Abstract: Objective early clearance of leukemia cells in adult acute lymphoblastic leukemia in clinical significance. Methods 45 patients with acute lymphoblastic leukemia patients with vincristine, daunorubicin, cyclophosphamide, prednisone and L-asparaginase induction chemotherapy to assess the first 15 to 21 day period the proportion of leukemia cells to leukemia cells in bone marrow cells under 5% leukemia cells as early removal criteria, statistical analysis of early clearance of leukemia cells and clinical outcome of adult acute lymphoblastic leukemia of the relationship. Results cases were followed up for 1 to 61 months, with a median follow-up time of 9 months. Early clearance of leukemia cells to obtain the total 57.8% of cases, unrelated to sex (P = 1.0), but older is not conducive to the early clearance of leukemia cells (P = 0.0419). Early bone marrow suppression after chemotherapy of leukemia cells in favor of early removal (P = 0.018). Early clearance of leukemia cells and closely related complete remission within 4 weeks (P = 0.000). Early clearance of leukemia cells were not nearly impossible to reach complete remission within 4 weeks, 4 weeks after these cases the proportion of complete remission is not high (52.7%). Early clearance of leukemia cells to survive longer than the total group of the control group (P = 0.0076). However, those of early leukemia cells clear the duration of complete remission, relapse rate, disease free survival, overall survival (1,2 years) and not those of early leukemia cells were not significantly different clearance (P> 0.05). Conclusion Early clearance of leukemia cells of adult acute lymphoblastic leukemia and a favorable prognosis.

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Condition analysis:
Remission induction therapy points to consolidate and maintain remission in three stages.
1) induced remission
At present, many with international standards VDLP programs: the vincristine (VCR) 2mg, intravenous injection, the first 1,8,15,22 days. DNR 40 ~ 60mg / (m2 · d), intravenous infusion, 1 to 3 days. L-asparaginase (L-Asp) 6000u / (m2 · d), intravenous infusion, 17 to 28 days. prednisone (Pred) 30 ~ 40mg / (m2 · d), oral, first 1 to 28 days. the first 14 days for Guchuan, as there is still more leukemia cells, bone marrow hyperplasia, the plus DNR 40 ~ 60mg / (m2 · d), intravenous infusion, 15 to 16 days, 28 days further Guchuan, such as not ease, intermittent 10 to 14 days, continue to section 2 of treatment.
2) consolidation therapy
The first course of treatment using the following programs 1,3,5,7: the VCR 2mg, intravenous injection, on days 1,8. DNR 40 ~ 60mg / (m2 · d), intravenous infusion, 1 to 2 days. L-Asp 12000u / (m2 · d), intravenous infusion, the first 2,4,7,9,11,14 days. Pred 30 ~ 40mg / (m2 · d), orally, 1 to 14 days.
2,4,6,8 treatment using the following scheme: Teniposide (VM26) 165mg / (m2 · d), intravenous infusion, the first 1,4,8,11 days. Ara-C 300 mg / (m2 · d), intravenous infusion, the first 1,4,8,11 days.
9 treatment: methotrexate (MTX) 690mg/m2, intravenous infusion, intramuscular injection of 6 hours after drip folinic CF 15mg, q6h, a total of 12 times. Use of the program was added 2 days before treatment alkalinization, hydration, liver, gallbladder and other measures.
3) maintenance treatment
Common drugs MTX 20mg/m2, oral, week 1 .6 - mercaptopurine (6-MP) 75mg/m2, orally, day 1. Cyclophosphamide 50mg/m2, orally, day 1, every May 5 to 7 days. progress in the treatment of acute lymphoblastic leukemia
Application of high-dose chemotherapy, making the 80% to 85% of adults with acute lymphoblastic leukemia patients achieved complete remission. For patients who failed conventional chemotherapy, allogeneic hematopoietic stem cell transplantation (AlloBMT) is still the main treatment. Targeted therapy is acute lymphoblastic Another new treatment approach.
Chemotherapy
Since the application of high-dose chemotherapy, especially high-dose methotrexate (MTX) and cytarabine (Ara-C) the use of 80% to 85% of adults with acute lymphoblastic leukemia   ALL patients with complete remission and long-term disease-free survival (DFS) of 30% ~ 40%; 75% ALL patients were cured. induction of remission program is the most common drugs include prednisone, vincristine, anthracyclines (daunorubicin, mostly ) and L-asparaginase, and also combined with cyclophosphamide, Ara-C (conventional dose or high dose), 6-mercaptopurine, or other drugs, early intensive treatment of the line. Dexamethasone at high concentrations in the cerebrospinal fluid, anti-leukemia effect strong, which in many programs in place of prednisone. MRC ALL97/99 results show that compared with prednisolone, dexamethasone in patients receiving central nervous system leukemia relapse rate was significantly reduced 3-year DFS were 87% to 79%.
Suggestion:
Remission induction therapy points to consolidate and maintain remission in three stages.
1) induced remission
At present, many with international standards VDLP programs: the vincristine (VCR) 2mg, intravenous injection, the first 1,8,15,22 days. DNR 40 ~ 60mg / (m2 · d), intravenous infusion, 1 to 3 days. L-asparaginase (L-Asp) 6000u / (m2 · d), intravenous infusion, 17 to 28 days. prednisone (Pred) 30 ~ 40mg / (m2 · d), oral, first 1 to 28 days. the first 14 days for Guchuan, as there is still more leukemia cells, bone marrow hyperplasia, the plus DNR 40 ~ 60mg / (m2 · d), intravenous infusion, 15 to 16 days, 28 days further Guchuan, such as not ease, intermittent 10 to 14 days, continue to section 2 of treatment.
2) consolidation therapy
The first course of treatment using the following programs 1,3,5,7: the VCR 2mg, intravenous injection, on days 1,8. DNR 40 ~ 60mg / (m2 · d), intravenous infusion, 1 to 2 days. L-Asp 12000u / (m2 · d), intravenous infusion, the first 2,4,7,9,11,14 days. Pred 30 ~ 40mg / (m2 · d), orally, 1 to 14 days.
2,4,6,8 treatment using the following scheme: Teniposide (VM26) 165mg / (m2 · d), intravenous infusion, the first 1,4,8,11 days. Ara-C 300 mg / (m2 · d), intravenous infusion, the first 1,4,8,11 days.
9 treatment: methotrexate (MTX) 690mg/m2, intravenous infusion, intramuscular injection of 6 hours after drip folinic CF 15mg, q6h, a total of 12 times. Use of the program was added 2 days before treatment alkalinization, hydration, liver, gallbladder and other measures.
3) maintenance treatment
Common drugs MTX 20mg/m2, oral, week 1 .6 - mercaptopurine (6-MP) 75mg/m2, orally, 1 time per day. Cyclophosphamide 50mg/m2, orally, day 1, every May 5 to 7 days. progress in the treatment of acute lymphoblastic leukemia
Application of high-dose chemotherapy, making the 80% to 85% of adults with acute lymphoblastic leukemia patients achieved complete remission. For patients who failed conventional chemotherapy, allogeneic hematopoietic stem cell transplantation (AlloBMT) is still the main treatment. Targeted therapy is acute lymphoblastic Another new treatment approach.
Chemotherapy
Since the application of high-dose chemotherapy, especially high-dose methotrexate (MTX) and cytarabine (Ara-C) the use of 80% to 85% of adults with acute lymphoblastic leukemia   ALL patients with complete remission and long-term disease-free survival (DFS) of 30% ~ 40%; 75% ALL patients were cured. induction of remission program is the most common drugs include prednisone, vincristine, anthracyclines (daunorubicin, mostly ) and L-asparaginase, and also combined with cyclophosphamide, Ara-C (conventional dose or high dose), 6-mercaptopurine, or other drugs, early intensive treatment of the line. Dexamethasone at high concentrations in the cerebrospinal fluid, anti-leukemia effect strong, which in many programs in place of prednisone. MRC ALL97/99 results show that compared with prednisolone, dexamethasone in patients receiving central nervous system leukemia relapse rate was significantly reduced 3-year DFS were 87% to 79%.