TA和DA方案治疗急性单核细胞白血病的疗效比较

 目的　比较吡柔比星（THP）联合阿糖胞苷（Ara-C）（TA组）和柔红霉素（DNR）联合Ara-C（DA组）治疗初治急性单核细胞白血病的疗效。方法　对2001年1月至2007年12月收治的43例初治急性单核细胞白血病患者（M5），采用以TA或DA为主的联合化疗方案进行治疗，其中TA组22例，DA组21例。结果　TA组与DA组的完全缓解（CR）率分别为59.1 %、28.6 %，1个疗程CR率分别为27.3 %、9.5 %，总有效率分别为68.2 %、33.3 %，差异有统计学意义（P＜0.05）。结论　对初治的急性单核细胞白血病（M5），以THP为主的联合化疗方案（TA）比以DNR为主的联合化疗方案（DA）有更高的CR率，TA方案可作为治疗初发M5诱导治疗的一线方案。     

二次异基因移植并发微血管病性溶血死亡1例

1 病例介绍 患者，男，31岁。2000年1月出现发热、肝脾肿大，查血常规示白细胞31.8×109／L，幼稚细胞76％；骨髓涂片示原始加幼稚单核细胞92％，确诊为急性单核细胞白血病(M5)。经1疗程DA方案化疗缓解。之后依次给予DA，HD-Ara-C，MAE，IDA等方案巩固，2000年8月行异基因外周血干细胞移植，预处理方案……     

米托蒽醌、VP-16、阿糖胞苷联合治疗难治性白血病的临床研究

目的探索有效的难治性急性白血病的化疗方案;方法用米托蒽醌、VP-16、阿糖胞苷联合化疗治疗难治性急性白血病12例;结果米托蒽醌、VP-16、阿糖胞苷联合化疗治疗难治性急性白血病有效率66.7%,明显高于对照组;结论米托蒽醌、VP-16、阿糖胞苷联合化疗是治疗急性白血病特别是复发患者有效的方案,副作用主要是骨髓抑制.     

急性单核细胞白血病46例临床分析

目的：探讨急性单核细胞白血病的临床特征和化疗疗效。方法：分析46例急性单核细胞白血病的临床资料。结果：M5约占急性髓系白血病21.2％，男性青壮年多见，漫润症状明显，部分以全血细胞减少起病。总缓解率54.3％。结论：以米托蒽醌为主的化疗方案较DA或HA方案疗效好，巩固治疗以造血干细胞移植和有HD-Ara-C在内的方案为佳。     

HA联合替尼泊苷或表柔比星治疗急性髓系白血病疗效观察

目的:探讨高三尖杉脂碱+阿糖胞苷联合替尼泊苷（HAT）或表柔比星（HAE)治疗急性髓系白血病（AML)的疗效及毒副反应。方法:回顾性分析了初治急性髓系白血病患者以HAT或HAE方案进行诱导化疗的疗效和毒性反应。统计完全缓解率（CR）及总生存（OS）率分析。结果:初治AML患者在HAT和HAE组一疗程诱导化疗CR率分别为90%和81%。两组中CR患者3年实际OS率分别为33.3%和53.8%。至随访结束HAT组无复发生存22.2%,HAE组30.7%。预期5年总生存率HAT组为20%,HAE组为44%。化疗相关的毒副反应主要为造血抑制和感染,患者可以耐受。结论:HA联合替尼泊苷或表柔比星诱导化疗疗效满意,不良反应可以耐受,可以作为一线诱导化疗方案。     

小剂量MAE方案治疗难治与复发急性白血病

目的:探讨小剂量米托蒽醌(MTZ)、阿糖胞苷 (Arc)联合依托泊甙(VP-16)治疗难治与复发急性白血病的疗效及毒副作用.方法:难治与复发急性白血病52 例,应用小剂量MAE方案化疗,完全缓解后应用中剂量阿糖胞苷或预激方案巩固.结果:22例急性非淋巴细胞白血病中,10例(45.5%)达完全缓解(CR),2例(9.1%)部分缓解(PR),总有效率为54.5%;30例急性淋巴细胞白血病中,9例(30.0%)CR,2例(6.6%)PR, 总有效率为36.6%.毒副作用主要是骨髓抑制、恶心、呕吐.结论:小剂量MAE 方案治疗难治与复发急性白血病的疗效较好,毒副作用较轻.     

鬼臼乙叉甙治疗11例急性单核细胞白血病

鬼臼乙叉甙(VP-16)是鬼臼毒素合成的常用衍生物。近年来已成为治疗多种实体瘤及急性白血病的新药之一。我们应用VP-16及Ara-C组成联合化疗方案治疗急性粒单细胞白血病(以下简称M_4)、单核细胞白血病(以下简称M5)。现将可评价的11例小结如下。     

米托蒽酯,VP—16,阿糖胞苷联合治疗难治性白血病的临床研究

目的探索有效的难治性急性白血病的化疗方案;方法用米托蒽醌、VP-16、阿糖胞苷联合化疗治疗难治性急性白血病12例;结果米托蒽醌、VP-16、阿糖胞苷联合化疗治疗难治性急性白血病有效率66.7%,明显高于对照组;结论米托蒽醌、VP-16、阿糖胞苷联合化疗是治疗急性白血病特别是复发患者有效的方案,副作用主要是骨髓抑制.     

MDS-RAEBT和AML-M5临床疗效与血浆sFAS水平及细胞凋亡的关系

目的：探讨骨髓增生异常综合征伴原始细胞增多转变型(MDS-RAEBT)与急性单核细胞白血病(AML-M5型)临床疗效的区别及其与细胞凋亡的关系。方法：观察以DAE或HAE为基本方案化疗的MDS-RAEBT和AML-M5两组患者的临床疗效。用常規方法提取22例MDS-RAEBT和28例AML-M5初治患者的单个核细胞，并分别用ELISA方法FACS方法检测两组患者血浆中的可溶性FAS(soluble isoforms of the fas，sFAS)和细胞凋亡相对百分比。结果：MDS-RAEBT组血浆中的sFAS水平高于AML-M5组，而细胞凋亡相对百分比和2个疗程的完全缓解率均低于AML-M5组，两组之间各指标比较差异有显著性(P＜0.05)。结论：MDS-RAEBT与AML-M5两者之间有明显的临床疗效差别，可能与sFAS抑制细胞凋亡有关。     

急性单核细胞白血病各亚型（M5a和M5b）免疫分型和细胞遗传学及临床特点分析

目的：研究急性单核细胞白血病各亚型的细胞形态学、免疫分型、细胞遗传学及临床特点,并分析M5a和M5b之间的差异及其与非M5白血病之间的差异.方法：取患者骨髓标本进行瑞氏染色及细胞组织化学染色用于形态学分析,运用四色流式细胞仪对患者骨髓标本进行免疫分型分析,采用R显带培养24小时患者骨髓标本,并对其进行染色体核型分析.结果：急性单核细胞白血病患者各亚型（M5a和M5b）之间的免疫分型没有显著差异,与非M5急性髓细胞白血病相比CD34表达减少.85例M5患者中正常核型50例,异常核型35例,其中正常核型在M5b中出现率较高.异常核型以＋8染色体异常最为多见.M5患者与非M5患者的无事件生存率及缓解率没有显著差异.结论：急性单核细胞白血病与非M5在细胞形态学、免疫分型及细胞遗传学方面存在差异,而临床结局及预后方面差异不明显.M5a和M5b在以上三方面没有明显差异.     

小剂量MAE方案治疗难治与复发急性白血病

目的：探讨小剂量米托蒽醌（MTZ）、阿糖胞苷（Arc）联合依托泊甙（VP-16）治疗难治与复发急性白血病的疗效及毒副作用。方法：难治与复发急性白血病52例，应用小剂量MAE方案化疗，完全缓解后应用中剂量阿糖胞苷或预激方案巩固。结果：22例急性非淋巴细胞白血病中，10例（45．5％）达完全缓解（CR），2例（9．1％）部分缓解（PR），总有效率为54．5％；30例急性淋巴细胞白血病中，9例（30．0％）CR，2例（6．6％）PR，总有效率为36．6％。毒副作用主要是骨髓抑制、恶心、呕吐。结论：小剂量MAE方案治疗难治与复发急性白血病的疗效较好，毒副作用较轻。     

应用肝动脉化疗栓塞治疗76例老年人中晚期原发性肝癌的疗效观察

目的探讨肝动脉化疗栓塞术加用生物反应调节剂对老年人、中晚期原发生性肝癌的疗效。方法对不能手术的老年人中、晚期肝癌７６例,用顺铂、表阿霉素、ＩＬ－２、丝裂霉素、碘油、明胶海绵进行肝动脉化疗栓塞（ＨＡＥ）继而全身应用ＩＬ－２。ＨＡＥ与应用ＩＬ－２交替进行。结果１年生存率为５１．３％,其中以临床Ⅱ期患者,单发结节型及巨块型患者疗效较好。主要副作用为栓塞术后综合征,个别患者出现急性肝功能衰竭。结论肝动脉化疗栓塞加用生物反应调节剂可提高老年人中、晚期原发性肝癌的疗效及延长生存期。     

替尼泊苷联合方案治疗交叉表达双系相关抗原急性白血病的临床研究

目的 :探讨替尼泊苷联合方案治疗交叉表达淋系和髓系抗原急性白血病的化疗疗效。方法 :应用替尼泊苷联合阿糖胞苷、环磷酰胺、长春地辛及泼尼松组成 TA或 TA+COP方案 ,治疗伴淋系抗原表达的急性髓细胞白血病 (L y+ AML) 2 4例和伴髓系抗原表达的急性淋巴细胞白血病(My+ AL L) 1 7例。结果 :完全缓解 (CR)率为 5 6 .1 % (2 3/ 4 1 ) ,总有效率为 80 .5 % (33/ 4 1 )。与常规方案 (DA、VDL P)诱导疗效相比有显著性差异 (P<0 .0 1 )。其中 L y+ AML 的 CR率为 5 8.3% ,总有效率为 79.2 % ;My+ AL L 的 CR率为 5 2 .9% ,总有效率为 82 .4 %。复治性 L y+ AML / My+ AL L 总有效率为 72 .7% (8/ 1 1 )。两种方案的骨髓抑制明显 ,毒副作用能够耐受。结论 :L y+ AML 和 My+ AL L不宜采用常规诱导缓解方案 ,TA和 TACOP方案宜作为此类患者的首选治疗方案     

Leukemia in Rochester (NY). A 17-year experience with an analysis of the role of cooperative group (ECOG) participation

Every adult acute nonlymphocytic leukemia patient in Rochester, New York seen from January 1975 to January 1982 was studied. Fifty percent of the patients did not receive combination chemotherapy. Among those who did, there was a significant selection bias toward placing patients with better prognostic features on protocol. Protocol patients were also treated with higher doses of chemotherapy than nonprotocol patients. However, these factors did not completely explain the significantly better complete response (CR) rate and survival among protocol patients. Eastern Cooperative Oncology Group (ECOG) participation remained an independent variable associated with a better outcome. An improvement in CR rate was seen during the 7-year period studied as compared to that seen between 1965 and 1974. The study provided evidence that the availability and use of ECOG protocols was a positive factor in the improvement of leukemia treatment in Rochester.     

Results of a pilot study for the treatment of childhood acute nonlymphoblastic leukemia

Eighteen children with acute nonlymphoblastic leukemia were entered on a pilot protocol. The drugs used were vincristine, daunorubicin, cytosine arabinoside, and prednisolone for remission induction, high-dose cyclophosphamide together with vincristine and mercaptopurine for consolidation, and cycles of vincristine, prednisolone, mercaptopurine, methotrexate, and daunorubicin for maintenance therapy. Prophylactic central nervous system therapy (cranial radiotherapy 2400 rad and intrathecal methotrexate 10 mg/m2 for five doses) was given once remission had been achieved. Fourteen of the 18 children (78%) achieved complete remission (CR) and 50% of those achieving CR remain in CR for 35+ to 87+ months. Survival for all children ranges from 2 to 88+ months with 50% remaining alive for 36+ to 88+ months. The protocol was well tolerated with minimal side effects. These results together with those of other recently reported studies indicate an improving prognosis for acute nonlymphoblastic leukemia in childhood.     

吡喃阿霉素在儿童恶性肿瘤治疗中的远期疗效与心脏毒性观察

目的：探讨吡喃阿霉素（4—6-tetrahydropy-ranyl—adriamycin，THP）治疗儿童恶性肿瘤的远期疗效，以及患儿对THP的耐受性。方法：在儿童急性自血病、晚期淋巴瘤和其他晚期恶性肿瘤的长期化疗中，以THP取代联合化疗方案中的柔红霉素（DNR）和阿霉素（ADR）。统计远期疗效，观察THP所致的心脏毒性发生率和其他并发症。结果：总计治疗92例儿童恶性肿瘤，按Kaplan-Meier生存率曲线法统计急性淋巴细胞白血病（ALL）、非霍奇金淋巴瘤（NHL）和急性髓系白血病（AML）的6年以上无病生存率（disease-freesurvival，DFS）分别76．43％、78．58％和46．47％。其他晚期实体肿瘤的CR和PR率分别为62．5％和25．0％。本组仅3例出现THP所致心脏损害（心律紊乱和传导阻滞），其中2例改用CTX和VP16后，最终获得长期无病生存。治疗中THP最大累积剂量为600mg／m^2。结论：以THP取代ADR和DNR，在保证远期疗效的基础上，可明显降低心脏毒性反应的发生率。     

Improved Outcome of a Pediatric-Inspired Protocol for High-Risk Adolescent and Young Adult Acute Lymphoblastic Leukemia Patients Using Peg-Asparaginase and Escalating Dose of Methotrexate: Tolerability and Outcome

BackgroundTreatment of acute lymphoblastic leukemia (ALL) in adolescent and young adult (AYA) patients using traditional adult chemotherapy protocols give low overall survival (OS) rates. Data are growing regarding the use of pediatric-inspired chemotherapy protocols in AYA patients with improvement in OS.Patients and MethodsTo assess efficacy and tolerability of using a pediatric-inspired protocol in AYA patients, we initiated our local prospective trial using a modified version of the Children’s Cancer Group 1900 protocol for newly diagnosed high-risk Philadelphia chromosome-negative ALL patients.ResultsA total of 40 patients were enrolled in the study (from 2015 to 2018). The median age was 18 years (range, 14-34 years). The complete remission rate after induction was 37 patients [93%] and after a median follow-up of 5 years, OS, disease-free survival (DFS), and event-free survival were 75%, 72%, and 60%, respectively. Use of this protocol was well tolerated with manageable toxicities. Pegylated asparaginase was given to all patients during the induction phase and was well tolerated.ConclusionThe use of a pediatric-inspired protocol for high-risk AYA ALL patients was effective and well tolerated with improvement in OS and DFS compared with historical data using adult protocols in such populations.     

Treatment for a high-risk group for childhood acute lymphoblastic leukemia]

Chemotherapy regimens for high-risk (HR) groups for childhood acute lymphoblastic leukemia (ALL) are briefly reviewed in this study. For patients with B-precursor ALL, the HR category includes patients more than 10 years of age who have a WBC count at diagnosis of more than the 50,000/microliter that is becoming a global standard for HR classification. Since 1981, the Children's Cancer and Leukemia Study Group (CCLSG) has developed a series of protocols for HR-ALL. These include the H811, H851, H874, H/HH911 and more recent H/HH941 protocols. With the H874 protocol in particular, patient outcomes with new intensive regimens strengthened by early treatment with cyclophosphamide (CPM) plus cytosine arabinoside (Ara-C), and reinduction therapy with THP-adriamycin, vincristine, prednisone and L-asparaginase seem to be better than outcomes of patients with the previous protocols. An intermediate-dose of CPM plus Ara-C showed a significantly higher event-free survival (EFS) rate than a high-dose regimen with the same drugs. The EFS rates at 4 years based on the H941 and HH941 protocols were 72.8% and 62.8%, respectively. Although the various prognostic factors for acute myelogenous leukemia (AML) have been inconsistent, bone marrow chromosome abnormalities including monosomy 7 an 11q23 rearrangement have become indicators for a poor prognosis, whereas patients with t (15; 17), t (8; 21) and inv (16) have a decreased likelihood of relapse after achieving remission. The 11q23 abnormality is a very important prognostic factor for infant acute leukemia. Based on these findings renewal protocols for AML, including hematopoietic stem cell transplantation, have been conducted by our CCLSG and other study groups.