right refractory T-5 may slow leaching ~ 19mg / (m2 d), 3 ~ 5 days, iv. With autoimmune hemolytic anemia and thrombocytopenia and are resistant to alkylating agent who prednisone for the indication, could slow leaching solution specific lymphocytes, commonly used doses of 20 to 60 mg / d and effective for use intermittent maintenance, the weekly service on the 2nd, 40-60mg / d, generally not in favor of long-term application. It also advocated short (five days) more volume prednisone (80 mg / d) program, as the chlorambucil treatment. 2. Combination chemotherapy might try using multiple myeloma M2, complete remission for 15%. Liepmen (1978) Application of the anti-cop lymphoma treatment of 36 cases of chronic lymphocytic leukemia and 16 cases of complete remission, the median survival period of over two years; CHOP treatment of stage C patients with chronic lymphocytic leukemia, efficiency up to 50 ~ 70%, dose method See related diseases. (2) radiation therapy significantly enlarged lymph nodes (including the mediastinum or splenomegaly) can consider local irradiation to alleviate the symptoms of oppression. Sparr, etc. (1974) Application thymus irradiation treatment of 22 cases, 11 cases of complete remission and partial remission seven cases. Heilmann (1978) Application of blood cells in vitro irradiation therapy in 12 cases, see B lymphocytes significantly decreased, and the T lymphocytes without change, but in need of special equipment. 32P only chemotherapy were considered invalid, the dose should be less than other types of leukemia, one each from 2mci (3.7 ~ 7.4 × 107 × 107Bq), a weekly ~ 2. (3) Other low-γ treatment Waldenstrom repeated infections and regular intravenous gammaglobulin. By corticosteroids or splenic radiation therapy, may consider splenectomy. Increased accumulation of lymphocytes, were separated may also be helpful.