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l of Traditional Chinese Medicine ; 2000 05
Current location: China paper Ce Medi Clin body of Chronic myeloid leukemia progressAbstract In recent years, chronic myeloid leukemia (CML) in the treatment of Chinese and Western Medicine on the basis of the past have made great progress, for the development of BCR ABL tyrosine kinase inhibitor, targeted therapy is the focus of CML, bone marrow transplantation the best way to treat CML, and with the signal transduction pathway of CML-depth study of individual therapy will be possible. The Chinese understanding of the disease each different, but not from the empty, poison, stasis three links.
Key words hydroxyurea in chronic myelogenous leukemia hematopoietic stem cell transplantation for molecular targeted therapy of Traditional Chinese Medicine Summary
Abstract: In recent years, CML treated with combination of TCM and WM has got great achievement on the basis of before.Pointing to the emphasis that the inhibitor of BCR ABL tyrosine kinases is the target treatment of CML, marrow transplantation is the most ideal method for CML; meanwhile, with further research on CML signal transmitting route, individualized treatment will be possible.Though every expert has his own idea to the disease from TCM, it still concerns 3 links of deficiency, toxin and stasis.Chronic myeloid leukemia (CML) is a clonal proliferation of hematopoietic stem cell disease, bone marrow with myeloid hyperplasia, peripheral blood leukocytosis and splenomegaly as the main feature. In recent years, CML treatment of Chinese and Western medicine on the basis of in the past have made great progress, are summarized below.(1), hydroxyurea (HU) for cell cycle specific inhibition of DNA synthesis of drugs, was recommended as the treatment of choice for CML drugs alone, but the efficacy of accelerated phase CML is poor, largely ineffective blast phase CML. [1] (2), busulfan (BU) an alkylating agent, is cell cycle non-specific drugs for most patients with CML in chronic phase is effective, but there are obvious side effects such as bone marrow suppression, rash, interstitial pulmonary fibrosis. (3) interferon (IFN a) treatment of CML has been nearly 20 years, can not be served as allogeneic stem cell transplantation ph CML in first-line treatment [2]. But in the 2006 edition of NCCN CML treatment guidelines have been adjusted to the second-line drugs [3].
2 Molecular targeted therapy
2.1 imatinib mesylate (Imatinib) synthetic specific tyrosine kinase inhibitor (STI571, trade name Gleevec) is a 2 pyrimidine derivatives of benzene, ammonia, PH positive leukemia clone inhibited the proliferation and anti-apoptotic effect became the first successful treatment of PH-positive CML targeted drugs [4], recent studies have shown that it can enhance the antigen presenting function of antigen presenting cells and T cells for the lifting of the tumor immune tolerance [5]. Imatinib can be significantly higher genetic response and major cytogenetic complete cytogenetic response with imatinib the researchers proposed Nico early as first-line CML treatment.
2.2 Dasatinib is structurally unrelated to imatinib, it binds to activated configuration abl, not only inhibit abl kinase, can inhibit the Scr family kinases. In addition to the vast majority of other mutant T351 bcr abl kinase are inhibited by imatinib inhibition than 300 times more than large, but also on imatinib-resistant CML and Philadelphia chromosome (ph) ALL have good tolerance and high efficacy.
2.3 AMN 107 is an amino-pyrrolo pyrimidine drugs, the structure is a derivative of imatinib, but also with the non-active conformation of the abl kinase binding, but their functions have stronger than imatinib about 25 times, and Dasatinib as are the second generation of signal transduction inhibitors. However, the difference is AMN107 and Dasatinib does not inhibit the Scr family kinases. Most of its resistance mutations with imatinib in patients with effective, but the T315 mutant is invalid.
3 hematopoietic stem cell transplantation
3.1 allogeneic hematopoietic stem cell transplantation (Allo HCT) can cure the only proven means of CML, most experts recommend patients 25 years of age regardless of how the clinical manifestations can be treated, for more than 25 years of age should be considered with clinical and the existence of risk factors for selection. These risk factors include patient gender, age, disease duration, donor related or not related), from diagnosis to transplant time, pretransplant treatment, conditioning regimen and so on. From diagnosis to transplant time should not exceed 1 to 2 years, chronic phase (CP) graft survival rate than in the accelerated (AP) or blast crisis (BP) is good, and recurrence rate. CP fellow of receiving HLA matched donor Allo HSCT patients with 5-year survival of 70% or more.
3.2 Non-myeloablative hematopoietic stem cell transplantation in elderly patients intended to broaden the indications Allo SCT to reduce transplant-related mortality and complication, non-myeloablative transplantation is currently used only for those applications STI571 in patients with treatment failure or too old or with serious disease can not tolerate traditional transplantation patients. Clinical reports of domestic non-myeloablative hematopoietic stem cell transplantation combined with imatinib CML, leukemia cells prior to transplantation with a reduced load, inhibit the proliferation of residual leukemic cells, and promote full donor chimerism changes in graft-versus-leukemia effect enhanced the role of is an effective treatment method [3].
3.3 autologous bone marrow stem cell transplantation in CML patients a considerable number of hidden ph-normal hematopoietic clones. Especially for patients diagnosed with CML, early mobilization and autologous transplantation, such stem cells after transplantation of hematopoietic function reconstruction.
4 Medical treatment
Chinese extract 4.1 (1) arsenic trioxide (As2O3) Chinese arsenic trioxide experimental results show that the main component, As2O3 partially reduced CML mononuclear cells bcr abl fusion protein and STATR protein, reduced or even blocked the BCR / ABL signaling, slow deterioration of the cells. Abroad studies have shown that As2O3 promote apoptosis effects, which make cells arrest at G1 phase and G2 / M phase checkpoint [4], in addition to reporting As2O3 application of clinical and imatinib on patients with CML in blast phase effect is significant [5]. (2) alkali homoharringtonine (HHT) is a semi-synthetic cytotoxic alkaloids. Is our original anti-leukemia drug. In recent years, European and American countries for HHT patients with late chronic phase CML. (3), hydroxycamptothecin (HCPT) is a kung PANGXIDONG plants from seeds of Camptotheca acuminata alkaloids isolated micro extraction, mainly through its inhibition of DNA topoisomerase I, interfere with DNA replication, the role of S phase cells than the G1 phase and G2 of the obvious, no effect on the G0 phase cells, HCPT and no cross-resistance to other anti-cancer drugs [6]. (4) meisoindigo is a synthesis of the methylation of indirubin derivatives. By reducing the STAT5, Erk protein content, in part to prevent the bcr abl malignant signal transduction, thereby inhibiting the proliferation of K562 cells and induced apoptosis. Another study [7] found meisoindigo CML leukemia cells by inhibiting the secretion of VEGF (vascular endothelial growth factor) and inhibit endothelial cell proliferation while promoting apoptosis, and reduce the adhesion between endothelial cells, interrupted the leukemia cells and endothelial cells to stimulate interaction between the chain and thus effective treatment of CML. Links in the paper for * [E] e-commerce on small and medium enterprises in Ningbo City, the issue of credit
* [Rest of the economy related] kind of Nanning Consumption of College Students,, affect the
* [Educational theory] On the professional development of teachers and teacher students professional orientation (jyx9)
* [Other related economic] competition in Changsha, the broadcast media market trend report (j


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