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Tongji Hospital initial outpatient service for leukemia drug discontinuance in China

Tongji Hospital initial outpatient service for leukemia drug discontinuance in China

On May 8th, the first China outpatient service for leukemia drug discontinuance was initially set up in Tongji Hospital. The chronic myelogenous leukemia(CML) patients are expected to live a drug free and diseases free life by this service.

Although targeted drug treatment is proved to be useful and efficient to chronic myelogenous leukemia(CML), the high price of the drugs brings heavy burden to the patients’ family. In the past four years, the research team of hematopathology in Tongji Hospital has helped 18 patients survive without medicine.

CML is a kind of malignant diseases which starts from hematopoietic stem cell. It accounts for 20 percent of adult leukemia. Currently, the small-molecule targeted drugs could bring a 90% survival rate of CML patients. However, the surging monthly medicine cost of 20000-40000RMB brings heavy financial burden to the hit families. Besides, one thirds of people will suffer from complications, such as ostealgia, diarrhea, skin rash, etc. So, all the domestic and international definitive guides set keeping healthy after drug discontinuance as the ultimate target of the treatment.

Zhou Jianfeng, the director of the department of hematopathology, together with his colleagues Professor Meng Li and Doctor Zhu Xiaojian, started a clinical research by keeping close observation of patients after drug discontinuance. The data shows that 40% of patients keep mitigating without recurrence and 99% of the rest recovered by taking medicine again. The data matched with the research results of French Research Group and Australian Adelaide Research Group.

In March, 2015, Ms Li, a CML patient for seven years, came to Tongji Hospital with a dream of having a healthy baby. She dared not pregnant because of the mountains of drugs she had taken in the past years, which, she believed would cause fetal malformation. After reading domestic and international literature, Professor Zhou found that although CML is not genetic, taking medicine during the pregnancy could cause 40 percent fetal malformation and easily lead to early abortion. Meanwhile, Ms. Li has received standard treatment for seven years and kept stable molecular remission for over two years. Also, relevant predictors showed that she was in low risk of recurrence. To make her “mother dream” come true, Zhou made the decision of drug discontinuance supervision. Ms. Li stopped taking medicine in March, 2015 and gave birth to a healthy baby in October, 2016 without any evidence of recurrence. The success of such attempts and challenges excited Zhou’s team, giving them the confidence that their research is significant.

If 40% patients could survive without target drugs, then is it possible to predict who will be the left 60% recurrence? According to the team’s research, the recurrence was closely related to the stem cells left in the patients’ body. Nowadays, a most advanced single cell sequencing analysis is under research. By comparing and analyzing the difference of stem cells in the patient’s body, the team will find the core factors of recurrence and design intervention intentionally. In the future, they may estimate recurrence and make the decision of drug discontinuance more accurately.

Professor Meng Li said: “The research is meaningful. Both international and domestic experience show that, drug discontinuance is safe for most patients under accurate supervision.” Stop medicine for a month can save at least 1000 RMB per month and 150000 RMB a year for a patient. Also, effective drug discontinuance can avoid other complications. It is a win-win measure to build harmonious doctor-patient relationship.

The outpatient service for leukemia drug discontinuance supervision is on Monday afternoon and Tuesday morning.