New Treatment Plan for T-Cell Acute Lymphoblastic Leukemia: Successful Results from Japanese Research.

Leukemia│A study in Japan aimed at children aged 0 to 25 to young people, adding new drugs, strengthening the dosage of conventional drugs, and extending intrathecal therapy as a chemotherapy regimen to improve the treatment effect of T-cell acute lymphoblastic leukemia, the results were successful Increase the survival rate of patients from about 70% to 91.3% in 3 years.

Written by: Yuuki@Medical Inspire 医． Thinking │ Image source: Busayamas Kasemphong＠Shutterstock, Kateryna Kon@Shutterstock, A3pfamily@Shutterstock │ Source:《Lancet Haematology》periodicals

Leukemia│Japanese research: A new treatment plan for T-cell acute lymphoblastic leukemia! New drugs + enhanced old drugs can help improve the survival rate of patients.

There are about 1,000 new leukemia cases in Hong Kong every year, and 10% of them are children. Leukemia is one of the blood cancers and there are many types. Among them, the type of cancer most children suffer from is acute lymphoblastic leukemia (ALL), and the incidence rate of children and adolescents is also higher than that of adults. About 80 to 85% of acute lymphoblastic leukemia is of the “precursor B-cell” type (B-ALL), while T-cell acute lymphoblastic leukemia (T-ALL) accounts for 10 to 15%. Leukemia progresses rapidly and is one of the top ten fatal cancers in Hong Kong, but it is also one of the cancers with the highest cure rate. However, compared with B-cell ALL, T-cell type is generally less effective for anticancer drugs. Relatively more difficult to deal with.

The Japan Pediatric Cancer Research Group (JCCG) and the Japan Adult Leukemia Joint Research Institute (JALSG), together with the country’s medical experts, have launched a joint study targeting children aged 0 to 25 to young adults with the addition of the new drug nelarabine and enhanced asparaginase (L-asparaginase) dosage and extended spinal cord intrathecal therapy to improve the therapeutic effect of T-cell ALL. As a result, the patient’s survival rate was successfully increased from about 70% to 91.3% at 3 years. The team has published the research results in the international scientific journal “Lancet Haematology” on May 8, Japan time.

Tcellular acute lymphoblastic leukemia

Generally speaking, stem cells produced by bone marrow will develop into mature bone marrow stem cells and lymphoid stem cells. Bone marrow stem cells will transform into three types of mature blood cells, including red blood cells, platelets and white blood cells; natural killer cells.Among them, B cells can produce antibodies and fight infection, while T cells help B cells produce antibodies to fight infection

The formation of T-cell acute lymphoblastic leukemia stems from the lesions of lymphoid T-cell blasts, and the continuous division makes the number out of control. The abnormal leukemia cells produced by the lesion are not mature cells and cannot perform their normal functions to help patients resist infection. Instead, they occupy the bone marrow space, suppress normal bone marrow hematopoietic tissue, and cause infiltration of peripheral blood vessels, bone marrow, systemic lymph nodes, spleen and liver. It can lead to multiple complications in patients and spread to the central nervous system or other organs, and the symptoms are most obvious in children.

Research purpose and method

Compared with precursor B-cell lymphoblastic leukemia, T-cell acute lymphoblastic leukemia has unique biological characteristics and its medical prognosis is generally poorer in disease development. In order to improve the treatment effect of T-cell acute lymphoblastic leukemia, which is generally poor, the research team launched a study in 2011 and listed the name of the trial as the ALL-T11 treatment plan. Children aged 0 to 25 and the AYA generation (AYA means 15 to 15 39-year-old Adolescent and Young Adult generation) patients with acute lymphoblastic leukemia were subjected to clinical trials.

The research team aims to reduce the treatment of intracranial radiation therapy and hematopoietic stem cell transplantation (Haematopoietic Stem Cell Transplant, HSCT) to patients, while reducing long-term side effects in growing children; -Frankfurt-Münster (BFM)-type treatment), which is a complex, multidrug enhanced chemotherapy regimen, adding the new drug nelarabine (nelarabine), intensifying the dose and frequency of the conventional drug L-asparaginase (L-asparaginase) , as well as changing the type of steroid to use dexamethasone (Dexamethasone), prolonging the intrathecal treatment of the spinal cord to improve the therapeutic effect.

Study finds treatment regimen effectively improves patient survival

The results of the study found that compared with the European conventional treatment model, the rate of radiotherapy and hematopoietic stem cell transplantation in patients with T-cell acute lymphoblastic leukemia was reduced by nearly half, the rate of radiotherapy dropped from 15% to 8%, and the acceptance rate of hematopoietic stem cell transplantation was reduced from 19%. % decreased to 10%; the survival rate increased from 75.9% to 86.4% and the overall survival rate reached 91.3%.

The researchers believe that the results of the ALL-T11 treatment plan are encouraging, and the team is conducting the ALL-T19 study as a follow-up study of ALL-T11, using the same treatment strategy as ALL-T11, expanding the age range to provide patients aged 0 to 65 The treatment intensity is suitable for all age groups. It is hoped that the research will contribute to the formulation of standard treatment plans for all age groups.