强化治疗成人急性白血病的临床报告

对成人急性非淋巴细胞白血病(ANLL)和淋巴细胞白血病(ALL)分别用A(H)D和VDD(p) M方案等诱导治疗,并根据化疗后骨髓白血病细胞减少程度个别化调整,初治ANLL和ALL的完全缓解(CR)率分别为0.8和0.72。及早用含第二线抗白血病药物的方案巩固。中高剂量Ara-C和MTX和ABMT的14例中,11例至今持续CR(CCR)。本方案毒性较大,特别对骨髓抑制显著,强化支持和对症治疗是必要的。     

Remission induction of ANLL with low dose cytosine arabinoside combined with retinoic acid

Fourteen cases of acute non-lymphocytic leukemia (ANLL) were treated with low doses of cytosine arabinoside (LDAra-C 20 mg/m/q12h) and etretinate (all-trans-9-3, 7-dimethyl-2, 4, 6, 8 non-atetraenoate, 75 mg/d). Of which 9 were untreated, 3 were in first relapse and 2 were refractory patients. Five of the 9 patients in the first group, and all 3 patients in the second group achieved complete remission (CR). The 2 cases with refractory ANLL showed no response. The CR rates in untreated, first relapse and refractory patients were 55.6%, 100%, and 0% respectively. In all, there was significant reduction of marrow cellularity in 13 patients, 5 of whom developed bone marrow aplasia with predominantly lymphocyte and plasma cells. Only 2 cases with M5 ANLL showed evidence of differentiating into monocytes and neutrophil in hypocellular marrow phase. The efficacy of this drug combination, however, appeared to be achieved through cytotoxicity rather than differentiation. The side effects in the treated cases included cheilitis, dermatitis, fever, petechiae, and impaired liver function, which soon improved upon discontinuation or reduction of dosage. This combination treatment might be most effective in achieving remission among elderly and severely infected patients with ANLL, and could be appropriate even for patients in first relapse.     

三尖杉酯碱与阿糖胞苷联合诱导人白血病细胞分化的研究

小剂量三尖杉醋碱(LD-Harr)与小剂量阿糖胞苷(LD-Ara-c)联合治疗ANLL患者10例。在治疗期间,末梢血液和骨髓中原始细胞减少或消失时,伴有短暂的成熟中性粒细胞增多,且在其中见有Auer小体。新鲜分离ANLL患者的骨髓白血病细胞,加Harr和Ara-c进行液体培养后,白血病细胞分化为成熟的粒细胞,在其中也见有Auer小体。治疗结果,10例中有8例完全缓解,1例部分缓解,1例未缓解、副作用较轻。     

急性非淋巴细胞白血病过程细胞克隆的变化

18例未治或复发ANLL,2例慢粒急变及10例完全缓解(CR)的ANLL患者作L-CFU,CFU-E及CFU-GM骨髓体外造血祖细胞培养。ANLL未治和复发组的L-CFU、CFU-E及CFU-GM集落数与正常对照有非常显著差异。ANLL的CR组,CFU-E和CFU-GM恢复正常,但L-CFU仍较正常对照组明显多,提示CR后,骨髓中仍残留有白血病细胞。初步认为PHA-MNCCM作为L-CFU的生长因子,有助于CR后ANLL残留白血病细胞检测意义。     

Terminal deoxynucleotidyl transferase in various immunophenotypic cells in leukemia]

The staining results of terminal deoxynucleotidyl transferase (TdT) in leukemic cells of peripheral blood or bone marrow in 55 patients showed that 22 (40%) patients were found positive for TdT staining: 17 patients with acute lymphoblastic leukemia (ALL), 2 acute non-lymphocytic leukemia (ANLL) and 3 hybrid acute leukemia (HAL). The positive rate of ALL (17/21) was significantly higher than that of ANLL (2/21, P < 0.005). The leukemic cells of HLA-DR+CD19+TdT- were demonstrated to express some of myeloid restricted antigens (HI98, HIM 4, HIM 5) (3/3), which suggested that these cases were leukemias of myeloid origin. None of the 8 patients with M 0/M 1 ANLL was positively stained for the enzyme. Our results showed that TdT detection is of great value in the diagnosis and differentiation of both poorly differentiated and hybrid acute leukemia.     

Experimental study on induction of apoptosis of leukemic cells by Boswellia carterii Birdw extractive]

The purpose of the study was to investigate the apoptosis of leukemic cells induced by Boswellia Carterii Birdw(BCB). The target leukemia cell line HL60 and bone marrow leukemic cells from 30 acute non-lymphocytic leukemic(ANLL) patients (3 M1 11 M2a 10 M3 1 M4a 5 M5b) were studied. Apoptosis was detected by morphological observation, DNA electrophoresis, percentage of DNA fragmentation test and flow cytometric cell cycle analysis. It is concluded that BCB can induce apoptosis in ANLL cells and HL60 cells.     

原代白血病细胞survivin基因表达与化疗药物诱导凋亡敏感性关系

目的：探讨原代白血病细胞survivin基因表达与化疗药物诱导凋亡的敏感性关系。方法：RT—PCR方法检测初发ANLL细胞suntivin mRNA的表达。DNA片段原位末端标记(TUNEL)方法检测不同化疗药物体外诱导的白血病细胞凋亡。结果：原代ANLL细胞与HHT、AcLa、Ara—C孵育15h后，survivin mRNA阳性表达的ANLL细胞凋亡率低于阴性表达者。联用HHT Ara—C或AcLa Ara—C体外处理原代ANLL细胞15h后．survivin mRNA阳性表达的ANLL细胞凋亡率亦低于阴性表达者。且survivin mRNA阴性的ANLL患者骨髓缓解(BMR)率高于survivin mRNA阳性者((2／2)对(3／11))。结论：sunrvivin基因阳性表达的ANLL细胞对化疗药物诱导凋亡不敏感。     

乳香提取物诱导急性非淋巴细胞性白血病细胞凋亡的实验研究

目的：研究乳香提取物诱导急性非淋巴细胞性白血病细胞凋亡作用。方法：应用形态学观察、ＤＮＡ电泳、ＤＮＡ片段百分率、流式细胞仪分析检测白血病细胞凋亡。结果：乳香提取物能诱导急性非淋巴性白血病细胞凋亡。结论：乳香提取物具有诱导急非淋白血病细胞凋亡作用     

小剂量阿糖胞苷治疗急性粒细胞性白血病的疗效观察

用小量阿糖胞苷(Ara-C)治疗6例急性粒细胞性白血病,完全缓解率达50％。治疗剂量按10mg/M~2/12h,皮下或肌肉给药。15天为一疗程。临床观察表明本法副作用小,宜用于年龄较大或低增生型白血病及骨髓增殖异常综合征病例。治疗过程中可产生骨髓抑制。故小量Ara-C在体内可能主要是阻止白血病细胞增殖,同时似有诱导分化作用。     

自体造血干细胞移植治疗恶性血液病

目的　评价自体造血干细胞移植 (AHSCT)治疗恶性血液病的疗效。　方法　用 AHSCT治疗白血病及恶性淋巴瘤患者共 5 8例 ,年龄 31.9± 10 .5 (14～ 5 8)岁。其中急性非淋巴细胞白血病 (ANL L ) 30例 (CR1 2 4例 ,CR2 5例 ,CR31例 ) ,急性淋巴细胞白血病 (AL L ) 18例 (CR1 13例 ,CR2 3例 ,CR32例 ) ,慢性粒细胞白血病 (CML ) 3例 (均获血液学缓解 ) ,恶性淋巴瘤 7例 (CR4例 ,PR3例 )。预处理化疗方案选用以下药物中任意两种或三种联合 :阿糖胞苷 3～ 4g/ m2 ,环磷酰胺 4～ 6 g/ m2 ,鬼臼乙叉苷 (VP- 16 ) 0 .5～ 1.0 g/ m2 。除 5例联合全身骨髓照射 (剂量为7～ 8Gy) ,其余均单用化疗。　结果　所有患者移植后均重建造血 ,移植相关死亡 1例 (1.72 % )。ANL L、AL L CR1期移植者 3年无病生存率分别为 5 2 .4%± 4.2 %和 46 .1%± 3.5 % ,复发率分别为 37.7%± 4.5 %和 40 .5 %±6 .7%。 10例 CML 和恶性淋巴瘤患者中 ,除 1例 期恶性淋巴瘤患者复发 ,余均获持续完全缓解。　结论　为降低白血病和恶性淋巴瘤的复发率 ,提高患者的无病生存期 ,无造血干细胞供者的 CR1 期白血病及恶性淋巴瘤患者应积极行 AHSCT。