Method for treatment of chronic lympholeukosis

FIELD: medicine, oncology.

SUBSTANCE: invention relates to a method for treatment of chronic lympholeukosis. Method involves intravenous drop and jet administration of antitumor chemopreparations and carrying out the autochemotherapy. At the 1-st and 8-th day of treatment cyclophosphan in the dose 750 mg/m2, vincristine in the dose 1.4 mg/m2 and doxorubicin in the dose 30 mg/m2 incubated with 200 ml of autoblood are administrated to patients. From the 1-st to 14-th day of treatment prednisolone is used every day in the therapeutic dose. The treatment course is repeated in 30-35 days depending on blood indices and patient state. The total treatment of courses is 4-5. Method provides reducing cardiotoxicity of doxorubicin and cumulative toxicity of chemopreparations that allows carrying out administration of antitumor chemopreparations in the full volume to patients of elderly age groups.

EFFECT: improved method for treatment.

1 ex

 

The invention relates to medicine, more specifically to methods of conservative treatment of diseases lymphoproliferative systems, and can be used in the treatment of patients of older age groups.

There is a method of treatment of chronic lymphocytic leukemia involving the use of systemic chemotherapy.

On the first day of treatment, patients intravenous cyclophosphamide 750 mg/m2, vincristine 1.4 mg/m2, adriamycin (doxorubicin) - 50 mg/m, and from the first to the fifth day prednisone 60 mg/m inside (Clinical Oncohematology. A guide for physicians./Edited Magalloway. - M.: Medicine, 2001).

The applied treatment is very effective, however, the toxicity of anthracycline antibiotics, first and foremost, if present, is one of the main factors limiting their use in the clinic.

The frequency of occurrence of cardiotoxic effect is directly dependent on the dose of doxorubicin and increases sharply at high cumulative doses. In this regard, the antitumor activity of anthracycline antibiotics cannot be implemented fully, especially in patients of older age groups suffering from diseases of the cardiovascular system.

There is a method of treatment of lymphoproliferative disorders, particularly non-Hodgkin's lymphomas, for which treatment use is as complex anticancer chemotherapy, United with Autocraft patients (hayrapetov KG “Traditional and modified autohemotherapy in complex treatment of patients nehodgkinski lymphomas”. Diss... Kida. the honey. Sciences. Rostov-on-don, 2002).

Suggested by the author, the method of administration of anticancer chemotherapy has a very significant effect on tumor cells, the rate of complete remission in up to 50%.

Despite the effect, the method has drawbacks. In this paper, the author proposes as the primary anticancer drug - intron with toxic side manifestations in the form of severe hepato - and nephrotoxicity. This makes it difficult, and often impossible the use of these regimens in these patients.

The purpose of the invention is to reduce the toxic manifestations of chemotherapy in the treatment of patients with chronic lymphocytic leukemia, improve efficiency and increase the duration of remission.

This objective is achieved in that after the evaluation of the General condition of the patient, morphological verification of diagnosis, General clinical research from a peripheral vein of the patient blood sample in a volume of 200 ml in capacity with anticoagulant. On the first day of treatment to the patient intravenously administered cyclophosphamide based 750 mg/ m2, vincristine based 1.4 mg/m2and on carubicin at a dose of 30 mg/m 2, incubated for 30 minutes at a temperature of 37°With Autocraft.

The introduction of drugs in the same number and sequence performed on the 8th day of treatment, from the 1st to the 14th day of treatment using prednisolone daily standard dose. Repeat the treatment 30-35 days, depending on blood counts of the patient. The total number of courses 4-5.

Declared “a Method of treating chronic lymphocytic leukemia” in comparison with the known involves an inventive step and has novelty. The novelty of the method lies in the possibility of effective treatment of chronic lymphocytic leukemia by use of anticancer drugs with the greatest damaging effect on tumor cells, while reducing the harmful toxic effects of chemotherapy by the use of complex treatment of autologous blood.

In the available sources of public information of Russia, CIS and abroad guidance on the treatment of chronic lymphocytic leukemia was not found.

Developed a Method for the treatment of chronic lymphocytic leukemia” industrially applicable. It can be reproduced and repeated many times in specialized hospitals oncological and hematological profile.

The method is as follows.

The patient perform obsolence the Kie studies verification of the diagnosis, the assessment of the General condition, identification of comorbidity. Conduct x-ray, ultrasound examination of the status and size of lymph nodes, liver, spleen. Further, in compliance with the rules of asepsis in a patient from a peripheral vein in the elbow bend produce fence 200 ml of blood in a container with standard anticoagulant. After that autologous blood is combined with doxorubicin at the rate of 30 mg/m2the body surface of the patient. The mixture is then incubated for 30 minutes at 37°and is re-infused, pre-connecting with 100 ml of physiological solution.

On the first day of treatment the patient perform intravenous drip of cyclophosphamide based 750 mg/m2and vincristine from the calculation of 1.4 mg/m2and doxorubicin at a dose of 30 mg/m2, incubated with Autocraft. The introduction of anticancer drugs is repeated in the same quantities and sequence on an 8-day treatment, from the first to the fourteenth day of the prescribed prednisolone daily standard dose. Depending on blood counts, repeat the treatment after 30-35 days, the total number of courses 4-5.

A specific example of “Way” can serve as a statement of history.

Patient F., 58 years history No. 1243/23, was admitted to the Hematology Department of the Rostov state medical University 12.02.2002 the ode diagnosed with:

The main one. Chronic lymphocytic leukemia, expanded stage IV stage by Rai.

A companion. Ischemic heart disease, atherosclerotic cardiosclerosis, angina, II functional class, failure 0 degree. Hypertension stage I. Chronic hepatocholecystitis. Chronic pancreatitis, exacerbation.

At admission showed hyperplasia of the cervical (2×2 cm), axillary (2×2 cm), inguinal (3×2 cm), lymph nodes, dough-vato-elastic consistency, not soldered together, with surrounding tissues, movable, painless, intact skin over them. Marked hyperplasia of the liver 4 cm below the edge of the costal arch, edge smooth, smooth, moderately painful, hyperplasia of the spleen - 8 cm below the edge of the costal arch, with a strong incisura, elastic consistency, painless.

In the blood test on admission: Hemoglobin - 98 g/l, eritr. - 3,2×1012/l, leucocytes - 120×109/l, lymphocytes - 88%, atypical lymphocytes - 8%, stab - 1%, segmented neutrophils - 2%, monocytes - 1%, platelets 100×109/HP

In kilogramme the number of lymphocytes is 45%. Ultrasound abdomen revealed hyperplastic lymph nodes paraaortal up to 2×3 cm in the liver hilus - 2×2 cm, hepatosplenomegaly. When needle biopsy podm the muscle lymph node verified diagnosis: chronic lymphocytic leukemia - histogenesis No. 54.

When ECG from 13.02.02: electrical axis rejected to the left. Sinus rhythm, disruption of the processes of depolarization in the myocardium lateral, posterior wall of the left ventricle.

Fluorogram from 13.02.02: chronic bronchitis. Deformation pulmonary pattern on both sides. The roots extended, sealed.

The hospital conducted therapy: cyclophosphamide 750 mg/m214.02 and 21.02.02/drip in physiological solution, doxorubicin 30 mg/m2/drip on autologous blood 14.02 and 21.02, vincristine 1.4 mg/m2/inkjet physiological solution, prednisolone 40 mg/m2a day with 14.02 on 21.02.02.

therapy was well tolerated: there was no nausea, vomiting, decreased in size lymph nodes up to 1.5×2 cm, respectively, liver and spleen 2 cm

Subsequent courses conducted in the same doses with an interval of 35 days. After the fourth treatment was observed regression leukocytosis up to 20 thousand. Thrombocytopenia was maintained within 98-79×109/l, hemoglobin - 98-102 g/l ECG dynamics - myocardial hypertrophy of the left ventricle, the disruption of the processes of depolarization in the myocardium of the left ventricle. Signs of ischemia, hypoxia were not found.

During treatment was observed regression of peripheral lymph nodes, and lymph nodes in the abdominal cavity, reducing the tion of the liver and spleen to the protrusion 2 cm from the edge of the costal arch.

At the present time is on maintenance therapy with lacerna 10 mg 1 time per 7 days.

The claimed method of treatment of 35 patients. All patients underwent treatment without complications. At the present time are in a satisfactory condition. Some of them returned to work, leads an active lifestyle.

Technical and economic effectiveness of the proposed Method lies in the ability to reduce adverse toxic manifestations of anticancer chemotherapy; to increase the duration of remission while reducing the overall number of medicines; to carry out in full the introduction of anticancer chemotherapy in patients of older age groups while improving their quality of life.

The method of treatment of chronic lymphocytic leukemia, including intravenous infusion and bolus injection of anticancer drugs and autohemotherapy, characterized in that the first and eighth day of treatment, patients injected with cyclophosphamide 750 mg/m2, vincristine 1.4 mg/m2and doxorubicin 30 mg/m2, incubated with 200 ml of autologous blood, from the first to the fourteenth day of use prednisolone daily therapeutic dose; repeat treatment after 30-35 days, depending on blood counts and condition of the patient; the total number of courses of treatment - 4-5.


 

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