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“罗一笑”刷爆朋友圈,白血病真的那么可怕吗?

2016年11月30日

整理:Janet

来源:肿瘤资讯


一夜间,朋友圈被刷爆,变成了这样……

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可,几个小时后,又变成了这样……

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暂且不论这些所谓筹款的是是非非,但相信转发朋友圈的人都是真心希望小朋友能尽快康复。那么,究竟白血病有多可怕?让我们从客观的角度用事实说话

目前儿童白血病的病因和发病机制尚不完全清楚,众多学者认为白血病的发生是环境因素和遗传因素共同作用的结果。尽管在过去数十年里,统计数据显示白血病是儿童癌症的主要类型,然而近几年来,随着化疗、放疗、骨髓移植的进步,多数白血病可以治愈。 

白血病易侵袭“一老一小”

白血病是常见的恶性肿瘤,根据年龄发病率可发现,5岁以下和15~20岁间有两个小高峰,40岁以后,随年龄增长发病率逐渐升高,60岁以后属发病高峰年龄。

白血病一般分为急性和慢性两大类。

●急性白血病常表现为突然高烧、有出血倾向、脸色苍白、疲乏等。有的病人因皮肤紫癜、月经过多或拔牙后出血难止,才被发现患有白血病。此外,急性白血病患者还会出现淋巴结和肝脾肿大、关节疼痛、眼眶部粒细胞肉瘤、牙龈增生肿胀、皮肤损害等。

●慢性白血病无自觉症状,起病十分缓慢,早期可感觉乏力、疲倦,后期出现食欲减退、消瘦、低热、盗汗及贫血、血小板减少等症状,但淋巴结肿大一定要引起患者注意。

多项因素决定治疗手段

适合的治疗主要取决于患者所患白血病的类型、年龄及患者的整体健康状况。白血病患者有很多治疗方面的选择,并且可能会接受不知一种类型的治疗。目前,白血病的治疗策略包括:

●观察等待疗法

●化疗

●靶向疗法

●放疗

●造血干细胞移植

对白血病患者而言,除了常规治疗方案外,某些处于临床研究阶段的治疗方案也是非常重要的选择,因此也可以在主诊医生的指导下参与某些新疗法的临床试验。需要注意的是,无论何时,关怀和护理都是缓解治疗副作用、控制疼痛或其他症状的有效手段。

那么,让我们再一起来看看20世纪60年代至今儿童肿瘤5年生存率的变化吧,是不是顿时感觉抗争白血病的信心增加不少呢?其实,白血病也并非不治之症!

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随访护理很关键

治疗白血病后,需要定期检查。例如,有些急性白血病患者在治疗后第1年需要每月检查一次,慢性白血病则可能是每6个月检查一次,有助于发现身体变化,及时积极采取治疗措施。

最后,为了搞清白血病的现状,小编也是费尽了心机,在此为各位医学专业人员安利一本2015年由Elsevier出版的第八版Nathan和Oski的小儿血液肿瘤学(Nathan and Oski’s hematology andoncology of infancy and childhood)。本书除了详细讲解血液学方面的知识构架,比如正常及异常血细胞、出凝血疾病、免疫疾病外,还添加了关于癌症治疗、实体瘤以及肿瘤支持疗法的相关内容,更新了我们对于血液肿瘤学的认识,值得一读。

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另外,小编也悉心收集了关于白血病的权威必读文章一同分享,要知道学无止境呀,为了让更多小伙伴们更好地认识白血病,小编也是拼了!

Acute Myeloid Leukemia – Prognosis 急性髓系白血病——预后

1. Patel JP, Gonen M, Figueroa ME, et al. Prognostic relevance of integrated genetic profiling in acute myeloid leukemia. N Engl J Med. 2012;366(12):1079–1089(全文).

Acute Myeloid Leukemia – Treatment 急性髓系白血病——治疗

2. Mandelli F, Vignetti M, Suciu S, et al. Daunorubicin versus mitoxantrone versus idarubicin as induction and consolidation chemotherapy for adults with acute myeloid leukemia: the EORTC and GIMEMA Groups Study AML-10. J Clin Oncol. 2009;27(32):5397–5403(全文).

3. Löwenberg B, Pabst T, Vellenga E, et al. Cytarabine dose for acute myeloid leukemia. N Engl J Med. 2011;364(11):1027–1036(全文).

4. Löwenberg B, Ossenkoppele GJ, van Putten W, et al. High-dose daunorubicin in older patients with acute myeloid leukemia. N Engl J Med. 2009;361(13):1235–1248(全文).

5. Mayer RJ, Davis RB, Schiffer CA, et al. Intensive postremission chemotherapy in adults with acute myeloid leukemia. Cancer and Leukemia Group B. New Engl J Med. 1994;331(14):896–90(全文).

6. Fenaux P, Mufti GJ, Hellstrom-Lindberg E, et al. Azacitidine prolongs overall survival compared with conventional care regimens in elderly patients with low bone marrow blast count acute myeloid leukemia. J Clin Oncol. 2010;28(4):562–569(全文).

7. Burnett AK, Milligan D, Prentice AG, et al. A comparison of low-dose cytarabine and hydroxyurea with or without all-trans retinoic acid for acute myeloid leukemia and high-risk myelodysplastic syndrome in patients not considered fit for intensive treatment. Cancer. 2007;109(6):1114–1124(全文).

8. Grimwade D, Hills RK, Moorman AV, et al. Refinement of cytogenetic classification in acute myeloid leukemia: determination of prognostic significance of rare recurring chromosomal abnormalities among 5876 younger adult patients treated in the United Kingdom Medical Research Council trial. Blood. 2010;116(3):354–365(全文).

9. Berman E, Wiernik P, Volger R, et al. Long-term follow-up of three randomized trials comparing idarubicin and daunorubicin as induction therapies for patients with untreated acute myeloid leukemia. Cancer. 1997;80(11 Suppl):2181–2185(全文). 

Acute Promyelocytic Leukemia 急性早幼粒细胞白血病

10. Powell B, Moser B, Stock W, et al. Arsenic trioxide improves event-free and overall survival for adults with acute promyelocytic leukemia: North American Leukemia Intergroup Study C9710. Blood. 2010;116(19):3751–3757(全文).

11. Lo-Coco F, Avvisati, Vignetti M, et al. Front-line treatment of acute promyelocytic leukemia with AIDA induction followed by risk-adapted consolidation for adults younger than 61 years: results of the AIDA-2000 trial of the GIMEMA Group. Blood. 2010;116(17):3171–3179(全文). 

12. Sanz MA, Montesinos P, Rayón C, et al. Risk-adapted treatment of acute promyelocytic leukemia based on all-trans retinoic acid and anthracycline with addition of cytarabine in consolidation therapy for high-risk patients: further improvements in treatment outcome. Blood.2010;115(25):5137–5146(全文). 

13. Lengfelder E, Hofmann WK, Nowak D. Impact of arsenic trioxide in the treatment of acute promyelocytic leukemia.Leukemia. 2012;26(3):433–442.

Acute Lymphocytic Leukemia 急性淋巴细胞白血病

14. Kantarjian HM, O'Brien S, Smith TL, et al. Results of treatment with hyper-CVAD, a dose-intensive regimen, in adult acute lymphocytic leukemia. J Clin Oncol. 2000;18(3):547–561(全文).

15. Rowe JM, Buck G, Burnett AK, et al. Induction therapy for adults with acute lymphoblastic leukemia: results of more than 1500 patients from the international ALL trial: MRC UKALL XII/ECOG E2993. Blood. 2005;106(12):3760–3767(全文). 

16. Goldstone AH, Richards SM, Lazarus HM, et al. In adults with standard-risk acute lymphoblastic leukemia, the greatest benefit is achieved from a matched sibling allogeneic transplantation in first complete remission, and an autologous transplantation is less effective than conventional consolidation/maintenance chemotherapy in all patients: final results of the International ALL Trial (MRC UKALL XII/ECOG E2993). Blood. 2008;111(4):1827–1833(全文).

17. Ravandi F, O'Brien S, Thomas D, et al. First report of phase 2 study of dasatinib with hyper-CVAD for the frontline treatment of patients with Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia. Blood. 2010;116(12):2070–2077(全文). 

18. Bassan R, Hoelzer D. Modern therapy of acute lymphoblastic leukemia. J Clin Oncol. 2011;29(5):532–543.

19. Patel B, Rai L, Buck G, et al. Minimal residual disease is a significant predictor of treatment failure in non T-lineage adult acute lymphoblastic leukaemia: final results of the international trial UKALL XII/ECOG2993. Br J Haematol. 2010;148(1):80–89(全文).

20. Marks DI, Paietta EM, Moorman AV, et al. T-cell acute lymphoblastic leukemia in adults: clinical features, immunophenotype, cytogenetics, and outcome from the large randomized prospective trial (UKALL XII/ECOG 2993).Blood. 2009;114(25):5136–5145(全文). 

21. Ravandi F. Managing Philadelphia chromosome-positive acute lymphoblastic leukemia: role of tyrosine kinase inhibitors. Clin Lymphoma Myeloma Leuk. 2011;11(2):198–203.

Chronic Myeloid Leukemia 慢性粒细胞白血病

22. O'Brien SG, Guilhot F, Larson RA, et al. Imatinib compared with interferon and low-dose cytarabine for newly diagnosed chronic-phase chronic myeloid leukemia. N Engl J Med. 2003;348(11):994–1004(全文).

23. Kantarjian H, Shah NP, Hochhaus A, et al. Dasatinib versus imatinib in newly diagnosed chronic-phase chronic myeloid leukemia. N Engl J Med. 2010;362(24):2260–2270(全文).

24. Saglio G, Kim DW, Issaragrisil S, et al. Nilotinib versus imatinib for newly diagnosed chronic myeloid leukemia. N Engl J Med. 2010;362(24):2251–2259(全文).

25. Kantarjian HM, Hochhaus A, Saglio G, et al. Nilotinib versus imatinib for the treatment of patients with newly diagnosed chronic phase, Philadelphia chromosome-positive, chronic myeloid leukaemia: 24-month minimum follow-up of the phase 3 randomised ENESTnd trial. Lancet Oncol. 2011;12(9):841–851.

26. Preudhomme C, Guilhot J, Nicolini FE, et al. Imatinib plus peginterferon alfa-2a in chronic myeloid leukemia. N Engl J Med. 2010;363(26):2511–2521(全文).

27. Branford S, Hughes TP. Mutational analysis in chronic myeloid leukemia: when and what to do? Current Opin Hematol. 2011;18(2):111–116.

Chronic Lymphocytic Leukemia – Prognosis 慢性淋巴细胞白血病-预后

28. Rai KR, Sawitsky A, Cronkite EP, et al. Clinical staging of chronic lymphocytic leukemia. Blood. 1975;46(2):219–234(全文). 

29. Dohner H, Stilgenbauer S, Benner A, et al. Genomic aberrations and survival in chronic lymphocytic leukemia.New Engl J Med. 2000;343(26):1910–1916(全文).

30. Rassenti LZ, Huynh L, Toy TL, et al. ZAP-70 compared with immunoglobulin heavy-chain gene mutation status as a predictor of disease progression in chronic lymphocytic leukemia. New Engl J Med. 2004;351(9):893–901.

Chronic Lymphocytic Leukemia – Treatment慢性淋巴细胞白血病-治疗

31. Rai KR, Peterson BL, Appelbaum FR, et al. Fludarabine compared with chlorambucil as primary therapy for chronic lymphocytic leukemia. N Engl J Med. 2000;343(24):1750–1757(全文).

32. Catovsky D, Richards S, Matutes E, et al. Assessment of fludarabine plus cyclophosphamide for patients with chronic lymphocytic leukaemia (the LRF CLL4 Trial): a randomised controlled trial. Lancet. 2007;370(9583):230–239.

33. Robak T, Dmoszynska A, Solal-Celigny P, et al. Rituximab plus fludarabine and cyclophosphamide prolongs progression-free survival compared with fludarabine and cyclophosphamide alone in previously treated chronic lymphocytic leukemia. J Clin Oncol. 2010;28(10):1756–1765(全文).

34. Hallek M, Fischer K, Fingerle-Rowson G, et al. Addition of rituximab to fludarabine and cyclophosphamide in patients with chronic lymphocytic leukaemia: a randomised, open-label, phase 3 trial. Lancet. 2010;376(9747):1164–1174.

35. Elter T, Gercheva-Kyuchukova L, Pylylpenko H, et al. Fludarabine plus alemtuzumab versus fludarabine alone in patients with previously treated chronic lymphocytic leukaemia: a randomised phase 3 trial. Lancet Oncol. 2011;12(13):1204–1213.

36. Böttcher S, Ritgen M, Fischer K, et al. Minimal residual disease quantification is an independent predictor of progression-free and overall survival in chronic lymphocytic leukemia: a multivariate analysis from the randomized GCLLSG CLL8 trial. J Clin Oncol. 2012;30(9):980–988.

37. Cramer P, Hallek M. Prognostic factors in chronic lymphocytic leukemia-what do we need to know? Nat Rev Clin Oncol. 2011;8(1):38–47(全文)

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