Senior childhood leukemia expert: unnecessary, not desirable

　　Yangcheng Evening News reporter Li Li

　　The popular TV series "Dear Child" has made many viewers feel the complicated taste of marriage and family.

Recently, the plot has ushered in a new conflict: Fang Yinuo and Xiao Lu, who have been divorced and reorganized their families, face a new dilemma that their daughter He He has acute lymphoblastic leukemia and is in urgent need of hematopoietic stem cell transplantation.

In the latest development of the plot, the bone marrow donor who finally waited for it suddenly changed his mind, and the doctor proposed a "last resort" - to have a child born from the biological parents.

　　With the real quality of life, "Dear Child" has recently sparked heated discussions among many young audiences.

In addition to re-examining the responsibilities of marriage and family, the latest plot of the child's illness brings the plot conflict to a climax.

However, in the opinion of Professor Zhou Dunhua, director of the Department of Pediatrics of Sun Yat-sen Memorial Hospital of Sun Yat-sen University and director of the Department of Pediatric Hematology/Oncology, the plot of "giving birth to a baby to save the baby" is artistically appealing, but from a professional medical point of view, it is "extremely wrong".

　　Plot 1

　　Transplant for acute lymphoblastic leukemia?

NO!

　　More than 80% of pediatric patients are cured with chemotherapy alone

　　In "Dear Child", Fang Yinuo and Xiao Lu's daughter, He He, was diagnosed with acute lymphoblastic leukemia. The doctor proposed a hematopoietic stem cell transplantation plan for this purpose, but the matching of relatives and friends was unsuccessful. information.

After finally waiting for a successful match, the donor changed his mind again... This made many ordinary viewers have the impression that "childhood leukemia is difficult to treat". Is this really the case?

　　Professor Zhou Dunhua introduced to the Yangcheng Evening News reporter: "Acute lymphoblastic leukemia is the most common type of leukemia in children, accounting for about 80% of childhood leukemia. In fact, more than 80% of children with lymphocytic leukemia do not need hematopoietic stem cell transplantation. , as long as it can be cured by chemotherapy. Yes, in terms of childhood acute lymphoblastic leukemia, we never talk about the survival rate of several years, but directly talk about cure. Because its prognosis is very good, which is more similar to adult leukemia s difference."

　　Professor Zhou Dunhua further explained: "Generally, for children with acute lymphoblastic leukemia, we will give them chemotherapy remission first. Most people can achieve remission after about two weeks of chemotherapy, and if they do not relapse for 5 years, then basically There is a 99% probability that there will be no recurrence, that is, a lifelong cure. Therefore, many people, including some film and television characters, immediately think of hematopoietic stem cell transplantation when they mention acute lymphoblastic leukemia, which is not correct." Zhou Dunhua For example, the professor said that many of the children she cured in the past have gone to college, got married and had children, and "they grew up just like normal children."

　　Plot 2

　　If transplanted, the best donor is from a sibling?

NO!

　　Acute lymphoblastic leukemia is more likely to relapse if treated this way

　　So, under what circumstances do patients with acute lymphoblastic leukemia need hematopoietic stem cell transplantation?

Professor Zhou Dunhua replied: "Those who are at high risk, especially those with severe drug resistance after chemotherapy, or those with relapsed leukemia, can be considered for hematopoietic stem cell transplantation. But first of all, the proportion of this situation is not high, ranging from 10% to 15%. %. In addition, even if a transplant is to be done, the current consensus in the medical community is not to prefer HLA (i.e. human leukocyte antigen, half inherited from the father and half from the mother) matched siblings as the donor. In other words, to have a child To save another child with acute lymphoblastic leukemia, doctors at home and abroad are not advocating."

　　Why can't this be done?

Professor Zhou Dunhua explained: "Because lymphocytic leukemia is different from myeloid leukemia, it is a cancerous transformation of lymphocytes. Lymphocytes themselves are very useful cells in anti-tumor, anti-inflammatory, anti-bacterial, and anti-virus, so After transplantation, it can identify the remaining cancer cells in the patient. But if the donor cells are too 'like' to the original cells, it can't identify the cancer cells, so even if the transplant is successful, the cancer is prone to recurrence."

　　In order to explain this, Professor Zhou Dunhua introduced a concept of "graft-versus-leukemia effect": "Simply put, the transplanted cells will kill the cells it thinks are 'heterogeneous'. Conversely, if it thinks these Cells are all of the same kind, so naturally they will not be 'killed'. Therefore, for acute lymphoblastic leukemia transplantation, it is best to have a little rejection - not too big, but not completely absent. If it is a full match The sibling donor, without any rejection at all, cannot kill cancer cells."

　　Of course, hematopoietic stem cell transplants required for many diseases are welcome to sibling donors.

For example, in the treatment of aplastic anemia or thalassemia, the first choice of HLA-matched sibling donors will be considered.

Professor Zhou Dunhua said: "Because they are not malignant tumors, the mechanisms are different."

　　Plot 3

　　After the child is sick, a "life-saving baby" is born again?

NO!

　　Acute lymphoblastic leukemia can't wait so long for you

　　"Dear Child" is adapted from "Left and Right" written and directed by Wang Xiaoshuai, which was officially released in 2008.

In the movie version, the idea of ​​divorced couples wanting to have a second child was naturally strongly opposed by the current husband and wife.

But in the end, the mother who was eager to save her insisted on doing so. Because the IVF was unsuccessful, she even chose to secretly have a natural conception with her ex-husband without telling others.

For her hesitant ex-husband, she gave the persuasive reason: "Instead of passively waiting like this, let's take the initiative. After 9 months, the umbilical cord blood can save the child." The plot of "Dear Child" has not yet developed. At this point, all have begun to face the same ethical and practical tests.

　　Regarding the plot of "giving birth to a baby to save the baby", Professor Zhou Dunhua shook his head: "Leukemia, especially acute lymphoblastic leukemia, can't wait for you that long. If it is a patient who needs hematopoietic stem cell transplantation, we generally remission after complete remission. After one or two chemotherapy treatments, a transplant must be done. This time is usually about two months, and no more than four months at most. Do you think the cancer cells can wait until my second child is born? This is obviously It is unrealistic. Also, in the process of waiting, the patient has to insist on chemotherapy in order to control the disease, but doing too much chemotherapy will make the patient too weak, which is not good for future recovery, and what is even worse is the use of too many chemotherapy drugs. resistance will develop.”

　　Even a nine-month waiting period is an ideal state.

In order to save the child, the original parents have another child, but in many cases, they are far beyond the golden age of conception.

　　Even if the original parents are successfully conceived, there is only a 1/4 chance of giving birth to a child with a full HLA match with the sick child.

"In most cases, a half-congruent is still born, which is similar to a father's transplant." Professor Zhou Dunhua said, "In fact, the China Marrow Bank has a large number of donors, so even if there is a sick child in the family who needs a transplant, parents don't need to worry too much. "

　　As for umbilical cord blood transplantation, Professor Zhou Dunhua said that Sun Yat-sen Memorial Hospital of Sun Yat-sen University where she works is one of the earliest medical institutions in the country to study umbilical cord blood.

She introduced that umbilical cord blood is indeed miraculous for many childhood diseases.

At the same time, cord blood is not as difficult to find as people think.

Professor Zhou Dunhua explained: "There are many cord blood banks in China, including the Guangdong Cord Blood Bank. In addition, because the rejection reaction of cord blood transplantation is relatively mild, it does not require complete matching, so the existing cord blood banks can basically meet the treatment requirements. Demand, there will rarely be a situation where a transplant is needed but cannot be allocated.”

　　"As doctors, we have the responsibility to spread science and correct medical common sense to the public." Professor Zhou Dunhua concluded that when the movie "Left and Right" was filmed, medical technology was not as perfect as it is now, "but today our medical level has greatly improved. Now, you don't need to have too much fear or anxiety about childhood acute lymphoblastic leukemia."