全反式维甲酸治疗APL诱发高白细胞症的临床观察

为了提高全反式维甲酸（ＡＴＲＡ）治疗急性早幼粒细胞白血病（ＡＰＬ）诱发高白细胞症的疗效，对２１例ＡＰＬ在ＡＴＲＡ治疗中出现的高白细胞症进行观察，并用羟基脲或三尖杉酯碱治疗。结果显示：对白细胞上升较迟峰值较低的普通组高白细胞症患者用羟基脲治疗有效，而对白细胞上升迅速且峰值较高的严重组高白细胞症患者用三尖杉酯碱治疗有较好的疗效。     

全反式维甲酸联合小剂量三尖杉酯碱治疗急性早幼粒细胞白血病18例

 目的　观察全反式维甲酸（ATRA）和ATRA联合小剂量三尖杉酯碱治疗急性早幼粒细胞白血病（APL）的疗效。方法　41例APL分为两组：A组23例采用ATRA。B组18例采用ATRA联合小剂量三尖杉酯碱。结果　A组完全缓解（CR）率为78.3 %,B组CR率为94.4 %,达到CR时间A组为（41.50±8.74）d,B组为（31.82±7.20）d（P＜0.01）,A组高白细胞症发生率为43.5 %,B组高白细胞症发生率为11.1 %（P＜0.05）。结论　ATRA联合小剂量三尖杉酯碱治疗APL的CR率高,能缩短CR时间,减少高白细胞症,有临床推广应用价值。     

全反式维甲酸联合小剂量三尖杉酯碱治疗急性早幼粒细胞白血病18例

目的 观察全反式维甲酸(AIRA)和ATRA联合小剂量三尖杉酯碱治疗急性早幼粒细胞白血病(APL)的疗效.方法 41例APL分为两组:A组23例采用ATRA.B组18例采用ATRA联合小剂量三尖杉酯碱.结果 A组完全缓解(CR)率为78.3%,B组CR率为94.4%,达到CR时间A组为(41.50±8.74)d,B组为(31.82±7.20)d(P<0.01),A组高白细胞症发生率为43.5%,B组高白细胞症发生率为11.1%(P<0.05).结论 ATRA联合小剂量三尖杉酯碱治疗APL的CR率高,能缩短CR时间,减少高白细胞症,有临床推广应用价值.     

全反式维甲酸联合小剂量三尖杉酯碱治疗急性早幼粒细胞白血病18例

目的 观察全反式维甲酸(AIRA)和ATRA联合小剂量三尖杉酯碱治疗急性早幼粒细胞白血病(APL)的疗效.方法 41例APL分为两组:A组23例采用ATRA.B组18例采用ATRA联合小剂量三尖杉酯碱.结果 A组完全缓解(CR)率为78.3%,B组CR率为94.4%,达到CR时间A组为(41.50±8.74)d,B组为(31.82±7.20)d(P<0.01),A组高白细胞症发生率为43.5%,B组高白细胞症发生率为11.1%(P<0.05).结论 ATRA联合小剂量三尖杉酯碱治疗APL的CR率高,能缩短CR时间,减少高白细胞症,有临床推广应用价值.     

全反式维甲酸联合小剂量三尖杉酯碱治疗急性早幼粒细胞白血病18例

目的 观察全反式维甲酸(AIRA)和ATRA联合小剂量三尖杉酯碱治疗急性早幼粒细胞白血病(APL)的疗效.方法 41例APL分为两组:A组23例采用ATRA.B组18例采用ATRA联合小剂量三尖杉酯碱.结果 A组完全缓解(CR)率为78.3%,B组CR率为94.4%,达到CR时间A组为(41.50±8.74)d,B组为(31.82±7.20)d(P<0.01),A组高白细胞症发生率为43.5%,B组高白细胞症发生率为11.1%(P<0.05).结论 ATRA联合小剂量三尖杉酯碱治疗APL的CR率高,能缩短CR时间,减少高白细胞症,有临床推广应用价值.     

全反式维甲酸联合小剂量三尖杉酯碱治疗急性早幼粒细胞白血病18例

目的 观察全反式维甲酸(AIRA)和ATRA联合小剂量三尖杉酯碱治疗急性早幼粒细胞白血病(APL)的疗效.方法 41例APL分为两组:A组23例采用ATRA.B组18例采用ATRA联合小剂量三尖杉酯碱.结果 A组完全缓解(CR)率为78.3%,B组CR率为94.4%,达到CR时间A组为(41.50±8.74)d,B组为(31.82±7.20)d(P<0.01),A组高白细胞症发生率为43.5%,B组高白细胞症发生率为11.1%(P<0.05).结论 ATRA联合小剂量三尖杉酯碱治疗APL的CR率高,能缩短CR时间,减少高白细胞症,有临床推广应用价值.     

全反式维甲酸联合小剂量三尖杉酯碱治疗急性早幼粒细胞白血病18例

目的 观察全反式维甲酸(AIRA)和ATRA联合小剂量三尖杉酯碱治疗急性早幼粒细胞白血病(APL)的疗效.方法 41例APL分为两组:A组23例采用ATRA.B组18例采用ATRA联合小剂量三尖杉酯碱.结果 A组完全缓解(CR)率为78.3%,B组CR率为94.4%,达到CR时间A组为(41.50±8.74)d,B组为(31.82±7.20)d(P<0.01),A组高白细胞症发生率为43.5%,B组高白细胞症发生率为11.1%(P<0.05).结论 ATRA联合小剂量三尖杉酯碱治疗APL的CR率高,能缩短CR时间,减少高白细胞症,有临床推广应用价值.     

全反式维甲酸联合小剂量三尖杉酯碱治疗急性早幼粒细胞白血病18例

目的 观察全反式维甲酸(AIRA)和ATRA联合小剂量三尖杉酯碱治疗急性早幼粒细胞白血病(APL)的疗效.方法 41例APL分为两组:A组23例采用ATRA.B组18例采用ATRA联合小剂量三尖杉酯碱.结果 A组完全缓解(CR)率为78.3%,B组CR率为94.4%,达到CR时间A组为(41.50±8.74)d,B组为(31.82±7.20)d(P<0.01),A组高白细胞症发生率为43.5%,B组高白细胞症发生率为11.1%(P<0.05).结论 ATRA联合小剂量三尖杉酯碱治疗APL的CR率高,能缩短CR时间,减少高白细胞症,有临床推广应用价值.     

全反式维甲酸联合小剂量三尖杉酯碱治疗急性早幼粒细胞白血病18例

目的 观察全反式维甲酸(AIRA)和ATRA联合小剂量三尖杉酯碱治疗急性早幼粒细胞白血病(APL)的疗效.方法 41例APL分为两组:A组23例采用ATRA.B组18例采用ATRA联合小剂量三尖杉酯碱.结果 A组完全缓解(CR)率为78.3%,B组CR率为94.4%,达到CR时间A组为(41.50±8.74)d,B组为(31.82±7.20)d(P<0.01),A组高白细胞症发生率为43.5%,B组高白细胞症发生率为11.1%(P<0.05).结论 ATRA联合小剂量三尖杉酯碱治疗APL的CR率高,能缩短CR时间,减少高白细胞症,有临床推广应用价值.     

全反式维甲酸联合小剂量三尖杉酯碱治疗急性早幼粒细胞白血病18例

目的 观察全反式维甲酸(AIRA)和ATRA联合小剂量三尖杉酯碱治疗急性早幼粒细胞白血病(APL)的疗效.方法 41例APL分为两组:A组23例采用ATRA.B组18例采用ATRA联合小剂量三尖杉酯碱.结果 A组完全缓解(CR)率为78.3%,B组CR率为94.4%,达到CR时间A组为(41.50±8.74)d,B组为(31.82±7.20)d(P<0.01),A组高白细胞症发生率为43.5%,B组高白细胞症发生率为11.1%(P<0.05).结论 ATRA联合小剂量三尖杉酯碱治疗APL的CR率高,能缩短CR时间,减少高白细胞症,有临床推广应用价值.     

TACE联合PSE在原发性肝癌并脾亢治疗中的应用

目的:探讨原发性肝癌行TACE联合不同程度PSE对术后血常规及肝功能部分化验指标的影响。方法:2014年4月至2014年6月对本院原发性肝癌伴脾功能亢进行TACE联合PSE治疗的患者45例,按照脾栓塞比例分为:脾栓塞程度＜50%(A组)、50%-60%(B组),术前及术后每周复查外周血WBC、PLT、AST、ALT、TBI至术后第8周,并进行Child分级。结果:A、B两组患者术后外周血中WBC、PLT计数均较术前有所升高,B组升高更明显,在随访末期A组明显呈下降趋势;A、B两组术前术后肝功能无明显变化。结论:在TACE联合PSE治疗中,脾栓塞比例是影响外周血WBC、PLT的重要因素;不同脾栓塞比例对肝功能无明显影响,高比例脾栓塞可加重栓塞后反应。     

PAD序贯自体造血干细胞移植治疗难治多发性骨髓瘤(附22例)

目的:多发性骨髓瘤(multiple myeloma,MM)至今仍不可治愈,几乎所有病人均会出现复发或难治,本文初步探讨硼替佐米应用于难治性MM患者PAD化疗并序贯自体外周血造血干细胞移植(autologous pe-ripheral blood stem cell t ransplantation,APBSCT)的可行性和疗效。方法:采用PAD(硼替佐米+阿霉素+地塞米松)方案治疗复发或难治性MM。结果:22例中3例难治MM患者给予PAD方案化疗4-6个疗程后,2例达到接近完全缓解(nCR),1例达到部分缓解(VGPR),并随后行APBSCT,动员方案PAD+CTX(PAD,环磷酰胺1.5g/m2,d15)联合G-CSF。预处理方案为马法兰140mg/m2。移植后采用沙利度胺100mg/天。所有患者在移植前均达到CR或VGPR,干细胞采集充分,安全有效,移植后造血功能均快速顺利重建。无1例死亡。移植后采用沙利度胺维持,随访3-12个月,病情稳定。结论:PAD用于难治MM患者的治疗达CR后,继续序贯进行APBSCT不仅可行,而且PAD不影响正常造血干细胞动员,故采用PAD和序贯用PAD+CTX动员方案的APBSCT的治疗手段,为难治MM患者的治疗提供新的治疗手段。但对长期生存的改善作用需进一步研究。     

Two cases of non-curatively resected scirrhous gastric cancer that responded well to weekly paclitaxel therapy

We report 2 cases in which the weekly administration of paclitaxel proved to be effective for patients with scirrhous gastric cancer who underwent a curability C operation. Weekly paclitaxel therapy was observed to effectively treat peritoneal and retroperitoneal dissemination. After this treatment the tumor markers decreased markedly. This weekly paclitaxel therapy was observed to cause no adverse effects, and thanks to the treatment the patients were able to consume normal meals. These patients could also be sufficiently treated as outpatients. Weekly paclitaxel therapy is thus considered to be effective for the treatment of advanced scirrhous gastric cancer with peritoneal and retroperitoneal dissemination.     

Effect of recombinant human granulocyte-macrophage colony-stimulating factor in patients with Hodgkin's disease: a phase I/II study.

PURPOSE: As bone marrow toxicity is the major limitation of the optimal administration of chemotherapy, we investigated whether recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) could prevent myelotoxicity or accelerate hematopoietic recovery after mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) chemotherapy. PATIENTS AND METHODS: Twenty-four previously untreated patients with Hodgkin's disease were included in a phase I/II study in which standard MOPP chemotherapy was followed by 5 days of GM-CSF at every other cycle. Patients were entered sequentially to receive one of four dosc levels (2, 4, 8, and 16 micrograms/kg of glycoprotein; 1.4, 2.8, 5.5, and 11.0 micrograms/kg of protein) and were randomly allocated to either 24-hour continuous intravenous (IV) infusion or twice daily subcutaneous (SC) injection of rhGM-CSF. RESULTS: WBC counts (mainly neutrophils, eosinophils, and monocytes) were significantly higher in cycles with rhGM-CSF than in cycles with MOPP alone. The total number of days of leukopenia (WBC count less than or equal to 2.0 x 10(9)/L) and neutropenia (absolute neutrophil count [ANC] less than or equal to 1.0 x 10(9)/L) was reduced in cycles with rhGM-CSF from 6.3 to 0.8 days and from 5.4 to 1.0 days, respectively. All dose levels of rhGM-CSF were effective in increasing the ANC, but only at the dose levels of 8 and 16 micrograms/kg did this significantly affect the scheduling of chemotherapy. Mild and reversible adverse reactions included low-grade fever, chest/bone pain, myalgias, erythemia, headache, fatigue, and periorbital edema. CONCLUSIONS: rhGM-CSF can be administered safely to patients with Hodgkin's disease and results in improved hematologic recovery after MOPP. Full-dose chemotherapy can be administered on time, resulting in an increase in the overall tolerated dose of myelosuppressive drugs when compared with historical controls. SC administration proved to be at least as effective as continuous IV infusion and should be preferred.     

Accelerated recovery from irradiation injury by angiotensin peptides

PURPOSE: Angiotensin peptides have been shown to affect the proliferation and chemotaxis of multiple cell types. More recent studies in this laboratory have shown that angiotensin II (AII) can increase colony formation and proliferation by hematopoietic progenitors and mesenchymal cells in vitro. As white blood cell (WBC) recovery after bone marrow injury requires progenitor proliferation, the effect of AII and angiotensin (1-7) [A(1-7)], a non-hypertensive fragment of AII, on recovery from total body irradiation was evaluated in C57Bl/6 mice. MATERIALS AND METHODS: The effect of angiotensin peptides on hematopoietic recovery and the number of progenitors in the bone marrow of irradiated C57Bl/6 mice was evaluated. RESULTS: Treatment of animals with angiotensin peptides accelerated hematopoietic recovery and increased the number of hematopoietic progenitors in bone marrow and in the blood. The increase in WBC concentration continued for a longer time after cessation of AII therapy than after treatment with filgrastim. Specifically, the number of WBCs continued to increase 21 days after irradiation with 7 days of angiotensin peptide administration. In contrast, the number of WBCs increased through day 13 with 7 days of filgrastim administration. On day 35 after irradiation (28 days after the last treatment), AII was shown to have increased the number of CFU-GM in the bone marrow of irradiated mice, whereas filgrastim administration had not. Angiotensin peptides also reduced the drop in platelet concentration after irradiation and increased the number of megakaryocyte precursors and megakaryocytes in the bone marrow. Receptor blocking studies indicated that losartan, an antagonist of the angiotensin type 1 receptor, blocked recovery of WBC levels in response to treatment with AII. In contrast, the increase in WBC levels in response to treatment with A(1-7), a ligand for other angiotensin receptors, was not affected by losartan. CONCLUSIONS: These findings suggest that these peptides utilize distinct receptors in the stimulation of hematopoietic recovery. In summary, systemic administration of angiotensin peptides led to an acceleration in hematopoietic recovery after irradiation. These peptides act to stimulate the formation of bone marrow progenitors, thereby facilitating recovery after myelosuppressive irradiation.     

惠尔血治疗消化道癌化疗后白细胞减少症的临床观察

观察采取先大剂量后小剂量基因重组人粒细胞集落刺激因子（Ｇ－ＣＳＦ），治疗消化道癌化疗后白细胞减少症的临床效果。对３０例患者进行前瞻性分组，初次化疗组和重复化疗组。化疗后４８ｈ以上，如果两次血常规检查白细胞数＜３．０×１０９／Ｌ，则采用惠尔血治疗。先大剂量皮下注射，待白细胞≥１０．０×１０９／Ｌ后，剂量减半维持７～１０天。治疗效果总有效率为９６．６％，６天内白细胞数１０．０×１０９／Ｌ的比率，初次化疗组明显高于重复化疗组。该实验提示采用先大剂量后小剂量惠尔血（Ｇ－ＣＳＦ）治疗消化道癌化疗后白细胞减少症有良好疗效。     

Model describing the relationship between pharmacokinetics and hematologic toxicity of the epirubicin-docetaxel regimen in breast cancer patients.

PURPOSE: The aims of the present study were (1) to characterize the pharmacokinetics of both component drugs and (2) to describe the relationship between the pharmacokinetics and the dose-limiting hematologic toxicity for the epirubicin (EPI)/docetaxel (DTX) regimen in breast cancer patients. PATIENTS AND METHODS: Forty-four patients with advanced disease received EPI and DTX every 3 weeks for up to nine cycles. The initial doses (EPI/DTX) were 75/70 mg/m(2). Based on leukocyte (WBC) and platelet counts, the subsequent doses were, stepwise, either escalated (maximum, 120/100 mg/m(2)) or reduced (minimum, 40/50 mg/m(2)). Hematologic toxicity was monitored in all patients, whereas pharmacokinetics was studied in 16 patients. A semiphysiological model, including physiological parameters as well as drug-specific parameters, was used to describe the time course of WBC count following treatment. RESULTS: In the final pharmacokinetic model, interoccasion variability was estimated to be less than interindividual variability in the clearances for both drugs. The sum of the individual EPI and DTX areas under concentration-time curve correlated stronger to WBC survival fraction than did the corresponding sum of doses. A pharmacokinetic-pharmacodynamic (PK-PD) model with additive effects of EPI and DTX could adequately describe the data. CONCLUSION: The final PK-PD model might provide a tool for calculation of WBC time course, and hence, for prediction of nadir day and duration of leukopenia in breast cancer patients treated with the EPI/DTX regimen.     

Endoscopic treatment of malignant stenosis in home care

At our institute, we have tried to increase the patient's quality of life (QOL) by endoscopic stenting for upper intestinal stenosis due to malignant tumor, which could not be treated by surgery or chemotherapy. We report the endoscopic stenting and home therapy for those patients. The subjects were 44: (esophageal stenosis: 13 cases, biliary stenosis: 31 cases) out of 60 patients who had intestinal stenosis or obstruction, which could not be treated by surgery or chemotherapy. Esophageal stenosis was treated mainly by stenting and laser cautery, and biliary stenosis was treated by drainage using stenting. The home stay period, effective treat period, life survival period, and complications were analyzed in each case. It was found that the mean home stay period, mean effective treatment period, and mean life survival period were 3.4 months, 4.0 months, and 5.5 months, respectively, with esophageal stenosis, and 3.7 months, 4.4 months, 5.5 months with biliary stenosis. Mean home stay period/life survival period was 62% in cases of esophageal stenosis, and 67% in cases of biliary stenosis. Complications were observed in 40.0% of patients with esophageal stenting and in 12.5% with biliary stenting. Esophageal stenting showed a higher incidence of complications; however improvements in the stenting instrument will reduce the number of complications. Endoscopic stenting is thus effective for upper intestinal stenosis due to malignant tumor, especially in increasing the patient's QOL when curative therapy is not indicated, and the patient stays at home. We believe patients with uncurable malignant disease should have home treatment as early as possible.     

Gynecomastia due to hormone therapy for advanced prostate cancer: a report of ten surgically treated cases and a review of treatment options

AIMS AND BACKGROUND: Gynecomastia is an abnormal increase in the volume of the male breast that is generally considered to be due to an increased estrogen/androgen ratio. Pathological causes of gynecomastia include organic diseases and therapy, such as the administration of estrogens and antiandrogens, which alter the ratio of circulating hormones. Hormone therapy for prostate cancer is generally well tolerated but often accompanied by the occurrence of gynecomastia and breast pain or tenderness. The increased use of antiandrogens as monotherapy is leading to an increase in the number of patients affected by gynecomastia. Treatments are available to alleviate or prevent the development of gynecomastia, including medical treatment with antiestrogens and aromatase inhibitors. Alternatively, mastectomy with excision of the gland, liposuction or an association of the two techniques have proved to be effective. Radiation therapy may provide effective relief from the breast pain associated with gynecomastia. In this paper we show the good results of mastectomy performed with a lower semicircular periareolar incision in men suffering from gynecomastia due to antiandrogen therapy for inoperable prostate cancer. In addition, we present a review of the various techniques used for the treatment of gynecomastia. METHODS AND STUDY DESIGN: During the period from September 1998 to May 2001, 10 patients receiving hormone treatment for metastatic or inoperable prostatic cancer were selected for the study if they had breast pain and bilateral gynecomastia. Five of these patients had been offered prophylactic radiotherapy before treatment but refused, while the remaining five patients had refused radiotherapy after hormone treatment. These patients were therefore given the option of surgical treatment. Before surgery all patients underwent clinical and ultrasound examination of the breast. All surgical samples were examined histopathologically. During follow-up clinical examinations were carried out one week, one month, six months, one year and two years after surgery. RESULTS: The results were satisfactory in all patients especially from an aesthetic point of view. Moreover, breast pain disappeared about one week after surgery. After a follow-up of 6-36 months (average, 22.8 months) no recurrences were observed. Only a few immediate postoperative complications were recorded (hematoma in one case and seroma in another). Histological examination of the excised glands showed fibrosclerotic tissue and a small amount of fat. CONCLUSION: Surgical liposuction can be considered an effective treatment for gynecomastia, in particular in the very early stages because the breast becomes irreversibly fibrous as the disease progresses. This surgical technique is simple and effective and is therefore to be considered favorable, especially because of the very short hospitalization and the absence of complications.     

The role of interferon-alpha in the management of myelomatosis.

The data provided in the medical literature suggest that alpha-IFN is a useful agent in the management of myelomatosis. In particular, its combination with conventional induction therapies of previously untreated MM patients may improve the overall response rate and probably increase the number of complete responders. On the other hand, even though alpha-IFN alone, in some patients with previously untreated MM, may induce good objective responses, it certainly remains less effective than conventional chemotherapy. Moreover, in a small proportion of advanced MM patients, alpha-IFN alone has induced objective responses. It is therefore possible that alpha-IFN should be combined with other therapeutic modalities to improve the observed response rate in these patients. Finally, alpha-IFN maintenance treatment seems to be one of the most promising therapies for patients with myelomatosis. However, the achievement of a "true" plateau phase after the induction treatment is certainly necessary to permit alpha-IFN maintenance treatment to prolong the response duration. As for the prolongation of survival duration observed in the Italian study, it requires confirmation by the other ongoing randomized studies. In the future, a better understanding of the mechanisms of action of alpha-IFN, as well as the increasing use of other biologic response modifiers, will improve the therapeutic modalities utilized to treat myelomatosis and therefore lead to better control of this so-far-incurable disease.