Expert Q&A: What is the Relapse Rate of T-cell Leukemia? What to Do About High Eye Pressure During Maintenance Therapy?

Expert Q&A: What is the Relapse Rate of T-cell Leukemia? What to Do About High Eye Pressure During Maintenance Therapy?

Source: Sunflower Children  

Author: Sunflower Children  

Editor: Yang Yuan  

Date: June 1, 2023  

Disclaimer:  

The online Q&A is not a treatment plan recommendation. Due to the inability to understand the patient's detailed condition and conduct face-to-face diagnoses, expert opinions are only for reference. For specific treatment plans, please visit a qualified hospital.  

In this edition of "Expert Q&A," we invited Dr. Ai Lian Guo, the head of the Hematology Department at Suzhou University Children's Hospital, to answer your questions.  

Suzhou University Children’s Hospital Hematology Department is the Jiangsu Province Children's Hematology Oncology Center, a national clinical specialty in pediatric hematologic diseases, and a key clinical specialty in Jiangsu Province. It also serves as a master's, doctoral degree awarding institution, and a postdoctoral research station. Currently, there are 230 open beds, including 18 transplant units for hematopoietic stem cell transplantation. The department has a Hematology Oncology Research Institute and a key laboratory in Suzhou City. There are 7 doctoral supervisors and 12 master's supervisors, training over 20 master's and doctoral students each year. The department has 54 specialized physicians and completes approximately 230 hematopoietic stem cell transplants annually, with a treatment level that ranks among the best in the country.

01  

Q: A 5-year-old boy was diagnosed with B-ALL at age 3 and is currently in the maintenance phase following the 2018 treatment protocol. Both MRD and NGS tests are negative. What should we do about his high eye pressure during maintenance therapy with dexamethasone? He is currently using three types of eye drops: Brimonidine, Carteolol, and Latanoprost.  

A: It is recommended to have regular ophthalmology follow-ups to monitor eye pressure during the maintenance treatment. If tolerable, continue with the current maintenance therapy regimen.

02  

Q: An 11-year-old girl diagnosed with intermediate-risk acute lymphoblastic leukemia (ALL) had a white blood cell count of 380 at diagnosis. Her bone marrow examination on day 19 showed MRD less than 0.1%, and on day 46, it was also less than 0.1%. She underwent chemotherapy according to the 2020 protocol and had no genetic mutations. She is currently in the 8th major maintenance phase. What is her prognosis? What is the relapse rate for T-cell leukemia?  

A: For the intermediate-risk group in acute lymphoblastic leukemia, the overall survival rate for T-lymphoid leukemia is approximately 80%-85%. For individual patients, it can be either positive or negative. It is advised to maintain regular treatment and monitor bone marrow status periodically.

03  

Q: A 7-year-old girl was diagnosed with standard-risk B-ALL at age 5, following the CCLG 2018 protocol. She is currently in the maintenance phase, and both MRD tests during the induction phase (19 days and 33 days) were negative, with no fusion genes or genetic mutations detected. In February 2023, her bone marrow examination also showed negative MRD and PCR results. I would like to ask:  

1. My child is particularly sensitive to domestic mercaptopurine during the maintenance phase. Now she has switched to imported mercaptopurine, but she can only take a quarter of a tablet every two days. She is taking four methotrexate tablets per week. I would like to know if such a low dosage will affect her prognosis?  

2. How many cycles are there in the maintenance phase for girls with standard-risk B-ALL under the CCLG 2018 protocol?  

A: There can be individual differences in maintenance medication. The goal of maintenance medication is to keep blood counts within ideal ranges. The maintenance phase for the 2018 protocol consists of 10 cycles, with each cycle lasting 8 weeks. For specific details, please consult the supervising physician.

04  

Q: An 18-year-old boy was diagnosed with leukemia at age 15. He had unstable blood counts previously and has received blood and platelet transfusions. He is currently in the sixth cycle of treatment and has been on medication for three weeks. His blood counts remain unstable, with platelet levels consistently between 60 and 70. What could be the reason, and what actions should we take?  

A: The treatment plan and specific medications are not detailed. It is recommended to monitor recent bone marrow condition, the level of bone marrow hyperplasia, and megakaryocyte counts. Regularly check blood counts and personalize the maintenance medication.

If you have many questions, you can get answers through the following two paths:  

1. WeChat — Search for the “Sunflower Children” mini-program. After entering the mini-program, use the keyword search function to obtain comprehensive information.  

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