2020年10月25日星期日

lidocaine for hemorrhoids,Questions about leukemia

    1. What is leukemia?

    Leukemia is a malignant disease of hematopoietic tissue, commonly known as "blood cancer". It is characterized by the neoplastic proliferation of a certain type of leukemia cells in the bone marrow or other hematopoietic tissues, which can infiltrate various organs and tissues in the body and affect the function of various organs. Damage, resulting in corresponding symptoms and signs. Clinically, there are often anemia, fever, infection, bleeding, and varying degrees of swelling of the liver, spleen, and lymph nodes. Immature cells can appear in bone marrow and peripheral blood.

    2. Why is leukemia called "blood cancer"?

    Leukemia has the same characteristics as other malignant cancers. which is:

    (1) Like malignant tumor cells, leukemia cells can proliferate indefinitely;

    (2) Like other malignant tumor cells, leukemia cells can invade various organs of the human body without hindrance, affect organ functions, and cause systemic failure and death;

    (3) Leukemia can also manifest as local infiltration, forming masses like tumors. Such as skin infiltrating nodules and common green tumors in the eye sockets of children. Therefore, most people often refer to leukemia as "blood cancer."

    3. Why do you get leukemia?

    The reason is not clear. Radiation, ionizing radiation, viruses, chemical substances (including poisons and drugs), coupled with possible genetic or immune deficiencies in individuals, can cause hematopoietic cells to undergo malignant transformation. Malignant cells have defects in differentiation and maturation. At the same time maintain the ability to divide and proliferate. Therefore, such malignant cells (leukemia cells) can continue to proliferate and accumulate in the body, spread from the hematopoietic tissue to the blood and various organs of the body, and the clinical manifestations of related leukemia appear.

    4. Is leukemia contagious?

    Leukemia is not an infectious disease. Although the exact cause of human leukemia is still unclear, there are many theories about the pathogenesis of leukemia, and no leukemia has been infected by close contact with leukemia patients. Although studies have found that certain viral infections, such as human T lymphocyte virus type I (HTLV-1), can induce certain small cell leukemias, mainly due to the reverse transcription DNA contained in this virus itself causing genetic mutations in patients Although it is caused by infection with this type of virus, there are mainly internal factors of such patients. In addition, it has also been reported that in some families, several family members have suffered from the same type of leukemia, but this is not due to mutual infection, mainly due to certain genetic defects shared by such family members. If leukemia is contagious, the medical staff who are in close contact with leukemia patients should be the first victims. However, in actual work, there is no leukemia among the medical staff.

    5. Can leukemia be inherited?

    It should be said that not all leukemias are genetically predisposed, but some leukemias are clinically seen in a certain race (such as white people), certain genetic defects (such as Down's syndrome) and certain family diseases (Such as Fanconi anemia) is more likely to occur. In identical twins, if one person suffers from acute leukemia, the probability of the other person suffering from acute leukemia (25%) is significantly higher than that of ordinary people (5/10 million). All of the above suggest that certain genetic factors may affect the incidence of leukemia.

    6. Who are prone to leukemia? What are the clinical manifestations of leukemia?

    The current research on the etiology of leukemia shows that whether a person develops leukemia may depend on the interaction of internal and external factors. According to relevant research, the incidence of leukemia may be higher than that of ordinary people, that is, the "high-risk" groups:

    (1) People who have been exposed to ionizing radiation due to some special needs or accidents, such as survivors of nuclear radiation such as atomic bomb explosions after tumors or other patients undergoing x-ray or gamma-ray irradiation or 32P treatment.

    (2) Long-term or chronic exposure to certain chemical reagents or drugs, such as benzene and its derivatives, certain anti-tumor drugs such as alkylating agents, or certain immunosuppressants, bismorpholine, etc.

    (3) Those who have been infected by a certain retro RNA virus (such as HTLV-I virus).

    (4) Patients with certain congenital and genetic diseases, such as Down's syndrome, Fanconi anemia, Bloom syndrome.

    The clinical characteristics of leukemia are mainly due to the inhibition of normal hematopoietic cell growth and the infiltration of organs by leukemia cells. Due to the infiltration or inhibition of leukemia cells to the bone marrow, the normal hematopoietic function is blocked. The clinical manifestations include:

    (1) Anemia occurs due to the reduction of mature red blood cells, which can be manifested as dizziness, fatigue, palpitations, and pale complexion.

    (2) Due to the decrease of normal mature white blood cells (mainly granulocytes), the anti-infection ability decreases, and the signs of fever or infection appear repeatedly.

    (3) There is a tendency to spontaneous blood in the skin and mucous membrane area due to the decrease of mature platelets. Such as spontaneous bleeding in the nasal mucosa and gingival area; bleeding from wounds after tooth extraction or other trauma is not easy to stop; skin ecchymosis, bleeding spots, etc.; female patients have increased menstruation, prolonged menstruation, etc.; a few patients may have gastrointestinal bleeding such as black stool , Hematochezia, and fundus or intracranial hemorrhage.

    (4) Organ infiltration: The manifestations vary according to the affected part, such as liver (or spleen, lymph node) enlargement; gingival hyperplasia; sternal tenderness; a small number of patients have testicular enlargement, skin or subcutaneous nodules; if nerve System involvement can also manifest as headache, vomiting, and vision changes.

    7. Does fever in leukemia patients necessarily have infection?

    Fever in patients with leukemia is not necessarily due to infection. Leukemia itself can also cause fever. Leukemia patients, especially those with increased leukemia cells, due to abnormal differentiation and proliferation of blood cells, abnormal nucleic acid metabolism, and more energy released, patients often exhibit fever. This fever can only be controlled by remission of leukemia after chemotherapy. However, in general, most of the fever in leukemia patients is caused by infection. Even if there is no clear focus of infection for the time being, antibiotics should be applied in time.

    8. What are the common infection sites of leukemia?

    Patients with leukemia have more infection sites, and the common ones are:

    (1) Oral cavity is the most common. Including the gums, buccal mucosa, and soft palate. It is manifested as ulcers or erosions, bleeding, and severe cellulitis caused by soft tissue infection.

    (2) Nasal cavity Hemorrhage and erosion of the nasal mucosa can cause perforation of the nasal septum in severe cases.

    (3) Respiratory tract, including trachea, bronchus and lung infections. Patients often have symptoms such as cough, expectoration, chest pain, and suffocation.

    (4) Perianal It is prone to occur in patients with hemorrhoids, anal fissures, or poor stools. Often presents local pain, swelling, erosion, and soft tissue cellulitis infection.

    (5) Urinary tract women are relatively common. It is manifested as urinary tract irritation or hematuria such as frequent urination, urgency, and dysuria.

    (6) Skin, boils, ulcers, etc. appear locally.

    9. Why do leukemia patients have anemia?

    The reasons why patients with leukemia have anemia at the same time are:

    (1) The production of red blood cells is reduced. This is because the abnormal proliferation of leukemia cells in the bone marrow inhibits the proliferation of the red blood cell line;

    (2) The development and maturation of red blood cells is also interfered by leukemia, and the life span of red blood cells is shortened;

    (3) Leukemia patients often accompany bleeding, which further aggravates anemia. Of course, after chemotherapy, the damage of chemical drugs to red blood cells can also aggravate anemia.

    10. Why do leukemia patients bleed easily?

    The mechanism that patients with leukemia are prone to bleeding is more complicated, and the reasons are roughly as follows:

    (1) In leukemia, the number of platelets decreases and dysfunction;

    (2) Destruction of coagulation factors and coagulation mechanism obstacles;

    (3) Due to the accumulation of leukemia cells in the blood vessel and the damage of the blood vessel wall, bleeding is prone to occur.

    11. What are the common bleeding sites in leukemia patients?

    Leukemia patients have extensive bleeding sites, and bleeding can occur in almost all parts of the human body, especially patients with acute leukemia. The more common bleeding sites are:

    (1) Skin manifested as petechiae, ecchymosis or large areas of purpura, or even hematoma. Even worse at venipuncture or after trauma;

    (2) Oral bleeding gums and oral mucosa. In mild cases, bleeding occurs after brushing teeth or eating hard food. In severe cases, bleeding may not stop without any incentives, or even blood blisters or hematomas;

    (3) Nasal cavity bleeding after bruising or without inducement;

    (4) Other Eyeball conjunctiva, gastrointestinal tract, urogenital system (vaginal bleeding in female patients) and cerebral hemorrhage.

    12. How does leukemia suffer from bone pain, joint pain, or sternal tenderness?

    A large number of leukemia cells proliferate in the bone marrow cavity of leukemia patients, which leads to increased pressure in the bone marrow cavity. In addition, when the periosteum and joint cavity are infiltrated by leukemia cells, it will also invade the periosteal nerve and cause the joint cavity pressure to increase and bone destruction to cause pain .

    13. What should I do if I have leukemia?

    Once a person is suspected or told to have a certain type of leukemia, be sure to keep calm. Although leukemia is a malignant disease of the blood system, the malignant disease is no longer a terminal disease since the development of medicine. At this time, you should cooperate with your doctor and actively cooperate with the treatment. It is not advisable to give up life easily or to go to the doctor if there is a disease, or to delay treatment by believing in any "remedies".

    14. Should leukemia patients avoid it?

    In terms of diet, it should be said that there is no food that leukemia patients cannot eat. Just to avoid unnecessary complications during treatment, patients with leukemia should pay attention to the following points in diet:

    (1) Pay attention to food hygiene and avoid eating cold, overnight or spoiled food. Fresh fruits must be washed and peeled before eating.

    (2) Try to avoid eating hard or fried foods, such as fish products, should try to remove bones and thorns to prevent hard objects from piercing the oral membrane, causing oral ulcers or even secondary local infections.

    (3) Pay attention to the reasonable combination of dietary structure, eat less spicy and pungent food, and eat fresh vegetables as much as possible. Those who have bad bowel habits or have habitual constipation before illness should pay special attention to supplementing foods rich in fiber. Keep daily bowel movements as smooth as possible to prevent constipation from aggravating hemorrhoids or inducing anal fissures, increasing the chance of local infection.

    15. Is blood type related to leukemia?

    The blood type is determined by the special antigenic substances present on the surface of human red blood cells. So far, no blood type has been found to be related to the occurrence of leukemia at home and abroad.

    16. Is leukemia simply a disease of white blood cells?

    Leukemia is not simply a disease of white blood cells, because in the series of hematopoietic system (erythroid, granulocyte, mononuclear, lymphatic, megakaryotic, etc.), leukemia can occur in addition to the series of white blood cells (granulocytes, mononuclear, lymphoid) In addition, other non-leukocyte series (megakaryocytes, erythroid) can also develop leukemia. In addition, no matter which series of leukemia, except for the acute and tumorous proliferation of cells in a certain stage of this series, due to the influence of tumor cells on normal hematopoietic tissues, the growth of other normal series of cells is also inhibited. Therefore, any series of leukemias will eventually show varying degrees of anemia (red blood cell reduction), bleeding (thrombocytopenia), and susceptibility to infection (abnormal number and quality of white blood cells).

    17. Will blood transfusion be contagious to leukemia?

    Although blood transfusion can cause the spread of certain infectious diseases (blood-borne viral diseases, such as hepatitis B, hepatitis C, AIDS, malaria, etc.) in rare cases, there is no leukemia caused by blood transfusion at home and abroad. Report. Of course, we cannot completely exclude that some people have imported blood products contaminated with certain special viruses, such as human T lymphocyte-type I virus (HTLV-type I disease), because the reverse transcription RNA contained in the virus is in The host T lymphocytes are transformed into proviruses and further integrated into the DNA chain of the host T cells. By activating the cell's own oncogenes, the T cells eventually proliferate malignantly, and then develop into leukemia. These people often have internal factors.

    18. Is leukemia an incurable disease?

    Although leukemia is a malignant disease of hematopoietic tissue, it was once incurable, but due to the development of medical technology, leukemia has become a treatable disease. Through active chemotherapy, radiotherapy, bone marrow or peripheral blood stem cell transplantation, and the application of biological response modifiers, more than half of the patients have been able to extend their survival. Some patients can be cured.

    19. What is the incidence of leukemia in China?

    Leukemia patients in China are about 3-4 people per 100,000 population, and there are more men than women. The incidence varies from region to region. Acute myeloid leukemia is the most acute leukemia, followed by acute lymphoblastic leukemia, and most of them are adolescents and children under 20 years old. Chronic myelogenous leukemia is more common in adults, and chronic lymphocytic leukemia is more common in the elderly.

    Chemotherapy can achieve complete remission of more than 75% of acute lymphoblastic leukemia and more than 65% of acute myeloid leukemia, and the 5-year disease-free survival rate is 50% and 30-40%, respectively. Most children and about one-third of adult acute lymphoblastic leukemia and 20% of acute myeloid leukemia can be clinically cured.

    20. How to distinguish between acute and chronic leukemia?

    The distinction between acute and chronic leukemia is mainly based on:

    (1) Life expectancy or natural progression The average life expectancy of patients with untreated acute leukemia is less than one year, while the average life expectancy of chronic leukemia is 1-3 years;

    (2) The differentiation and maturity of leukemia cells. The main leukemia cells in the bone marrow or peripheral blood of acute leukemia are primitive (lymphoid, granular or mononuclear) cells, while the bone marrow and peripheral blood of chronic leukemia are mainly mature and Immature granulocytes (chronic myeloid leukemia) or mature small lymphocytes (chronic lymphocytic leukemia).

    twenty one. Will acute and chronic leukemia transform each other?

    The acute and chronic concepts of leukemia are fundamentally different from the acute and chronic concepts of other diseases (such as acute and chronic hepatitis, acute and chronic gastritis, etc.). Leukemia is divided into acute and chronic diseases, except for the difference between the rapid onset of the disease, the speed of development, and the length of the natural course, the key lies in the maturity of leukemia cells. The main leukemia cells in the bone marrow or peripheral blood of acute leukemia are primitive cells. The bone marrow and peripheral blood of chronic leukemia are mainly mature and immature granulocytes or similar mature small lymphocytes. After treatment, patients with acute leukemia, although they have lived with the disease for months or years, are still acute leukemia rather than chronic leukemia in nature. However, some chronic leukemias, such as chronic myelogenous leukemia, may have a significant increase in the number of blasts and the number of blasts in the bone marrow during a certain stage of the pathology, and the transition to acute leukemia occurs, that is, chronic myeloid leukemia or chronic myeloid blasts. Elephant.

    twenty two. How to distinguish leukemia and leukemia?

    The body reacts to certain diseases or external stimuli, which can be manifested as a significant increase in peripheral blood white blood cells, and immature cells may appear at the same time. This phenomenon is called a leukemia-like reaction. The difference between leukemia-like leukemia and leukemia is that the leukemia-like white blood cell changes do not have tumor characteristics, and there are certain disease triggers. When the triggers are removed, the leukemia-like reaction disappears, so the changes are temporary, so it is not difficult. Differentiate from leukemia. However, in individual cases, except for the obvious changes in white blood cells, the bone marrow picture showed an increase in the ratio of myeloblasts and promyelocytic cells, which resembled acute leukemia. In the case of leukemia, red blood cells and platelets should not be affected; further methods such as cellular immune typing and chromosome analysis can be used to distinguish leukemia.

    twenty three. Are leukemia and sepsis the same thing?

    Both leukemia and sepsis can have similar clinical manifestations, such as anemia, fever, purpura, hepatosplenomegaly, abnormal increase in white blood cells and the appearance of immature cells, etc., but the two are two completely different diseases in nature . The former is a malignant tumor of hematopoietic tissue, while the latter is a systemic infection caused by a certain bacterial infection entering the blood circulation. Patients with leukemia may develop sepsis due to secondary severe infection at a certain stage of the disease course. Sepsis will never turn into leukemia.

    twenty four. What is pre-leukemia?

    Pre-leukemia (pre-white) refers to a hematological abnormality that is difficult to determine for a considerable period of time before the appearance of leukemia. It is a retrospective diagnosis made after the occurrence of leukemia. Myelodysplastic syndrome (MDS) has a considerable number of patients with MDS-RAEB and MDS-RAEB-t that can transform into leukemia as the disease progresses. The MDS-RAEB and MDS-RAEB-t phases of these patients are called white pre-white . The main clinical features of pre-whiteness are: most patients have different degrees of anemia, and although it is difficult to improve the anemia through various treatments; some patients can also show abnormalities such as fever or bleeding at the same time; routine blood tests show pancytopenia or either 2. The secondary cells are reduced, showing pathological hematopoiesis phenomena such as giant red blood cells, giant platelets, and nucleated red blood cells; tertiary blood cells or any two blood cells in the bone marrow show pathological hematopoiesis. The proportion of primitive cells can be increased, but it has not yet reached the leukemia standard.

    25. What is the FAB classification of acute leukemia?

    In 1976, blood cell morphology experts from three countries including France (Franch), the United States (American) and Britain (Britain) discussed and formulated diagnostic criteria for acute leukemia classification, referred to as FAB classification. According to this standard, acute non-lymphocytic leukemia can be divided into seven subtypes, M1-M7, and acute lymphocytic leukemia can be divided into three types L1-L3 based on this standard. This classification method has been widely adopted by countries all over the world, and its purpose is to unify the classification and diagnosis of acute leukemia.

    26. What does MIC classification of acute leukemia mean? What are the advantages compared with FAB typing?

    MIC is the abbreviation of Morphology (Morphology, M), Immunology (Immunology, I) and Cytogenetic (Cytogenetic, C). The MIC classification of acute leukemia, as the name suggests, is based on the morphological, immunological and cytogenetic characteristics of leukemia cells to make a diagnosis of leukemia. The use of MIC classification can make up for the shortcomings of FAB classification only by morphological classification. In addition to morphological characteristics, MIC is still based on a series of specific antigens carried or expressed on the surface of leukemia cells (such as myeloid antigens, T, B or non-T, non-B lymphoid antigens), and the application of monoclonal antibodies is used for determination and labeling. Improve the accuracy and objectivity of leukemia classification. At the same time, chromosome banding technology and other cytogenetic methods are used to detect whether there are chromosomal abnormalities in leukemia patients, which can provide valuable references for guiding clinical judgments and prognosis.

    27. What are the types of acute leukemia?

    Acute leukemia can be divided into two categories: acute lymphocytic leukemia (acute lymphatic leukemia, ALL) and acute non-lymphocytic leukemia (acute non-lymphatic leukemia, ANLL). According to the FAB classification standard revised in 1985, ANLL is divided into 7 types such as M1-M7. They are:

    M1: Undifferentiated myeloblastic leukemia;

    M2: Partially differentiated myelocytic leukemia;

    M3: Acute promyelocytic leukemia;

    M4: Acute myelocytic leukemia;

    M5: Acute monocytic leukemia;

    M6: Acute red blood disease or erythroleukemia;

    M7: Acute megakaryocytic leukemia.

    According to the morphological characteristics of FAB, ALL is divided into three types: L1, L2, and L3.

    Type L1: Primitive lymphocytes have uniform round nuclei and little cytoplasm;

    Type L2: The primordial lymphocytes vary greatly, the nucleus may be irregular, and the cytoplasm is more than that of L1;

    Type L3: Primitive lymphocytes have smaller nuclear chromatin, the cytoplasm is blue to dark blue, and vacuoles are formed.

    In addition, according to immunological characteristics, ALL can be divided into two major categories, T cells and B cells, and then divided into multiple subtypes. Except for L1 type acute lymph which must be B-cell type acute lymph, there is no obvious correlation between the morphological type and immunological type of acute type.

    28. How is acute leukemia diagnosed?

    Diagnosis of leukemia is mainly based on the patient's clinical manifestations, blood picture and bone marrow examination results, with> 30% of the blast cells in the bone marrow as the standard for diagnosing acute leukemia. (The latest WHO diagnostic criteria has taken ≥20% blast cells in the bone marrow as the criteria for the diagnosis of acute leukemia.)

    29. What are the clinical features of acute myeloid leukemia?

    Acute myeloid leukemia, referred to as acute granule. It is mainly manifested as the malignant proliferation of granulocytes. It has two subtypes: undifferentiated granulocytic leukemia (M1) and partially differentiated granulocytic leukemia (M2). Patients with this disease often start suddenly and progress quickly. Clinical infections and bleeding are common and often cause death. Approximately 10% of the cases progress slowly, most of them are elderly, showing weakness, pale, weak and other anemia symptoms, as well as bleeding and infection.

    30. What are the clinical features of acute promyelocytic leukemia?

    Acute promyelocytic leukemia is an acute leukemia dominated by promyelocytic proliferation, which is type M3 of FAB classification. The onset is rapid, rapidly worsening, bleeding tendency is obvious, and diffuse intravascular coagulation is prone to occur. The number of white blood cells in the peripheral blood does not usually increase, and the promyelocytic cells in the bone marrow are more than 30%. This type of leukemia can be alleviated by inducing the maturation, differentiation or apoptosis of leukemia cells.

    31. What are the characteristics of acute myelocytic leukemia?

    Acute myeloid and monocytic leukemia (abbreviated as acute myeloid, ANLL-M5). There are granular and mononuclear cell lines in the bone marrow or (and) peripheral blood, or the primitive cells of "emergency granular mononuclear cells" have both granular and mononuclear morphological characteristics. If promyelocytic and promyelocytic proliferation are the main proliferation, protomyelocytic mononuclear cells and monocytes should exceed 20%; if promyelocytic mononuclear cell proliferation is the main proliferation, promyelocytic and promyelocytic cells should exceed 20%.

    Clinically, the performance of "Ji Lidan" has the following characteristics:

    (1) Gum hyperplasia, swelling, bleeding, ulcers, necrosis, etc. are more common;

    (2) Nasal mucosal infiltration, nasal congestion, hyposmia, hard palate ulceration, throat edema and suffocation caused by suffocation, etc.;

    (3) Skin leukemia lesions are more common, which can be manifested as diffuse maculopapular rash, hard nodules, masses, pustular, bullous, or exfoliative dermatitis;

    (4) Infiltration of the intestinal wall, ulcers, gastrointestinal dysfunction, etc. are relatively easy to see;

    (5) Renal failure and proteinuria are more common, which are related to monocytes and granulocytes rich in lysozyme-easy to form lysozymeemia and lysozyme urine;

    (6) Joint pain and swelling are relatively common;

    (7) In terms of treatment, the curative effect of emergency granular single and emergency single is worse than other acute non-lymphocytic leukemia.

    32. What is the difference between red blood disease and erythroleukemia?

    Acute red blood cells are mainly manifested by malignant proliferation of primordial red blood cells and premature red blood cells, with megaloblastic changes seen. Clinically, it is often misdiagnosed as megaloblastic anemia. Acute erythroleukemia is manifested as malignant hyperplasia of two lines of red and white (mainly granules), and finally can develop into a typical acute myeloid leukemia or acute myelomonocytic leukemia. It is generally believed that leukemia can develop into erythroleukemia, and the latter can be further transformed into acute leukemia. However, clinically not every case has such a transformation process, and some cases may die of complications before transformation. Failed to show the whole process of disease development.

    33. Why do patients with acute promyelocytic leukemia have more bleeding than other leukemias?

    These seven factors are because there are a large number of abnormal particles in the leukemia cells of this disease. These particles are rich in procoagulant substances and plasminogen activating substances. With the proliferation of leukemia cells or the destruction of chemotherapy, the procoagulant and fibrinolytic active substances A large amount of human blood is released, causing disseminated intravascular coagulation and fibrinolysis, which in turn causes obvious bleeding tendency throughout the body. Gingival bleeding, epistaxis, and large ecchymosis are common clinically, and patients often die from intracranial hemorrhage.

    34. What is the immunophenotype of leukemia? How does it help the clinic?

    The immunophenotyping of leukemia is to use monoclonal antibodies to detect the antigens on the surface or cytoplasm of the corresponding white blood cells, to more detailed classification and series sources of malignant cells, to accurately understand the different differentiation stages of the tested white blood cells, which is helpful for clinical Type, judge prognosis, and guide treatment. At present, this technology has become an important method for clinical treatment of leukemia and basic medical research.

    35. What is a green tumor?

    Green tumors, also called protogranuloma or granulocytic sarcoma, are local masses formed by the aggregation of leukemia cells. Because these cells contain abundant peroxidase, the cut surface of the tumorigenic mass is green and named. Green tumors are common in children and young people with acute granules, and there are more men than women. It usually invades the periosteum, dura mater and ligament tissues, most commonly in the orbit, and can cause asymmetric exophthalmos. It is also seen in the cheekbones, paranasal sinuses, ribs, sternum and pelvis. The bone marrow cavity, breast, liver, kidney, gastrointestinal, gonads (testes, ovaries), muscles, etc. can also be involved. This tumor mass may appear before the typical hematological changes of leukemia.

    36. What is congenital leukemia?

    Any leukemia diagnosed within the fourth week after birth is called congenital leukemia. The skin manifestations are the most common at birth. About 50% of cases, except for purpura, often have 0.2-0.3 cm leukemia nodules. In addition to hepatosplenomegaly, dyspnea is more common, and the cell types are more non-lymphocytes than lymphocytes. Most children die of respiratory failure within days to months after diagnosis.

    37. What is hypoproliferative leukemia?

    Acute leukemia is called hypoproliferative leukemia when it shows bone marrow with reduced nucleocytosis. Its main characteristics are: more common in the elderly; slow progress of the disease; infiltration of leukemia cells is not obvious, liver and spleen are generally not swollen; peripheral blood triline cells are reduced, no or only a few blasts are seen; bone marrow shows decreased proliferation, primitive Cells account for more than 30%. Combination chemotherapy is still the main treatment for this type of leukemia, but the prognosis is poor.

    38. What is smoky leukemia?

    If you think of acute leukemia as a raging fire, it is not difficult to understand that smoky leukemia is an insidious leukemia disease state with the potential to cause fire. The prominent feature of this disease is that the disease progresses slowly for a period of months or even years. The blood picture also shows anemia, white blood cell and thrombocytopenia, and the bone marrow picture contains only 5%-30% of the original cells. Later, as the disease progresses, the clinical symptoms also tend to be severe. At present, this type of leukemia has been attributed to the refractory anemia with excessive blastoblasts in myelodysplastic syndrome (MDS-RAEB) and the transformational type with refractory anemia with excessive blasts (MDS-RAEB-t ).

    39. What is chronic leukemia?

    Chronic leukemia is a malignant hematological disease with relatively mature leukemia cells, and its natural course is longer than that of acute leukemia. According to the morphological type of leukemia cells, it is roughly divided into two types: chronic myeloid leukemia and chronic lymphocytic leukemia. The latter still includes some rare types of leukemia, such as hairy cell leukemia, young lymphocytic leukemia, adult T-cell leukemia and so on.

    40. What is chronic myeloid leukemia?

    Chronic myeloid leukemia (chronic myeloid leukemia) is a myeloproliferative disorder, which is caused by pluripotent stem cell pathology and is characterized by the unrestricted proliferation of the granulocyte system. It can be seen at any age, but the peak incidence is around 40 years old. Ph1 chromosome can be detected in 90% of patients with this disease, and abnormalities in the corresponding gene structure can also be found in the remaining 10% of patients through molecular biology methods. This disease has an insidious onset, with mild early symptoms, including low-grade fever, night sweats, and weight loss. Splenomegaly is clearly characteristic of the disease. Peripheral blood leukocytes increase, mostly granulocytes below the myelomyelocytic stage; platelets do not decrease or even increase in the early stage. Bone marrow hyperplasia is extremely active, with an increased proportion of mid-myelomyelocytic and late-myelomyelocytic cells. Megakaryocytes are more common and may have different degrees of myelofibrosis. The natural course of chronic myelogenous leukemia can be divided into three stages:

    (1) In the chronic phase, the symptoms are mild, about 3-4 years;

    (2) In the accelerated phase, there are more symptoms and hematological changes, and the patient may die due to infection or bleeding;

    (3) In the blast phase, the symptoms and hematological changes are similar to acute leukemia.

    41. What are the diagnostic criteria for the treatment of chronic myeloid leukemia?

    The criteria for diagnosing chronic myelogenous leukemia are:

    (1) Peripheral blood neutrophils are elevated, immature granulocytes are more than 10%, and primitive granulocytes are less than 5%-10%;

    (2) Bone marrow granulocytes are highly proliferative, mainly mid- and late-myelocytic granulocytes, primordial granulocytes <10%;

    (3) Neutrophil alkaline phosphatase (NAP) score decreased;

    (4) Ph1 chromosome positive and/or bcr-abl fusion gene positive.

    The diagnostic criteria for the accelerated phase of chronic myelogenous leukemia are:

    (1) 10%-20% of primitive cells in peripheral blood or bone marrow;

    (2) With anemia or thrombocytopenia;

    (3) Green tumors appear.

    The criteria for the blast phase of chronic granulocytes are the same as those for acute leukemia.

    42. What are the treatments for chronic myeloid leukemia?

    The treatments for chronic myelogenous leukemia include:

    (1) Chemical (drug) treatment;

    (2) Leukocyte removal technique (can be used temporarily when the white blood cells are too large);

    (3) Alpha-interferon treatment;

    (4) Allogeneic bone marrow transplantation (for patients under 40) is currently the only cure.

    The accelerated phase and blast phase of chronic particles should be administered according to the principles of treatment of acute leukemia.

    43. What is the blast crisis of chronic myeloid leukemia?

    When the blast cells in the blood and bone marrow of patients with chronic myelogenous leukemia reach or approach the level of acute leukemia, it is called chronic myelogenous blast crisis or chronic myeloid blast, which is the end-stage manifestation of chronic myelogenous leukemia. The increased primordial cells can be primordial granulocytes (called "protomyelocytic transformation") or primordial lymphocytes (called "protolymphatic transformation"). Acute leukemia should be treated at this time, but the effect is often poor. The median survival period is 4-6 months, rarely more than 1 year.

    44. What clinical manifestations of patients with chronic myeloid leukemia indicate the possibility of acute change?

    Patients with chronic myelogenous leukemia should be alert to the possibility of acute change when the following clinical manifestations occur, and should seek medical treatment in time:

    (1) Progressive anemia: Symptoms of anemia appear within a short period of time (patients with chronic granules generally do not have anemia in the chronic phase), and they continue to worsen;

    (2) The fever persists and cannot be controlled with general antibiotics;

    (3) Progressive enlargement of the spleen;

    (4) Bleeding tendency;

    (5) Changes in blood and bone marrow.

    45. What is chronic lymphocytic leukemia?

    Chronic lymphocytic leukemia (chronic lymphocytic leukemia) is a malignant proliferative disease of lymphocytes with certain immune insufficiency in the lymphocyte lineage. These mature lymphocytes accumulate in the body, which can make the lymph node structure disappear, increase the lymphocytes in the blood and bone marrow, enlarge the lymph nodes and liver and spleen, and finally involve other tissues outside the lymphatic system. The monoclonality of the chronic lymphocyte cell line. More than 95% of chronic lymphocytes are B-cell type, and 5%-10% of cases are T-cell type. Patients often have abnormal immune function. The disease progresses slowly, and the average survival time from the time of diagnosis is about 4 to 6 years. Because this disease occurs in the elderly, about 1/3 of the deaths of cases are often unrelated to this disease.

    46. What is hairy cell leukemia?

    This disease is a special type of chronic B lymphocytic leukemia. Patients present with anemia, fever, splenomegaly, and peripheral blood cells often decrease. The main basis for the diagnosis of this disease is to see characteristic hairy cells in the peripheral blood or bone marrow. The periphery of the cell cytoplasm is irregular, with jagged or pseudopod-like protrusions, and sometimes elongated hairs. Phase contrast microscopy and scanning electron microscopy are important means to identify hair cells. Acid phosphatase stains positive and is not inhibited by L-tartaric acid. The characteristic of immunophenotyping is that CD25 and CD11 are strongly positive. Splenectomy is the first choice for treatment, and high-dose interferon and adenine dehydrogenase inhibitors are effective in treating this disease. Those with conditions may consider bone marrow transplantation.

    47. What is mixed leukemia?

    Mixed leukemia is a group of acute leukemias with considerable differences in nature, and its cell morphology is difficult to classify according to FAB diagnostic criteria. The use of monoclonal antibodies and molecular genetics technology can divide mixed blood disease into two types:

    (1) Dual-phenotypic leukemia cells express both granular and lymphocytic cell antigens simultaneously;

    (2) Double series type The patient has two groups of leukemia cells, which express granular and lymphoid antigens respectively. If it is a series of cells first, then transformed into another series of cells with or without treatment, it is called series conversion;

    (3) Double clonotypes are very rare. Using cytogenetic methods, it can be seen that leukemia cells are composed of two completely different clones. Judging the type of mixed leukemia is of great significance in formulating the treatment plan and prognosis of the leukemia.

    48. What is plasma cell leukemia?

    This disease is a leukemia originating in plasma cells, which is rare in clinical practice. It can be divided into two categories:

    (1) In patients with advanced multiple myeloma, where the tumor cells spread into the blood and the plasma cells in the peripheral blood reach more than 20%, it is called secondary plasma cell leukemia;

    (2) Primary acute plasma cell leukemia, the patient has no clear history of multiple myeloma, is young at onset, and has extensive infiltration of abnormal plasma cells. The clinical manifestations are similar to acute leukemia, with anemia, thrombocytopenia and leukocytosis. In the classification of peripheral blood leukocytes, plasma cells are more than 20%, plasma cells in bone marrow are obviously proliferated, and primitive plasma cells and immature plasma cells are significantly increased. The disease develops rapidly, the treatment effect is poor, and the average survival period is about 4-5 months.

    49. What is called central nervous system leukemia (white brain)? What manifestations suggest that white brain may have occurred?

    Leukemia of the central nervous system is mainly caused by the infiltration of leukemia cells into the meninges or brain parenchyma, causing patients to show corresponding neurological and/or psychiatric symptoms. Brain whites can be seen at any stage of the course of leukemia. When a leukemia patient has unexplained headache, nausea, blurred vision or diplopia, strabismus, facial paresthesia, facial muscle paralysis, deviated tongue or paraplegia, dysfunction or abnormal mental behavior, disturbance of consciousness during the course of the disease ( When drowsiness, lethargy, coma), etc., be aware of the occurrence of brain whites. Further diagnosis can be made by measuring the pressure of cerebrospinal fluid, routine cerebrospinal fluid, biochemical and pathological examinations.

    50. How to diagnose central nervous system leukemia (white brain)?

    The diagnosis of "white brain" is mainly based on the following points:

    (1) Have corresponding symptoms and signs of central nervous system involvement;

    2) Cerebrospinal fluid: increased pressure> 200 mm water column; white blood cell count in cerebrospinal fluid> 0.01×109/L; qualitative cerebrospinal fluid protein test is positive or protein quantitative> 45mg/dl; leukemia cells can be found in cerebrospinal fluid;

    (3) Nervous system diseases caused by other reasons are excluded.

    Among the above-mentioned articles, finding leukemia cells in cerebrospinal fluid is the most useful for diagnosis.

    51. Why do leukemia patients need to check the fundus?

    The fundus examination of leukemia patients is usually based on the following reasons:

    (1) To determine whether there is leukemia cell infiltration in the fundus of the eye;

    (2) To clarify the presence or absence of combined fundus hemorrhage, because fundus hemorrhage is often regarded as a precursor of intracranial hemorrhage;

    (3) When the patient is suspected of having intracranial hemorrhage or white brain due to symptoms such as headache, vomiting, etc., examination of the fundus helps to determine whether the patient has increased intracranial pressure through changes in the optic papilla, which is often life-threatening In emergency situations, active treatment such as dehydration and lowering of intracranial pressure is required.

    52. What is the "prognosis" of leukemia?

    The so-called "prognosis" refers to the pre-estimation of the outcome of the disease. It is usually expressed by probability indicators such as cure rate, recurrence rate, remission rate, disability rate, mortality rate, and survival rate. The prognosis of leukemia refers to the pre-estimation of the outcome of a leukemia patient through the probability of the outcome and outcome of the leukemia and the corresponding influencing factors.

    53. What are the unfavorable factors affecting the prognosis of acute leukemia?

    Unfavorable factors affecting the prognosis of acute leukemia are:

    (1) Children under the age of 1 and over 9 years old, especially those over 60 years old;

    (2) Boys are worse than girls;

    (3) The white blood cell count before treatment is above 50×109-100×109/L;

    (4) The platelet count before treatment is less than 20×109-50×109/L;

    (5) FAB classification belongs to L1, L3, M4, M5, M6, M7;

    (6) The immunophenotype of lymphocytic leukemia belongs to T cell or certain B cell type;

    (7) Accompanied by some chromosomal abnormalities, especially breaks and translocations, such as t(9;22), etc.;

    (8) Leukemia cells in the bone marrow decrease slowly after treatment, and it takes longer or shorter time to achieve remission;

    (9) Patients with obvious hepatosplenomegaly or central nervous system leukemia.

    54. What are the stages of leukemia treatment? What are the different goals of each stage?

    The treatment of leukemia can generally be divided into two main stages: induction remission treatment and post-remission treatment. The latter can be further divided into two stages: consolidation treatment, intensive treatment and maintenance treatment. The purpose of inducing remission is to quickly reduce the leukemia cells as much as possible, so that the hematopoietic function of the bone marrow can return to normal and reach the standard of complete remission. The purpose of post-remission treatment is to further eliminate the remaining leukemia cells in the body through the use of long-lasting consolidation and intensive treatment, prevent the recurrence of leukemia, prolong the remission and survival time, and strive to cure the leukemia.

    55. What is the complete remission of leukemia?

    Complete remission of leukemia requires the following conditions:

    (1) There is no clinical symptoms and signs caused by leukemia infiltration, and life is normal or close to normal;

    (2) Routine blood tests showed hemoglobin ≥100g/L (male) or ≥90g/L (female and children), absolute value of neutrophils>1.5×109/L, platelets ≥100×109/L, in peripheral blood No leukemia cells were found;

    (3) The blast cells in the bone marrow are less than 5%, and the red blood cells and megakaryocyte lines are normal.

    When the patient meets the above three items at the same time, it is a complete remission; if the patient’s bone marrow examination meets the relevant standards, but the clinical or blood routine tests have not yet reached the corresponding standards, it is regarded as a partial remission; otherwise, it is not remission.

    If counted from the date of complete remission after treatment, those without recurrence of leukemia for 3-5 years are called continuous complete remission of leukemia.

    56. What is a clinical cure for leukemia?

    Any leukemia patient who has no recurrence after 5 years of stopping chemotherapy or who has survived disease-free for 10 years is regarded as clinically cured.

    57. Can continuous complete remission of leukemia be regarded as a clinical cure for leukemia?

    Continuous complete remission of leukemia and clinical cure of leukemia, although both belong to the long-term survival state of leukemia (from the date of diagnosis of leukemia, disease-free or disease-free survival time of 5 years or more than dead), but the two are not equivalent . Only when patients with continuous complete remission continue to keep the leukemia without recurrence for more than 5 years after the termination of chemotherapy, can they be regarded as clinically cured.

    58. Why should chemotherapy be continued after the leukemia is completely resolved?

    In patients with untreated leukemia, the leukemia cells in their bodies are about 5×1010~1013. In patients with complete remission, although the clinical symptoms and signs of leukemia have completely disappeared, and the blood and bone marrow images have basically returned to normal, there are still a considerable number of leukemia cells (108-109 or less) in their body at this time, and they are in Leukemia cells can still be infiltrated in some hidden places outside the bone marrow, and these residual leukemia cells can cause disease recurrence. In order to further destroy the remaining leukemia cells, prevent recurrence, prolong the remission and survival time, and strive for the cure of the leukemia, active consolidation and intensive treatment are still needed after complete remission and continue for a long period of time (2 to 3 years).

    59. What is Leukemia Minimal Residual Disease?

    Leukemia minimal residue refers to the state where a small amount of leukemia cells are still left in the body after the leukemia has been completely relieved by induction chemotherapy or after bone marrow transplantation. It is generally believed that the total number of leukemia cells in the body of leukemia patients is about 1012 when they visit a doctor. After chemotherapy is induced to complete remission, the leukemia cells can be reduced to 1010. At this time, it is difficult to detect the presence of leukemia cells using general morphological methods, but in fact there are still leukemia cells in the patient’s bone marrow, and the number can be 109 or less. These remaining cells become the root cause of the recurrence of leukemia.

    60. What is the significance of detecting minimal residual leukemia?

    The significance of detecting minimal residual leukemia is:

    (1) It is helpful to predict the recurrence of leukemia earlier; to guide the clinical treatment of leukemia, according to the number of leukemia cells in the body to decide whether to continue chemotherapy or stop treatment;

    (2) It is helpful to find out whether the leukemia cells are drug-resistant earlier, and guide the clinical selection of more sensitive and lethal treatment measures accordingly;

    (3) It is helpful to evaluate the purification effect of autologous hematopoietic stem cell transplantation.

    61. How to judge the recurrence of leukemia?

    Leukemia patients who have achieved complete remission after treatment are called leukemia recurrence if any of the following occurs in the course of the disease:

    (1) The original cells in the bone marrow or the original single+you single or the original lin+you lin >5% but less than 20%, who have not reached the complete bone marrow remission standard after one course of effective anti-leukemia treatment;

    (2) Myeloblasts in the bone marrow (primary single + young single or primary lymph + young lymph)> 20%;

    (3) Those with infiltration of leukemia cells other than bone marrow, such as green tumors, central nervous system leukemia, and testicular leukemia.

    62. What is "extramedullary recurrence" of leukemia?

    Leukemia extramedullary recurrence refers to the evidence of leukemia cell infiltration found in other tissues or organs other than the bone marrow when the bone marrow examination of the leukemia patient is still in complete remission. Extramedullary recurrence is common in the central nervous system, reproductive system (such as male testes, female ovaries) or skin infiltration such as green tumors. Extramedullary recurrence can exist alone, but extramedullary recurrence is often a precursor to a full recurrence of leukemia.

    63. What is a "shelter" for leukemia?

    The so-called leukemia sanctuary refers to the central nervous system and testis and other organs in the body. Due to its natural tissue structure characteristics (blood brain barrier and blood testis barrier), many anti-tumor drugs cannot enter or are not effective in it. The concentration of killing tumor cells. Local tumor cells can survive and multiply, and become the root cause of recurrence of leukemia in the future.

    64. What is the difference in treatment principles between acute leukemia and chronic leukemia?

    Generally speaking, for patients with acute leukemia, sufficient combined chemotherapy should be given as soon as possible from the date of diagnosis, and attention should be paid to the prevention and treatment of extramedullary leukemia (white brain or testicular leukemia). In terms of medication, attention should be paid to the principle of individualization, that is to say, for young patients with good clinical conditions (except acute promyelocytic leukemia), intensive chemotherapy should be given. On the contrary, for the elderly and poor clinical conditions (such as severe infection or obvious bleeding tendency), due to the poor tolerance of patients to intensive chemotherapy and high treatment-related mortality, treatment should be relatively conservative. For chronic leukemia, due to the relatively old age of onset of patients, leukemia progresses generally slowly, so slow and gentle medication is generally used. For individual patients with very slow progress, the drug can even be stopped for observation for a period of time, but Patients who are qualified and suitable for allogeneic stem cell transplantation should still be actively treated.

    65. Why should the chemotherapy of acute leukemia be combined with drugs?

    The purpose of the combination medication is to use different drugs to act on different stages of the cell proliferation cycle to mutually enhance the killing effect of the drugs on leukemia cells. The combination of several drugs with different side effects can reduce or even offset the toxic side effects of drugs while enhancing their anti-leukemia effects. Therefore, the combination of drugs can more selectively kill leukemia cells, so that the host cells can recover faster.

    66. What is the cell cycle?

    The cell cycle refers to a period from the end of a cell division to the end of the next division. In a cell cycle, the cell undergoes a series of complex changes, especially the capacity of DNA doubled. After the cell grows, it divides into two daughter cells, which are the same as the mother cell. The cell cycle can be divided into four continuous processes according to the changes in DNA. They are:

    (1) G1 phase, which is the early stage of DNA synthesis;

    (2) S phase, the DNA synthesis phase;

    (3) G2 phase, also known as late DNA synthesis;

    (4) M phase, this phase is the mitotic phase of the cell. In this phase, the genetic material in the cell-the chromosome has an average longitudinal division of 2, and is divided equally into two daughter cells as the cell divides.

    67. What are proliferating and non-proliferating cells?

    Proliferating cells refer to cells in the cell proliferation cycle. Non-proliferating cells are those cells that are in a dormant state and no longer enter the cell proliferation cycle (Go phase). Since proliferating cells always maintain active division and continuous proliferation, they are more sensitive to anticancer drugs and are easily killed by chemotherapy drugs. Non-proliferating cells, because the cells are in a "dormant state" and only re-enter the proliferation cycle under certain conditions, such cells are not sensitive to chemotherapy and are often the root cause of tumor recurrence.

    68. What are cell cycle specific drugs?

    Cell cycle-specific drugs are those that only target malignant tumor cells during the proliferation cycle. A drug that kills cells at a certain stage. For example: hydroxyurea, cytarabine, mercaptopurine, methotrexate, etc., can interfere with DNA synthesis and have specific killing effect on the S (DNA synthesis) phase of malignant tumor cells; vincristine and vinblastine, It can specifically kill cells in the M (mitotic) phase.

    69. What are cell cycle non-specific drugs?

    Cell cycle non-specific drugs refer to drugs that have a killing effect on cells in each phase (G1, S, G2, M) or resting phase (C0 phase) of the cell proliferation cycle. Most of them can bind to the DNA in the cell and block its replication. So as to show its role in killing cells. Alkylating agents in anticancer drugs and anticancer antibiotics such as doxorubicin and bleomycin belong to this category of drugs.

    70. What is leukemia resistance?

    Leukemia drug resistance means that leukemia cells are not sensitive or resistant to the chemotherapy drugs used. When a patient has undergone several courses of combined chemotherapy, the percentage of leukemia cells in the bone marrow does not decrease significantly or decreases temporarily, but after a short period of treatment, it quickly increases to the level before chemotherapy. This situation can be regarded as Leukemia is resistant. The drug resistance of leukemia cells is one of the main reasons for the failure of the current leukemia treatment.

    71. How does drug-resistant leukemia occur?

    There are two possibilities for the occurrence of drug-resistant leukemia: one may be that the subpopulations of drug-resistant cells that originally existed in the body gradually aggregate and proliferate as sensitive cells are selectively killed, and eventually become the main cell population. It is primary drug resistance; another possibility is that chemotherapeutic drugs induce changes in cell characteristics, leading to drug resistance, which is secondary drug resistance.

    72. What is refractory leukemia?

    In the treatment of leukemia, when the following situations occur, it can be called refractory leukemia:

    (1) Newly treated patients are ineffective to conventional induction chemotherapy;

    (2) Leukemia that recurs early within 6 months of the first remission;

    (3) Although they relapsed 6 months after the first remission, but the original regimen re-induction therapy failed;

    (4) The second or more recurrence patients.

    73. Is there any rescue after the recurrence of leukemia?

    Leukemia after recurrence is more difficult to treat than newly treated patients, but there are still quite a lot of relapsed patients who have undergone active treatment and have again achieved complete remission or even long-term survival. At present, in order to overcome clinical drug resistance, the following is often used in the treatment of relapsed or refractory leukemia:

    (1) Choose a combination of drugs without cross-resistance to form a new chemotherapy regimen;

    (2) Use increased doses of conventional drugs;

    (3) Choose new anti-leukemia drugs with different mechanisms of action from conventional drugs. For patients with relapsed leukemia, if there is a suitable hematopoietic stem cell donor, we should strive for allogeneic stem cell transplantation after the first remission.

    74. Under what circumstances can patients with leukemia stop chemotherapy?

    When the leukemia patient's condition is completely relieved, and after two years of active intensive consolidation therapy, or after receiving allogeneic (or autologous) stem cell transplantation, at the same time the minimal residual leukemia test result is negative, the chemotherapy can be truly terminated. For leukemia patients whose condition has not yet resolved, when there is a serious life-threatening infection or bleeding during chemotherapy, chemotherapy can be postponed as appropriate, but this does not mean that chemotherapy will not be stopped.

    75. What are the side effects of leukemia chemotherapy?

    Most anti-tumor drugs, due to the lack of ideal selectivity, often cause different levels of damage to various organs while killing tumor cells. In the chemotherapy of leukemia, the most common and main side effects are as follows:

    (1) Bone marrow suppression. The degree of suppression of the bone marrow by various anti-tumor drugs, the speed of appearance, and the duration are different. For example, the treatment of CML with human dose of Malilan can make the patient's white blood cells decrease rapidly, but if the dose is not reduced or the drug is stopped in time, It can cause severe bone marrow aplasia that cannot be recovered. -Bone marrow suppression caused by general chemotherapy is prominently manifested as white blood cell and thrombocytopenia. As long as hematopoietic stem cells are not severely affected, the changes in blood and bone marrow here are temporary and recoverable.

    (2) Gastrointestinal reactions Almost all anti-leukemia drugs can cause gastrointestinal symptoms of varying degrees, manifested as loss of appetite, nausea, vomiting, abdominal pain, diarrhea, and even blood in the stool. The above reaction can be caused by drug stimulation, or due to drug damage to the proliferating gastrointestinal mucosal epithelial cells. A few drugs can act on the vomiting center of the brain. Gastrointestinal reactions generally do not affect treatment. Recently, with the application of central antiemetic drugs, gastrointestinal reactions have been controlled or reduced to a great extent. For very few patients with frequent diarrhea or bloody stools, the drug needs to be stopped Observe and give corresponding active treatment.

    (3) Immunosuppression Chemotherapy can inhibit the immune function of the body to varying degrees. This is one of the reasons why patients are prone to infection or difficult to control after chemotherapy.

    76. What is the cause of leukemia, uric acid and nephropathy?

    Leukemia patients, especially those with a high total number of white blood cells, during the advanced stage of the disease or during combined chemotherapy, due to the massive destruction of leukemia cells, the intracellular nucleic acid (purine) metabolite-uric acid increases sharply. Due to the increased excretion of uric acid, it is easy to form urate crystals in the environment where the renal tubules are acidic (pH<5.5) and block the renal tubules, resulting in obstructive kidney damage, which is called leukemia uric acid nephropathy. Because patients with this disease can have hyperkalemia and renal failure in severe cases, in the tumor lysis syndrome, fluid replacement, diuresis, alkalization of urine and allopurinol for lowering uric acid should be given before routine chemotherapy. For severe kidney damage, hemodialysis should be considered.

    77. Is hair loss caused by chemotherapy temporary or permanent?

    Since most anti-tumor drugs kill leukemia cells, they also have a killing effect on a variety of cells with strong proliferation in the body. In addition to normal hematopoietic cells in the bone marrow, germinal cells, oral and gastrointestinal mucosal epithelial cells, spermatogenic cells or oocytes will also be damaged. Therefore, it often causes hair loss after chemotherapy. Hair loss caused by chemotherapy is completely temporary. Once the condition is relieved and the intermittent period of chemotherapy is prolonged, the patient will be able to grow black hair. Moreover, the hair that grows later tends to be denser and slightly curly than the original one, which will definitely not affect the appearance.

    78. Why is it important for leukemia patients to keep their stools open?

    Patients with constipation or dry stools are often prone to anal fissure. Leukemia patients have significantly lower anti-infection ability due to factors such as leukemia or chemotherapy. Once anal fissure occurs, perianal infection is very easy to cause. In severe cases, the bacteria can cause serious conditions such as bacteremia or sepsis through the human blood of the local damage, which not only increases the suffering of the patient, but also has a great impact on the treatment. Therefore, it is very important for every leukemia patient to take precautions before they happen, keep the stool unobstructed and pay attention to local hygiene.

    79. What is tumor lysis syndrome? How to prevent it?

    Tumor lysis syndrome refers to a group of symptoms caused by the disintegration of a large number of tumor cells and the release of their cellular contents and metabolites during the chemotherapy of leukemia or other tumors. Including hyperuricemia, hyperphosphateemia, hypocalcemia, hyperkalemia, acute uric acid nephropathy, etc. should be given symptomatic treatment. Adequate rehydration, alkalization and diuresis and preventive oral allopurinol can play a certain role in prevention and treatment.

    80. What should leukemia patients pay attention to during chemotherapy?

    Leukemia patients should pay attention to the following points during chemotherapy:

    (1) In terms of diet, although the gastrointestinal reaction caused by chemotherapy will cause the patient to lose appetite and appetite during this period, in order to maintain the necessary physical strength and nutrition, the patient should take as much vitamins and high-priced protein as possible Food. Do not eat spicy food, raw or cold, hard and bad foods. Fresh fruits should be washed and peeled before eating.

    (2) Pay attention to personal hygiene and wash hands before meals and after going to the toilet to prevent illness from entering the mouth when the resistance is extremely low.

    (3) Keep the stool unobstructed, and take a bath as much as possible to keep the local area clean. For people with hemorrhoids or constipation, Zhichuangning suppositories and laxatives can be used routinely.

    (4) Reduce contact with the outside world. Reduce unnecessary visits. If you encounter a crowded environment or have "cold" patients around, you should wear a mask to reduce the chance of cross infection.

    (5) It is not advisable to place too many flowers in the patient's room or ward, especially flowerpots, which can reduce infections caused by mold spores and bacteria in the flowers or soil.

    (6) Try not to pick ears or pick teeth with hard objects to prevent local damage and infection.

    81. Why do I have to do bone puncture repeatedly if I have leukemia

    There are several reasons for repeated bone penetration in patients with leukemia:

    (1) Confirmation of diagnosis For patients with leukemia who have been morphologically confirmed, it is necessary to conduct further examinations of bone marrow cytochemistry, immunology and cytogenetics to determine the subtype of leukemia and determine its prognosis.

    (2) Observation of curative effect For patients with leukemia who have not yet resolved, usually 10 to 14 days after chemotherapy, bone puncture is required to understand the treatment response of the last chemotherapy and help doctors determine further treatment options and medication choices. If a patient, after a course of combined chemotherapy, the percentage of leukemia cells in the bone marrow decreases significantly or less than 40% compared to before chemotherapy, it indicates that the patient may be insensitive to the chemotherapy regimen used, and more drugs should be used for further treatment Dosage, or change the treatment plan, choose other drugs.

    (3) Judging the prognosis If the patient has undergone multiple regimens combined with chemotherapy, but the percentage of autohematological cells in the bone marrow does not decrease significantly, or once decreased but rises to the pre-treatment level in a short period of time, it indicates the presence of leukemia cells in this patient Primary drug resistance is difficult to treat and the prognosis is poor.

    (4) Monitoring of changes in the condition For patients who have achieved complete remission after chemotherapy, although the bone marrow picture is nearly normal, it should be reviewed regularly. The purpose is to detect changes in the condition as soon as possible and give timely and effective treatment.

    82. Is bone marrow puncture harmful to the human body?

    Generally speaking, bone marrow puncture has no effect on human health. However, there is a difference between bone marrow puncture and venous blood sampling. Broadly speaking, bone puncture is also one of the traumatic examinations. In addition, the bone piercing needles currently used in China are not disposable consumables, so puncture accidents may occur during the operation in rare cases. When choosing some special parts for bone puncture, such as sternum puncture, etc., you should ask an experienced doctor to operate.

    83. Why do patients with leukemia need lumbar puncture?

    The purpose of lumbar puncture for leukemia patients is to:

    (1) Diagnosis requires cerebrospinal fluid examination by lumbar puncture to determine whether the patient has central nervous system leukemia.

    (2) Treatment needs. Because there is a natural tissue barrier between the blood vessels and the meninges—the blood-brain barrier, it is difficult for most systemic chemotherapeutics administered intravascularly to pass through this barrier freely and in the cerebrospinal fluid. To achieve an effective therapeutic concentration, so that the central nervous system becomes a "shelter" for leukemia cells and the source of recurrence. Therefore, for patients without obvious "white brain" manifestations, routine preventive intrathecal chemotherapy is still required. For those who are clearly combined with "white brain", regular lumbar puncture and intrathecal injection of chemotherapy drugs should be more important.

    84. Under what circumstances do leukemia patients need intrathecal chemotherapy?

    Leukemia patients need intrathecal chemotherapy in the following situations:

    (1) When the patient has unexplained headache, vomiting, abnormal vision, hemiplegia, paraplegia, disturbance of consciousness (drowsiness, lethargy, coma) or abnormal mental behavior during the course of the disease, regardless of whether the cerebrospinal fluid test is abnormal, it should be given as "white brain" Intrathecal chemotherapy.

    (2) For patients with newly-treated or recurrent acute leukemia, if their leukemia type is acute single, acute granular single, or acute leaching, although there is no clinically any neurological or psychiatric symptoms, they should still be given regular sheaths during systemic chemotherapy. Internal chemotherapy. If the type of leukemia is acute granule, erythroleukemia, or other types, intrathecal chemotherapy is performed after the patient's bone marrow symptoms are relieved. If the cerebrospinal fluid test is abnormal, Shan should be given regular and regular intrathecal chemotherapy in time.

    (3) For patients with peripheral blood leukemia >50×109/L at the time of diagnosis, or those who have had cerebral hemorrhage during the course of the disease, regardless of whether there are clinical "white brain" symptoms, and regardless of whether the cerebrospinal fluid test is normal, they should be intrathecal as soon as possible Chemotherapy.

    85. Will repeated lumbar puncture and intrathecal chemotherapy make people "silly"?

    Strictly speaking, chemotherapeutics used for intrathecal injection may cause chemical arachnoiditis, arachnoid adhesion or even central nervous system--chemical damage to a certain degree, but it will not make people "stupid".

    86. Why do I need to lie supine for several hours after intrathecal chemotherapy?

    This is mainly because the cerebrospinal fluid circulates in one direction. In order to allow the drug injected from the spinal canal to spread to the head, so that it can exert an effect on the leukemia cells in the meninges or brain parenchyma, the depilatory supine position must be better than sitting or sitting position. Other positions are good. In addition, lying supine is also beneficial to reduce headaches and other side effects caused by changes in brain pressure after lumbar puncture.

    87. What happens when patients with leukemia should not do waist puncture?

    Lumbar puncture is not suitable when patients with leukemia have severe sharp pain, jet vomiting, or papilledema during ophthalmoscope examination. Because the above symptoms often indicate increased intracranial pressure, if lumbar puncture can easily induce "brain herniation" at this time, it will directly affect the center of life and cause cardiac and respiratory arrest. In addition, when the patient has skin and soft tissue purulent infections locally after puncture, or when the patient has severe bleeding tendency and low platelets (<2.0×109/L), lumbar puncture should not be performed immediately to prevent the spread of infection and spread. Intracranial or local hematoma formation.

    88. What should I do if intrathecal chemotherapy is ineffective or not suitable for patients with "white brain"?

    For patients with "white brain" who are not suitable for lumbar puncture intrathecal chemotherapy (such as spinal deformity, arachnoid adhesion, skin damage and infection at the puncture site, etc.), whole cranial + spinal cord radiotherapy can be used instead. In addition, some drugs that can penetrate the blood-brain barrier (such as carmustine, cyclohexylnitrosourea, etc.) can also be used, or by increasing the dose of certain anti-tumor drugs (such as medium and large doses of methotrexate, Large doses of cytarabine, etc.), so that these drugs can reach an effective concentration in the cerebrospinal fluid, thereby playing the same therapeutic effect as intrathecal chemotherapy.

    89. Are "white brain" patients easy to become "silly" after receiving radiotherapy?

    Radiotherapy is to kill local tumor cells through physical radiation of whole brain + whole spinal cord. Because brain tissue may undergo degeneration, atrophy or necrosis after radiation exposure, especially when the cumulative radiation dose exceeds 6000-6500 CGy, there is a possibility of mental disorders (becoming "stupid") due to leukoencephalopathy. However, through a large number of clinical observations, the incidence of leukoencephalopathy is less than 1% when pure whole brain radiotherapy is more than 2000CGy, and there is no significant increase compared with intrathecal chemotherapy (leukoencephalopathy incidence 1%).

    90. Can patients with leukemia receive surgical operations?

    The answer to this question should not be generalized. First of all, you have to figure out what leukemia is, and under what circumstances. If it is chronic leukemia, such as chronic myelogenous leukemia, hairy cell leukemia, the patient has symptoms of compression due to large spleen, and the effect of chemotherapy is not good, or splenic infarction or spleen rupture occurs, surgical spleen resection is beneficial to the patient. However, if the patient needs surgery due to cholelithiasis or appendicitis, it should be considered based on the patient's general condition at the time. Those who can be treated conservatively will not be operated on. However, if the condition cannot be controlled by conservative treatment, the lesion should be surgically removed.

    For patients with acute leukemia, when the condition has not yet reached a complete remission, the patient’s white blood cells and platelets are low due to the primary blood disease or chemotherapy. If there is a surgical emergency, there is a risk of surgery (such as wound bleeding, hematoma, infection Uncontrollable, etc.) is relatively large. In this case, conservative treatment should be sought first. If conservative treatment is ineffective and surgery is necessary, the operation should be performed under the support of active blood transfusion, platelet transfusion and strong anti-infective treatment. For patients whose acute leukemia has completely resolved. The indications for surgical emergencies are basically the same as those of ordinary people, but the bone marrow suppression period after chemotherapy should be avoided. Pay attention to the corresponding support, anti-infection and other treatments before and after the operation.

    91. When is it safe for patients with leukemia to extract their teeth?

    As the saying goes, "Toothache is not a disease, it hurts to kill people." For leukemia patients, if they are often tortured by dental disease, they must be in a bad mood. Particularly in patients’ residual roots and broken teeth, bacteria are often hidden. Once the leukopenia is caused by chemotherapy, local infections can easily occur in the affected teeth, which can cause maxillofacial soft tissue cellulitis in severe cases. It is necessary for these patients to choose an appropriate time to extract the tooth. Generally, you can choose a rest period between two chemotherapy. When the absolute value of neutrophils in the blood picture is> 1.5×109/L and the number of platelets> 50×109/L, tooth extraction is relatively safe. If local conditions permit, and the patient can persist until the leukemia is completely relieved before extracting the teeth, the operation will be safer, and the incidence of postoperative wound infection and bleeding will be further reduced.

    92. Can I have children after suffering from leukemia?

    The current treatment of leukemia is a comprehensive treatment based on cytotoxic drugs combined with chemotherapy. Because the cytotoxic drugs used can kill leukemia cells to a great extent, they also often have a considerable degree of killing or teratogenic effects on all cells in the body that are proliferating, such as gonadal cells and mucosal epithelial cells. Especially when leukemia patients are combined with leukemia infiltration of the testis or ovary, in order to treat these extramedullary leukemia lesions, it is necessary to supplement systemic chemotherapy with necessary local radiotherapy. These measures will undoubtedly cause normal germ cells and leukemia cells to "perish". Therefore, the fertility of leukemia patients after the above treatment will be greatly affected, and the incidence of fetal malformation, disability or death, and miscarriage is extremely high after marriage, or once pregnant. Based on considerations such as eugenics, it is better for leukemia patients to be infertile.

    93. Can I still work after suffering from leukemia?

    For patients with acute leukemia, before the disease is relieved, due to the influence of the disease itself or chemotherapy, the living ability and working ability of the patient will be greatly affected, and the patient at this time is not suitable for work. But when the condition is completely relieved and regular intensive consolidation treatment has been completed for one year, if the patient's physical strength permits and there are psychological needs in this regard, he can consider doing some work within his capacity. However, chronic leukemia, due to its slow development, may remain stable for a long time without hospitalization or even medication. For these patients, they should be encouraged to participate in work that does not affect the patient's treatment.

    94. Do all leukemias require active chemotherapy from the date of diagnosis?

    Yes, patients with acute leukemia should be given active chemotherapy from the day they are diagnosed, unless the patient has a serious infection (such as pneumonia or sepsis) or a significant tendency to hemorrhage throughout the body. Under the premise of active anti-infection, blood transfusion or platelet apheresis, active systemic chemotherapy can be given after the general condition of the patient is slightly improved. Such waiting period should not be too long, because the infection of leukemia patients or bleeding is caused by leukemia itself Because leukemia cells have the upper hand in hematopoietic tissues, inhibiting normal hematopoiesis, causing severe reduction of neutrophils, platelets, etc., causing severe infection or bleeding, early control of leukemia will help the early recovery of normal hematopoietic stem cells and also help Control infection and bleeding tendency.

    For patients with chronic leukemia, whether chronic granule or chronic lymphocytic disease, corresponding chemotherapy should be given from the date of diagnosis, but the intensity of treatment should be different from that of acute leukemia. This is mainly because the age of onset of chronic leukemia patients is too old, and the leukemia Progress (especially for chronic lymphatic) is generally slow, and overly intense or aggressive chemotherapy may increase the risks associated with treatment, such as organ failure or further weakened immunity leading to serious life-threatening infections.

    95. What is interferon? What types of leukemia can interferon have a therapeutic effect on?

    Interferon is a cytokine produced by monocytes and lymphocytes. Divided into 3 kinds of α, β and γ. Since the 1980s, many studies have shown that interferons (especially α-interferon and γ-interferon) not only have anti-virus and immune function, but also have obvious anti-cell proliferation effects. Therefore, interferon has been used to treat a variety of leukemias. For example, a large dose of interferon-α can be used to treat the chronic phase of chronic granulocytes, which can effectively reduce white blood cells and shrink the enlarged spleen, and a considerable number of patients can be treated with chromosomal abnormalities (Ph1 chromosomes) unique to tumor cells. disappear. Research on hairy cell leukemia also found that the effective rate of high-dose interferon treatment can reach more than 75%. However, the effective rate of high-dose interferon treatment in patients with chronic lymphocytic is relatively low, only 50%±. There are relatively few studies on interferon in the treatment of acute leukemia, and only a few studies have been reported. It is used in children with acute leaching after allogeneic bone marrow transplantation. Alpha-interferon can reduce the incidence of cytomegalovirus infection and interstitial pneumonia, and can also significantly reduce the recurrence rate of leukemia in patients.

    All in all, in the current treatment of leukemia, the treatment of interferon is mainly shown to be helpful for chronic leukemia (chronic phase), hairy cell leukemia, and chronic leukemia. Due to the high cost of interferon treatment and many side effects (such as reduced mobility, mental retardation, etc.) in large doses, it is currently not widely used in China.

    96. What are stem cells?

    Stem cells are the most primitive cells in hematopoietic tissues and other tissues. They have self-replication ability and the potential to differentiate into various series of cells, so they are also called pluripotent stem cells.

    97. What are the characteristics of human hematopoietic stem cells?

    Human hematopoietic stem cells are morphologically similar to small lymphocytes, occupying only about 1% of nuclear cells in bone marrow. Human hematopoietic cells come from the mesothelial cells of the embryonic yolk sac, which are the most unique somatic cell group in the human body. It has extremely high self-renewal, multi-directional differentiation and long-term hematopoiesis potential and self-repair ability after injury. In addition, it also has extensive migration and specific orientation (so-called "homing") characteristics, can be preferentially positioned and planted in an appropriate microenvironment (such as bone marrow, etc.), and exists in a non-proliferative state and lacks a series of related antigens.

    98. What are the characteristics of bone marrow?

    Bone marrow is a spongy, gelatinous, fatty tissue. It is mainly composed of blood vessels, nerves, reticular tissue and stromal cells, among which are filled with parenchymal cells (hematopoietic cells). Normal human bone marrow accounts for about 3.4% to 5.9% of body weight, with an average of 4.6%. Bone marrow is divided into red marrow (hematopoietic marrow) and yellow marrow (fatty marrow). When a person is just born, the red marrow fills the skeletal cavity of the whole body. As we age, the red marrow gradually changes to yellow marrow. This change starts at the far end of the body and develops centripetally. By adulthood, the red marrow only exists in the limbs. The proximal end of the long bones and the skeletal cavity in the skull, sternum, ribs, shoulder bones and ilium.

    99. What is bone marrow transplantation? What are the types of bone marrow transplantation?

    Bone marrow transplantation refers to the transplantation of the donor's bone marrow hematopoietic stem cells to the recipient (patient) to restore the normal hematopoietic function of the latter. Bone marrow transplantation can be divided into allogeneic bone marrow transplantation (HLA-matched sibling or non-relative bone marrow), syngeneic bone marrow transplantation (genetically identical single-egg twin bone marrow) and autologous bone marrow transplantation according to the source of bone marrow. Three kinds.

    100. Which diseases is suitable for bone marrow transplantation?

    Allogeneic (syngeneic or allogeneic) bone marrow transplantation is suitable for the treatment of acute radiation sickness, aplastic anemia, leukemia, myelodysplastic syndrome, myelodysplastic disease, congenital immunodeficiency disease or certain inborn metabolic diseases . Autologous bone marrow transplantation is mainly suitable for patients with leukemia in complete remission and patients with solid tumors that are sensitive to chemotherapy or radiotherapy (preferably bone marrow is not affected).

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