盐酸戊乙奎醚及阿托品治疗急性有机磷农药中毒效果的Meta分析

目的评价我国文献报道的盐酸戊乙奎醚与阿托品治疗急性有机磷农药中毒（acuteorganophosphoruspes-ticidepoisoning,AOPP）的效果及安全性。方法检索维普中文科技期刊、万方医学数据库、中国知网2000年1月-2010年12月收录的文献中有关盐酸戊乙奎醚与阿托品治疗AOPP效果的比较研究,以Peter等的文献质量评价系统对纳入文献进行质量评价,采用RevMen5．0软件进行Meta分析。结果共纳入6篇文献480例,试验组（采用盐酸戊乙奎醚治疗）229例,对照组（采用阿托品治疗）251例。6篇文献均为中、高质量文献,基线资料比较无显著差异。Meta分析结果显示试验组治愈率较对照组高14％[RR：1．14,95％CI（1．08,1．20）,P〈0．00001],平均住院时间较对照组缩短4．45d[MD=-4．45,95％CI（-6．56,-2．35）,P〈0．0001],不良反应发生率较对照组降低92％[RR=0．08,95％CI（0．04,0．15）,P〈0．00001]。结论从现有临床证据看,盐酸戊乙奎醚治疗AOPP效果较阿托品好,但由于可供分析的样本量有限,尚需更多大宗病例的随机临床对照试验结果进一步验证。     

盐酸戊乙奎醚救治急性有机磷农药中毒

目的探讨长托宁(盐酸戊乙奎醚注射液)在救治有机磷农药中毒中的作用和优点。方法随机将56例口服有机磷农药中毒患者分为对照组和治疗组,对照组给予阿托品和氯磷定治疗;治疗组给予长托宁和氯磷定治疗。结果与对照组相比,长托宁组阿托品化时间、胆碱酯酶恢复时间、总治愈率、平均住院天数,均优于阿托品组。两组比较有显著差异。且长托宁组不良反应发生率低,症状少,发生后易恢复或纠正。结论长托宁治疗有机磷农药中毒明显优于阿托品,值得临床推广应用。     

42例急性有机磷中毒抢救的临床体会

目的总结急性有机磷中毒抢救的方法。方法对42例有机磷中毒患者进行持续微量泵泵入阿托品,严格观察使之阿托品化,防止出现阿托品过量以及阿托品中毒。结果 42例病例除5例死亡外,其余病例均经治疗后好转出院,治愈率88.10%。患者达到阿托品化的平均时间为(138.5±38.2)min,阿托品化需药量(78.3±6.8)mg。出现阿托品过量及中毒2例(4.76%),出现病情反跳3例(7.14%),出现中间综合征者2例(4.76%)。结论在急性有机磷中毒的抢救中使用持续微量泵入阿托品,可以降低达到阿托品化的需药量,并且可以降低出现阿托品过量及中毒的风险。     

盐酸戊乙奎醚治疗重度有机磷中毒的疗效观察与护理

目的探讨采用新型选择性长效抗胆碱药物盐酸戊乙奎醚(长托宁对重度有机磷中毒救治的护理要点和方法。方法2002年11月~2007年6月收治的67例口服有机磷农药致重度中毒患者,以盐酸戊乙奎醚替代阿托品作为抗胆碱药物进行救治。以1998年6月~2001年1月期间以阿托品救治的45例重度有机磷毒物中毒者为对照组。结果对照组治愈率80%,病死率20%,中毒治疗平均8.3 d。盐酸戊乙奎醚组治愈率95.5%,病死率4.5%,中毒治疗平均9.6 d。盐酸戊乙奎醚组治愈率明显高于对照组,中毒治疗时间两组无显著差别。结论盐酸戊乙奎醚用于有机磷中毒能降低病死率,提高治愈率。而且它为长效制剂,用法用量较阿托品明显容易控制和掌握,可以取代阿托品作为常规抗胆碱类解毒剂使用。但护理观察时要注意与原"阿托品化"指标的区别。     

盐酸戊乙奎醚治疗重度有机磷中毒的疗效观察与护理

目的探讨采用新型选择性长效抗胆碱药物盐酸戊乙奎醚（长托宁对重度有机磷中毒救治的护理要点和方法。方法2002年11月--2007年6月收治的67例口服有机磷农药致重度中毒患者,以盐酸戊乙奎醚替代阿托品作为抗胆碱药物进行救治。以1998年6月～2001年1月期间以阿托品救治的45例重度有机磷毒物中毒者为对照组。结果对照组治愈率80％,病死率20％,中毒治疗平均8．3d。盐酸戊乙奎醚组治愈率95．5％,病死率4．5％,中毒治疗平均9．6d。盐酸戊乙奎醚组治愈率明显高于对照组,中毒治疗时间两组无显著差别。结论盐酸戊乙奎醚用于有机磷中毒能降低病死率,提高治愈率。而且它为长效制剂,用法用量较阿托品明显容易控制和掌握,可以取代阿托品作为常规抗胆碱类解毒剂使用。但护理观察时要注意与原“阿托品化”指标的区别。     

Salbutamol in acute organophosphorus insecticide poisoning – a pilotdose-response phase II study

Background: Treatment of acute organophosphorus (OP) insecticide poisoning is difficult, with many patients dying despite best care. Pre-clinical studies have shown benefit from salbutamol, possibly due speeding alveolar fluid clearance or reducing bronchoconstriction. In this small pilot dose-response study, we aimed to explore whether addition of nebulized salbutamol to standard care might improve resuscitation.

Methods: We performed a single-blind phase II study comparing the effect of two different doses of nebulized salbutamol versus saline placebo, in addition to standard treatment. Primary outcome was oxygen saturations over the first 60?min of resuscitation; secondary outcomes included heart rate, incidence of dysrhythmias, time to ‘atropinization’, atropine dose required, and mortality.

Result: Seventy-five patients were randomized to receive 5?mg (Salb5, n?=?25) or 2.5mg (Salb2.5, n?=?25) of salbutamol, or saline placebo (NoSalb, n?=?25), by nebulizer. Oxygen saturations did not differ between groups over the first 60?min of resuscitation (median AUC NoSalb: 1376 [95% CI 1282 to 1470], Salb2.5: 1395 [1305 to 1486], Salb5: 1233 [1100 to 1367]; p?=?.9898). Heart rate was also similar across the three arms. Median time to full atropinization, and atropine dose required, were the same for all three arms (NoSalb 15.0 [10–16] min and 12.6 [8.0–13.4] mg, Salb2.5 15.0 [10–16] min and 12.6 [9.3–16.8] mg, and Salb5 15.0 [10–20] min and 12.6 [10.7–20.6] mg; p?=?.4805 and p?=?.1871, respectively). Three (12%) patients died in the Salb2.5 and Salb5 groups and two (8%) in the NoSalb group.

Conclusion: This pilot study, within the limitations of its small size and variation between patients, found no apparent evidence that administration of nebulized salbutamol improved resuscitation of patients with acute OP insecticide self-poisoning. The data obtained provides a basis to design further studies to ultimately test the role of salbutamol in OP insecticide poisoning.     

Efficacy and outcomes of lipid resuscitation on organophosphate poisoning patients: A systematic review and meta-analysis

ObjectiveOrganophosphate (OP) pesticides are still widely available in developing countries, leading to numerous accidental or suicidal poisonings every year. Lipid emulsion treatments are commonly used in resuscitating OP poisoning patients but few studies regarding their use have been reported. Our meta-analysis aimed to analyze the efficacy and outcomes of lipid resuscitation on OP poisoning patients.MethodsA systematic search for associated studies was conducted in Pubmed, EMBASE, MEDLINE, the Cochrane Library and the Chinese National Knowledge Infrastructure. Collected data was pooled using Revman v5.3. Outcomes included prognosis (cured vs. mortality rates), hepatic function (serum ALT, AST, Total Bilirubin (TBIL) level), serum acetylcholinesterase (AchE) level and respiratory function (rate of respiratory muscular paralysis).ResultsSeven randomized controlled studies consisting of 630 patients meeting inclusion criteria were identified. Lipid emulsion helped to improve the cure rate [OR = 2.54, 95% CI (1.33, 4.86), p = 0.005] and lower the mortality rate [OR = 0.31, 95% CI (0.13, 0.74), p = 0.009]. Serum ALT, AST and TBIL in patients undergoing lipid resuscitation were lower than those in the control groups [ALT, SMD = ?1.52, 95% CI (?2.64, 0.40), p = 0.008; AST, SMD = ?1.66, 95% CI (?3.15, 0.16), p = 0.03; TBIL, SMD = ?1.26, 95% CI (?2.32, 0.20), p = 0.02]. Serum AchE level were increased in patients treated with lipid emulsion [SMD = 2.15, 95% CI (1.60, 2.71), p < 0.00001]. Rate of respiratory muscular paralysis was lower in patients undergoing lipid resuscitation than those in the control groups [OR = 0.19, 95% CI (0.05, 0.71), p = 0.01].ConclusionBased on our meta-analysis of included RCT reports, lipid resuscitation seems likely to help improve prognosis and liver function of OP poisoning patients. However, larger multi-center RCTs are still recommended.     

急性有机磷农药中毒阿托品用量探讨

目的探讨急性有机磷农药中毒（AOPP）时，阿托品用量对AOPP转归的影响。方法将中度中毒以上患者分成中度中毒组、重度中毒组及濒死组，观察三组中阿托品首剂量、阿托品化量、阿托品总量、阿托品过量例数及死亡率。再将重度中毒组及濒死纽中阿托品过量患者归为阿托品过量组，阿托品不过量者为阿托品适量纽，比较两纽中毒的时相发展、并发症及死亡率。结果阿托品化量及阿托品总量濒死组〉重度中毒组〉中度中毒组（P〈0．05）。阿托品过量组中的中间综合征（IMS）、中毒性心肌炎的发生率明显低于阿托品适量组（P〈0．05）。结论AOPP时，中毒程度不同，阿托品的用量也不同，阿托品化量及首剂量也不同。维持阿托品化时易致阿托品过量，但轻度阿托品过量不会增加开．亡率及并发症．     

长托宁替代阿托品救治急性有机磷中毒的临床研究

目的研究评价长托宁在治疗急性有机磷中毒(AOPP)中的疗效及安全性。方法选择我院收治的86例AOPP患者随机分为2组,其中治疗组使用长托宁(盐酸戊乙奎醚)治疗共40例,对照组采用阿托品治疗共46例,对M样症状消失时间、药物不良反应发生率、胆碱酯酶恢复60%时间等指标进行统计分析。结果M样症状消失时间治疗组为(2.8±1.7)h,对照组为(4.6±1.3)h;胆碱酯酶恢复60%时间治疗组为(2.3±2.8)d,对照组为(3.8±3.3)d;药物不良反应发生率治疗组为(7.4±4.1)%,对照组为(23.3±12)%,上述2组指标均存在显著差异。结论与阿托品相比长托宁具有症状消失快、心动过速等不良反应发生率低、缩短住院时间等特点,值得进一步临床推广应用。     

长托宁联合血液灌流在重度有机磷中毒救治中的疗效分析

目的探讨长托宁联合血液灌流救治重度有机磷中毒的治疗效果。方法选择2010年1月至2013年4月,重复应用长托宁、氯解磷定结合血液灌流的46例患者为治疗组;选择2008年1月至2009年12月重复应用阿托品、氯解磷定的21例患者为对照组,观察两组患者24h血清胆碱酯酶（CHE）水平、CHE恢复时间、治愈率及中间期肌无力综合征、肺部感染、呼吸衰竭等并发症情况。结果治疗组入院后24h血CHE水平降低（P〈0．05）,CHE恢复时间缩短（P〈0．05）,治愈率提高（P〈0．05）,中间期肌无力综合征、肺部感染、呼吸衰竭等并发症明显减少（P〈0．01或〈0．05）。结论应用长托宁联合血液灌流救治重度有机磷中毒,效果显著,值得推广应用。     

盐酸戊乙奎醚在急诊剖宫产术中的效果观察

目的对比观察急诊剖宫产术麻醉前使用盐酸戊乙奎醚与阿托品对产妇及新生儿的影响。方法100例急诊剖宫产术患者随机分成两组,即盐酸戊乙奎醚组(A组)和阿托品组(B组),术前分别静注盐酸戊乙奎醚和肌注阿托品,记录用药前、麻醉前、麻醉5min及10min、术毕时的血压(SBp)、DBp、心率(HR)、血氧饱和度(SpO2)及胎儿娩出后1min和5min的Apgar评分。结果A组HR在各时点均无明显变化,B组在麻醉前、麻醉后5min、10min的HR与用药前相比均不同程度增高,两组在SBp、DBp、SpO2及Apgar评分方面无统计学差异。结论盐酸戊乙奎醚用作急诊剖宫产的术前用药可保证产妇血流动力学稳定,对新生儿无不良影响,值得临床进一步推广使用。     

高压氧辅助治疗压力性损伤疗效的Meta分析

目的：评价高压氧辅助治疗压力性损伤的疗效。方法：检索CNKI、维普、万方数据库、PubMed、Web of Science、The Cochrane Library自建库到2020年12月使用高压氧辅助治疗压力性损伤的随机对照研究，由2名护理研究生进行文献筛选、信息提取及纳入文献的方法学质量评价，使用RevMan 5.4软件对筛选出的数据进行Meta分析。结果：纳入6项随机对照研究共321例患者，其中162例患者接受压力性损伤传统治疗，设为对照组。另159例患者在对照组治疗基础上联合高压氧治疗，为试验组。Meta分析结果显示，高压氧辅助传统治疗提高了压力性损伤的治愈率[RR=0.66，95%CI(0.55，0.80)，P<0.001]和总有效率[RR=0.20，95% CI(0.10,0.41)，P<0.001]，缩短了压力性损伤的愈合时间[SMD =-1.99，95% CI(-2.52，-1.47)，P<0.001]。结论：在压力性损伤治疗过程中，应用高压氧联合传统治疗比单纯的传统治疗的效果要显著。     

盐酸戊乙奎醚对罗库溴铵应用于麻醉诱导时效及恢复情况的影响

目的通过观察盐酸戊乙奎醚或阿托品对不同诱导剂量罗库溴铵的作用时效及恢复情况的影响,为罗库溴铵的临床应用及麻醉诱导气管插管剂量的选择提供一定的临床依据。方法选择全麻下行择期手术患者60例,随机分成三组。Ⅰ组：罗库溴铵2倍95%有效剂量（ED95）剂量组（0.6mg/kg）;Ⅱ组：罗库溴铵3倍ED95剂量组（0.9mg/kg）;Ⅲ组：罗库溴铵4倍ED95剂量组（1.2mg/kg）,每组20例。每组再根据两种不同的麻醉术前药随机分为长托宁组ⅠP组、ⅡP组、ⅢP组和阿托品组ⅠA组、ⅡA组、ⅢA组,每组各10例。ⅠP组、ⅡP组、ⅢP组入室后麻醉诱导前10min静注长托宁1.0mg,ⅠA组、ⅡA组、ⅢA组术前0.5h肌注阿托品0.5mg。记录给药后4个成串刺激（TOF）值、肌颤搐反应数、T1消失时间、最大抑制程度和TOF70%。结果肌松程度：ⅠP组与ⅠA组比较,ⅠP组的肌松程度,即TOF%衰减速率在45s、60s、75s、90s、105s及120s几个时间段显著增快（P〈0.01）。ⅡP组与ⅡA组比较,ⅡP组的TOF%衰减速率仅在45s时间段显著增快（P〈0.01）,余时间段差异无显著性。ⅠA组与ⅡA组比较,ⅠA组的TOF%衰减速率在45s、60s、75s和90s几个时间段的衰减显著较慢（P〈0.01）;气管插管条件：所有气管插管都一次完成,ⅠP组优秀为9例,良好为1例;ⅠA组优秀为6例,良好为4例,两组比较差异有显著性（P〈0.05）;恢复指数：ⅠP组的恢复指数较ⅠA组大,差异有显著性（P〈0.05）。ⅡP组的恢复指数较ⅡA组大,差异有显著性（P〈0.05）。TOF70%：ⅠP组TOF70%与ⅡP组和ⅢP组比较、ⅡP组和ⅢP组的TOF70%、ⅠA组的TOF70%与ⅡA组和ⅢA组比较及ⅡA组和ⅢA组的起效时间差异有显著性（P〈0.01）。结论盐酸戊乙奎醚可显著缩短2倍ED95诱导剂量的罗库溴铵的起效时间,并可延长罗库溴铵的恢复指数,即降低罗库溴铵的恢复速率。2倍ED95诱导剂量罗库溴铵合并术前药长托宁可在给药后60s获得满意的气管插管条件。3倍、4倍ED95诱导剂量罗库溴铵可在给药后45s获得满意的气管插管条件。     

长托宁联合阿托品氯磷定治疗急性有机磷农药中毒59例临床分析

目的:探讨长托宁联合阿托品、氯磷定抢救急性有机磷农药中毒(AOPP)患者的效果。方法:将2006年1月-2012年12月收治的AOPP患者118例随机分为对照组和观察组各59例,分别应用阿托品+氯磷定治疗和长托宁+和阿托品+氯磷定治疗,比较两组患者的胆碱酯酶(ChE)恢复时间、住院时间和病死率。结果:治疗组ChE恢复时间、住院时间和病死率均显著低于对照组(P0.05)。结论:长托宁联合阿托品、氯磷定治疗AOPP的疗效较阿托品、氯磷定好,且疗程短、病死率低。     

Clinical response and relapse in patients with chronic low back pain following osteopathic manual treatment: Results from the OSTEOPATHIC Trial

Clinical response and relapse following a regimen of osteopathic manual treatment (OMT) were assessed in patients with chronic low back pain (LBP) within the OSTEOPATHIC Trial, a randomized, double-blind, sham-controlled study. Initial clinical response and subsequent stability of response, including final response and relapse status at week 12, were determined in 186 patients with high baseline pain severity (≥50 mm on a 100-mm visual analogue scale). Substantial improvement in LBP, defined as 50% or greater pain reduction relative to baseline, was used to assess clinical response at weeks 1, 2, 4, 6, 8, and 12. Sixty-two (65%) patients in the OMT group attained an initial clinical response vs. 41 (45%) patients in the sham OMT group (risk ratio [RR], 1.45; 95% confidence interval [CI], 1.11–1.90). The median time to initial clinical response to OMT in these patients was 4 weeks. Among patients with an initial clinical response prior to week 12, 13 (24%) patients in the OMT group vs. 18 (51%) patients in the sham OMT group relapsed (RR, 0.47; 95% CI, 0.26–0.83). Overall, 49 (52%) patients in the OMT group attained or maintained a clinical response at week 12 vs. 23 (25%) patients in the sham OMT group (RR, 2.04; 95% CI, 1.36–3.05). The large effect size for short-term efficacy of OMT was driven by stable responders who did not relapse.     

宫腔镜检查前不同途径应用长托宁的临床观察

【目的】对比宫腔镜检查前不同途径应用长托宁的临床效果及安全性。【方法】将104例患者随机分为三组,A组：长托宁（O．01mg／kg）肌注组,B组：长托宁（0．01mg／kg）滴鼻组,C组：阿托品（0．5mg／人）肌注组。观察患者用药前、用药后（5min、10min、15min及60rain）的心率、血压、血氧饱和度、口干、瞳孔、面红的变化。【结果】用药5min后,A和B组血压无明显变化,C组血压明显增高,A、B组与C组相比有明显统计学差异。血氧饱和度各组无明显变化。用药15min后,A和B组心率无明显变化,C组心率增快,A与B组无明显差异,A、B组与C组相比有统计学差异。此外,三组均口干、腺体分泌减少;C组瞳孔增大较明显,A、B组无明显变化。【结论】长托宁对心率、血压无明显影响,麻醉术前用药安全、可靠,但对心率过缓者慎用,且长托宁滴鼻使用更为简便。     

机械通气联合血液灌流抢救急性重度有机磷农药中毒

目的:探讨机械通气联合血液灌流对急性重度有机磷农药中毒的临床疗效。方法:40例患者分为治疗组19例和对照组21例,对照组为机械通气和常规治疗,治疗组在对照组基础上联合血液灌流。观察两组机械通气时间、胆碱酯酶恢复正常所需时间、阿托品用量及多器官功能障碍综合征(MODS)、中间综合征(IMS)发生率和治愈率。结果:与对照组相比,治疗组治愈率明显提高、MODS及IMS发生率减少、机械通气时间和胆碱酯酶恢复正常所需时间明显缩短、阿托品用量明显减少(P<0.05或P<0.01)。结论:在常规治疗的基础上,机械通气联合血液灌流对急性重度有机磷农药中毒疗效显著。     

Evaluation of an internal guideline for the diagnostics of deep vein thrombosis]

BACKGROUND AND PURPOSE: In line with the application of evidence-based medicine as part of the day-to-day clinical practice of a community hospital internal guidelines concerning relevant diagnostic or therapeutic problems were developed. The authors retrospectively compared all data of patients with the tentative diagnosis of deep vein thrombosis (DVT), who underwent further diagnostics before and after implementation of an internally developed guideline for the diagnostics of DVT. The aim was to evaluate if the internal guideline was applied by the doctors in the daily routine and if the implementation led to a change and rationalization of the diagnostic process, in particular with regard to reducing invasive examinations. METHODS: In a retrospective controlled cohort study the medical records of in- and outpatients (n = 371) receiving further diagnostics following a tentative diagnosis of DVT were screened. The kind of examinations, the duration of the diagnostic process and the rate of hospitalization for DVT were compared between the intervention group (n = 185), treated in the initial 10 months following guideline implementation, and the control group (n = 186), treated in the 10 months prior to implementation. Furthermore, the physicians' compliance with the internal guideline was assessed. RESULTS: After implementation in 114 of 185 cases (62%) the treating doctors based their diagnostic procedure on the internal guideline. There was a significant decrease of phlebographies (45.4% vs. 74.2%; RR 0.61 [95% CI 0.51; 0.73]). By contrast, the number of D-dimer tests (81.6% vs. 33.3%; RR 2.45 [95% CI 1.98; 3.03]) and of duplex sonographies (42.2% vs. 21.5%; RR 1.96 [95% CI 1.42; 2.71]) increased significantly. A reduction of the hospitalization rate for further diagnostics of primary ambulant patients (51.3% vs. 60.4% of the tentative cases; RR 0.85 [95% CI 0.69; 1,04]) without a significant change in the final number of DVT diagnoses (33.3% vs. 27.6%; RR 0,83 [95% CI 0,61; 1,13]) was found. There was a slight increment in the mean length of diagnostic process (2.12 vs. 1.84 days). CONCLUSION: The implementation of an internal guideline for the diagnostics of DVT led to a significant reduction of the hospitalization rate and to a considerable change of the diagnostic procedure in favor of noninvasive diagnostic tests, for patients presenting with a diagnosis of suspected DVT.     

Interferon Alfa Versus Interferon Alfa Plus Cytarabine Combination Therapy for Chronic Myeloid Leukemia: A Meta-Analysis of Randomized Controlled Trials

Objective

This article compares the effect of interferon alfa plus cytarabine (IFN-alfa + Ara-C) versus IFN-alfa alone on the chronic phase of chronic myelogenous leukemia.

Methods

Electronic searches were performed in the Cochrane Central Register of Controlled Trials, PubMed, EMBASE, Chinese Biomedical Database, China Journal Full-text Database, and Chinese Scientific Journals Database. The languages were limited to Chinese and English. Randomized controlled trials were selected by 2 investigators. Analyses were performed using RevMan 5.0 software.

Results

A total of 3139 patients in 4 studies met the inclusion criteria. In those patients, complete hematologic response and cytogenetic responses showed significant improvements in favor of IFN-alfa + Ara-C, with complete hematologic response relative risk (RR) of 1.15 (95% CI, 1.09–1.21), complete cytogenetic response RR of 1.87 (95% CI, 1.47–2.38), partial cytogenetic response RR of 1.48 (95% CI, 1.25–1.75), and major cytogenetic response RR of 1.61 (95% CI, 1.42–1.83), respectively. The overall 3-year survival rate in the IFN-alfa + Ara-C group was 86% compared with 79% in the IFN-alfa group (RR = 1.09; 95% CI, 1.03–1.14). In the other 2 studies, 5-year overall survival was 69% compared with 63%, respectively (RR = 1.08; 95% CI, 1.01–1.15). However, IFN-alfa and Ara-C involved higher risk of hematologic toxicity, gastrointestinal adverse events, and severe mucositis compared with IFN-alfa monotherapy (RR = 2.63 [95% CI, 1.94–3.56); RR = 3.38 [95% CI, 2.28–5.00], and RR = 8.84 [95% CI, 3.82–20.46], respectively). Weight loss and skin rash were also observed more frequently in the combination treatment group (RR = 2.00 [95% CI, 1.47–2.73) and RR = 3.75 [95% CI, 2.13–6.59], respectively).

Conclusions

In patients with chronic myelogenous leukemia in the chronic phase, the combination of IFN-alfa + Ara-C demonstrated improved complete hematologic response, superior cytogenetic responses, and higher rates of 3- and 5-year survival than IFN-alfa alone. However, combination therapy is more likely to cause serious adverse effects. Well-designed studies will be required to determine the outcomes and adverse effects of the 2 drugs as treatment for patients with chronic myelogenous leukemia who cannot afford molecularly targeted drugs.