About blood....血肉相连

CML病人支援團體The Max Family‧助病人找藥物贊助

2009-09-16T12:30:00.003+02:00

光明日報／良醫‧報導：黃秀儀‧2008.09.10

慢性骨髓細胞白血病（Chronic Myeloid Leukemia, CML）的治療費用高昂，單是藥物每月就要逾8000令吉，造成有些病人為了省錢而不按時服藥，影響病情。病人面對的種種問題促使“The Max Family”病人支援團體籌委會的誕生，藉各種活動如藝術繪畫來提高病人的生活素質，讓他們體會生命的真善美，勇於與病魔抗爭。

翻閱“The Max Family”的源起，義工翁美欽說，Maximiliano M.Rivarola（簡稱Max）生病之前，是個活躍於各項體育活動的少年，但不幸於17歲逝世。他的繼母佩特（Mdm. Pat）聯同其他朋友為他設立“The Max基金會”（The Max Foundation），以幫助其他CML病人，各國的病人支援團體也以其名字Max作為團體名稱。“The Max Family”附屬於“The Max基金會”。

她披露，相關組織在歐洲國家如意大利、德國等很普及，亞洲國家如印度、泰國、菲律賓等也很活躍，但本地還沒有類似組織，造成病人求助無門。

“病人每月的藥費非常昂貴，平均每月近萬令吉，我們的工作之一就是為病人尋找藥物贊助。”

翁美欽說，數名義工、10名病人和吉隆坡中央醫院血液科的一名護士陳秀琴在2006年6月開會，探討成立支援病人團體的可能，議決結果是可行的，就開始積極籌備設立事宜。

她表示，這些病人分別來自吉隆坡中央醫院、國大醫院和馬大醫藥中心，他們很積極地看待成立病人支援小組一事。然而，申請註冊事宜萬事俱備，只欠東風，即獨缺“批准信函”，以致他們還無法招收會員和籌款。

撥電給病人出席講座

雖然如此，5個月後，他們仍舉辦第一個病人工作坊，安排醫生講解慢性骨髓細胞白血病（CML），因為有些患者仍不瞭解此病。

當時，籌委會很擔心觀眾的反應，也不曉得患者是否願意分享、會否冷場等，於是他們逐一撥電給每個病人、醫生，期望他們赴會。活動獲得不俗的反應，有約130人出席，更意外的是有一家中文媒體（即《光明日報》）來採訪，為他們打了一劑強心針。

由於現今的資源有限，故活動都集中在吉隆坡，並以工作坊為主。

去年他們竭盡所能，成功地在馬六甲辦工作坊，反應令人鼓舞。籌委會計劃在未來把活動擴展到其他州屬，包括檳城、柔佛、古晉和亞庇，令這些州屬的病人也能受惠。

翁美欽說，義工費盡思量策劃活動內容，比如今年的工作坊主題是“希望的色彩”（Colours of Hope），通過繪畫來表達病人的心聲，再由心理輔導醫師解說，進一步加強病人的心理素質。

義工當翻譯
助患者與醫生溝通

義工翁美欽說，義工面對的最大挑戰是語言，因為很多華裔病人不諳國語和英語，造成他們在求診時無法良好溝通，醫生就需要義工幫忙翻譯。

她指出，由於病人常常要花很長的時間等待復診，故義工也希望未來能安排病人利用等待的時間做一些提昇自己的事，包括小組討論和輔導。

“這需要醫生的幫忙和配合，盡可能把所有病人安排同一天復診，以方便義工安排活動。”

另一個問題是病人能夠自律多久，按時服藥。有些病人覺得自己的病況受控制，就會“偷懶”或為了省錢而不按時服藥。不按時服藥會有基因突變的問題，

屆時再採取醫療措施已於事無補。因此，義工要不時提醒他們按時服藥的重要性。

患病醫生設部落格
幽默漫畫為病患打氣

拉薩莫哈末醫生（Dr. Abd Razak Muhammad）是團體的第一號人物，也是慢性骨髓細胞白血病（CML）病人。他在去年9月進行骨髓移植手術，目前進展良好，並已重返崗位值勤。不過，鑑於他的情況還在觀察中，院方盡可能減少他的工作量。

現年37歲的拉薩是骨科外科醫生，在2005年末證實患病，並在18個月後獲得弟弟捐贈骨髓進行手術。

他也設立一個部落格：http://drrazak.blogspot.com，內容記載他的求診經過、手術後的情況，還附有不少逗趣的漫畫，顯現他的樂觀和幽默。這讓其他病人、親朋戚友瞭解他的進展，並藉此鼓勵他們。

白血病的定義

白血病是造血系統的一種惡性疾病。患者體內有大量白血病細胞廣泛而無控制地增生，這些異常細胞會出現在骨髓、血液及淋巴組織中，影響正常血細胞的生長。

認識正常的血細胞可以加深了解白血病。血細胞主要在骨髓及淋巴系統的其他器官製造，骨髓是骨腔內的軟化海棉狀組織。骨髓內的原始細胞又稱幹細胞，會分化生長成3種血細胞、白血球、紅血球及血小板。他們負責不同的功能：
‧白血球抗感染，消滅入侵身體的細菌或病毒。這種白血球又稱為粒細胞。
‧紅血球將氧氣從肺部輸送至身體各部。
‧血小板協助凝血，可以控制身體受傷部位的出血。

淋巴系統包括骨髓、淋巴結、脾、胸腺及扁桃腺；在這系統內產生兩種血細胞（也歸納為白血球）──B型及T型淋巴細胞。
‧B型淋巴細胞抗感染，他們產生“抗體”對抗細菌。
‧T型淋巴細胞也有抵抗入侵物的能力，同時也能對抗癌細胞。

當發生白血病時，骨髓會產生大量不成熟或型態異常的白血球，這些細胞未能及時排出骨髓腔，就會積聚在骨髓腔內，導致其他正常血細胞沒有足夠空間生長。最後正常血細胞數目下降，因而引起病人時常出現感染、貧血及出血問題。

在美國約3萬1500人於今年內被診斷出白血病，當中包括2萬8800成人及2700兒童，大約2萬1500人也將因此而死亡。患者的存活期會因病型、發病年齡、患者本身的身體狀況及所接受的治療而有差異。平均來說，診斷白血病後，有65%的患者可以生存1年，5年後患者的存活率會降至44%。

白血病分兩種

白血病的分類有兩種，一種是以受影響的白血球類型而定，例如淋巴細胞白血病、骨髓細胞白血病（以異常粒細胞為主的白血病）等。另一種是以病情進展速度及嚴重性而定，例如急性白血病、腦膜白血病等。急性白血病病情進展快速，患者血液裡會發現很多不成熟白血球。慢性白血病病情進展緩慢，血液裏的白血球比較成熟及外型多正常。白血病分類非常重要，因為可以預測病情進展及決定治療手法。以下是其他白血病的簡介：

急性骨髓細胞白血病（AML）

在50至70歲的成年人最常見，又稱為急性非淋巴細胞白血病（ANLL）。這種白血病的亞型又名急性前骨髓細胞白血病（APL），與出血症狀有關。

急性淋巴細胞白血病（ALL）

是10歲以下兒童最常見的白血病類型，也常常影響65歲或以上的老年人。多數病例是以B型淋巴細胞病變為主。自從90年代後期以來，此型的存活率已從70年代中的38%驟然上升至60%，而同時期之兒童存活率已由54%上升至82%。

慢性淋巴細胞白血病（CL）

通常影響老年人並以家族性形式發病，患者可能發病多年，在沒有治療下也無自覺症狀。

你知道嗎？
慢性骨髓細胞白血病

慢性骨髓細胞白血病是和基因有關連的疾病，但不是遺傳疾病。發病率是每10萬人中有1至1.5 人，患者的體內皆有“費城染色體”（Philadelphia Chromosome），即第九和第廿二對染色體的角色易位（Translocation），造成白血球的數量不受控制地增加。

醫學界還無法找出此病症基因突變的原因，只確定少數病例和輻射有關。現今患者可選擇服藥或移植骨髓，有望控制病情或可能治癒。一般上，患者及早接受治療可延長生命期。

CML病人支援團體
有意進一步瞭解詳情者，可聯絡：
電話：03-42969088
電郵：mymaxfamily@gmail.com
洪威勉：wei.meng.ang@themaxfoundation.org
翁美欽：mei.ching.ong@themaxfoundation.org

骨髓移植救血癌病人

2009-09-16T12:21:00.001+02:00

骨髓移植救血癌病人

2007-05-05 11:25 星洲日報

基本上，血癌可以分成4種類，而其中的治療是複雜和困難的。通常病人，尤其是老年人，存活的機率不高。

唯一能取得較大“根治率”的方法，就是“骨髓移植”；（Bone Marrow Transplantation，BMT）。甚麼是骨髓移植呢？哪一些血癌或血液病，才能做骨髓移植呢？病人的年齡有甚麼限制呢？骨髓移植的優點和缺點，是甚麼呢？

4种類血癌

急性粒狀細胞血癌（Acute Myeloid Leukaemia，AML）

急性淋巴胚細胞血癌（Acute Lymphoblastic Leukaemia ，ALL）

慢性粒狀細胞血癌（Chronic Myeloid Leukaemia，CML）

慢性淋巴細胞血癌（Chronic Lymphocytic Leukaemia，CLL）

4種骨髓移植法

血液專科鄭琪興醫生（Dr. Alan Teh）最近在一項專訪中，講解“骨髓移植”的方法：

共有4種骨髓移植法：

同種異體骨髓移植（Allogeneic Bone Marrow Transplantation）
捐出骨髓者，是病人的第1線至親，如兄弟姐妹，或是從“骨髓登記中心”的非親屬的組織適合人士。

同系基因骨髓移植（Syngeneic BMT）
捐骨髓者是病人的雙胞胎中的一人。

自體骨髓移植（Autologus BMT）
病人自己捐出骨髓。病人在做過化療之後，抽出自己的骨髓冷凍，然後才移植回病人體內。

小型同種異體移植（Mini Allograft）
這是一種新的骨髓移植法。它與第1種的同種異體移植法是相同。不同點是：所使用的化療藥物，毒性沒有那麼強烈而已。

移植母細胞

骨髓移植的目標：它最大目標，是先使用高劑量化療藥物，殺死病人骨髓內的癌細胞。隨後，把骨髓裡抽出的健康母細胞（Stem Cells）移植進入病人體內。如此，病人的骨髓就能生長出新的血球。

年紀越大‧風險越高

在進行骨髓移植之前，醫生必須做出以下3項考慮：

年齡重要
年齡：病人年齡越大，做骨髓移植風險越高，這是因為老年人較多發生併發症。目前，同種異體骨髓移植的年齡，是在40歲以下者。自體骨髓移植和小型同種異體移植的年齡，不可超過60歲者。

適合治療的血液病
適合進行骨髓移植的血癌和血液病：不是每一種血癌或血液病，都適合進行骨髓移植。只有以下者才適合進行骨髓移植：
1.急性粒狀細胞血癌：在經過第一次緩解期之後，很適合進行骨髓移植者。
2.慢性粒狀細胞血癌。
3.血球再生障礙血癌（Aplastic Leukaemia）。
4.急性淋巴胚細胞血癌：第二次緩解期後，進行骨髓移植尤佳。
5.非霍克金氏淋巴癌：復發後，才進行骨髓移植。
6.多發性骨髓癌（Multiple Myeloma）：50歲以下的病人，較適合進行骨髓移植。基本上，多發性骨髓癌是一種絕症。

捐骨髓人
適合捐骨髓的人：同種異體的捐骨髓人的組織，必須符合病人的組織。只要捐髓人健康就可，沒有年齡限制。

HLA須符合才能捐髓

如果醫生認為，病人最適合進行同種異體骨髓移植的話，那麼，就應選擇一個最適當的捐髓人。

最重要的一點是：捐獻人的HLA必須和病人相同。甚麼是HLA呢？HLA是：“人體白血細胞抗原”（Human Leucocyte Antigen）系統。只要通過驗血，就能知道結果。

為甚麼HLA必須符合，才能做骨髓移植呢？

因為HLA是人體內的一道防衛系統，它能辨別侵入人體內的“非我族類”。如果輸入的“骨髓白血球細胞”與原來的白血球細胞形態有異的話，HLA就能辨認出來，並且能對付它們。這就出現了“移植物對抗宿主”的反應，也就是我們常說的“器官排斥”現象。

抽取骨髓的方法

醫生可從捐髓者體內的2個位置裡抽取母細胞：其一是：從骨髓裡抽取；其二是：從血液裡抽取。

母細胞能製造出不同血球細胞：即紅血球、白血球和血小板等等。

先化療，後移植

鄭琪興醫生說：“我們為病人進行骨髓移植最重要的考量是：病人在經過化療和藥物後都無法痊愈，最後才考慮骨髓移植。”

骨髓移植必須在病情未復發時就要進行，因為一旦病發後才移植的話，療效就會較差。

不必做移植的血癌

雖然如此，在急性粒狀細胞血癌之中，也有一些“亞型”（Sub-Types）的血癌，是不必做骨髓移植。例如AML-M3亞型血癌，只要用藥治療，療效可達70至80%。

必須先做檢驗

近年來，在做骨髓移植之前，有許多儀器能準確地“預測”骨髓移植的療效。例如檢驗骨髓、特別標誌和分析染色體等等。

發明特效藥

至於慢性血癌，骨髓移植已經不是唯一的治療法了，因為，目前發明的特效藥，例如Imatinib（Glivec），能有效殺死慢性血癌細胞，幾乎絕跡。

雖然慢性血癌仍然不能“根治”，不過，病人卻能延長壽命。

骨髓移植治療淋巴癌

至於淋巴癌病人在化療後又復發，就需做骨髓移植。

骨髓移植時所用的骨髓，最適合的是兄弟姐妹的，因為他們的HLA符合。

淋巴癌病人在進行骨髓移植時，通常是使用病人自己的骨髓，它有以下特點：

醫生使用高劑量（劇毒）化療，治療病人淋巴癌時，會把骨髓裡的細胞，包括淋巴細胞全部殺死，這樣一來，骨髓裡就出現一片空白。因此，醫生就把病人自己的骨髓移植回去，使淋巴細胞重生。

事實上，這種治療法，是病人在搶救自己的骨髓。

非血癌的血液病

在大馬，骨髓移植除了用來治療血癌之外，也用來治療其他一些“非血癌的血液病”：

血球再生障礙症：這不是癌症，而是一種血液病。病人的骨髓裡一片空白，無法製造各種血球。為甚麼骨髓會一片空白呢？病因是：輻射、化學毒物、病毒和未知的原因所造成。非常嚴重時，唯一的治療法是：骨髓移植。

地中海貧血症：兒童患上“大型地中海貧血症”（Thalassaemia Major），有關病童必須每一個月輸血。這會導致出現許多併發症，例如體內會累積大量鐵質等等。唯一的治療法：骨髓移植。

骨髓移植的療效

如果病人年輕，所接受的骨髓又是HLA配合者，那麼，血癌治愈率可高達約70%。

剩下的30%病人，骨髓移植是會失敗，因為血癌會復發。

不進行骨髓移植之後，出現死亡者，如果是“同種異體”移植的話，死亡率約佔10至15%。如果是“自體骨髓移植”，則死亡率會更低的。

大馬的骨髓移植成功率，可以媲美歐美國家的骨髓移植。迄今，大馬的政府與私立醫院大約已進行了約一千多宗骨髓移植了。

骨髓移植的費用非常昂貴。在私立醫院裡，大約需要10萬令吉。如果到外國進行的話，則需要30萬至40萬令吉之間。

捐獻骨髓者是非常安全，無需擔心會有副作用，因為骨髓會重生。

Curing blood cancers

2008-11-27T09:39:00.004+01:00

Curing blood cancers

LIVING WITH CANCER
By Dr LEONG KIN WAH

The Star, Sunday November 23, 2008

Are cures possible for leukaemias and lymphomas? The answer is definitely in the affirmative.

BLOOD and blood related cancers form about 20-25% of all cancers. They include acute leukaemias, lymphomas and multiple myeloma.

Over the past four decades, there have been tremendous improvements in treatment, leading to cure for the majority of patients with childhood acute leukaemias and aggressive non-Hodgkin’s lymphomas. Significant improvements in treatment of other blood cancers have lead to more than doubling of survival times and cures for many.

The IRIS trial of 553 patients with chronic myeloid leukaemia demonstrated a survival of 88% at six years with imatinib treatment. Data and graph from Andreas H et al, Blood 2007;110: abstract 25.

In the 70s and 80s, the improvement was the result of combination cytotoxic chemotherapy. In the 90s and now the 21st century, monoclonal antibodies and small molecules, synthetically created, were the reasons for another leap in the success of treatment. They are considered targeted therapy.

In my line of work, at times it is very difficult to convince patients that many of those with cancers and leukaemias can be treated, with many being cured. Many of them continue to live normal lives when the disease is cured or controlled. There is no denying that the treatment may be difficult or even dangerous at times, but the outcome (results) speaks for itself.

This difficulty stems from advice given by lay people and even some doctors, who are either ill informed or have ulterior motives. One of my patients with acute leukaemia, who went into clinical depression, did not sleep for days and became psychotic after being told her condition resulted from her not praying enough.

She required anti-psychotic medication and managed to complete her treatment and is now still well after seven years (which is considered a cure).

All the patients that I know of who had aggressive lymphomas and acute leukaemias who declined to have advanced scientific researched treatments have succumbed and died.

A Canadian study clearly shows the addition of Rituximab improved their results from about 50% to above 70% cure rates in aggressive Hodgkin’s lymphoma in over 290 patients. Data and graph from Laurie H et al, JCO 2005;23:5027-5033.

Using scare tactics to make patients buy unnecessary vitamins, health foods and alternate therapy is all too common now, which can lead to harm.

The following examples highlight the recent advances. These are by no means all the advancements. Stem cell transplantation, which is used in the treatment of leukaemias and lymphomas, is not touched on here as it too complex to discuss in a short article.

In chronic myeloid leukaemia, the latest published results of a large trial called IRIS shows that 88% of patients are alive after six years of continued treatment with imatinib.

Prior to this, less than 20% of patients are alive at six years, unless they were able to have bone marrow transplantation. This is a more than a 400% improvement! These results would even exceed survival after a heart attack or stroke.

It is now estimated that 80% of patients will still be alive at 10 years of treatment. Imatinib, first used in 1998, is an oral tablet that is taken daily with hardly any side-effects.

In childhood acute lymphoblastic leukaemia, with the introduction of combination chemotherapy, mainly by German researchers in the 80s, a steady improvement in cure rates and survival emerged.

Now, the cure rate for acute lymphoblastic leukaemia in children exceeds 80%. This is highlighted in a recent publication by the Americans showing a 83% cure rate (figure 2). Similar advances in adult acute leukaemia have been achieved, though the improvements are less dramatic.

In aggressive Hodgkin’s lymphoma, the use of four to six months of multi-agent cytotoxic chemotherapy has also dramatically improved the results, leading to cure rates about 50%. With the addition of Rituximab, a monoclonal antibody, created to target the lymphoma cells, the results has further improved with a cure rate above 70%. (figure 3).

In acute promyelocytic leukaemia, the PETHEMA trial with 225 patients showed that 90% of patients were cured when all-transretinoic acid (ATRA) was used optimally. This is compared to the pre-ATRA era where the cure rate in Malaysia was only 20-30%.

This is an astounding improvement. ATRA was first introduced to the world from China in the late 80s. It is actually a derivative of vitamin A. It is able to change the leukaemia cells, allowing them to mature and die, leading to a cure. Added on to chemotherapy, the cure rates are now above 80% in Malaysia.

Another new medication, arsenic trioxide, has also recently been shown to be very effective for this leukaemia.

So, how can anyone say that no one can be cured from cancer or have an extremely marked improvement of their survival? The evidence speaks for itself.

Leukaemias and lymphomas are one of the most feared cancers and now so many patients are doing so well. Many newly introduced medications including alemtuzumab, dasartinib, nilotinib, bortezomib, decitabine, thalidomide and lenalidomide will further enhance our ability to treat and cure blood cancers.

A Beautiful Day

2008-11-16T14:28:00.005+01:00

Haematology Day, Hospital Ampang - 15th Nov 2008

Haematology Day 2008

2008-10-30T10:24:00.006+01:00

The Max Family 季刊

2008-10-07T07:03:00.011+02:00

Maximize Life Workshop 18/10/2008

2008-09-15T11:58:00.004+02:00

保險員抗血癌21年‧靠毅力試新藥延命

2008-09-15T10:08:00.002+02:00

光明日報 2008-09-01

（吉隆坡）來自愛爾蘭都柏林（Dublin）的保險公司營業訓練員佐爾（Joe Shrieves）患上慢性骨髓性白血病（Chronic Myeloid Leukemia, CML），醫生說他最多可活4年，但他卻靠毅力捱過21年。這些年他從沒有放棄治療，親身參與新藥臨床試驗，以期拉長自己的生命線。他說：“只有不斷地嘗試才能達到成功，並擁有成功。”秉著這種不屈不撓的抗病精神，他的人生活得更有意義。

雖然佐爾勇於嘗試，但他也飽受試新藥的副作用，如關節疼痛與源源不絕的疲累感，需逾1天恢復，他更因此患上糖尿病。雖然如此，他仍堅持到底，勇於與癌細胞週旋。

現年62歲的佐爾在今年於意大利Beveno的“CML病人領袖會議”上，分享自己的心路歷程，藉此鼓勵其他病人。

本地“The Max Family”病人支援團體籌委會理事范先生在“CML病人一日工作坊”上，徐徐述說佐爾的故事後，全場響起熱烈的掌聲，大家都認同他熱愛生命的表現。

醫生宣佈可活4年

佐爾患病前和很多人一樣，生活如常，追求事業的成功與輝煌，人際關係的和諧及美滿。他愛玩“5人室內足球”（5-a-side indoor soccer），平均每週2至3次。他也愛下棋，不時到當地的一間俱樂部與其他棋友一較高低，日子過得充滿朝氣。

後來，他逐漸感到很疲倦，偶爾出現莫名發燒的症狀，但他不以為意。過了1年多後，佐爾終於去求診，診斷結果證實他患了慢性骨髓性白血病（CML）。他問醫生自己可活多久？醫生的坦白讓他忘不了。

醫生說：“好消息是你在未來的2至4年裡可以活得很好，且很有素質。再說，現今有很多相關藥物研究在進行中，這些都能幫助患者過較好的生活。 ”

在那期間，他和醫生也尋求適當的骨髓，包括他的兄弟姐妹，可是骨髓並不適合。

骨髓檢測顯示改善

在接下來漫漫的14年中，他服用藥物控制白血球數量，但也飽受不少藥物副作用的痛苦和折騰。不過，他仍積極地活得多姿多彩，繼續每週1次的踢球。

今年2月杪，佐爾的骨髓檢測顯示前所未有的進步，他感到欣喜萬分，因為一切的努力並沒有白費。在5人室內足球賽場上，又見佐爾的身影。他在無法踢球2年後，重返球場，與球友一較高低。

“我已經62歲了，沒有什麼好抱怨了。比起那些和我一起踢球卻不斷喘息的年輕煙客，我覺得自己的狀態好極了！”

治療過程有領悟
健康才可擁有一切

佐爾是醫院裡唯一的慢性骨髓性白血病（CML）病人，無法像其他病症的病人可向病友訴苦。無論他面對什麼問題，都是孤軍作戰，那種滋味很難受。

當他決定參與新藥研究後，因為研究是在另一家醫院，他才轉院，終於碰到其他病友，共同面對病魔的挑戰。

走過漫漫的治療過程，佐爾給其他病人的勸勉是：盡可能維持家庭和工作之間的平衡，不要盲目追求成功，任何事都排在健康之後。“擁有健康，才真正擁有一切”，他用生命體會這個道理。

血小板降關節痛
新藥副作用受折騰

2001年7月杪，即使佐爾已增加藥量，但白血球數量仍節節上升。恰好他看到報章上有一則關於CML新藥臨床研究的報導，決定參與相關臨床研究。結果新藥發揮效用，但也承受一些副作用，最嚴重的是血小板直線下滑，造成他必須停止服藥幾次，以緩和情況。

他的骨髓檢查報告也顯示，病情沒有進展，而他也受關節疼痛與疲倦困擾，不得不暫停工作。

去年8月，他又參與另一項新藥臨床研究。5天後，他發現自己很虛弱，原本像鋼鐵般堅強的意志也變得脆弱如棉花，他幾乎已要放棄。試新藥的第9天，他停止服用新藥，醫生卻發現他的血糖飆升，體重減少14磅。他必須接受胰島素注射，以控制血糖水平。3週後，他重新試藥。

邁進2008年2月，他的首個骨髓檢查報告顯示病情有進展，這是21年來最好的成績。他期許未來的骨髓檢查報告有更好的消息。

光明日報／良醫‧報導：黃秀儀‧2008.08.31

CML病人勿怕定期檢查‧骨髓刺穿術僅輕微痛

2008-08-18T12:25:00.003+02:00

光明日報

（吉隆坡）慢性骨髓細胞白血病（Chronic Myeloid Leukemia, CML）病人須定期做骨髓刺穿術（Bone Marrow Aspiration, BMA）。此檢查是用空心的穿刺針直接抽取少量骨髓，會引起短暫的疼痛。根據臨床調查顯示，大部份病人都可接受BMA的疼痛，然而有不少病人對此檢查存有疑慮與擔心，造成他們逃避或拒絕檢查，延誤病情。血液科專科醫生強調，BMA很安全，對診斷病情和療程的進展起著關鍵作用，故病人不要抗拒和害怕接受檢查。

血液科專科醫生鄭旭丞說，進行骨髓刺穿術（BMA）前，病人需側臥或俯臥，醫生在病人的髂後（臀部上方突出的部位）局部皮膚消毒，鋪上無菌的布巾，並進行局部麻醉。過後，用穿刺針向骨面垂直刺入，抽出約10毫升骨髓，抽取時病人會感到輕微疼痛。抽取完成後，醫生會用紗布蓋上刺穿點，並按壓1至2分鐘，再用膠布固定紗布。整個過程約10至20分鐘。

他在“CML病人一日工作坊”上表示，骨髓是存在於松質骨間網眼中的一種海綿狀組織，屬於人體的造血組織，能製造紅細胞、血小板和各種白細胞。醫生抽取骨髓後，會將樣本交給化驗室進行化驗，以確認病人的進展。

減少疑慮和恐懼

鄭旭丞指出，首次進行檢查的病人可在檢查前，向有經驗的病人瞭解詳情，以減少疑慮和恐懼。

此外，他們也可向醫生要求止痛藥或麻醉藥。若病人有藥物敏感，在檢查前一定要告訴醫生，並要對醫護人員有信心。他與病人交流及分享時披露，病人檢查後不需住院，除非有特別情況如血小板很低，醫生會讓病人休息較久，甚至住院1天。因此，病人進行相關檢查時，最好有家人陪同。

鄭旭丞指出，醫護人員能做的是向病人仔細解釋相關步驟，樹立信心，減少緊張和恐懼心理。

同時，給予止痛或麻醉藥，嚴格遵守無菌運作程序，以防感染。

防穿刺點受感染

“BMA沒有致命風險，病人可能會面對的情況是流血、細菌感染、藥物敏感和致傷內臟。致傷內臟是最嚴重的情況。”

他透露，如果病人在檢查後出現發燒、穿刺點出血、穿刺點疼痛持續或惡化及穿刺點紅腫，就要及時告訴醫生，以便採取應對措施。

“做完檢查後多少會有點痛，若情況持續多天或越來越痛，就要就醫查出原因。”

鄭旭丞說，病人檢查後需平躺約半小時至1小時，通常24小時後就可自由活動。病人也不要讓穿刺點上的紗布沾到水，以防感染。紗布可在24小時後取下。

研究顯示多數病人
可接受穿刺疼痛

鄭旭丞說，本地醫生在今年4至5月杪進行骨髓刺穿術疼痛程度的研究。調查顯示，在108位病人中，72人認為他們可以接受骨髓刺穿術的疼痛，18人覺得非常疼痛，另18人覺得完全不痛。是項研究在吉隆坡、吉蘭丹、檳城和砂拉越進行。

另外，48人在進行相關檢查前感到恐懼，45人覺得可以面對，43人覺得焦慮，13人嘗試避免及8人拒絕檢查。

“在108人當中，有55人的主治醫生會常問他們是否需要止痛藥或麻醉藥，從來沒有佔33人，偶而17人及至少1次3人。至於病人對檢查有何期許方面，在106人中，有77人需要止痛藥，60人要麻醉藥，59人要有家人陪伴及38人希望有醫生的講解。”

骨髓刺穿術Q&A

Q1：骨髓刺穿術（BMA）有沒有後遺症？我太太穿刺過的部位在下雨天覺得疼痛，是否風濕造成？
A1：一般檢查後會有一段時期覺得疼痛，過後疼痛便消失。你太太的情況屬個案，也許和心理有關。

Q2：多久做1次BMA？
A2：若是CML病人，每3至6個月做1次檢查。

Q3：CML的檢查分幾個階段？
A3：通常醫生先做BMA，這是檢查一粒粒細胞的情況，第二是細胞遺傳學（Cytogenetic）檢查，即檢查細胞內的基因，第三是螢光原位雜交（FISH）檢測，更仔細地檢查細胞的情況。第四是聚合酵素鏈鎖反應（PCR），即檢查基因產生出來的蛋白質。PCR分幾種，視情況而定。

Q4：如果病況穩定，是否可以減少藥量？
A4 ：需視病人的穩定階段，有者血小板、紅血球、白血球穩定，但基因還不穩定，隨時會產生突變。目前，無論甚麼情況，病人都要按時按量服藥，不能停止。

Q5：病人會否在初期須服藥，後期要打針的問題？
A5：CML病人不會面對這種情況。

Q6：PCR要控制到多少才算理想？每年都要做1次PCR嗎？
A6：0最好，但不表示體內完全沒有癌細胞，因為PCR檢查也有極限性。現今，能少過0.1已很理想。檢查次數看情況而定，包括病人的病況、經濟能力等。

Q7：我服藥後會嘔吐，要如何改善？
A7：吃藥時要喝足夠的開水，或把藥量分成2次吃，或睡前才吃藥。有者沒有吃飽就吃藥，會嘔吐。如果把藥嘔出，一定要再吃一次，除非是吃藥1至2小時後才嘔吐就沒有關係。有者把藥搗碎吃，那是不鼓勵的做法，因為有些藥要吃下去後才能分解，有的要在吃時咬碎才有效。

Q8：吃藥後要戒口嗎？
A8：不需戒口。

Q9：為何醫生在我的胸骨抽取骨髓，而不是髂後？
A9：BMA可經髂後或胸骨抽取骨髓。一般醫生都從髂後抽取骨髓。若髂後抽取不到骨髓，醫生就會從胸骨抽取，有時則是醫生較擅長從胸骨抽取骨髓。由於胸骨很靠近心臟，因此醫生要非常小心。

光明日報／良醫‧報導：黃秀儀‧2008.08.05

相關帖子
Bone Marrow Examination, 骨髓穿刺检查

藝術治療創作過程‧培養正面情緒抗病

2008-08-18T12:19:00.007+02:00

光明日報

（吉隆坡）“藝術治療”（Art Therapy）是結合各種藝術形式和心理學的非語言性療法，經由創作的過程，使當事人的情緒獲得紓解，進而有更正面的心態接受治療。治療對象比一般心理治療為廣，包括智能障礙、喪失語言功能、重病者等。一名慢性骨髓性白血病（Chronic Myeloid Leukemia, CML）患者沙喜米（Sahimi）現身說法，表達自己在創作的過程中找到心靈的寄托和希望，抗病的士氣高昂。

他也投入義工行列，日子過得和常人沒有太大差別。

沙喜米也是畫家。他重申，常人很難理解病人的心情，加上病人有很多難用言語表達的情緒，造成溝通不良的情況出現。如果病人能通過藝術如繪畫表達心情，可幫助他們釐清思緒和紓解心情，減少壓力及提昇抗病士氣。

他在“CML病人一日工作坊”上指出，生病後，病人會很珍惜他們能夠做的事，能走5公里也會很開心，建立他們的成就感。紓解情緒鼓勵自己他在7年前證實患病，初時難免沮喪和擔心，但他藉着繪畫，紓解情緒和鼓勵自己，並投入義工的行列。他的舉動也影響其他同領域的朋友，他們陪他一起對抗病魔，不時參與各類輔導病人的活動。

沙喜米說，很多病人初時不相信自己會畫畫，一旦開始後，他們會發現原來自己會畫畫，而且畫得多姿多彩，心情即變得不一樣。他們變得很有信心、積極、快樂等，這些正面情緒就是抗病的另一帖藥。

當他宣佈大家可以開始畫畫時，有者一時之間不懂得畫什麼，與家人、朋友略為討論後才下筆。有者馬上就在白紙上畫畫，大樹、太陽、屋子、人、花、葉子、小鳥……迅速地填滿整張白紙。

畫出心情映現感情

2個小時後，沙喜米與義工們逐一把每張畫展示給大家看，分享畫者的心情寫照。

結果，大家的繪畫主題不約而同以“我的家園”、“我的故鄉”、“我的甘榜”及“愛心無界限”居多，色調也呈五顏六色。這場繪畫與分享活動使大家發現，原來自己真的會畫畫，並畫得很棒，信心與希望像講堂裡的冷氣，佈滿身體的每個氣孔，場面溫馨。

沙喜米重申，在藝術的領域裡，沒有對與錯、美不美的問題，病人不要擔心自己畫得糟糕，重要的是畫出自己的心情。

“畫畫可映現你的真實感情和思想。現在，你把自己當成一個6歲的小孩，想畫什麼都可以。”

CML Maximize Life Workshop for Patients & Care Givers, 26 July 2008

2008-07-02T16:09:00.002+02:00

Date: 26 July 2008 (830am to 5pm)
Venue: Hospital Ampang, Selangor
Registration close on: 16 July 2008
All Malaysian CML patients & their caregivers are invited

please click on the poster for contact details.

CML Alliance Maximize Life Workshop

2008-04-02T17:01:00.003+02:00

CML Alliance Maximize Life Workshop

Date: 26 April 2008 (8.30am - 4.15pm)
Venue: Hospital Ampang, Selangor
Registration close on: 18 April 2008

Cord blood storage questionable

2007-11-23T06:08:00.000+01:00

The Star, Friday November 23, 2007

KUALA LUMPUR: Doctors have expressed concern about the storage and effectiveness of cord blood.

Health Minister Datuk Seri Dr Chua Soi Lek said the complaints were on how long cord blood could be kept and unsubstantiated claims by private cord blood banks.

“The doctors want us to control matters like the advertising. So there will be guidelines from the ministry that will have to be adhered to,” he said, adding that the guidelines would be drawn up by a National Committee on Stem Cell Services.

Dr Chua said while cord blood was stored to potentially treat diseases such as lymphoma, leukaemia and thalassemia, there were claims and advertisements stating that it could treat illnesses including diabetes, cerebral palsy and regenerative disease.

“There are a lot of unsubstantiated claims.

“Besides, we do not know how long it takes for the samples to become defective during storage or if the quantity collected is enough,” he said.
He said private cord blood banks in the country charged between RM2,500 and RM5,000 for registration followed by a yearly subscription of between RM125 and RM250.

At present, there are three cord blood banks operating in the country.

The American Association of Paediatrics, in its latest policy statement, stated that private umbilical cord blood storage as a “biological insurance” should be discouraged because there was not enough evidence to support the routine harvesting and storage of umbilical cord.

Dr Chua said the ministry received an annual allocation of RM16.8mil and a one-off grant of RM15.6mil to boost its cord blood services.

Just the facts (Stem Cell Therapy)

2007-11-05T09:37:00.000+01:00

from the Star November 4, 2007
by Dr Ng Soo Chin

Debunking certain myths about stem cell therapy.

THERE is something fascinating about stem cell therapy (SCT) – a google search on the subject yielded 3.35 million hits!
It is of interest to a diverse group of people, including doctors (haematologists, cardiologists, neurologists, paediatricans, geriatricians endocrinologists and so on), basic research scientists, politicians, religious leaders, the pharmaceutical industry, and last but not least, the lay public, including patients.
Recently our honourable Health Minister rightly pointed out that there are many claims of stem cell therapy that are misleading and advised patients to exercise caution to avoid being taken for a ride.
There are some "stem cell therapists" touting promising treatment results in Malaysia and worldwide.
This is an immediate and present danger to our innocent patients.

What are stem cells?

Stem cells are fascinating. They are undifferentiated, master cells capable of self-renewal (immortal!) and have the ability to differentiate into various specialised tissues.
It is important to distinguish the type of stem cells we are talking about – the embryonic stem cells (ESC) present in the inner cell mass of pre-implanted embryo or the "adult" stem cells (ASC) present in umbilical cord blood, amniotic fluid or in blood/marrow.
There are significant differences between ESC and ASC. ESC is pluripotent i.e. capable of developing into any of the cell types found in the human body.
ASC are able to make a few cell types and are considered as multipotent.
To date no formal trials using ESC have been conducted because of safety issues related to uncontrolled growth, which result in tumor formation, which has been seen in laboratory animals.
ASCs are attractive as research tools and for treating disease as they do not involve the destruction of embryos. They are also attractive as it may be possible to use a patient’s own stem cells to generate tissue for transplant, thus avoiding problems with immune rejection common to other types of transplantation.
However the limited ability of ASCs to form other tissues may limit its application.
Though the phenomenon of plasticity has been described in ASC i.e. the ability of ASC to form cells of different lineage under suitable environments, scientists are not sure how this can be exploited adequately in clinical settings.

What are the potential uses of stem cells?

Stem cells have potential uses in many different areas of research and medicine.
It has the potential to revolutionise our approach in the study of human biology and treatment of diseases. Some of the important potential applications are as below:
In regenerative medicine:
Due to their ability to replace damaged cells in the body, stem cells could be used to treat a range of conditions, including heart failure, spinal injuries, diabetes and Parkinson’s disease.
It is hoped that transplantation and growth of appropriate stem cells in damaged tissue will regenerate the various cell types of that tissue.
For example, haematopoietic stem cells (stem cells found in bone marrow) could be transplanted into leukaemia patients to generate new blood cells, or neural stem cells may be able to regenerate nerve tissue damaged by spinal injury.
Developmental studies:
For human developmental studies which will shed light on why some cells become cancerous and how some genetic diseases develop, which may lead to clues as to how they may be prevented.
New drug testing and screening of toxins:
These can be done on stem cells grown in the laboratory which would provide a better testing model than current animal models.

Is stem cell therapy an established form of therapy?

This depends on what type of stem cell therapy we are talking about. Haematopoietic stem cell transplant (HSCT), or better known as bone marrow transplant, is an established and curative form of treatment for blood cancers such as leukaemia, lymphoma, myeloma, bone marrow failure syndromes such as aplastic anemia and certain genetic diseases such as thalassaemia or severe combined immunodeficiency state.
It has taken haematologists (experimental and clinical) a good 35 years to reach the current state of practice whereby annually up to 40,000 or more HSCT are done yearly.
In Malaysia, more than a thousand patients had HSCT and around 70% of these patients are long-term survivals.
Transplant medicine is now rather refined with various forms of HSCT being performed, ranging from autologous transplant (stem cells from patient) to allogeneic transplant (stem cells from donors).
Innovative changes to the conditioning regimen enable older patients to undergo HSCT in reduced intensity HSCT.
Stem cell therapy other than HSCT remains experimental treatment and should only be conducted in the setting of clinical trials under close supervision and also needs clearance from appropriate ethnic committees.

What are clinical trials all about? Should we just trust the opinions of our ‘prominent ‘doctors?

We are now living in an era whereby the practice of medicine should be evidence-based. Clinical trials are essential to generate unbiased data based on careful studies on variables that we are interested in.
For instance, if we are interested to find out if treatment A is useful for a particular disease, the answer will be forth-coming after three phases of study.
In Phase1 studies, we have to ascertain whether treatment A is safe to give to humans, followed by Phase 2 studies which would examine whether treatment A is effective or not.
The acid test is in Phase 3 trials when treatment A is compared to an established treatment and hopefully it is able to demonstrate superior results with acceptable side effects – then treatment A is destined for pay-back time.
In the case of a new drug, FDA or EU registration will be sought before marketing is allowed.
Before clinical trials are approved, the protocols are subjected to scrutiny by an independent ethical committee comprising doctors, and at least a lawyer and a lay person.
Generally the data after studies are published in established medical journals and also presented in important clinical meetings so that the knowledge gained from study is assessable to every interested party.
One would expect the same results be duplicated if similar studies are performed elsewhere.

What are the prerequisites for successful stem cell therapy?

For stem cell therapy to work, the prerequisites would include understanding/defining the clinical problem, knowing the right type of cells to give and in adequate number, overcoming the immunological barrier if allogeneic or stem cells from outside source is used, putting the stem cells in the right place and finally getting the transplanted stem cells to work.
One would appreciate why HSCT is an established science, while in the setting of stem cell therapy with the aim to replace damaged myocardium after acute myocardial infarction (AMI), there are many unresolved issues.
Bortin reported the first 203 cases of BMT done in the 70s – only five of them survived. The current HSCT results are much better (transplant related mortality is <5%>

What are the raging ethical debates on stem cell therapy that even President Bush is caught up with?

The ethical issue only arises in ESC as use of ESC results in the destruction or "death" of an embryo.
This is a passionate issue that has resulted in strict government regulation in some countries forbidding creation of embryo for research purposes.
There are also legitimate fears that some rogue scientists will attempt human cloning, which is banned in all countries.
ESC, when transplanted into experimental animals, generally continue to multiply in an untamed fashion, with a tendency to form tumours or various unwanted tissues.
It would be difficult to justify the use of ESC in human therapy unless the problem of potential tumour formation is fixed.
There are no ethical issues with the use of adult stem cells, but one of the potential hurdles for the use of adult stem cells is their limited ability to generate different cell types.

There are claims that stem cell therapy could cure diabetes mellitus, spinal injury, and Parkinson’s disease ... and the list goes on. How credible are these claims? Apparently such services are available in Malaysia!

These are claims and they will remain as claims unless and until they are backed up by good science and data. One should view them critically and not take leave of our senses.
It is worthwhile checking out some of these claims at good websites such as Quackwatch. Quackwatch Inc. is an American non-profit organisation that aims to "combat health-related frauds, myths, fads, fallacies, and misconduct" with a primary focus on providing "quackery-related information that is difficult or impossible to get elsewhere."
On the claims by the stem cell companies, the Quackwatch comments were: their theories and methods are simplistic; their treatments may have adverse effects; they offer no credible outcome data; and their promises go far beyond what is now possible. No reason to believe that they are providing a legitimate service. As the good old saying goes – when something is too good to be true, it usually is.

What is the chance of Malaysia becoming the hub of stem cell therapy?

While I do not underestimate the "Malaysia boleh" entrepreneurship attitude, to grow a RM250mil business from a not-tested technology is stretching it too far!
It is more than irrational exuberance to believe that this will happen. We should keep our feet on the ground and participate in some good basic research.
The local UKM research laboratory headed by Prof SK Cheong performed some interesting studies on the role of mesenchymal cells as a cancer delivery agent and continual research in the same direction will enable us to tap on advances that can be translated from laboratory to bedside in time to come.

Do we need to have some regulations to safeguard the general well-being of our patients?

The answer is a resounding yes. Any form of stem cell therapy advertisement should be vetted by the Ministry of Health and stem cell therapy other than HSCT should only be conducted in the setting of a clinical trial so that the practice/results can be monitored.
The chances of rogue doctors creating havoc with uncontrolled SCT is much higher than a rogue scientist running foul of law. We are duty bound to "protect’ our patients.

Do I think stem cell therapy will fulfil its great promises and transform the practice of medicine?

It is not a question whether it will happen but rather when this will happen. While haemopoietic stem cell therapy/transplant is an established modality of treatment, other form of stem cell therapy is still at very early stage of development.
Prof Peter Braude, a leading stem cell researcher, feels that stem cell therapy needs to be nurtured safely and methodically to provide real benefits to patients in the future.
Much more basic research work needs to be done.
In a positional statement, the International Society for Stem Cell Research proclaimed that no reputable scientists think stem cell therapy (other than haemopietic stem cell therapy) is ready for prime-time yet. The people who are providing such therapies are mavericks!

The saga of ATC

In May 1996, a group of doctors involved in cancer care (including the author) wrote in a letter to The Star highlighting the exploits of a Singapore doctor (his clinic was called clinic Sinai!) treating Malaysian patients with advanced cancer using ATC (autologous target cytokines).
There were no absolutely firm scientific data on the ATC treatment. The patients were promised fantastic results and charged exorbitant fees.
We voiced our distress that patients were misled and wonder whether our health authority can stem such unhealthy practices.
There was some interesting follow-up development – the Malaysian authority could not take any action against the Singapore doctor since he is not registered here while the Singapore counterpart cannot take action against him because he was not treating patients in Singapore!
He was ultimately nabbed by the Singapore authority for internet advertising and deregistered accordingly.

Dr Ng Soo Chin is a consultant haematologist. For further information, e-mail starhealth@thestar.com.my. The views expressed are those of the writer and readers are advised to always consult expert advice before undertaking any changes to their lifestyles. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
The author is the current President of Malaysian Society of Haematology. Some contents of the article are taken from a lecture entitled “Stem Cell therapy–do we know where we are going to?” delivered by the author in a symposium organised by Malaysian Academy of Sciences in July 2007.

骨髓移植没排斥　血癌青年张国文逐渐康复

2007-09-30T16:07:00.000+02:00

原刊光华日报，二零零七年九月二十八日

（吉隆坡28日讯）在热心人士的捐髓、妹妹的细心照顾，来自世界各地的网友、读者和朋友的鼓励之下，自去年5月得知自己患上急性血癌，并于今年5月22日进行骨髓移植手术后的癌症病患张国文，如今已经过5个月的观察期，身体状况正处于康复中，骨髓移植没有出现排斥的现象，情况稳定。

虽然目前仍需依靠药物的治疗，但在张国文保持着的乐观心态。身边朋友和读者的关怀，令他在手术后的短短5个月期间，身体快速康复，在下星期只需做最后的复诊后，张国文就可以回到家乡（槟城）与爸妈团聚。

他说，返回家乡的他之后只需每个月回来吉隆坡安邦医院身体检查，然后定时服药，直到病情完全痊愈为止。

现在的他目前只需要服用排斥、高血压以及抗生素的药物，而不需要像以前那样依靠气管将这些药物输进心脏。

期待返回槟城老家

期待返回槟城老家的他如今已开始为返家乡做好准备，包括退掉他和妹妹租居的公寓房间。

接下的他希望，如果身体健康允许的话，他将会恢复工作，而且之前他的老板已答应他，在他康复后会安排较轻松的工作如文员的工作给他。

对于这位体贴的老板，张国文感激不尽，而且他会为所有关心他的朋友、家人、捐赠者、本报爱心读者，坚强地活下去，继续他的人生旅程！

活在当下学习放开

“人生无常，勇于挑战。活在当下，学习放开。明天会更好！”这是张国文送给所有血癌病患的寄语，我想这句话应该同时也可以送给全天下所有人。

血癌病患张国文在成功等待“新生命──周边血”，到完成骨髓移植手术的他至今度过了5个月的观察期，目前无须留院的他接受了本报的访问。

眼前的他看起来脸色很好，也开始长出头发，这次的抗癌过程对张国文来说，是他人生一个最大的转捩点，让他变得更乐观，更懂得生命为何物。

回乡探亲发烧差点送命　最忌病菌感染

顺利等待从3120公里外的台湾送回来“新生命──周边血”并完成骨髓移植的张国文目前已不需留院，尽管如此还在观察期间的他最重要是避免病菌感染，最担心的是生病。

光华日报记者周五早上预定时间抵达张国文与妹妹目前居住的安邦斯里班丹公寓，记者按了门铃，铃声响了许久，终于看见简单朴实的张国文亲自为记者开门。

张国文受访时并没有刻意为专访而打扮，简单的他当时穿上一件鲜橙间隔粉黄色T恤和一条及膝盖深蓝格子短裤，迎面而来的张国文脸上戴着口罩。

张国文一看见记者的一句话就是：“请问你们有人生病吗？伤风？感冒？”，记者还笑着回应说：“我们都百毒不侵！”随后国文才进一步解释说：“医生吩咐，生病者包括伤风、感冒者等一律拒绝拜访。”

曾经试过有一次，他返回家乡探望父母，结果发烧，差点送命，惹得他被主诊医生痛骂一顿。

公众给予的大爱　抗癌路上不感寂寞

张国文从没想到，其患上急性血癌及找寻骨髓的事件会引起公众人尤其是光华日报读者给予他的大爱，让他抗癌路上不感寂寞。

自张国文患有急性血癌事发后，各界公众人士纷纷为他伸出援手，慈济佛教会还安排义工前往其住家帮他瘫痪的母亲梳洗，甚至还有广大热心人士捐助及在光华日报及网络上留言，为他祝福、鼓励和打气。

他说，他卧床期间从光华日报看见许多人写下寄语为他祝福，甚至还有记者特地在网上下载读者给他留言，及寄给他看，这些举动都让他动容与感激。

他在访问中亲笔写下给光华日报读者的寄语，写出心中想对所有关心他的读者和社会人士话：“谢谢所有光华读者的大爱，让我感到不寂寞，感动”。

会坚强活下去

来自坚强家庭的张国文从获知自己患上血癌、至到寻获骨髓，到现在骨髓成功移植后目前仍处于观察期的他，最想对家人及朋友说：“感谢大家一路的关爱。我会好好的！”

他透露，自己并非哭包一族，他知道家人及朋友们对他的关爱，或许家人会流泪，可是他知道大家都把泪水往心里留，对于大家的爱护与期待，他会好好坚强的坚持下去。亲笔感谢妹妹

张国文妹妹张今连为了他的病情而停薪留职，全日陪伴、照料着生病的哥哥，对于妹妹，一直以来内向及不敢于表达的张国文，也透过文字亲笔道出对妹妹的感谢。

他在文中写着：“亲爱的妹妹，辛苦你一路来的照顾，不只是我，还有全家人让你担心，辛苦了。我会快快好起来。我们家会越来越好。一起走过难关的。谢谢有你的爱。”

要给救命恩人　送上真挚的拥抱

张国文要为捐献骨髓救他一命的台湾女子送上真挚的拥抱。

张国文说，到现在为止，他本身还没有机会向这名让他生命成功延续的女子道谢。由于医生向他说明，根据医学手术要求，在一年内，他不能与捐献骨髓者见面。

他在访问中遥望天台说道，他希望一年后，可以在获得这名女子的资料、住家地点后，亲自飞往台湾，向对方道谢外，还会给对方一个热情的拥抱，以感谢对方救命之恩。

Cancer of the lymphatic system

2007-09-14T11:39:00.000+02:00

From The Star, Sunday September 9, 2007

It's World Lymphoma Awareness Day next Saturday. Let's take a look at this disease, and find out why, despite its increasing incidence, there's such a lack of awareness about it.

DESPITE being one of the fastest growing cancers types in the world, there is a dire lack of public awareness of lymphoma across the globe. Early detection makes a huge difference in the ability to combat this disease; it is therefore essential that the public are educated and aware of this condition, its symptoms, and how it affects lives.

To drive this much-needed awareness, the Lymphoma Coalition � a network of patient groups from around the world � will launch the first Worldwide Lymphoma Awareness Day (WLAD) on September 15 2007.

By improving symptom recognition, the Lymphoma Coalition hopes to increase early diagnosis and treatment, which will improve prognosis and even save the lives of those affected by lymphoma. WLAD is endorsed by the International Union Against Cancer (UICC) and will become an annual date of increasing importance on the health calendar, providing a platform for lymphoma awareness and education activities around the world.

The need for awareness

# The symptoms of lymphoma are often mistaken for less serious illnesses such as flu, fatigue or glandular fever

# It is essential that the symptoms of this condition are recognised early, as if treated appropriately some types of lymphoma can be cured

# If left untreated, some types of lymphoma can be fatal within six months

# In excess of one million people are living with lymphoma around the world today

# Initial diagnosis of lymphoma can be difficult � disease education can help patients receive the information and support they need

What exactly is lymphoma?

Over 348,000 people worldwide are diagnosed with lymphoma each year. Approximately 186,000 people worldwide die each year from the disease. Lymphoma is the fifth most common cancer in men in and the seventh most common cancer in women.

According to consultant haematologist Dr Chang Kian Meng, lymphoma is a complex disease that is relatively little known by the general public, despite its growing prevalence worldwide.

Yet various treatments are available with the potential to relieve symptoms of the disease for extended periods of time or, for certain types of NHL, to offer the possibility of a cure.

Lymphoma can occur at any age, including childhood. In Malaysia, the incidence of lymphoma is increasing each year, commented Dr Chang.

According to the National Cancer Registry 2003, the incidence of lymphomas in males is 402 cases per 100,000 population, which is 4.2% of the overall cancer incidence, and in females, the incidence is 240 per 100,000 population, which is 2.5% of the overall cancer incidence.

In essence, lymphoma is a general term for cancer of the lymphatic system. The lymphatic system is part of the body's immune system, made up of a complex network of lymph organs including bone marrow, the thymus and the spleen.

The lymphatic system carries white blood cells (lymphocytes) around the body. When lymphocytes develop abnormally, they can collect in the lymph nodes and form tumours.

Lymphomas are divided into two main types: Hodgkin's lymphoma (HL) and non-Hodgkin's lymphoma (NHL). NHL by far is the most common.

Approximately 70-80% of lymphomas involve the lymph nodes and the remaining 10-20% occurs in the extra nodal sites such as the skin, gut, bone marrow and other organ's tissues.

Types of lymphoma

Hodgkin's lymphoma

Hodgkin's lymphoma is a rare form of lymphoma characterised by a particular abnormal tumour cell � Reed Sternberg � not present in other forms of lymphoma. It accounts for about 15% of all lymphomas.

Non-Hodgkin's lymphoma (NHL)

Any lymphoma that is not Hodgkin's lymphoma is classified as non-Hodgkin's lymphoma. It is the most common cancer of the lymphatic system (85%). The common types of NHL are B cell lymphoma (80-85%) and T cell lymphoma (15%). NHL occurs mainly in adults, with peaks between 45 and 60 years old.

Types of Non-Hodgkin's lymphoma

There are more than 30 different sub-types of NHL, which are generally classified into two equal groups, depending on the tumour growth rate.

Indolent (low grade): Slow growing and may be asymptomatic for many years, which means that patients do not always require immediate treatment.

When needed, treatment usually achieves a disease-free period or remission. However, indolent NHL often relapses or recurs and more treatment is needed.

Aggressive (intermediate/high grade): Fast growing lymphomas which become rapidly fatal within six months to two years and require urgent treatment.

Although the name "aggressive" sounds very serious, these lymphomas often respond very well to treatment. Unlike indolent NHL, patients with aggressive NHL are more likely to be cured with treatment.

Symptoms of lymphomas

The most common symptom of lymphoma is a painless swelling of the lymph node, for example in the neck, under an arm (axilla) or groin. Other symptoms may include:

# Recurrent fevers

# Unexplained weight loss (defined as losing 10% of weight over six months).

# Night sweats

# Chills

# Extreme fatigue and tiredness

# Itching without an apparent cause or rash

Lymph nodes or tissues elsewhere in the body may also swell. The spleen, for example, often becomes enlarged in lymphoma and may cause abdominal pain or discomfort.

The enlarged lymph nodes can sometimes cause other symptoms by pressing against a vein or lymphatic vessel (swelling of an arm or leg), a nerve (pain, numbness, tingling), or the stomach (early feeling of fullness).

Sometimes, there are no symptoms present at all and lymphoma is discovered by accident during a medical examination or investigation for a different condition.

Causes of lymphoma

According to Dr Chang, the exact cause of lymphoma remains unknown. Several factors have been linked to an increased incidence of lymphoma, including industrialisation and certain chemicals in insecticides and wood preserving materials.

However, some forms of lymphoma are more likely to develop in people who have taken drugs to prevent rejection of an organ following a transplant or who have reduced immunity, for example people with HIV or AIDS.

It is known however, that lymphomas are not contagious and cannot be passed down through families

Diagnosis of lymphoma

The only method for accurate diagnosis of lymphoma is a biopsy of an enlarged lymph node.

Dr Chang says: "Correct diagnosis and staging of the disease will enable doctors to plan an effective treatment regimen. Staging of the disease can be done via bone marrow test, CT scan, MRI and PET scan."

Current treatment options

The treatment of NHL aims to cure the disease whenever possible or to obtain as long a lasting remission as possible. In addition, the treatment should aim to improve the quality of life of the lymphoma patient.

The treatment given to NHL patients is specifically chosen for each individual and depends on a number of factors, including whether symptoms are present, class and stage of disease and the overall health of the patient.

According to Dr Chang, the first treatment should be the best treatment by optimising the use of the best medications or agents. Currently, the best option for treatment of B-cell NHL is a combination therapy of rituximab, a monoclonal antibody, and chemotherapy given over six to eight courses.

Rituximab targets B cells, and stimulates the body's own immune system to help it kill the B cell. Rituximab does not affect other cells, which may explain why it causes fewer side-effects than other cancer therapies. When treatment is over, healthy B cells come back and should return to normal levels within six to 12 months.

With chemotherapy, patients may experience mild and reversible side effects. The most common side effects are nausea and vomiting, hair loss, and transient low blood counts that occur 10 to 14 days after treatment. Patients may require antibiotics or hospitalisation if they develop fever.

Dr Chang mentioned that the success rates for of rituximab chemotherapy combinations are very impressive, with remission rates of 80% and cure rates (three to five years disease-free period) of up to 60-75%.

He added that it is important for patients to understand that low grade indolent lymphoma is generally incurable and tends to remit or relapse. A viable option for this group of patients is maintenance rituximab to prevent relapses and ensure prolonged duration of remission and good quality of life for patients.

Dr Chang commented that in general, most lymphomas are treated with chemotherapy. However, in rare instances, radiotherapy may be the first option for localised indolent disease. (Radiotherapy is the use of high energy x-rays to kill lymphoma cells or to slow their growth and development.)

Stem cell transplantation is another viable option for NHL patients with advanced aggressive disease or relapsed disease. In this procedure, patients are given high-dose chemotherapy which destroys the bone marrow and all cancerous cells.

Healthy stem cells (undeveloped lymphocytes), harvested from the patients prior to high-dose chemotherapy, or from a carefully matched donor, are given to a patient to enable the body to replenish its supply of healthy white blood cells.

Advice for patients

From his years of experience managing lymphoma patients, Dr Chang also highlighted some important points for patients to consider:

# Maintain a healthy, balanced nutrition.

# Continue light exercise after second and third week to ensure adequate stamina.

# Strict attention must be paid to personal hygiene and food preparation (sterile).

# Avoid uncooked foods like salad, raw egg and raw meat.

# Avoid handling pet wastes during period of chemotherapy.

# Maintain a positive attitude.

His advice to all lymphoma patients: "It is important to realise that many patients are cured today with modern treatment. Approach the disease with a positive attitude. There is a wealth of information on the Internet with regards to disease information and best treatment options. Discuss these options and treatment decisions with your doctor."

Stand Up and Live for Life

2007-05-29T08:17:00.000+02:00

People living with CML in Malaysia break new ground by organizing a two day workshop for those affected by the disease.

Read the rest of story here - from the website of The Max Foundation.

Cladribine Therapy for Hairy Cell Leukemia: Does Schedule Matter?

2007-05-29T01:30:00.000+02:00

Daily or weekly cladribine provided equivalently high response and survival rates, with similar toxicity profiles.

Cladribine monotherapy yields a high response rate and durable remission for most patients with hairy cell leukemia (HCL), usually with only one treatment cycle. Varying treatment schedules have been employed, including 7-day continuous infusion, daily 2-hour infusions for 5 days, and weekly 2-hour infusions for 6 weeks; some reports have suggested that fewer treatment-related complications occur with the once-weekly schedule. The Polish Adult Leukemia Group conducted a randomized prospective comparison of two cladribine regimens in 116 previously untreated HCL patients: 0.12 mg/kg during 2 hours daily for 5 consecutive days, or the same dose and infusion time once weekly for 6 weeks. Patients with complete responses (CRs) received no further therapy, whereas those with partial responses continued with additional treatment. No antibiotic or cytokine prophylaxis was used.

Most patients (74%) required only a single treatment cycle to achieve CR. Five patients had no response, and three early deaths occurred due to infection within 4 months of therapy initiation. For daily versus weekly schedules, no differences in CR (76% and 72%), 6.5-year overall survival (91% and 88%), or median progression-free survival rates (4.3 and 5.1 years) were seen. Toxicity did not differ for the two treatment schedules. Severe (grade 3/4) infections occurred in 18% of the daily- and 26% of the weekly-treated patients, and no differences were noted in treatment-related cytopenia or transfusion requirements. Second neoplasms, primarily solid tumors, were diagnosed in seven patients, with a median time to diagnosis of 2.3 years.

Comment: For patients with previously untreated HCL, this study demonstrated similarly high response and survival rates, with no difference in toxicity rates, for weekly versus daily cladribine dosing schedules. Serious infectious complications, including early deaths due to sepsis, were not uncommon, however, and suggest a role for prophylactic antibiotics and cytokine support.

Michael E. Williams, MD

Published in Journal Watch Oncology and Hematology May 25, 2007

Citation(s):

Robak T et al. Cladribine in a weekly versus daily schedule for untreated active hairy cell leukemia: Final report from the Polish Adult Leukemia Group (PALG) of a prospective, randomized, multicenter trial. Blood 2007 May 1; 109:3672-5.

Scientists Develop Artificial Blood

2007-05-13T09:32:00.000+02:00

Scientists from the University of Sheffield are developing an artificial 'plastic blood´, which could act as a substitute for real blood in emergency situations. The 'plastic blood´ could have a huge impact on military applications.
Because the artificial blood is made from a plastic, it is light to carry and easy to store. Doctors could store the substitute as a thick paste in a blood bag and then dissolve it in water just before giving it to patients – meaning it´s easier to transport than liquid blood.

ADAMTS13 and Thrombotic Microangiopathy

2007-05-10T01:05:00.000+02:00

High antibody titers and persistence of undetectable ADAMTS13 activity during remission indicate poor prognosis and predict relapse.
Free full text from Journal Watch

一個月內殺死2種癌細胞，格列衛具奇蹟性療效

2007-04-10T15:46:00.000+02:00

2007-04-10
原载光明日报

格列衛Gleevec（Imatinib Mesylate）是新一代分子標靶治療的代表，屬口服藥物，超過90%的慢性骨髓性白血病（CML）和胃腸基質瘤（GIST）患者服用一個月內就有明顯的好轉，癌細胞不只逐漸死去，正常細胞的增生也得到控制。此藥有輕微的副作用，如噁心、體液滯留、嘔吐、體重增加等，但只要遵照醫生囑咐即無大礙。格列衛是美國藥物管理局（FDA）批准的第一個以分子生物學學理抑制癌基因訊號傳遞的治癌藥物。

血液病理及癌症專科醫生梁健華表示，隨着醫療科技的進步，醫學界對癌症的了解已到達細胞基因的層次，知道什麼基因病變會造成某些癌細胞的產生。

因此，新一代研發的藥物能藉由抑制特殊癌細胞產生的機轉，準確殺死癌細胞而不破壞正常細胞的功能，這就是所謂的標靶治療（targeted therapy）。

終生須服藥

他解釋，格列衛的作用是抑制一種因細胞基因病變而突變的蛋白質酪胺酸激（tyrosine kinase）。這種突變的蛋白質（mutant protein）主要可在慢性骨髓性白血病（chronic myeloid leukemia, CML）和胃腸基質瘤（gastrointestinal stromal tumor, GIST）這兩種癌細胞中發現。因此，格列衛對這兩種癌症有奇蹟性的療效。

“它的出現是慢性骨髓性白血病和胃腸基質瘤患者的一線曙光。超過90%的患者服藥一個月內就有明顯的好轉，癌細胞不只逐漸死去，正常細胞的增生也受控。不過，患者一生都需服用此藥以控制病情。”

審核速度破紀錄

資料顯示，格列衛（研發初期稱為STI571）在1998年6月初次用於臨床試驗，試驗的卓越療效在1999年的美國血液病年會中發表，造成轟動。

研發並推出此藥的諾華公司（Novartis），於2001年2月27日向美國藥物管理局（FDA）申請STI571的上市許可，此藥因突破性的療效而被優先審核，於5月10日獲得核准，僅花費10週，打破以往藥品的審核紀錄。上市的STI571商品名在美國是Gleevec，在其他國家稱Glivec。

病患月需8000藥費
符條件可終生豁免

血液病理及癌症專科醫生梁健華披露，格列衛療效卓越，但價格不菲，按一般的劑量服用，一個月需花約8000令吉。

不過，諾華藥劑公司於2002年推出了“格列衛全球患者援助項目”（Glivec International Patient Assistance Program, GIPAP），宗旨是讓所有符合條件，應該受益於格列衛，但無經濟能力支付的患者終生免費獲得格列衛治療。

“這樣廣泛性和慷慨的藥物援助計劃是前所未聞的，除了每月一小筆處理費之外，病人完全不需要付錢。我們真的希望有更多公司仿效這項計劃。”

資料顯示，援助計劃從2002年啟動至今，全球81個發展中國家，已有2萬1362位病人受惠。

“我的病人中有六七十人在這項援助計劃下受惠，其中3人是胃腸基質瘤（GIST）患者，其餘為慢性骨髓性白血病（CML）患者。所有病人都非常感激這項援助計劃。”

脾臟恢復正常體積
患者生活如常

梁健華表示，他曾有一位患上慢性骨髓性白血病近4年的患者，病情惡化至脾臟極度腫大，呼吸和移動都有困難。當時格列衛剛上市，服用後她很快地克服了這些病症，脾臟也恢復正常的體積。服藥至今超過4年的她情況良好，可以勝任日常生活中的任何事。

此外，一位94歲的胃腸基質瘤病人，服用格列衛至今3年多，健康極佳，去年還到北京遊玩。

他說，他為此編寫了《The Human Side‧Facing Cancer：Hope, Treatment, Reality, The Human Spirit, True Stories》一書，裡頭收集了病人親自撰寫的抗癌心路歷程，也包含了醫生對好幾種常見癌症的講解，以增加病人和其家屬及公眾人士對癌症的認識。

懂多一點

胃腸基質瘤（GIST）

胃腸基質瘤是一種罕見的胃腸道癌症，在格列衛問世之前，對於無法以手術切除的胃腸基質瘤，仍沒有一個有效的療法，病人平均只能活幾個月。

慢性骨髓性白血病（CML）

慢性骨髓性白血病是一種因骨髓干細胞發生染色體異位（這種現象稱為費城染色體，Philadelphiachromosome）而引起的血癌。患者的白血球不受控制地增生，造成脾臟腫大、身體疲弱、腦部血管受影響等情況，最終死亡。

此症的最好療法是骨髓移植，不過適合的損贈者難尋，因此很多病患都在兩三年內因病情惡化去世。（光明日報‧2007.04.10）

慢性骨髓細胞白血病，基因突變發病非遺傳

2007-01-24T14:36:00.000+01:00

光明日报，二零零七年一月十九日。

慢性骨髓細胞白血病（Chronic Myeloid Leukemia, CML）雖和基因有關，但卻不是一種遺傳疾病。此病的發病率為每10萬人中有1至1.5人，患者的體內皆有“費城染色體”（Philadelphia Chromosome），即第九和第廿二對染色體的角色易位（translocation），造成白血球的數量不受控制地增加。目前醫學界仍無法找出此病症基因突變的原因，只確定少數病例和輻射有關。患者可選擇服用藥物“格列衛”（Imatinib）或移植骨髓，有望控制病情或可能治癒。

不過，“格列衛”的費用高昂，一個患者每月的藥費至少逾8083令吉，衛生部尚未全面大量津貼此藥物予患者。大馬曾經或正在服用“格列衛“的患者逾450名，其他一些經骨髓移植治療而痊癒的患者則不需服用“格列衛”。

馬大醫藥中心血液學專家哈利斯拉曼醫生（Dr. Haris Rahman）說，基本上骨髓可以製造紅血球、白血球及血小板，主要來源是骨髓中的芽細胞經分化而形成不同型態的細胞。

“若生成白血球系列的芽細胞增生太多且成熟不全，造成周邊血液及骨髓中的白血球無限制地增加，包括成熟和不成熟的白血球，則會導致慢性骨髓細胞白血病。”

費城染色體為指標

他在“什麼是慢性骨髓細胞白血病？”講座會上說，白血病通常分急性和慢性。

所謂急性是指病程較為迅速、血液或骨髓中存在大量不成熟的芽細胞；慢性白血病則指病程進展較為緩慢、血液或骨髓中存在的大都是較成熟的白血球。

他說，病人體內有沒有費城染色體是檢驗的重要指標，因為一般上逾9成的患者體內皆有費城染色體。這類染色體因首次在美國費城被發現，故以此命名。

哈里斯以紅綠燈來比喻此病症的階段和治療。病症階段一般分成慢性期（chronic phase）、加速期（accelerated phase）和急變期（blastcrisis)。而治療的反應則是血液檢查上緩解（hematologic remission）、染色體檢查上緩解（cytogenic remission）及分子生物學上緩解（molecular remission）。

“患者最好能在治療中達到血液檢查上緩解，因為這是最容易達到的結果。若患者達成，就要更上一層樓，治療的結果要達到染色體檢查上緩解及分子生物學上緩解。若已達到分子生物學上緩解，表示病情已控制良好，甚至可能沒有費城染色體了。”

畢業於英國雪菲爾大學的哈里斯表示，患者初期沒有明顯症狀，病情的發展相當緩慢。在加速期和急變期的部分，患者在晚上會出現莫名發燒、流汗或感到很疲倦等症狀。一些研究報告指出，有些患者出世時，多潛能幹細胞（pluripotent stem cells）可能已經有所改變，但卻在成年後才發病。

目前在馬大醫學院執教的他說，現今醫學界只確定CML和基因突發有關，病因有待研究。有少數的病例和輻射有關係，例如日本的廣島、長崎曾被投下原子彈，急性白血病和慢性骨髓白血病患者於核爆後有激增的現象。患者及早接受治療，長期存活率可能隨着增加。

合適骨髓不易找
格列衛為主要藥物

衛生部首席臨床血液學專家曾建明醫生說，過去異體幹細胞移植被視為唯一能夠治療慢性骨髓細胞白血病（CML）的療法，但是幹細胞移植需要有適合的骨髓配對，即使有眾多兄弟姐妹者也未必可找到適合的骨髓，造成移植面對諸多困難。

此外，移植過程中，大約20-30%患者會因副作用而逝世，存活者也有20%機會復發，故以藥物控制病情成了另一個選擇。

他說，目前“格列衛”是治療CML的主要藥物。據一項研究報告顯示，經過5年的觀察，70%仍在服用“格列衛”的患者沒有出現嚴重的副作用，存活率達90%。“格列衛”有一些副作用如皮膚出現黑斑、嘔吐、肌肉酸痛、噁心、體重增加等。

“服用‘格列衛´的患者需長期觀察和監測病情，若無法在預定的時期達到分子緩解，醫生會考慮更換療法，包括增加藥量、進行幹細胞移植或用第二代靶標療法（targeted therapy) ，如服用藥物Dasatinib和Nilotinib。”

他重申，CML的最佳療法和“格列衛”的安全性仍須通過許多臨床研究才能確定。

CML病人支援團體（Max Family）

在去年7月杪成立的CML病人支援團體（Max Family）是一個非政府組織，提供協助予病人和病人家屬，讓他們能有更佳的生活品質，更有能力面對治療。

此團體歡迎所有的CML病人加入，欲知詳情者可聯絡翁美欽，電郵：mymaxfamily@gmail.com

CML三個病情階段

1.慢性期（chronic phase）
血液及骨髓中只有少量的芽細胞，輕度或無臨床症狀，此期可以延續數月到數年之久。如果不治療，慢性期平均維持約2-5年，存活率大約是4年。

2.加速期（accelerated phase）
此期的特徵為血液及骨髓中芽細胞（blast）大於15%，前骨髓細胞（promyelocyte）大於30%，嗜鹼性球（basophils）大於20%，血小板數量（platelet counts）小於100000/L，或
是無法控制的脾臟腫大。加速期平均維持約3-6個月。

3.急變期（blast crisis )
血液或者骨髓中有30%以上的芽細胞，有時可以在骨髓外形成腫瘤，如骨骼、淋巴結，甚至在腦脊髓組織。

治療三階段

1.血液檢查上緩解（hematologic remission）：血球計數到達正常的數量。
2.染色體檢查上緩解（cytogenic remission）：染色體檢查恢復正常。
3.分子生物學上緩解（molecular remission）：聚合酵素鏈鎖反應（PCR）檢查為陰性反應。

移植非親屬骨髓，馬大首宗手術成功

2007-01-21T10:05:00.000+01:00

中国报，星期六，20/01/2007。

(吉隆坡19日訊）馬大醫院首宗成人非親屬骨髓移植手術，成功進行，18歲華裔少年接受1名新加坡熱心人士捐贈的骨髓后，至今已在康復中。

黃金耀（18歲）是于去年3月，證實患上血癌，由于親屬並沒適合骨髓，所以必須向非親屬的骨髓捐贈者中，尋找合適骨髓。

主治醫生顏曉詩指出，國內有意捐贈骨髓的7000人當中，並沒發現適合黃金耀的骨髓。

“我們過后唯有到新加坡，尋求骨髓捐贈計劃單位的協助，並且成功找到適合的骨髓。”

顏醫生表示，國人對捐贈骨髓的醒覺並不高，有者則對捐贈骨髓存有誤解，以致已登記捐贈骨髓者只有7000人，這使血癌病患常常面對沒有適合骨髓的難題。

她補充，有意捐贈骨髓者，只需到醫院抽血檢驗，程序簡單。

顏曉詩醫生今日出席骨髓病患黃金耀，成功進行非親屬骨髓移植手術者會時，發表談話。

籌獲20萬

她說，儘管院方曾成功為血癌兒童病患，移植骨髓，可是成人非親屬骨髓移植手術，卻是有史以來的首宗。

她指出，院方花約半年為病患尋找適合骨髓，而移植骨髓手術是在去年11月杪進行。

“手術非常成功，病患目前已在康復中。”

黃金耀的醫藥費，獲得馬華公共服務與投訴局主任拿督張天賜，以及一些單位贊助。據瞭解，張氏為黃金耀籌獲約20萬令吉。

他表示，支付黃氏手術后剩余款額，將用作協助其他病患。

張天賜說，馬大醫院成功進行成人非親屬骨髓移植手術后，證明我國的醫術值得信賴，病患目前能以更廉宜價格，在國內進行骨髓移植手術。

New Lease of Life for Cancer Boy

2007-01-21T09:51:00.000+01:00

The Star, Friday, 19th January 2007.

KUALA LUMPUR: Teenage leukaemia patient Wong Kim Yau can now breathe a sigh of relief after successfully undergoing a bone marrow transplant from an unrelated donor, thanks in large to public donations.

Haematologist Dr Gan Gin Gin who headed the University Malaya Medical Centre (UMMC) team, said the teenager was responding positively following the operation last November and was being kept under observation.

Seventeen-year-old Kim Yau's plight was highlighted in the newspapers in the middle of last year after a matching non-related donor backed out at the last minute when a medium advised her against it.

Diagnosed with acute myeloid leukaemia since 2005, Kim Yau was in urgent need of a bone marrow transplant and needed money to find a donor and have the operation as soon as possible.

His father is an odd-job worker and his mother a housewife.

Donations totalling some RM200,000 poured in from all walks of life especially through a special fund set up by the MCA Public Service and Complaints Department and Sin Chew Daily.

UMMC director Dr Ikram Shah Ismail said this was the first time the hospital had conducted an adult “stem cell” transplant involving a non-related donor, which is an uncommon occurrence.

“Normally, the donor will be related to the patient, as there is a higher chance of finding a match. But in this case, there was no suitable family donor and luckily, there was a match from an unrelated donor,” he told a press conference here yesterday.

The unrelated donor was identified through Singapore's Bone Marrow Donor Programme after a search for an unrelated local donor proved futile.

Dr Gan said it was difficult to find an unrelated donor locally although there was a government donor registry as not many people were aware of it or had misconceptions about it.

Also present was MCA Public Services and Complaints Department head Datuk Michael Chong, who thanked all donors who helped make a difference and for saving Kim Yau's life.

“Having such an operation done in a local hospital goes to show that Malaysians need not go overseas to do it as it can be done here,” he said.

The cost for the operation at UMMC was about RM70,000.

Chong said what was left in the fund would be channelled to help other patients.

News from ASH: Treatment with epoetin alfa once every three weeks achieved target hemoglobin

2006-12-20T00:11:00.000+01:00

New investigational study results report that 80,000 units of epoetin alfa (Procrit) administered once every three weeks may increase hemoglobin (Hb) levels and improve quality of life in patients with non-myeloid malignancies who are not receiving chemotherapy or radiation therapy. The study is published in the November supplement of the medical journal Blood as part of the American Society of Hematology (ASH) 48th Annual Meeting

More Glivec long term data

2006-12-20T00:09:00.000+01:00

A study published in the New England Journal of Medicine underpinned Glivec® (imatinib) as a durable and well-tolerated long-term therapy for newly diagnosed adult patients with a form of blood cancer known as Philadelphia chromosome-positive (Ph+) chronic myeloid leukemia (CML). According to the publication, the five-year overall survival of patients who received Glivec as initial therapy is higher - estimated at 95% when excluding deaths from causes unrelated to CML or prior transplantation - than that in any previously published prospective study of the treatment of CML, a disease with limited survival options before the approval of Glivec.

News freom ASH: Final data from phase III study show single-agent alemtuzumab is superior to chlorambucil for B-CLL

2006-12-20T00:08:00.000+01:00

Patients with B-cell chronic lymphocytic leukemia (B-CLL) may soon have a more effective treatment option earlier in the course of their disease, according to final data from the CAM 307 international Phase III study presented at the 48th Annual Meeting of the American Society of Hematology. These data showed alemtuzumab was superior to chlorambucil as a first-line therapy with respect to progression free survival (PFS) in previously untreated patients with B-CLL. Patients receiving alemtuzumab also exhibited higher overall and complete response rates with a manageable safety profile, compared with patients who were treated with chlorambucil.

News from ASH: Multiple Myeloma Patients Respond To Retreatment With VELCADE(R) (Bortezomib) For Injection

2006-12-19T23:40:00.000+01:00

Millennium Pharmaceuticals, Inc. (Nasdaq: MLNM) today announced findings from two retrospective analyses evaluating VELCADE(R)(bortezomib) for Injection as retreatment therapy in heavily pretreated relapsed multiple myeloma (MM) patients. These data showed overall response rates (complete response [CR] and partial response [PR]) to retreatment as high as 60 percent among patients who had an initial response to VELCADE treatment and as high as 29 percent among patients who did not show a response to their initial VELCADE treatment. These data were presented at the American Society of Hematology (ASH) 48th Annual Meeting in Orlando, Fla., December 9-12, 2006 and show repeat use of VELCADE in relapsed MM patients can improve disease outcomes, including in patients who did not respond to their first treatment of VELCADE.

"Relapsed patients have limited treatment options as they often develop resistance to therapy, especially when treated to progression," said Dixie Esseltine, M.D., Vice President, Global Medical Affairs, Millennium. "These results showed that patients can receive VELCADE in multiple lines of therapy, with treatment-free intervals and potentially benefit from retreatment with VELCADE with an improved clinical response."

A support group for CML patients

2006-12-02T06:27:00.000+01:00

From The Star, Friday, December 1, 2006.

By ESTHER CHANDRAN
Photos by RAJA SHAMSUL BAHREN

A NEWLY formed local support group is organising its first get-together to raise awareness on chronic myeloid leukemia (CML).

Talks will be thrown in for the benefit of CML patients at the event at the Kuala Lumpur Hospital tomorrow organised by Max Family.

Max Family president Dr Abd Razak Muhamad said CML is a disease of the bone marrow producing too many white blood cells that progresses slowly and occurs during or after middle age.

In providing support and helping patients know more about the disease, The Max Foundation local representative Ong Mei Ching, who emceed at the recent CML Day: Chit Chat and Fun afternoon, gave an introduction on the disease.

Max Family welcomed haematologist and lecturer from University Malaya Medical Centre Dr Haris Rahman who spoke on CML.

He gave an overview of CML and shared the basics patients need to know to help them understand and cope with the disease.

Consultant haematologist from the Ampang Hospital Dr Chang Kian Meng also shared the platform when he spoke on CML: Now and Future, providing an overview on the overall management and treatment of CML as well as the future direction for patients living with CML.

Dr Abd Razak, a CML patient, said the support group is a platform for patients to share their problems and raise issues and concerns on CML.

“We are trying to establish a voice for CML patients so that they can come together, meet and talk about their problems.

“It is important for CML patients out there to know that there is such a group and they can turn to us for help and better understanding of what they are going through,” he said.

“We also want to organise more talks and have family days and outings for those in the group,” he said.

To contact Max Family, call 012-787 8084 (Dr Abd Razak), 013-363 3769 (Raja Noradzmi), 012-364 3168 (Shikin) or 012-303 8616 (Mei Ching).

Outcome of Transformed Diffuse Large B-Cell Lymphoma

2006-11-29T03:14:00.000+01:00

Patients presenting with concomitant indolent and aggressive lymphoma had lower complete remission rates following induction chemotherapy, but their 5-year overall survival was equivalent to patients with de novo diffuse large B-cell lymphoma.

Free full text from Journal Watch

Genetic Profile of Waldenström Macroglobulinemia

2006-11-29T02:45:00.000+01:00

WM is related more closely to chronic lymphocytic leukemia than to multiple myeloma.
Free full text from Journal Watch

Chit Chat & Fun - CML Day

2006-11-16T03:28:00.000+01:00

The newly formed local support group for Chronic Myeloid Leukemia (CML), known as Max Family organizes their first event on Saturday, 25^th November, 2006.

Themed CML Day: Chit Chat & Fun, this is the first step of the local support group, which was formed to help and support local patients and their care givers to understand and cope with the disease. More importantly, with the advancement of effective treatment available, having CML does not equate a death sentence nowadays, this awareness should be disseminated to general public and medical personnel in order to optimize outcome in the management of CML.

Those interested, please contact the organizers
Miss Mei Ching, 012-3038616, email: mchingong@gmail.com
Miss Shikin , 012-3643168, email: ashikin.ishak@gmail.com

D-Dimer Might Help Identify Patients Who Need Extended Anticoagulation

2006-10-29T11:47:00.000+01:00

Patients with unprovoked venous thromboembolism who had abnormalD-dimer results a month after stopping standard anticoagulationtherapy benefited from extended drug therapy, researchers reportin the current New England Journal of Medicine.

Of some 600 patients who received D-dimer testing after stoppingat least a 3-month course of anticoagulation therapy, abouta third had abnormal results. These patients were then randomizedto resume or not resume therapy. About 3% of those who resumedtherapy experienced either recurrent thromboembolism or majorbleeding, compared with 15% of those who did not resume therapy.

Given that the threshold for an abnormal D-dimer level wasn'tclearly defined, that the assay wasn't performed until a monthafter therapy was stopped, and that it's unclear whether allpatients in the study might have benefited from continued anticoagulationtherapy, Journal Watch Cardiology Editor-in-Chief Dr. HarlanM. Krumholz concludes that this strategy is of "uncertain value."

Link: Journal Watch Cardiology summary (Free)

New Tool Helps Blood Specialists Improve Patient Care

2006-09-15T05:06:00.000+02:00

The American Society of Hematology (ASH(TM)) and American Board of Internal Medicine (ABIM) announce the development of the first in a new wave of performance evaluation tools for blood specialists.

In response to a change in requirements to maintain ABIM certification, ASH and ABIM have co-developed the Hematology Practice Improvement Module (PIM), a web-based tool physicians use to complete their practice performance assessment requirement for recertification. Participants in ABIM's Maintenance of Certification program, must complete several self-evaluation steps, including reviewing patient charts and answering questions that determine compliance with pre-established performance measures developed by ASH that are important in the care of patients

They're starting off with MDS and moving on with Myeloma. Good move.
See:
http://www.hematology.org/education/recertification/pims.cfm

Living next door to CML

2006-07-19T11:48:00.000+02:00

46 years have passed since the marker of CML, Ph chromosome was identified in 1960, it is interesting to see remarkable achievements and the shift in treatment paradigm for this fatal blood cancer.

By 2006, data of medium to long term follow-up for newly diagnosed CML treated with Imatinib Mesylate is available. The IRIS study reported at median follow-up of 54 months, 84% of the patients are surviving without disease progression, and if only those in chronic phase are assessed, 93% still remain in chronic phase. This is indeed remarkable, as the physicians treating CML will recognise that in the old days; more than half of the patients will have progressed by 3 years.

Natural history of CML has been very well characterised, with only cytoreductive treatment, almost all patients will eventually transform into fatal acute leukemia, by 5-7 years of follow-up, most, if not all patients, would have succumbed to the disease.

Introduction of successful allogeneic stem cell transplant into the scene during the late 60s has brought a light of hope to patients. Although still remains as the only treatment modality that can claim to cure CML, allogeneic transplantation has its limitation.

The joy that was brought in by Interferon treatment was also proven to be short-lived. The highly innovative therapeutic concept of modifying immune system to eradicate abnormal CML cells in the marrow was proven to be effective by the changing concept of allogeneic stem cell transplantation. However, Interferon therapy met its bottle-neck soon by virtue of low response rate and high incidence of side effects.

2001 was a year to be cheered when Imatinb (Glivec) was fast tract for approval by FDA to treat Ph Chromosome positive CML. Today, 5 years later, the result of IRIS study clearly indicating the effectiveness of Imatinib, especially when used early in the disease phase.

Today, the decision making on treatment strategy of CML has become more complicated than ever. Despite impressive result showed by IRIS study, no evidence supports total eradication of CML, in fact almost all patients are still having very low level of abnormal cells in the marrow; those who stopped Imatinib treatment for whatever reason eventually have the disease relapse again. All these observations suggest that if the ultimate aim of CML treatment is to achieve a cure, i.e. no detectable disease and the patient can be freed from medication eventually, then the only option still remains allogeneic transplantation.

Should we risk the 20% risk of early mortality in allogeneic transplantation? This is the most difficult question to answer as, again quoting the IRIS study, 93% of patients are still in chronic phase after 4.5 years and they are totally asymptomatic and might be leading a more healthy life than those transplant recipients.

With the approval of Dasatinib (Sprycel) last month, large proportions of patients who do not or lose response to Imatinib are able to achieve good disease control again. Although longer follow-up is needed for concrete conclusion making, this has opened up yet another chapter of ever increasing options of managing CML.

Basic researches and clinical studies have brought wonderful improvement in CML, from a universally fatal disease in the past, followed by curing a proportion of patients following allogeneic stem cell transplantation, and now in the beginning of new millennium, we can expect more than 90% of patients leading a normal life, albeit on long term medication.
Maybe the future paradigm of CML treatment will changed to a model of chronic suppressive treatment, like diabetes and hypertension – with long term medication and meticulous monitoring, substituting another drug when the response is lost.

Think of it, this is remarkable for a disease that used to claim life within 5 years.

Of course, for a country like Malaysia, funding the astronomical cost of the treatment remains an issue.

Are we ready to adopt the possible changes in concept of cancer treatment – effectively control the devil and live along with it?

the Chimera

2006-07-10T14:06:00.000+02:00

The term Chimerism is often used by Hematologists in allogeneic Hematopoietic Stem Cell Transplantation (HSCT) setting.

In Greek mythology, the Chimera (Greek Χίμαιρα; Latin Chimaera) is a monstrous creature made of the parts of multiple animals. Chimera was one of the offspring of Typhon and Echidna. Descriptions vary – some say it had the body of a goat, the tail of a snake or dragon and the head of a lion, though others say it had heads of both the goat and lion, with a snake for a tail. (Link to Wikipedia)

In HSCT, mixed chimerism denotes the state in which both the bone marrow system of patient and donor are functioning in the recipient. This is especially common in the reduced-intensity HSCT setting, where the preparative regimen is not intensive enough to completely ablate the recipient’s pre-existing bone marrow.

The newly established immune system of donor origin can slowly eliminate the patient’s hematopoietic system; sometimes this process can be hastened by infusing lymphocytes from the donor to the recipient, a process known as Donor Lymphocyte Infusion (DLI).

Tests are available to assess the state of chimerism in a patient; specimen can be obtained from bone marrow or peripheral blood. The state when all the blood cells are from donor origin is termed full donor chimerism.

It is believed that the transient presence of mixed chimerism in a particular patient can promote immune tolerance, thus resulting in reduced incidence of severe GVHD. This concept remains to be proven and is currently being studied in scientific researches

Good News, Yet Another Challenge

2006-07-03T19:08:00.000+02:00

Last week, Palmdoc blogged about the news of Dasatinib (Sprycel) approved by FDA on 29^th June 2006 for treatment of CML and Ph positive ALL resistant to prior therapy.

Few will disagree that stem cell transplantation (HSCT) still remains the only curative treatment for CML. However, due to its limitation, no more than half of the patients with CML receive HSCT as part of their treatment; those eligible for HSCT still have to face 15-30% chance of running into serious complications.

When Imatinib (Glivec) was approved by FDA in 2001, it rapidly changed the algorithm of CML treatment, especially those who are not suitable for HSCT. The gloomy outcome of these patients improved markedly with high percentage of disease control, including molecular remission. So effective was Imatinib that most treatment centers substitute the drug as upfront treatment for patients who are candidate of HSCT.

Of course challenges remain, some patients are not responding to Imatinib right from the beginning, some lose their response after certain period of time and some cannot tolerate the side effects.

One of the biggest challenges of Imatinib was accessibility. The main problem was cost, at the standard dose of 400 mg daily, it comes to about RM 8350 a month. This will total to RM 100,000 annually for a medication that need to be taken long term, as long as one is still responding.

Malaysians are lucky when the pharmaceutical company launched a program known as GIPAP; this has enabled eligible patients to get Imatinib at NO cost. To date, GIPAP has enrolled few hundred Malaysian patients since 2002. This is indeed an extraordinary chapter in the history of Hematology in Malaysia.

It is said that Dasatinib (Sprycel) will be priced at about 50% higher than Imatinib, and it is expected to hit the market really soon. All of us who treat CML and Ph positive ALL have patients, who are in urgent need of Dasatinib, most of them probably cannot afford to purchase the medication.

Biggest challenge lying ahead is accessibility. Will there be another GIPAP-like program from Bristol-Myers Squibb?

FDA Approves SPRYCEL™ (dasatinib) With Two Indications

2006-06-29T07:47:00.000+02:00

Bristol-Myers Squibb Company (NYSE: BMY) announced today that the U.S. Food and Drug Administration (FDA) has granted accelerated approval of SPRYCEL, an oral inhibitor of multiple tyrosine kinases, for the treatment of adults in all phases of chronic myeloid leukemia (CML) (chronic, accelerated, or myeloid or lymphoid blast phase) with resistance or intolerance to prior therapy, including Gleevec®* (imatinib mesylate). The effectiveness of SPRYCEL is based on hematologic and cytogenetic response rates. There are no controlled trials demonstrating a clinical benefit, such as improvement in disease-related symptoms or increased survival. The FDA also granted full approval of SPRYCEL for the treatment of adults with Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ALL) with resistance or intolerance to prior therapy. Bristol-Myers Squibb anticipates that SPRYCEL will be available within days nationwide.

Hematopoietic Stem-cell Transplantation (HSCT) - GVL

2006-06-22T12:23:00.000+02:00

Few observations have deepened our understanding on HSCT over the last decades:

Syngeneic HSCT suffers higher disease relapse rate than allogeneic HSCT.
Patients receiving T-Lymphocyte depleted graft (i.e. removing the lymphocytes in the graft before transplanting into the patient, with the purpose to reduce the risk of GVHD) have higher disease relapse rate.
Patients with more GVHD after allogeneic HSCT have lower disease relapse rate.

These facts suggest that the newly established immunity of the graft, in addition to causing GVHD, they do recognize the residual cancer cells as foreign too, thus initiate an immunology attack on the remaining malignancy.

This concept was further supported and proven in patients with Chronic Myeloid Leukemia (CML); those who relapsed after allogeneic HSCT, especially when it was detected very early via molecular technique, often the patient can be brought back into remission again by infusing Lymphocytes from the donor, a process known as Donor Lymphocyte Infusion (DLI).

Today, we call this phenomenon Graft-versus-Tumour effect. So in the case of CML, it is known as Graft-versus-Leukemia (GVL) effect. By and large, this effect is most pronounced in CML compare to other blood-related cancers.

If we look back at the initial concept of HSCT, where the cure of disease is thought to be solely contributed by high dose chemotherapy (Preparative regimen), and the role of the graft is only to re-establish hematopoiesis, the aforementioned observations invite a rethink of the biology of HSCT.

Indeed, it has been proven again and again that the new immune system plays a big role in eradicating the disease. It is feasible to reduce the intensity of preparative regimen, as long as the drugs are immunosuppressive enough to prevent rejection of graft, in order to reduce toxicity to the patients, and let GVL takes effect to cure the patients.

With this concept, what is known as Reduced Intensity Conditioning Transplant (RICT), or better known as mini-transplant as a more ‘public-friendly’ term has emerged as a modality of treatment in the last few years. This approach has enable many previously ‘medical unfit’ patients to undergo HSCT as part of their treatment against blood cancers.

It is too premature to conclude RICT is a replacement of conventional HSCT. They are best viewed as compliment to each other in the armamentarium of treatment strategy against leukemia, rather than as competitors.

Whatever it is, the future will see more understandings in the immunology of HSCT, and from researcher’s bench it will translate into a better clinical care of patients.

In the new millennium, allogeneic HSCT should be viewed as a form of adoptive immunotherapy, rather than merely high dose chemotherapy.

HSCT..(1)
HSCT..(2)
HSCT..GVHD

Adding Thalidomide to Standard Treatment Improves Survival in Elderly Patients With Multiple Myeloma

2006-06-15T10:04:00.000+02:00

Elderly patients with multiple myeloma who receive thalidomide (Thalomid, Celgene Inc) in addition to standard melphalan and prednisone survive longer and have a longer time to progression than do patients who receive either the standard regimen or stem-cell transplant, according to a team of French investigators that presented its findings here at the 42nd annual meeting of the American Society of Clinical Oncology.

"The results of the investigative regimen, standard treatment plus thalidomide, were so superior that we stopped enrollment of the study," said principal investigator Thierry Facon, MD, in a briefing. "This way, the patients in the standard-treatment arm had the choice of having thalidomide added to their treatment." Dr. Facon, a professor of hematology at the University of Lille in France, pointed out that the current study had a 3-group design, including standard treatment, standard treatment plus thalidomide, and stem-cell transplantation.

He and his coinvestigators undertook the study to determine whether adding thalidomide would improve outcomes in elderly patients with multiple myeloma. They also wanted to see how the 2 treatments fared in comparison with stem-cell transplantation. Therefore, the 436 patients, who were 65 to 75 years old, were randomized to receive one of the following treatments:

* Twelve courses of 0.25-mg/kg melphalan and 2-mg/kg prednisolone, given for 4 days at 6-week intervals.
* Melphalan and prednisolone along with thalidomide; with thalidomide at the maximum tolerated dose, but not to exceed 400 mg/day.
* Stem-cell transplant, which consisted of 2 cycles of vincristine, doxorubicin, and dexamethasone; a course of cyclophosphamide at a dose of 3 g/m2 along with granulocyte-colony stimulating factor (G-CSF) and peripheral blood stem-cell harvesting; followed by 2 courses of melphalan along with stem cells at a dose of 100 mg/m2.

Good news to reaffirm what we already know.

Patients with Chronic Myelogenous Leukemia Continue to Do Well on Imatinib at 5-Year Follow-Up

2006-06-15T10:01:00.000+02:00

Very encouraging news from ASCO 2006:

The findings from the 5-year follow-up study of the International Randomized Study of Interferon plus Ara-C vs STI571 in Chronic Myeloid Leukemia (IRIS) study were presented by Dr. Druker on behalf of the IRIS study group.

Investigators conducted the long-term study after a phase 3 study had found that imatinib was superior to the interferon cocktail in 1106 patients newly diagnosed with CML in chronic phase. As a result of those findings, the investigators allowed patients in the control group to switch to imatinib, and they then followed them for 5 years. The investigators used the following criteria to assess treatment:

* Complete hematologic response.
* Complete or partial cytogenetic response, which they defined respectively as 0% and 1% to 35% metaphases, respectively.
* Major cytogenetic response, the sum of complete and partial responses.
* Major molecular response, or more than 3 log reductions of BCR-ABL transcript levels from the standardized baseline.
* Time to progression, defined as a loss of hematologic or cytogenetic response.
* Evolution to either accelerated phase or blast crisis.
* Death due to any cause during treatment.
* Overall survival.

After a median follow-up of 54 months, 72% of the 553 patients who were initially randomized to imatinib remain on treatment, Dr. Druker said. He noted that 5% had discontinued due to adverse events and 9.5% had dropped out due to an unsatisfactory therapeutic effect, while 11% had discontinued due to other reasons and another 2.5% had crossed over to the interferon regimen.

The cumulative best response rate for a complete hematologic response was 97%, while 88% of patients had had a major cytogenetic response and 82% had had a complete cytogenetic response. The overall survival rate was 90%, and that rate was increased to 93% when bone marrow–transplant patients were excluded.

The vast majority, 84%, had not progressed while on treatment, and 93% had been free from accelerated phase or blast crisis episodes. The annual rate of progression to accelerated phase or blast crisis had been less than 1% in the fourth year, a rate that was itself lower than each of the previous 3 years, for which such rates were 1.5%, 2.8%, and 1.6%, respectively.

Of the 436 patients with a major cytogenetic response at 12 months, nearly all, 96%, were free of progression to the accelerated phase or blast crisis at 54 months. Of those who did not have such a response at 12 months, 81% were free from these events (P < 0.001 compared with responders). Further, no patient with a major molecular response in the first 12 months had this type of progression within the follow-up period.

New CML drugs get names.. at last

2006-06-15T09:23:00.000+02:00

Medpage reports:

Two drugs are waiting in the wings if Gleevec (imatinib) fails or is too toxic for patients with chronic myeloid leukemia (CML).
Both are safe and active against CML in patients resistant to or intolerant Gleevec, according to reports in the June 15 issue of the New England Journal of Medicine.
One of the new drugs — Tasigna (nilotinib) — is a more potent analog of Gleevec, which is the current standard of care for the disease, according to Hagop Kantarjian M.D., of the M.D. Anderson Cancer Center here.
The other — Sprycel (dasatinib) — has a different mechanism of action from either Tasigna or Gleevec, although all three drugs target the BCR-ABL tyrosine kinase whose unregulated activity is the hallmark of CML, according to Moshe Talpaz,, M.D., also of M.D. Anderson.

Tasigna and Sprycel. Two new names to get used to ;)

Hematopoietic Stem-cell Transplantation (HSCT) - GVHD

2006-06-12T16:17:00.000+02:00

First of all, what it means:

Graft - the organ or tissue that is donated from a donor to a recipient.

Host - the person who received the graft.

When a graft is being transplanted to the recipient, immune system of the host will recognise it as a "foreigner" and thus reject the graft. In fact, this has been the major obstacle for organ transplantation until effective drugs to suppress the immune system of the host was discovered.

In the context of HSCT, the rejection problem is more complicated than solid organ transplant. The graft (hematopoeitic stem cells) not only recovers the blood component of the recipient, it will create a new immune system in the host as well. It is possible for the host's immune system to reject the graft, known as graft rejection; This is not very common, as during preparative phase, immunity of patient is heavily suppressed.

When the graft reconstitute, Lymphocytes from the donor origin will recognise the host as a different entity from its origin, thus initiate an immune reaction toward various organs, most commonly the skin, gut and liver (because these organs have many antigen presenting cells). Without preventive measures, almost all allogeneic HSCT recipients will develop this problem, known as Graft-versus-host disease (GVHD). As the name suggested, it is the newly grown immunity from the graft that is attacking the host.

Thus the other side of the coin, when the recipient's own immunity attacks and rejects the graft, it can be termed Host-versus-graft, otherwise known as graft failure or graft rejection.

The success of HSCT over decades has been contributed by better prevention and treatment of GVHD. At least 50% of patients develops GVHD within the first 3 months of HSCT, medically termed acute GVHD (aGVHD). In about 10-20% of patients, aGVHD is severe and can lead to death.

The most commonly used preventive measure for aGVHD is immunosuppressive drugs, the most widely utilised medications are Cyclosporin A and Methotrexate (for a few doses). Other methods including manipulating the graft by removing T-Lymphocytes, which are largely responsible for the reaction of GVHD, but this can compromise the therapeutic efficacy of HSCT. Reducing the intensity of preparative regime is believed to reduce the incidence of aGVHD, but it is still subject to debate.

The newly established immune system from the graft will develop tolerance to the host after sometime. Thus in contrast to solid organ transplant recipients, most patients do not need to take immunosuppressive drugs for life long. Depending of the disease status and degree of GVHD, immunosuppressive drugs will be slowly withdraw from the patients few months after allogeneic HSCT.

HSCT..(1)

HSCT..(2)

HSCT..GVL

Technorati : GVHD, HSCT

Hematopoietic Stem-cell Transplantation (HSCT)..(2)

2006-06-06T12:45:00.000+02:00

The very initial objective of HSCT (Hematopoietic Stem-cell Transplantation ) was rather straight forward – eradicate the leukemic cells with very high dose of radio-chemotherapy, and replace the damaged bone marrow by transplanting the marrow from a suitable donor. It was hoped that the intensive treatment will kill off all the malignant cells.

The term preparative regimen, also known as conditioning regimen refers to the high dose radio-chemotherapy (or chemotherapy alone) that is given to patient before the donor’s stem cell is infused. Traditionally, the preparative regimen serves three purposes:

Eradicate the malignant cells in order to achieve a cure.
Suppress the immune system of the host (patient), to minimize the risk of graft rejection.
Create a space in the marrow for the new stem cell to ‘home’ and engraft.

To achieve the first aim, the preparative regimen needs to be as intensive as possible; the dose is limited by other organ’s toxicity e.g. liver, heart and lung. This was the major obstacle for transplanting older patients and those medically unfit, many patients were excluded from transplant program due to their age and medical condition.

It takes years of clinical experiences and continuous research for us to understand the biology of HSCT better. HSCT has since far evolved from a simple ‘high dose chemotherapy with stem cell replacement’ concept.

Today, HSCT is best viewed as a form of immunotherapy.

Link HSCT
Link Pemindahan sum-sum tulang
Link organ transplantation

Hematopoietic Stem-cell Transplantation (HSCT)..(1)

2006-05-26T16:08:00.000+02:00

Early works in 1950s demonstrated that animal received big dose of total body irradiation died rapidly due to damage on the gut and brain. Lower doses of irradiation resulted in delayed death from bleeding and infection, which were the manifestation of permanent bone marrow failure from the irradiation.

In animal models, infusion of either genetically identical bone marrow (syngeneic transplantation) or its own pre-stored marrow prevent death from bone marrow failure, as the ability to regenerate blood cell was restored sometime after graft infusion.

In contrast to transplantation of other organ e.g. kidney, rejection of the donor’s marrow (graft) was not a big problem, as during the total body irradiation, recipient’s immunity will be suppressed as well. In contrast, the animals received marrow graft from genetically non-identical donor (allogeneic transplantation), often succumbed to a disease known as “wasting disease” later, which was due to inflammation induced by the new immunity system from the graft; this is what known as “Graft-versus-host disease” or GVHD. So the main rejection problem in HSCT is on the opposite direction from solid organ transplantation, i.e. the newly established immunity system from the donor is rejecting the recipient.

The discovery of Human Leucocyte Antigen (HLA) system in late 1950 marked the major advance in the field of transplantation. Transplanting between HLA identical siblings, later from non-related donor, has markedly reduced the incidence of graft rejection and GVHD.

The other advance including the use of drugs to suppress the activity of the newly established immune system in order to reduce and control the severity of GVHD.

Today, HSCT is not only performed from HLA identical donor, but also from donor who is not fully HLA-matched with the patient. Thanks to the improved understanding of biology of transplantation and discovery of newer drugs, HSCT has evolved into a useful mode of treatment for various blood and non-blood related diseases.

HSCT..(2)

HSCT..GVHD

HSCT..GVL

Pemindahan Sum-sum Tulang

2006-05-08T12:34:00.000+02:00

This webpage was created by Dr. Alan Teh, consultant hematologist at Subang Jaya Medical centre.
Thanks Dr. Alan for allowing me to use this page.

Note: this was an old webpage that no longer being updated. Nevertheless, it still serves as a good 'starting point' to understand stem cell transplantation.

PEMINDAHAN SUM-SUM TULANG (BONE MARROW TRANSPLANTATION) - TANYA-SOAL UNTUK PESAKIT-PESAKIT DAN KELUARGA

Apa itu sum-sum tulang (bone marrow)?

Sum-sum tulang adalah tisu yang didapati di dalam tulang. Sum-sum tulang menghasilkan bahagian-bahagian darah termasuk:

Sel darah putih - berfungsi menentang penyakit
Sel darah merah -berfungsi mengangkut oksijen
Platelets - berfungsi menolong menghalang pendarahan

Apa itu pemindahan sum-sum tulang?

Pemindahan sum-sum tulang allogeneic - ini adalah pemindahan sum-sum dari penderma kepada penerima (pesakit). Penderma biasanya adik-beradik (abang atau kakak) pesakit yang mana jenis tisunya adalah sama.

Pemindahan sum-sum tulang autologous - ini terjadi bila sum-sum tulang pesakit diambil terlebih dahulu dan disimpan, dan diberikan semula kepada pesakit kemudiannya.
click here to read more

Other links in Malaysian Medical Resources and here

Malaysian bone marrow donor registry

Transplantation

2006-05-02T16:40:00.000+02:00

Let’s look at the concept of organ transplantation.

Allogenic transplantation is the transfer of organ between same species (e.g. human to human), but genetically different individuals; most of organ transplants in human are allogenic transplantation.

The principle is replacing a non-functioning organ with a functional one. The source of organ can be from people who has died or living donor (family or altruistic).

Take kidney transplant for example.

In general, first step in organ transplantation involves taking out the organ from the donor and transfer it into the patient’s body. This involves mainly surgical technique.

The skill to perform such an operation has been documented since long time ago, but early attempts of transplanting organs end up with failure of the new organ to function, a phenomenon known as graft rejection.

It was until the 1940s when scientists discover the importance of immunology in transplantation. In short, the patient’s immunity rejected the organ from another individual.

The first successful kidney transplant was performed in 1954, by Dr. Joseph E. Murray in Boston. The donor and the patient are identical twin, thus the exact similarity of genetic make-up has prevent rejection of the transplanted organ.

Dr. Joseph E. Murray won the Nobel Prize in 1990.

In the 1950s, two important drugs were discovered – corticosteroid and Azathioprine. These drugs suppress immunity, thus enable some successful cases of organ transplants 1960s. By taking these medicine, the patient’s immunity is suppressed, thus prevent rejection of the transplanted organ.

In 1970, a more powerful immunosuppressant, Cyclosporin was discovered. This has enable organ transplantation to be carried out in larger scale and the survival of grafts (transplanted organs) is greatly improved.

Today, a variety of organs can be transplanted between individuals; recent well-known transplantation was a face transplant in France late 2005.

I will review in the next blog the difference of Hematopoietic Stem Cell Transplantion from solid organs transplantion.

Chronic Myeloid Leukemia..(5) - The Magic Orange Pills

2006-04-25T13:04:00.000+02:00

May 10, 2001

Food and Drug Administration, USA approved Imatinib Mesylate (Glivec, STI571) for treatment of CML, this made Glivec the fastest ever drug getting approval for treatment of cancer.

Magic Cancer Bullet by Dan Vasella

Glivec has been shown to be incredibly effective in the treatment of CML, initially in patients who failed all known effective treatments, now it is widely use as the “standard” treatment for newly diagnosed patients.

It is an orange colour capsules to be taken by mouth, it does not cause hair loss as most people are feared of with cancer treatment.

The problem behind this effective drug is the cost. It has to be taken as long as disease is responding, that might means years and years. A bottle of Glivec costs about RM8350.00, depends on the dosage, most patients need to take 1 to 1.5 bottle of Glivec each month; the total cost can be astronomical, you go and do the math.

Good news for Malaysian patients is that, the pharmaceutical company producing Glivec runs an international patient assistance program named GIPAP, via coordination by non-profit organization based in USA, hundreds of Malaysian patients are benefiting from this and have affordable access to the medication.

Kudos to them for a Good Samaritan job!!

For further information regarding dosage, side effects and access to the drug, please discuss with your physician.

Chronic Myeloid Leukemia..(4) - a bit of genetics

2006-04-13T15:47:00.000+02:00

Human has chromosomes, which carry genes. These in turn will be translated into production of protein with various functions and actions in normal human body.

The chromosome pairs are named after numbers, from 1 to 22; the last pair of chromosome, or sex chromosome are named X and Y, for female and male, respectively.

Human genes are designated by capitalized italics (e.g. BCR-ABL gene).

Proteins are designated by having the first letter capitalized, without the use of italics (e.g. Bcr-Abl protein).

As pointed out earlier, central to the genesis of CML is Ph chromosome, which is a translocation between chromosome 9 and 22. Essentially a small part of chromosome 22 breaks off and move to chromosome 9; likewise a small part of chromosome 9 goes to chromosome 22. This results in an abnormal chromosome 22 (Ph chromosome), which is shorter than its usual normal counterpart.

The gene carried at the break point of chromosome 9 is known as ABL gene (Abelson gene). The name Abelson is derived form a virus known as Abelson murine leukemia virus, which is a virus that can induce leukemia in mice. The protein produced by this gene, known as Abl protein, is actually an enzyme named tyrosine kinase.

At the point on chromosome 22 where the small part of chromosome 9 is translocated to it, a gene known as BCR (breakpoint cluster region) sits there; it produces a protein known as Bcr protein.

When these two genes meet, they produce BCR-ABL fusion gene, giving rise to Bcr-Abl fusion protein tyrosine kinase, which has abnormal signals and stimulates the stem cells to proliferate excessively. This is central to the development of CML.

CML is the one of the most understood human cancer. Implication of the vast understanding of its biology has lead to emergence of Imatinib Mesylate (Glivec), one of the most effective treatments for CML. Imatinib Mesylate was known as Signal Transductase Inhibitor 571 (STI571) before it was marketed.

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Disclaimer

As patient confidentiality is to be maintained, identity of the patients in the stories has been altered.

There is also no intention of advertising for any party involved.

The author is not responsible for any consequence arises by using the information in this blog without proper consultation with qualified physician.

本网志不可当着醫療意見。个人健康問題，務必諮詢執業醫護人員。

Chronic Myeloid Leukemia..(3) - milestones

2006-04-11T15:03:00.000+02:00

Ist part of CML click here.
2nd part of CML click here.

Chronic Myeloid Leukemia (CML) is the first well characterized and recognized leukemia. I shall write a brief milestone of scientific discoveries for this fascinating disease.

In October 1845, Dr. John Hughes Bennett published his paper in the Edinburgh Medical and Surgical Journal Titled “Case of hypertrophy of the spleen and liver in which death took place from suppuration of the blood”.

This was the first official publication of the disease now known as Chronic Myeloid Leukemia (CML).

115 years later (1960), Nowell and Hungerford detected a consistentchromosomal abnormality identified as 22q– in personswith this disease. Both of them worked in Philadelphia.

In 1973, Rowley observed that the Ph chromosomeresulted from a reciprocal translocation that also involvedchromosome 9.

This abnormality is now designated t(9;22)(q34;q11); also termed as Philadelphia (Ph) chromosome. Exactly what bring up the changes still remains enigmatic.

Philadelphia (Ph) chromosome

The abnormal chromosome results in gene fusion, namely BCR-ABL fusion gene which was discovered in the 1980s. The cells carrying this abnormal gene acquire a proliferative advantage thus outgrow the normal blood cells; this is the hallmark of CML in chronic phase.

Current WHO classification requires demonstration of Ph Chromosome or BCR-ABL gene or its protein product to establish a diagnosis of CML.

Chronic Myeloid Leukemia..(2)

2006-04-06T17:28:00.000+02:00

1^st part of Chronic Myeloid Leukemia (CML) click here.

Treatment of CML in chronic phase is discussed below.

Generally the patient feels well at this stage, some might even reject the idea that they need to be treated.

With modern treatment nowadays, aim of therapy is not only to relieve symptom, but to prolong survival time and if possible, to cure the disease. As have been mentioned earlier, CML will eventually progress into blast crisis if left untreated.

Treatment options for CML are basically categorized as:

Symptomatic treatment / control of white blood cells

Effective drugs are available for this purpose. The most widely used drug is Hydroxyurea (Hydrea). It is effective to cut down the number of WBC and reduce the spleen size. However this type of treatment does not affect the abnormal precursor cells in the bone marrow. Disease will progress naturally and the treatment becomes ineffective after some time.
Hydroxyurea, however remains a very effective option for symptom control especially at the initial phase. It also has bearable side effect.

Curative treatment

To date, hematopoietic stem cell transplantation (HSCT), more commonly known as bone marrow transplantation is the only option that has definitive potential to cure the disease. HSCT carried out early and using siblings as the donor offers the best chance of cure.
HSCT however can be complicated by short and long term side effects. There is risk of dying during transplantation, which is unacceptable to some patients as they are well during the early stage of disease.
As more HSCT are being carried out world wide, improvement in both techniques and supportive care has resulted in better results.
However, many patients do not receive HSCT either due to lack of suitable donor or medically unfit for the procedure (e.g. advance age).

Potentially curative treatment

Imatinib Mesylate (Glivec, STI571) has made a major impact on the treatment strategy in CML. Approved in year 2001 by FDA USA; Imatinib has since become the ‘standard’ treatment for patients with CML. It is an oral capsule like Hydroxyurea.
Imatinib has shown excellent result in people with newly diagnosed CML. It normalizes the WBC rapidly, more importantly, a big proportion of patients achieve cytogenetics remission, i.e. clearance of abnormal cell clone in the bone marrow. Studies in the past have shown that the disappearance of Ph chromosome in the marrow is associated with prolonged survival.
However, many questions remain while Imatinib is effective. The relatively short experience of using this new medication precludes a firm conclusion of effect on long term survival. Emerging data also shows that some patients might lose response after some time. The long term toxicity of a new medicine remains to be seen.
Another medicine known as Interferon was the treatment of choice before Imatinib was introduced into clinical practice. It is an injection and commonly gives rise to side effects. The effectiveness is less compare to Imatinib; nowadays it has fallen out of favor. However, it remains a good choice for people who cannot tolerate Imatinib.

More effective medicines are in the pipeline into clinical practice. As more options are available, decision on which is the best approach becomes more complex. Always discuss this issue with the treating hematologist.

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Disclaimer

As patient confidentiality is to be maintained, identity of the patients in the stories has been altered.

There is also no intention of advertising for any party involved.

The author is not responsible for any consequence arises by using the information in this blog without proper consultation with qualified physician.

本网志不可当着醫療意見。个人健康問題，務必諮詢執業醫護人員。

Chronic Myeloid Leukemia..(1)

2006-04-03T21:43:00.000+02:00

Chronic Myeloid Leukemia (CML) is the second most common leukemia seen in Malaysian adults. As the name chronic suggests, it is typically running a less aggressive course compare to Acute Myeloid Leukemia (AML).

CML is nowadays a very well characterized disease, numerous researches have revealed the underlying biology of the disease and it has enjoyed one of the most significant breakthrough in the modern treatment of cancer.

CML is a disease of older population, but in local practice, experience is that Malaysian patients are probably younger than that report by the western literature.

The disease is characterized by abnormal proliferation of white blood cells; in contrast to AML, the white cells are able to mature until almost the very last stage. This increase in WBC causes the spleen to enlarge considerably. In fact, CML is one of the common causes of grossly enlarged spleen (splenomegaly in medical term).

The disease is divided into 3 phases according to its behavior.

Chronic Phase

This is the earliest stage of CML. Most patients have no symptom at all during early chronic phase. The number of white cells increases considerably and the spleen is mildly enlarged. More patients are detected at this stage nowadays being picked up by medical check up before employment or enrolment into higher education institutes. This stage usually lat for about 3-5 years. Controlling the white cells count is easy at this stage with available treatments.

Acceleration Phase

At this phase the disease progresses. The spleen enlarges further making patient feels discomfort at the left abdomen. Usually the white cells count goes higher than previous phase; red blood cells and platelets might start dropping to abnormal level. Patients typically feel unwell. Treatments that previously worked well are not as effective at this stage. Acceleration phase lasts for about 6 – 18 months.

Blast Phase

This is so called the terminal phase of CML. It behaves like acute leukemia; in fact at this stage, the bone marrow appearance is that of acute leukemia. Left untreated, it lasts for weeks to months. Treatment for acute leukemia is employed at this stage.

It is notable that although each patient progresses at different phase, virtually all patients will develop into blast phase eventually.

CML remains however one of the most treatable blood cancers. Impressive progresses have been made in the past decades and armamentarium of treatment is rapidly expanding. It is utmost important to consult a hematologist for appropriate planning of treatment.

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Disclaimer

As patient confidentiality is to be maintained, identity of the patients in the stories has been altered.

There is also no intention of advertising for any party involved.

The author is not responsible for any consequence arises by using the information in this blog without proper consultation with qualified physician.

本网志不可当着醫療意見。个人健康問題，務必諮詢執業醫護人員。

Stem Cell and the Heart..(2)

2006-03-28T21:44:00.000+02:00

1st part of this topic see here

Now it is quite convincing that improvement of heart failure patients is not really due to regeneration of heart muscle, rather it is thought that the “implantation” of stem cells stimulates cytokines and change the microenvironment of the damaged heart muscle.

It was rightly pointed out by the author of the article that history of bone marrow transplantation (BMT) should serve as a model of cellular therapy for the heart. BMT researched started in the 1950s in animal models; initial attempts in men failed because of rejection of the transplanted marrow; few successfully engrafted patients suffered from Graft-versus-Host disease (which was a new disease then), clinicians have to go back to the lab again only to realise later importance of histocompatibility; and the story goes on.

Since the first successful BMT in 1968, it has become standard treatment for many malignant and non-malignant blood and non-blood related diseases. As we understand more about BMT and rationale of what we are doing, new problems are also emerging and researches have to go on to fine tune the treatment.

It took almost 30 years for the pioneer of BMT, Dr. Edward Donnall Thomas to be awarded half the Nobel Prize in 1990. Likewise, it took many years for us to appreciate that BMT is not “total killing of bad marrow and replace with a new one”, but it is actually an “Adoptive Immunotherapy”.

In both BMT and cellular therapy of the heart, much is still need to be learnt and done. Basic scientist and clinician are still learning how to bring knowledge from laboratory bench to the bedside, and vice versa to bring new findings and problem back to the bench from the bedside.

I totally agree with what has been written by the cardiologist blogger, “at present it appears that stem cell therapy for the failing heart is clearly not yet ready for prime time” and Palmdoc in MMR "there is great potential but clearly there is a need for more research and properly conducted clinical studies". Treatment with stem cell for the heart should only be carried out in the context of clinical trials.

Last but not least, we should urge our local newspaper and media to stop acting like medical journal, in reciprocal, medical professionals should not “publish” their results on these media for whatever reason, proper medical journals are available.

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Disclaimer

As patient confidentiality is to be maintained, identity of the patients in the stories has been altered.

There is also no intention of advertising for any party involved.

The author is not responsible for any consequence arises by using the information in this blog without proper consultation with qualified physician.

本网志不可当着醫療意見。个人健康問題，務必諮詢執業醫護人員。

Stem Cell and the Heart..(1)

2006-03-28T21:36:00.000+02:00

Peripheral blood stem cell treatment for heart disease was recently performed in a medical centre in Malaysia as reported in the Star.

A blog appeared in Malaysian Medical Resources website related to this event (see here and here), and subsequently a local Cardiologist blogger responded to this issue.

No doubt cardiology has achieved remarkable progress in the past decades. Coronary artery obstructions are overcome with medications, stents and bypass surgery; damaged valves can be replaced by artificial one and arrhythmias are effectively treated with pace makers and implantable cardiac defibrillator. These advances increase the long term survival of heart disease, with a significant portion of them living with a chronically failed heart. The so called “end-stage” heart failure patients really have a bad outlook if not being transplanted, but the difficulty in finding a donor for the heart is known to everyone.

It was from this background that “Cellular-based therapy” has been the focus of researches in the hope to find a better treatment for those with chronic heart failure. This is also known as “Regenerative Treatment” or “Cardiomyoplasty”.

So what have a hematology blogger got to do with Cardiomyoplasty? Answer is simple, because we deal with stem cells. Hematologists also do share interest in this issue.

A scientific article was published in November 2005 in the renowned cardiology journal Circulation. Titled Cell-Based Cardiac Repair: reflection at the 10-Year Point, this article summarised the current understanding and limitation in this issue.

Early researches in 1990s started with myoblast, which was derived from skeletal cells. After animal studies showed promising results, human trials started in 2000 mainly in those who suffered end stage heart failure, with direct injections of myoblast into the bad areas of the heart.

When the concept of stem cell plasticity was widely accepted (i.e. stem cells can transform to any form of cells, e.g. Blood stem cells can mature into heart muscle), researchers have shifted the focus to hematopoietic stem cells, because they are more easy to obtain compared to myoblast.

Most of these early studies show promising results. Patients do improve in term of symptoms, contractile function of the heart and some other end points.

But most of these studies are small in sample size and many of them are not having a control group. It is always premature to make conclusions from small studies. As pointed out by Palmdoc in MMR, the biggest randomised trials to date with satisfactory number of patients has failed to show benefit mobilising stem cell for patients suffer heart attack.

There are still a lots of questions remained to be answered before it can be applied to everyone in daily practice.

Areas of uncertainty include (and many more besides this list):

Now we know that actually the stem cells do not really transform into heart muscle (cardiomyocytes). Majority of myoblast become a structure similar to other skeletal muscle; most of blood stem cells disappear after some times, those which were thought to be growing into heart muscle cells were actually “fused” with the pre-existing heart muscle, rather than making themselves become one. Amazingly, without growing new heart tissue, the cardiac function improved. How did this happen? More works need to be done in the lab before we have a clearer answer. Example quote by the author of the article was that some medications are known to improve heart function, but we cannot simply interpret this as the medications have make the heart muscle to regrow.
The preference between stem cell from bone marrow and peripheral blood remains unresolved. In fact, exactly what type of “stem cell” should be the choice is still a debate.
Common methods of delivering stem cells to the heart are direct injection, injecting via coronary artery or merely give certain drug to mobilise the stem cells out form marrow and let them “home” to the ailing heart. Again, the best delivery method remains to be studied.
Side effects have been reported in some trials. Cardiac arrhythmias were noted in some patients who received myoblast, currently all subjects undergoing treatment with myoblast are required to have an implantable cardiac defibrillator. Usage of growth factors to mobilise stem cells from marrow has been associated with restenosis of stent in some patients.

2nd part of this topic click here

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Disclaimer

As patient confidentiality is to be maintained, identity of the patients in the stories has been altered.

There is also no intention of advertising for any party involved.

The author is not responsible for any consequence arises by using the information in this blog without proper consultation with qualified physician.

本网志不可当着醫療意見。个人健康問題，務必諮詢執業醫護人員。

Acute Myeloid Leukemia..(4) - APML, history

2006-03-22T15:11:00.000+01:00

Treatment of APML see here

APML(Acute Promyelocytic Leukemia, M3) is a statue in the history of leukemia, in fact in the history of cancer. The main treatment modality of cancer treatment has been killing – by surgery, chemotherapy, radiation or combination of the above. This proved to be effective especially if the cancer is detected early; but the patient has a price to pay by undergoing all the side effects.

The introduction of ATRA in the treatment of APML opened up a new paradigm. Instead of cane, clinicians use carrot – let the leukemic cells mature thru and died naturally, thus reducing the impact of chemotherapy, and more importantly, this strategy has resulted in marked improvement in cure rate.

Without the scientists’ researches on the mutation of the cells and progress in basic understanding of the process of APML formation, we will still be rudimentary in the treatment of this form of leukemia.

As Asians, it is notable that the hematology team in Shanghai, China was the one championed treatment with ATRA. The Chinese clinicians were also the pioneer in using Arsenic in the treatment of this disease.

APML was first described in publication in 1957 by Swedish author Leif Hillestad. Severe bleeding and rapid fatality was noted, hence he named it “the most malignant form of acute leukemia”.

In the late 70s, scientists discovered the abnormal translocation invovlving chromosomes 15 and 17 in cases of APML, although the significance of this was still in enigma. In the late 80s, gene controlling the normal Vitamin A receptor was found in chromosome 17; from there onwards, research had advanced, and today we know that the translocation of chromosome 15 and 17 leads to abnormal Retinoic acid (Vit. A) receptor, and this prevent the cells from normal maturation and finally give rise to APML.

Importance of this knowledge is that, we can design treatment that targeting at reversing the underlying defect rather than merely kill them with crude methods.

The usage of ATRA actually preceded the full revelation of APML secret. In late 70s, the idea of inducing cancer cells into maturation was tested, and vitamin A derivatives were found to be useful. In APML cells particularly, the cis-isomer of Retinoic acid was not effective, whereas the trans-isomer (which is ATRA) was found to induce APML cells into maturation. In 1985, for some reasons, ATRA was solely manufactured in Shanghai.

ATRA was first used in Rui Jin Hospital, Shanghai to treat patients in 1987; remarkable results were reported by the chief investigator Zhen-Yi Wang*. There was no manufacturer of ATRA outside China then; French hematologists were the only partner in using ATRA supplied from China to treat patients in Europe.

Researches and trials bloomed after 1989, when a giant pharmaceutical company, Roche started to manufacture ATRA. Roche actually manufactured ATRA on request from French hematologists. ATRA from China was no more available to them after the Tien An Men Square event (Chinese version here). Soon the enthusiasm of using ATRA was spread to both sides of Atlantic, confirming the effectiveness of new approach of treatment. Today, ATRA that we use in Malaysia is produced by Roche, under the trade name of Versanoid.

The Chinese researchers and clinicians made another important chapter in APML when they use Arsenic (砒霜) to treat leukemia. As early as 1971 this drug was used in Harbin, China for the treatment of leukemia. In 1996, it was used in Rui Jin Hospital in APML patients who did not response to ATRA or relapsed after ATRA; the efficacy was confirmed, further trials established Arsenic as the best treatment for relapsed or refractory disease.

In fact Arsenic was an old drug in both chinese and western medical practice. The discovery in APML treatment has put Arsenic on the spotlight again. Today, early results from China, where APML patients were treated with combination of ATRA and Arsenic without chemotherapy, are encouraging. In the near future, we might not need chemotherapy at all to cure APML.

APML remains a model of disease in the cancer history. Basic researches to understand the biology of disease, coupled with development of new drug (or rediscovery on old drugs), lead to remarkable success of treating this entity; once known as the most malignant form of AML, APML is one of the most curable cancer in 2006 with possibility to do this without chemotherapy.

ATRA might not be the most effective treatment for APML, but it will remain as an important milestone in the history of medicine.

*Dr Zhen-Yi Wang (王振义), the first Asian researcher invited to deliver the Ham-Wasserman lecture in the annual meeting of American Society of Hematology, 2003.

main source of reference: British Journal of Haematology, 2003;122:539

认识白血病

2006-03-21T19:45:00.000+01:00

资料来自维基百科

白血病是多种造血组织的癌症的總稱。亦稱為血癌。

白血病的病源是由于细胞内脱氧核糖核酸的变异形成的骨髓中造血组织的不正常工作。骨髓中的干细胞每天可以制造成千上万的红血球和白血球。白血病病人过分生产不成熟的白血球，妨害骨髓的其他工作，这使得骨髓生产其它血细胞的功能降低。白血病可以扩散到淋巴结、脾、肝、中枢神经系统和其它器官。

类型

白血病有多种类型，白血病的类型主要由血液内不正常的血细胞的类型来区分，此外临床分急性和慢性白血病。

急性淋巴细胞性血癌（ALL）
急性骨髓性白血癌（AML）
慢性淋巴细胞性白血癌（CLL）
慢性骨髓细胞性白血癌（CML）

成年人中最常见的是AML和CML。

症状

骨髓的破坏导致血小板缺乏，血小板是血液凝固过程的重要因素。白血病患者容易获得青肿或出血时血液不易凝固。同样，红血球的缺乏可以导致氣喘和暈眩。骨痛或关节痛可能发生，原因是癌症可能扩散到这些部位。头痛和呕吐可能是癌症扩散到中枢神经系统的表现。

急性骨髓性白血癌经常有小出血（皮肤上出现小红点），牙床肿胀也是一个典型的迹象。急性淋巴细胞性血癌可以导致胸腺肿胀、严重的咳嗽甚至窒息。慢性骨髓细胞性白血癌可以导致胰脏腫大。慢性淋巴细胞性白血癌的特点是淋巴节肿胀。

病因

对白血病病因的精确原因还在研究中。一般骨髓干细胞内的DNA变异导致它们的恶化。其原因可以是暴露在放射线中、接触致癌物質和其它细胞内遗传物质的变异。

治疗

主要疗法有化学疗法及骨髓移植(造血干细胞移植)。

在过去30年中，存活率提高了一倍，但其绝对数值依然相当低。1970年的存活率是22%，1990年代的存活率是43%。

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Disclaimer

As patient confidentiality is to be maintained, identity of the patients in the stories has been altered.

There is also no intention of advertising for any party involved.

The author is not responsible for any consequence arises by using the information in this blog without proper consultation with qualified physician.

本网志不可当着醫療意見。个人健康問題，務必諮詢執業醫護人員。

Acute Myeloid Leukemia..(3) - APML

2006-03-21T14:34:00.000+01:00

Acute promyelocytic leukemia (APL) is one of the variants of acute myeloid leukemia (AML). It was classified as AML-M3 in the older French-American-British (FAB) classification system, and acute promyelocytic leukemia with t(15;17)(q22;q12) in the WHO classification system.

APML cells exhibits a specific chromosomal mutation, translocation between chromosomes 15 and 17, medically written as t(15;17). This abnormality produces a gene known as PML/RAR-alpha (Promyelocytic Leukemia/Retinoic Acid Receptor).

APML cells are characteristic and can be recognized by hematologists under the microscope. Specific tests on the cells (cytogenetics and molecular tests) will confirm the diagnosis of APML.

APML is associated with excessive bleeding; the bleeding usually worsens when chemotherapy is started as the dead leukemic cells release chemicals and induce more bleeding. Until the new treatment approaches developed in the late 1980s, lots of patients succumbed to bleeding complication.

General principles of treatment of APML will be outlined below. The treatment is different from other type of AML.

Currently APML carries the best hope of cure compare to other types of AML. It is reasonable to expect at least 75% of patients will be cured using currently available treatment.

When a newly diagnosed patient with APML presented to the clinician, he or she will requires support with blood and blood products for bleeding tendency.

An oral medication is used to treat APML. This is known as All-Trans Retinoic Acid (ATRA). It is a type of vitamin A. ATRA is different from conventional chemotherapy; it promotes the immature leukemic cells to mature and die by apoptosis, or programmed cell death. Thus it avoids the commonly seen complication of bleeding. ATRA is given for 8 to 10 weeks daily until the patient achieves remission.

Chemotherapy is also used in APML, usually at the second or third day after ATRA. In contrast to AML treatment, Cytarabine is not usually needed. Commonly utilised regimen is 3 doses of an Anthracycline (Idarubicin or Daunorubicin)

Once remission is achieved, post-remission therapy with 2 to 3 cycles of an Anthracycline is given in a monthly fashion. This is followed by low dose maintenance treatment with oral chemotherapy and ATRA for a period of 18 to 24 months. Note that in other type of AML maintenance treatment has generally been shown to be of no value.

Generally transplantation is not needed when response to treatment with ATRA is satisfactory.

25% of patients might still relapse after treatment with ATRA. Currently the most effective treatment for this group of patients is using Arsenic as injection. The ancient drug Arsenic has undergone a renaissance in the treatment of this disease.

The best method of preventing second relapse after treatment with Arsenic is under active researches currently.

history of APML click here

See here for information on AML

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Disclaimer

As patient confidentiality is to be maintained, identity of the patients in the stories has been altered.

There is also no intention of advertising for any party involved.

The author is not responsible for any consequence arises by using the information in this blog without proper consultation with qualified physician.

本网志不可当着醫療意見。个人健康問題，務必諮詢執業醫護人員。

Chemotherapy..化学治疗..(2)

2006-03-18T18:07:00.000+01:00

1st part on Chemotherapy click here

The discussion below is mainly applicable to chemotherapy treatment for Acute Myeloid Leukemia (AML) and Acute Lymphoblastic Leukemia (ALL). Treatment for other diseases is usually less intensive.

The most serious side effect of chemotherapy is myelosuppression – reduction of normal blood cells due to the suppressive effect of drug on bone marrow function. As stated before, chemotherapy regimen in the treatment of acute leukaemia represent one of the most intensive therapy used by clinicians.

The decrease in blood cells (medically termed cytopenia) is predictable after intensive dose of chemotherapy is given. Typically in a newly diagnosed patient, the normal functioning blood cells are already reduced due to leukemia; after the administration of chemotherapy, they will decrease further.

The marked decrease of blood cells is obvious one week after the chemotherapy. Depending of the dosage and combination of the drugs, this will continue for days to even weeks. This explains why typically a newly diagnosed AML patient will need to be hospitalized for approximately one month to undergo treatment.

The 3 major components of blood are all affected.

White blood cells (WBC)

WBC will decrease to very low level, sometimes undetectable, condition known as neutropenia. During this period, the patient is very susceptible to infection; In fact, most patient undergoing treatment for AML will experience fever and infection. Fever and infection need to be treated immediately with antibiotics. Infections can be from bacteria, fungus, virus or some other less commonly encountered organisms.

If needed, physicians will give a drug known as WBC growth factors can accelerate the recovery of low WBC. It is given commonly by subcutaneous injection (into the fat tissue under skin).

Infection remains one of the most important causes of death in AML.

Platelets

Platelets are blood cells helping body to prevent excessive bleeding by forming clots. As like WBC, platelets level will reduce markedly following chemotherapy, condition known as thrombocytopenia.

It is common during this period; patients experience minor bleeding e.g. gum bleed, skin bruises and bleeding spots. Major serious bleeding can occur in the brain, gut, lung and other.

Platelets transfusion is given when the level is very low or when the patient bleeds.

Red blood cells (RBC)

Short of RBC leads to tiredness and weakness, in some patients bleeding further worsen this problem Anemia is the term used to describe low RBC in the body.

RBC transfusion will restore the level and reduce symptoms.

Drugs known as Erythropoietin can increase the RBC level but it takes time to achieve the effect. Transfusion is the most effective measure to overcome anemia rapidly.

Take example a newly diagnosed AML patient. Induction chemotherapy is given for the first seven days; from the second week onwards, WBC, Platelet and RBC will drop further, usually reach maximal reduction by the end of second week. Recovery usually begins by middle to end of the third week, if condition permits, patient can be discharged home by the end of fourth week.

During this period o hospitalization, intensive supportive treatments –intravenous fluids, blood and blood products, antibiotics etc are required to support the patient through the effects of both disease and chemotherapy.

化学治疗是什么？ - 血球减少 -- 资料来自中华肿瘤网

在接受化学治疗的期间，医护人员会定期的为您验血，以了解血球数目的变化。您应请教医师，何时血球数会降低，以早做应变。

白血球降低之自我照顾

白血球具有抵抗感染的功能，因您的疾病本身及治疗的关系，使白血球减少，抵抗力也跟着降低。这时候一不注意就可能受到感染，感染将会延长您的住院及下一次化学治疗时间，同时可能危及生命。所以在「预防胜于治疗」的原则下，您及亲属要配合的项目有：

1．限制访客：有传染病、感冒者严禁探访，每次以1～2人为限。

2．戴口罩：包含病人、家属、访客。当口罩潮湿时，立即更换，效果会更好。

3．室内谢绝盆栽、鲜花、假花。

4．采熟食及需剥（削）皮之新鲜水果。

5．个人卫生的配合：

★饭前、便后用肥皂洗手。

★每天洗澡，便后清洗肛门并以热水坐浴。

★手指甲、脚趾甲应剪短修平并保持清洁。

6．保持皮肤及黏膜之完整：

★预防口角炎、黏膜炎：每次进食后，以漱口水或盐水漱口；口腔黏膜若有红肿、溃疡则应每1～2小时漱口一次。

★使用电动刮胡刀。

★避免灌肠，忌量肛温。

7．勿憋尿，一有尿意，马上去小解。女性病人，大小便后，应由前往后擦拭以防感染。每日至少饮水3000cc（除非有禁忌）。

8．当您白血球数目降低时，请避免接近患感冒的人，以免受到感染。

9．使用空气净化机时，滤网记得要常更换并保持机身清洁。

10．保持病房及卧房之清洁，地上勿堆积物品。

11．尿壶、便盆每次使用后应立即清洗、晾干，置放床旁椅或床上易取用之处，切忌置于底面上。

贫血或倦怠时之自我照顾

接受化学治疗后会造成骨髓抑制现象，其中红血球数目减少而导致血色素下降，可能在活动较多时，会感到有点倦怠、头晕。

·尽量休息以减少耗氧。减少剧烈性活动。

·您在改变体位时，动作宜缓慢，避免头晕而跌到。

·当您有需要，例如照顾小孩、买菜、家事等可寻求家人的帮助。

·尽量摄取营养丰富的食物，以促进红血球恢复，如：萝卜干、蛋黄、内脏类、瘦肉、贝类、绿色蔬菜等。

·必要时输血。

血小板减少时的配合事项

血小板具有凝血及止血作用，因您的疾病本身或治疗（化学药物及放射线治疗）的关系，会使得血小板量不足而导致不同程度的出血，如：牙龈、鼻腔、肠胃、肺、脑的出血，其中以脑出血最易危及生命，因此希望您针对下列各项多加注意与配合，可以减少危险的发生。

一、颅（脑）内出血的预防：

1．养成每日大便的习惯，避免用力解便，可配合软便剂使用。

2．避免感冒，因用力咳嗽会引起脑出血。

3．有头痛、呕吐情形，立即通知医护人员。

4．必要时，应绝对卧床，在床上使用便器。

5．改变姿势应缓慢，采渐进式活动，如：由躺→坐，坐→站。

二、胃肠道出血的预防：

1．摄取温和、软质、无刺激性食物。

2．在无禁忌下，每日饮水2000cc～3000cc，且多吃蔬菜、水果。

3．观察每日大便颜色及性质。

4．避免自行灌肠、忌量肛温。

三、口腔粘膜出血的预防：

1．保持口腔清洁及舒适，勤漱口。

2．使用软毛牙刷或棉花棒刷牙，避免使用牙线。

3．出现牙龈出血，应立即通知医护人员。

四、皮肤出血的预防：

1．避免碰撞、刮伤及重压。

2．穿着宽松衣物。

3．使用电动刮胡刀，避免用剃刀以预防刮伤出血（胡子若太长先用剪刀修短）。

4．抽血或打针后，在穿刺部位加压5－10分钟，直到不再出血，才可放开。

5．抽骨髓后，在穿刺部位加压或平躺一小时以利止血。

6．观察皮肤变化：是否有出血点，或瘀斑扩大，若有应通知医护人员。

五、上呼吸道出血的预防：

1．勿抠鼻孔。

2．避免用力擤鼻，若一定要擤鼻，则由两侧鼻孔同时并张口吻合擤鼻。

3．避免张口呼吸，若有张口呼吸情形，可用湿纱布轻盖口鼻或少量多次饮水，避免呼吸道因过于干燥而出血。

若有下列情况发生，请尽速联络您的医师或急诊室就诊。

·流血不止或大面积瘀青。

·皮肤出现红点或其他过敏反应。

·发烧、发冷或颤抖。请勿使用含Aspirin的退烧药，若有需要请与医师讨论。

·注射部位溃烂或肿痛。

·任何不寻常之疼痛。

·呼吸急促。

·严重腹泻或便秘。

·血尿或血便。

·呕吐厉害无法进食。

·口腔炎严重或疼痛厉害。

Click here for 化学治疗..(1)

______________________________________

Disclaimer

As patient confidentiality is to be maintained, identity of the patients in the stories has been altered.

There is also no intention of advertising for any party involved.

The author is not responsible for any consequence arises by using the information in this blog without proper consultation with qualified physician.

本网志不可当着醫療意見。个人健康問題，務必諮詢執業醫護人員。

Chemotherapy..化学治疗..(1)

2006-03-18T16:37:00.000+01:00

Chemotherapy literally means any chemical compound (drug) used for the treatment of disease. Commonly the word chemotherapy is equal to drug for the treatment of cancers. Probably a more specific term for this purpose will be cytotoxic chemotherapy or antineoplastic chemotherapy.

Chemotherapy offers a systemic treatment for cancers; the medication is absorbed into the blood stream and travel throughout the whole body, in attempt to kill the cancer cells. It is most commonly given to the patient via injection or as pills to swallow; other less commonly administered methods are also present.

Most of the haematology malignancies are systemic disease as they involve the blood stream, thus the most commonly used modality of treatment is chemotherapy. Multiple drugs are usually combined to achieve a better therapeutic effect; this is known as combination chemotherapy.

Treatment of acute leukaemia represents one of the most intensive chemotherapy regimen used by clinicians. Serious side effects are seen in almost all patients; these require hospitalization for monitoring and care.

In general, chemotherapy works on the principle that active and rapidly dividing cells will be affected and killed. Since chemotherapy has no way to differentiate between cancer and non-cancer cells, the normal body cell that is rapidly diving will be damaged as well. Normal cells that are most likely to be affected are bone marrow, digestive tract, reproductive cells and hair follicles.

Side effects that might occur immediately or soon after chemotherapy are:

Nausea (feeling of vomiting) and vomiting
Few patients may develop allergic reaction
Pain at the injection site. Certain drugs are viscid and irritate the veins, which give rise to burning sensation. Always inform the doctor or nurse immediately if pain is felt, as in some instances the drug might leak out from the vein (extravasations); this can give rise to skin damage and ulcer formation.

Nausea and vomiting is probably the most well known side effect of chemotherapy besides hair loss. Currently there are effective prevention and treatment for this. Antiemetics are drugs that prevent vomiting, they are given before starting chemotherapy and sometimes for few days after that; as effective antiemetics are available nowadays, most patients have no vomiting while undergoing treatment.

Other side effects will occur some time later after the chemotherapy, they are as listed below:

Digestive tract

Poor appetite, taste changes, diarrhea and constipation can occur days after chemotherapy. Certain chemotherapy can cause ulcers in the mouth and the rest of the gut (known as mucositis). Preventive measures include modifying diet habits such as avoiding spicy, oily food, taking meals in smaller quantity and maintaining good oral hygiene is important.

Hair loss

Most but not all chemotherapy drugs cause hair loss. This typically occurs 2 to 3 weeks after treatment. Hair will generally re-grow after completion of treatment.

Reproductive cells

Women tend to have no menstruation (amenorrhea) during chemotherapy. This can be temporary or permanent, depending of the type and dosage of drug. Certain drugs tend to cause infertility, consult the physician for this issue.

Bone marrow cells

Bone marrow is one of the most active organs in the body. Blood cells are growing rapidly making it very sensitive to the effect of chemotherapy. As the leukemic cells are killed, the remaining normal blood cells will also be affected. This will decrease the number of blood cells in the body, known as myelosuppression – one of the most serious side effects of cancer chemotherapy.

Those outlined above are the side effects caused by most chemotherapeutic drugs. Specific drug can cause unique side effect that affect organs e.g. heart, kidney, nerve etc. They will be highlighted by the physician during the course of treatment.

Even among a lot of doctors, chemotherapy is perceived as something very difficult to deal with. I shall discuss the important effects of chemotherapy, mainly myelosuppression in another write up.

2nd part on Chemotherapy click here

化学治疗是什么？ -- 资料来自中华肿瘤网

化学治疗是癌症的治疗方法之一，通常会合并使用多种化学药物来治疗癌症，（以期望能杀死更多的癌细胞并避免抗药性的产生）。化学药物可经由血液循环杀死于手术及放射治疗无法消灭的癌细胞。

癌细胞与正常细胞不同，癌细胞的生长与分裂速度比较快，且不受控制并会溃散至身体其他部位，化学药物就是针对这种特性来杀死癌细胞，但对体内生长较快速的正常细胞也很容易造成伤害，带来一些烦人的副作用。了解化学治疗对癌细胞及正常细胞的作用及影响，将有助于减轻您对化学治疗的恐惧，并且更容易处理副作用。

主治医师依您的疾病及身体状况来决定化学药物的肿瘤（将会安排您在门诊或住院中接受化学治疗），通常当您接受第一化学治疗时，医师会建议您于住院中接受治疗，以便观察您治疗的情形及可能产生的副作用。

每种疾病所接受的疗程及时间也不同，化学治疗的进行可能为每周或每月一次。在两次化学治疗中间会有一段休息时间，让身体恢复因接受化学治疗所受到的伤害，以便进行下一个疗程。

化学治疗的目的：

治疗癌症、控制病情、解除或减轻症状

化学治疗的途径：

·口服·皮下、肌肉、静脉、动脉注射·腹膜腔注射·肋膜腔注射·腰椎穿刺·颅内注射·膀胱内注射·局部涂抹

学习如何面对化学治疗？

虽然化学治疗可能会带给您身心的改变，例如：外观暂时改变而使人际关系受到影响，但却能治疗您的疾病。所以，让我们勇于面对化学治疗，并学习如何避免及减轻化学治疗所带来的困扰。

化学治疗可能带来的困扰

化学治疗后，您可能会发现自己身体及心理出现变化，譬如：您可能有大量掉发的现象，或在化学治疗后产生恶心、呕吐及其他身体上的不适；也许您会感到孤独无助，害怕会发生什么或发生时该怎么办，有时也有倾诉无门的感觉。

您可以学习适应化学治疗

虽然化学治疗会使您面对许多的困扰，但经由一些学习您可以适应得更好。此外，好好地照顾自己，尽可能保持良好的生理及心理状态。寻求病友、亲友及家人的支持将可使您适应得更好。

化学治疗期间，您的感受如何？

感觉对化学治疗的焦虑及不安，是学习适应化学治疗的第一步，所以请花点时间想一想下面的问题：

·您了解自己为何需要接受化学治疗吗？

·您了解化学治疗对您身心方面的影响吗？

·该不该告诉别人您的感受？

·您担心必须停止工作或其他活动吗？

·您担心医疗费用的问题吗？

·您担心所爱的人会受您治疗的影响吗？

注射化学药物时应注意事项

接受化学治疗途径有很多，如口服、皮下注射、腰椎穿刺，最常见的是静脉注射药物。若是由静脉注射药物，特别是具有发泡性或刺激性的化学药物，常会因药物渗出血管外而引起皮肤的伤害，如红肿、组织坏死、溃疡等，为确保您的安全，请您务必配合下列事项：

（一）在注射化学药物前，请先解小便。

（二）若您在注射化学药物时，注射部位有针刺感、烧灼感、疼痛、红肿等之任何一种异状时，请立即通知护理人员。并遵照护理人员指示，进行冷敷或热敷。

（三）若静脉注射过程有发生针头脱落或渗出点滴时，请通知护理人员处理。

（四）若需离开病室，请通知护理人员暂时停止化学治疗。

（五）注射化学药物时请勿（或减少）沐浴、更衣、上下床等活动。必要时，请医护人员协助。

化学治疗常见的副作用有哪些？

引起化学治疗副作用的原因

化学药物除了会杀死癌细胞外，对一些生长速度较快的正常细胞也容易造成伤害。例如人体内的消化系统上皮细胞、毛囊上皮细胞及血液，多为生长快速的细胞。当您进行化学治疗时，正常细胞也会受到伤害，于是产生副作用。副作用发生的程度及时间依不同的化学药物而异。在每两次化学治疗间，将有一段休息时间供身体正常细胞恢复。

化学治疗的副作用有：

·恶心、呕吐

·口腔炎（嘴破）

·腹泻或便秘、掉发

·血球减少

白血球减少：易感染

血小板减少：易出血

血色素降低：贫血、倦怠

·肢端麻木或末梢感觉异常

·其他：

1．皮肤色素沉淀，发红、烧灼感

2．血管刺痛不适

3．小便颜色暂时性改变

4．心脏功能的影响

5．肺脏功能的影响

6．肝脏功能的影响

7．肾脏功能的影响

8．生殖功能的影响

9．止吐剂等引起之椎体外综合症

化学治疗常见副作用的处理

化学治疗可能有许多的副作用，但是不一定会一一呈现在每个人身上，并且大部分的副作用在化学治疗结束后会逐渐消失。在下文中将介绍一些常见的副作用及处理方式；这些副作用发生的机率及严重程度依您个人所接受的化学药物不同而有所差别。可请您的主治医师告诉您较可能发生何种副作用及该如何处理。当您发生任何不适时，请详细告诉照顾您的医护人员，以便他们做适当的处理。此外，请切记，副作用的发生并不表示病情恶化，副作用的严重程度与治疗结果也不相关。

恶心和呕吐

这是接受化学治疗的人最常见及最害怕的副作用，通常在化学药物滴注时或滴注后发生，症状来得快，但消失得也很快。

·治疗前，您的医生会给您适当的止吐剂。

·治疗后，您可继续服用止吐剂防治呕吐的发生。

处理方式

（一）饮食

·当胃口差、无食欲时，可以少量多餐，饮食内容多样化，采温和无刺激性食物，亦可进食自己特别喜欢的食物，或采用饮食代用品，如：奶昔、冰淇淋、安素等高蛋白、高热量的食物。

·吃冷食或接近体温的食物，如：三明治、吐司、小点心。

·摄取清淡食物，避免甜食、油腻、高盐份及含香料食物和刺激性食物。

·与别人共同进食时，需注意餐具的清洁。

（二）化学药物滴注期间，尽量使自己放松，可利用听音乐、看书、阅读、睡觉等方法转移注意力。

（三）呕吐后，请特别注意口腔的清洁——使用温开水加柠檬汁（或加盐巴）来清洁口腔。

（四）尽量摄取水份，除了静脉注射点滴外，可用喝汤、水、果汁等方式补充水份。

口腔炎（嘴破）

在接受化学治疗后，口腔的黏膜会变薄，若不稍加留意可能有些小伤口，使您在进食时不舒服而影响食欲。

·您每天可利用手电筒、压舌板、镜子等工具检查口腔。

·若十分疼痛时，可含些碎冰减轻疼痛，某些化学药物可以在给药期间就口含冰块，有预防或减轻嘴破的效果。

·改用软毛牙刷，并且于每次吃完东西后立即漱口。

·若发炎情况令您十分不适时，可请医生开药治疗。

·每二个消失使用漱口水或开水，确实清洁口腔。

食物原则

·避免吃会刺激口腔黏膜的食物，如：过辣、过酸及油炸食物，并避免抽烟及喝酒。

·多摄取含蛋白质与维生素C的食物。

·多喝水。

·避免粗糙或太热、太干之食物。

·可进食冰冷之食物。

掉发只是短暂的

您可能渐渐地或突然地掉落一些或甚至全部的头发。短时间内可能自觉会影响外观，使自己感到很沮丧，不过别担心，一旦停止化学治疗后，您的头发又会渐渐地长回来的。

处理方式

·预先剪短您的头发，可使掉发不那么明显、突然。

·准备假发、丝巾、帽子或适当发饰，在掉发前先改变装扮，慢慢适应。

·整理头发时，动作尽量轻柔，避免使用染发剂、发胶或烫发。

·选择较温和的洗发精。

腹泻或便秘

化学药物之副作用对肠道的影响，可能产生肠道蠕动过快或过慢，而出现腹泻或便秘的症状，我们建议的处理方式为：

腹泻时的处理：

·多喝水、果汁、汤以防止脱水。

·进食低纤维食物，如香蕉、通心粉、乳酪。

·使用止泻剂。

·避免进食油腻、高纤维的食物，如木瓜、蔬菜。

·最重要的是肛门的照顾，定时热水坐浴，减轻肛门的不适。

便秘时的处理：

·使用高纤维的食物，如：橘子、桃子、梨、蔬菜、麦片粥。

·饮用大量水份。

·适当的运动，如散步、打球。

·维持每天排便的习惯。

·若有服用止痛剂，请配合软便剂使用。

·大便过于坚硬可能使肛门受伤，唯一的照顾方式与腹泻相同：定时热水坐浴。

再次提醒您：如何做好肛门护理

（一）肛门卫生的重要性

因为疾病会使我们身体抵抗力变弱，而放射线及化学药物治疗的副作用，容易使肛门粘膜受损，进而造成感染，所以良好的肛门卫生是很重要的。

（二）我们应如何保护及维持呢？

1．养成良好的排便习惯，若有便秘或腹泻时，应遵医嘱服用软便剂或止泻剂。因为便秘时用力解便和腹泻时多次排便擦拭，皆会造成肛门黏膜或肛门括约肌受损。

2．饮食方面应均衡，便秘时多摄取水分及含纤维食物，腹泻时应采清淡饮食，尽量避免刺激性、辛辣及油腻食物。

3．每日大便后要热水坐浴十五分钟，每日至少一次，若腹泻时更应加强坐浴次数。

4．坐浴后轻轻拭干肛门，可用吹风机吹干，以维持肛门周围干燥，勿用力擦拭。

5．穿着舒适吸汗透气的裤子。

6．若肛门黏膜已破损，请加强热水坐浴及局部干燥，必要时可遵医师指示用药。

（三）我们的希望：

也许治疗使您疲累，但若您愿意多花一点心力配合，将使您治疗期间更顺利。并请随时告知医护人员您肛门的情况，以便提供协助。

化学治疗对性的影响

化学治疗对性的影响，可能会因药物的种类、年龄及健康状况而产生不同的影响。在接受化学治疗期间，只要体内及身体状况许可下可进行性行为，但必须做避孕工作，因为化学药物会造成精子或卵子的异常，胎儿可能有畸型的危险性。

（男性方面）

治疗会影响精虫的数目及活动力，可能造成暂时性或永久性的不孕，但性生活则不受影响，因可能造成永久性的不孕，若将来有生育的计划可考虑在治疗前将精子存在精子银行，若有这方面的问题请在接受化学治疗前与医师详谈。

（女性方面）

治疗对卵巢功能影响的程度与使用药物剂量和年龄有关。会减少其荷尔蒙的分泌，因此女性接受化学治疗期间月经可能变得不规则、或完全停止；甚至会出现不孕症及胎儿畸型等副作用。有些女性患者会因荷尔蒙分泌受影响，而出现类似更年期的症候如脸潮红、灼热感、及阴道干涩等，可能会影响性生活，此时可使用一些水溶性阴道润滑剂改善。

给关心病患的亲友恳切的叮咛

相信您们都非常关心化学治疗是什么？对您的家人（朋友）将有什么影响？您该如何帮助您的家人（朋友）？本手册将会提供一些建议，以期能帮助您的家人（朋友）渡过化学治疗。

＊请体谅患者因治疗而常心情不好，并且无法进行日常的活动。

＊当患者情况较好时，请鼓励他（她）进行日常活动。

＊以一般要求对待患者，切勿要求过严或太过宠爱。

＊请清楚地让患者知道您愿意听他（她）倾诉，与他（她）分享心中感想。

＊请发挥您的耐性，患者的情绪总有好转的时候。

＊尽量鼓励患者保持希望，接纳他（她）各种情绪。

＊在安全第一的前提下，尽量带患者进入您的社交活动。

＊为病患准备一些营养均衡的食物，少量多餐。

＊让病患在吃东西时有所选择，不要强迫吃某种食物。

＊陪病患吃饭可使他心情愉快，胃口更好。

＊如果病患超过一天没喝水或2－3天未进食，请联络医师以提供必要的营养补充。

良好的日常生活照顾

良好的日常生活照顾可以使您恢复得快一点，并且可以减轻或防止一些副作用的发生。在治疗期间可请教医护人员您应该注意的事项，尽可能保持良好的体力与精神，摄取均衡的营养，进行适当的活动，保持轻松的心情，充足的休息，当然，别忘了给自己找点乐子。

均衡营养的重要

癌症病人较一般人需要更多的热量及蛋白质来修补受伤的正常细胞及增强免疫系统的作用。均衡的营养可提供足够的能量来帮助您的康复，您可以请教营养师为您调配，吃得太多或太少都不好。

摄取均衡的饮食

各种不同的食物可以帮助您得到需要的维他命、矿物质、蛋白质、糖类、脂肪以及纤维素。您不需要按照一定的菜单，只要口味合适，适当地摄取各类食物都是对您有益的。

少量多餐

一次使用的食物不要太多，一方面较易消化，另一方面较不易引起呕吐。在治疗前后，有一点要提醒您的是，若胃口不好而去吃您平常爱吃的东西时，您可能会觉得这些东西变难吃了，那是因为您的味觉受化学治疗的影响而暂时改变了，因此不要灰心。

补充水份，并且每天的饮食中最好包括下列的食物：

＊蔬菜及水果

＊米饭或全麦面包

＊鱼、肉、蛋、奶或豆类

增加热量

当您觉得口腔状况还好的时候，尽量多吃，您可以在饭后吃些甜点，吃面包时多涂些果酱、花生酱。当然，请医师给您一些维他命，也可帮助康复。

给自己找乐子

作画

您可以试着拿起彩笔随手写写画画，或是捏捏泥土，虽然您不是专业人员，但是您可能因此而发现自己有此天分；若您喜欢音乐，有时您可以玩奏乐器。这些创作活动一方面可以帮助您转移注意力不再烦恼；另一方面也可以帮助您表达出言语无法传达的情绪！

写日记

您有不易启齿，无法向人倾诉您的感觉、心情吗？何不准备一本空白的本子或日记？记下您的想法，一方面有助于思考问题，一方面也可解脱心中的抑郁。提起笔吧！说不定您可以出本书哦！

听音乐

可以分散不舒服的感觉，可以选择您喜欢听的节目，这是最不费力的。

看电视

平时忙于工作或家务，此时，生病的您，放松心情，挑些娱乐性高的节目来陶冶自己的心情吧！

打牌

当您的体力恢复到可以久坐，又有兴趣的话，打牌是个好主意。

学会照顾自己

运动的好处

当您觉得身体状况还好时，可以做一些运动，因为运动能帮助您减轻压力，减轻恶心感并有助于提高免疫系统的功能。

在运动时您要注意：

* 尽量找机会活动筋骨，照顾自己，就算在床上或坐着都可以做伸展运动。

* 在您感觉舒适的范围内，尽可能地运动，并逐渐增加运动量。

* 在您体力允许的情况下，散步时钟很好的运动，当体力逐渐恢复的时候，可试着进行一些活动量较大的运动，如游泳。

放松心情的重要性

放松心情可帮助您稳定情绪，增强免疫功能，减轻副作用。

您可以：

* 听音乐，尤其是一些柔和、轻快的调子或是自然的虫鸣、鸟叫、流水声。

* 做做运动。

* 接受按摩，您可以请专业人士或亲友为您进行按摩。

* 试着找一些让您的心情最能放松的方法。

睡眠及休息的重要性

在化学治疗期间，您可能特别感到容易疲倦，体力不济，却又有失眠或睡不好的情况发生，但良好的睡眠及休息对您的恢复有极大的帮忙。您若有睡眠方面的问题，可以：

* 在睡前看看书，听听音乐或洗个热水澡，帮助心情瓶颈。

* 避免在睡前喝茶、咖啡等含有咖啡因的饮料。

* 拔掉电话或其他可能干扰您睡眠的因素。

* 若真的无法入睡，可以请医师帮忙开药。

休闲娱乐的重要

虽然您正在接受化学治疗，并不代表您必须过无趣的生活，只要在体力许可范围内多进行一些休闲活动，都是对您有益的。您可以看看电影，培养嗜好，与朋友聚会，甚至可以工作。进行这些令人心情愉快的活动，将可使您忘却烦恼，对您的病情大有好处。

给关心病患的亲友恳切的叮咛

* 鼓励病患参加各种活动，增加生活乐趣。

* 提议一些特别的活动并与病患共同进行。

* 多多表达您的关心及鼓励。

* 尊重病人的要求，当他需要休息时，帮助他尽量休息。

起伏的情绪与良好的日常生活照顾

在治疗期间，有时候您觉得很好，充满自信，充满希望，觉得病情正在控制好转之中；有时候您又觉得沮丧、孤独、无助，或许您会担心经济问题，家里的事情是否妥善处理，孩子由谁照顾等。情绪的起伏是正常的事，但请不要让它成为您的困扰。

情绪起伏的安抚

当被医师告知罹患癌症，再乐观的人也难免产生沮丧、害怕、愤怒的情绪。当您有这些令人难过的情绪产生时，请试着表现出来，不要故易忽视这些情绪问题；面对您的情绪并试着处理情绪的问题，将可使您的心理较平衡，脑袋较冷静，较有利于作一些重要的决定。保持一个乐观、开放的态度，将使您顺利地渡过治疗期，更能忍受生理上的痛苦。

重获平衡

在治疗的过程中，您的生活可能会发生改变，所以必须调整您的生活型态，以面对化学治疗的种种副作用等等。但这不表示您一定得情绪低落，您可试着用一些方法，帮助自己重新获得平静的情绪。

聊聊天

大部分的人在将心中的忧虑、痛苦说出来后，会觉得心中舒坦多了，不再那么害怕和孤独。您可以试着与别人谈谈心中的感受，您可以找您的家人、好朋友或与您“共患难”的病友。当然，社工人员及护理人员也都是您可以倾吐的对象。说出来，您会觉得好多了！

必要时寻求支持

每个人对化学治疗的反应都不同，所需要的支持也不同。大部分的人都发现他们无法独自接受化学治疗，需要亲友的支持及照顾。同时有很多其他癌症病人和您一样，您并不孤独。自我照顾的要点就在于知道自己何时该寻求他人的支持及援助。

寻求关心您的人的支持，他们可以和您聊天，帮你解决生活上及情绪上的困扰，这些都可帮助您更易适应肿瘤的治疗。

相关之医疗人员的支持

您的主治医生及照顾您的医护人员都是良好的咨询对象，您可以将问题写下来，于病房查房或门诊时请教他们，不管是关于您的病情发展，治疗的副作用及效果，或合适可工作等问题，若有特殊情绪上的困扰，医护人员也可以帮您寻求其他必要的专家到病房来提供照顾。

给亲友们表达支持的机会

您的亲友都非常关心您，他们虽很愿意帮助您、陪您，却又怕说错话或做错事，引起您的不高兴，而使他们什么都不敢说也不敢做。只有您可让他们了解您的需要，您需要他们的帮忙，同样地，他们也需要您的帮忙。

寻求其他帮助

除了医护人员的指导协助之外，您也可以去图书馆、书店，找一些关于癌症治疗、宗教思考、营养保健的书来阅读。

参加互助团体

参加病友所组成的互助团体将有助于您分享经验心得，得到支持。这类团体依不同的癌症年龄而有所不同，您可就近请教医护人员这方面的资讯。

宗教、信仰

很多医院都设有佛堂，祷告堂牧师室及教堂，可向各医院服务中心或相关机构寻求相关资料。

记录治疗过程

在记事本上，记录下您诊断的时间，治疗的时间，产生的副作用，住院的时间，及进行的试验。这些记录将帮助您了解治疗进度。

帮助自己过得更好

虽然您可能因化学或放射治疗而产生一些身心方面的副作用，但您仍可想办法使自己过得舒服些，平稳的心情，良好的自我照顾及亲友的支持，可以帮助您顺利地度过化学治疗期。

给关心病患的亲友恳切的叮咛

·您可提供病患一些特殊的帮助，如：帮他（她）照顾小孩，上街购物，煮东西或陪患者进行治疗。

·与患者保持联系，由于治疗的缘故，患者在身心方面都较疲惫，因此由您采取主动较好。

·联络亲友，推派一位主要的联络人，来联络及分配各种支持患者的活动。

您的治疗计划

您的医师将详细地解释您个人的治疗计划及治疗目的。治疗计划将因您的病情不同，而会有不同的药物、不同的给药时间及不同的疗程。

Click here for 血球减少 - 化学治疗..(2)

______________________________________

Disclaimer

As patient confidentiality is to be maintained, identity of the patients in the stories has been altered.

There is also no intention of advertising for any party involved.

The author is not responsible for any consequence arises by using the information in this blog without proper consultation with qualified physician.

本网志不可当着醫療意見。个人健康問題，務必諮詢執業醫護人員。

Colours of Hope and Life

2006-03-15T15:19:00.000+01:00

These photos is taken from photo gallery of The MAX Foundation, click here.

Read the story of a Malaysian artist with blood cancer (CML) here and here. His paintings titled "Colours of Hope and Life" are shown above.

About blood....血肉相连

CML病人支援團體The Max Family‧助病人找藥物贊助

骨髓移植救血癌病人

骨髓移植 救血癌病人

Curing blood cancers

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LIVING WITH CANCERBy Dr LEONG KIN WAH

A Beautiful Day

Haematology Day 2008

The Max Family 季刊

Maximize Life Workshop 18/10/2008

保險員抗血癌21年‧靠毅力試新藥延命

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CML Maximize Life Workshop for Patients & Care Givers, 26 July 2008

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Cord blood storage questionable

Just the facts (Stem Cell Therapy)

骨髓移植没排斥 血癌青年张国文逐渐康复

Cancer of the lymphatic system

Stand Up and Live for Life

Cladribine Therapy for Hairy Cell Leukemia: Does Schedule Matter?

Scientists Develop Artificial Blood

ADAMTS13 and Thrombotic Microangiopathy

一個月內殺死2種癌細胞，格列衛具奇蹟性療效

慢性骨髓細胞白血病，基因突變發病非遺傳

移植非親屬骨髓，馬大首宗手術成功

New Lease of Life for Cancer Boy

News from ASH: Treatment with epoetin alfa once every three weeks achieved target hemoglobin

More Glivec long term data

News freom ASH: Final data from phase III study show single-agent alemtuzumab is superior to chlorambucil for B-CLL

News from ASH: Multiple Myeloma Patients Respond To Retreatment With VELCADE(R) (Bortezomib) For Injection

A support group for CML patients

Outcome of Transformed Diffuse Large B-Cell Lymphoma

Genetic Profile of Waldenström Macroglobulinemia

Chit Chat & Fun - CML Day

D-Dimer Might Help Identify Patients Who Need Extended Anticoagulation

New Tool Helps Blood Specialists Improve Patient Care

Living next door to CML

the Chimera

Good News, Yet Another Challenge

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Hematopoietic Stem-cell Transplantation (HSCT) - GVL

Adding Thalidomide to Standard Treatment Improves Survival in Elderly Patients With Multiple Myeloma

Patients with Chronic Myelogenous Leukemia Continue to Do Well on Imatinib at 5-Year Follow-Up

New CML drugs get names.. at last

Hematopoietic Stem-cell Transplantation (HSCT) - GVHD

Hematopoietic Stem-cell Transplantation (HSCT)..(2)

Hematopoietic Stem-cell Transplantation (HSCT)..(1)

Pemindahan Sum-sum Tulang

PEMINDAHAN SUM-SUM TULANG (BONE MARROW TRANSPLANTATION) - TANYA-SOAL UNTUK PESAKIT-PESAKIT DAN KELUARGA

Transplantation

Chronic Myeloid Leukemia..(5) - The Magic Orange Pills

Chronic Myeloid Leukemia..(4) - a bit of genetics

Chronic Myeloid Leukemia..(3) - milestones

Chronic Myeloid Leukemia..(2)

Chronic Myeloid Leukemia..(1)

Stem Cell and the Heart..(2)

Stem Cell and the Heart..(1)

Acute Myeloid Leukemia..(4) - APML, history

认识白血病

类型

症状

病因

治疗

Acute Myeloid Leukemia..(3) - APML

Chemotherapy..化学治疗..(2)

Chemotherapy..化学治疗..(1)

Colours of Hope and Life

骨髓移植救血癌病人

LIVING WITH CANCER
By Dr LEONG KIN WAH

骨髓移植没排斥　血癌青年张国文逐渐康复