急性髓细胞白血病细胞遗传学的研究进展

急性髓细胞白血病(AML)的发病率占整个急性白血病的77%,染色体异常涉及到FAB的各型。染色体异常不仅有数量的改变,而且有结构的变化,二者可同时发生,也可单独存在,在白血病获得完全缓解(CR)后可消失,复发时再出现,甚至出现新的染色体改变。1　数目异常8号染色体三体性( 8)　是AML中最常见的染色体异常[1]。可单独或同时伴有另外的染色体异常。大约17%的M3患者初诊时有 8,同时伴有t(15;17)。 8并非只见于某一特定的FAB的亚型,但在M1、M2和M5中多见,应用荧光点杂交技术能提高检出率[2]。除 8外,在AML中4、11、13、21和22号染色体的三…     

急性淋巴细胞白血病治疗前后白血病细胞动态观察的临床意义

目的 对急性淋巴细胞白血病（ＡＬＬ）完全缓解期骨髓白血病细胞的临床意义进行较深入的研究。方法 对２７例ＡＬＬ患者治疗前后的骨髓进行细致的形态学分析，并对白血病细胞的消长进行跟踪研究。结果 诱导缓解结束后１５ｄ复查骨髓判断疗效较为准确。第１次确定完全缓解时骨髓白血病细胞比例与持续完全缓解时间呈负相关。缓解期白血病细胞比例轻度增高者如治疗及时，部分仍可恢复缓解。结论 对ＡＬＬ的完全缓解标准应从严掌握。     

急性淋巴细胞白血病治疗前后白血病细胞 动态观察的临床意义

目的：对急性淋巴细胞白血病（ＡＬＬ）完全缓解期骨髓白血病细胞的临床意义进行较深入的研究。方法：对２７ 例ＡＬＬ患者治疗前后的骨髓进行细致的形态学分析,并对白血病细胞的消长进行跟踪研究。结果：诱导缓解结束后１５ ｄ 复查骨髓判断疗效较为准确。第１ 次确定完全缓解时骨髓白血病细胞比例与持续完全缓解时间呈负相关。缓解期白血病细胞比例轻度增高者如治疗及时,部分仍可恢复缓解。结论：对ＡＬＬ的完全缓解标准应从严掌握。原幼淋巴细胞达５％ ～２０％ 时,可判断为复发趋势。识别及监测缓解期骨髓白血病细胞对维持完全缓解、延长生存期有重要意义。     

DC细胞刺激γδ T细胞的抗白血病作用

目的：研究γδT细胞的体外生存期和抗白血病活性。方法：对外周血采集物用GM－CSF＋IL－4进行培养，使其分化和扩增为树突状细胞（dendritic cells,DC)，然后用DC和细胞因子IL－2刺激其CD4^ T细胞扩增后，协同DC共同刺激γδT细胞扩增，再与多种白血病细胞株进行混合培养，进而用MTT比色法研究抗白血病能力。结果：γδT细胞能在体外长期大量扩增，扩增的γδT细胞对多种白血病细胞株具有杀伤作用。结论：γδT细胞可望用于白血病的临床免疫治疗。     

急性髓细胞白血病细胞IL—2受体基因的研究

为研究髓细胞白血病（ＡＭＬ）细胞白介素－２受体（ＩＬ－２Ｒ）基因及ＩＬ－２在ＡＭＬ中的作用，用逆转录－聚合酶链反应（ＲＴ－ＰＣＲ）对４１例ＡＭＬ患者化疗前白血病细胞ＩＬ－２Ｒα ｍＲＮＡ和ＩＬ－２ＲβｍＲＮＡ进行检测，并对部分ＩＬ－２Ｒ基因阳性表达细胞用＾３Ｈ－ＴｄＲ掺入法测定其对重组人ＩＬ－２（ｒＨＩＬ－２）的反应。结果显示，ＡＭＬ组织ＩＬ－２Ｒα和ＩＬ－２β基因表达是一普遍现象，４１例中白血病     

31例急性非淋巴细胞白血病细胞DICKE法体外培养的观察

作者用Dicke法对31例急性非淋巴细胞白血病(ANLL)患者,治疗前的骨髓中白血病细胞进行体外培养。结果有集落生长者18例,平均生存期65d,无1例治疗后缓解;无集落生长者13例,平均生存期119.8d,其中经化疗二个疗程以上者6例,有4例完全缓解。作者认为,ANLL患者治疗前用Dicke法培养骨髓白血病细胞,观察有无集落生长,对预后判断有一定意义。     

急性白血病患者血清及头发中8种微量元素的研究

用原子吸收光谱技术测定30例急性白血病及配对30例健康人血清及头发中的Se、Z n、Ge、Cu、Co、V、Sr、Ti等8种微量元素.结果:急性白血病患者血清及头发中的Se、Zn、Ge、Co、V等的含量均明显低于对照组(P<0.01),而Cu、Sr则高于对照组,除头发Cu外,两组也有显著性差异(P<0.01).血清及头发Ti略高于对照组,但无统计学意义(P>0.05).急性白血病患者入院后死亡组与完全缓解(CR)组血清及头发中8种微量元素含量,除死亡组头发Cu高于CR组有显著意义(P<0.05)外,其余元素两组间均无差异,提示急性白血病患者体内微量元素改变对预后似无意义.     

Acute leukemia in adults: assessment of remission induction with combination chemotherapy by clinical and cell-culture criteria.

Remission induction was assessed by clinical and cell-culture criteria for 65 patients with acute myelogenous leukemia (AML), 11 patients with chronic myelogenous leukemia (CML) in blast crisis and 19 patients with acute lymphoblastic leukemia (ALL). Cyclophosphamide, cytosine arabinoside and vincristine (CAV) therapy resulted in complete remission in 23 of 50 previously untreated patients with AML and in 3 of the 11 patients with CML. Fourteen patients with ALL responded to vincristine-prednisone induction therapy and two to induction therapy with CAV. The median duration of survival of the responding patients was 2.2 years, compared with 4 months for the patients who did not respond to treatment. Granulopoietic colony formation, assessed by assay of colony-forming units dependent on colony-stimulating activity in culture (CFU-C), was abnormal in 37 of 42 bone marrow aspirates from patients with AML before treatement. CFU-C concentration increased when leukocyte-conditioned medium (LCM) was added to the cultures; 13 cultures had normal or elevated CFU-C concentration with LCM. Marrow cells of patients with ALL or CML in blast crisis demonstrated a similar pattern. Serial studies of marrow CFU-C concentration of 31 patients with AML demonstrated a change to a normal pattern with successful remission induction. Results of this study suggest that administration of purified LCM to leukemic patients might increase granulocyte production from potential but unstimulated granulopoietic precursors. This therapy would lessen the probability of death from infection during remission induction.     

不同血液病病人骨髓CFU-F的变化

本文主要利用体外细胞液体培养技术,对几种血液病病人骨髓CFU-F增殖能力及其对GM-CFU刺激作用等几方面进行检测。结果表明,MDS和巨幼红细胞型贫血病人骨髓CFU-F集落明显高于正常对照(P<0.01),且MDS病人骨髓CFU-F的变化与病情严重程度有密切关系;ALL病人骨髓CFU-F、GM-CFU集落数都明显低于正常对照(P<0.01),处于缓解状态的白血病病人CFU-F集落数明显高于未缓解者(P<0.01)。我们认为,并不是所有的血液病病人都有骨髓微环境的变化,但往往微环境的变化出现在严重及预后不佳者。     

高热体外净化骨髓白血病细胞的研究

利用台盼蓝拒染试验和祖细胞体外集落培养法对正常造血细胞和ＨＬ６０白血病细胞受热后的存活率做了观察，证实高热对白血病细胞具有选择性杀伤作用，并比较了两种方法所反映的存活率。     

Correlation between growth pattern in vitro and karyotype of bone marrow cells and prognosis in adult acute nonlymphocytic leukemia

Summary Growth pattern in vitro and karyotype of cultured bone marrow cells were studied in 31 patients with acute nonlymphocytic leukemia. Two different growth patterns were identified: cluster growth (pattern I), and no growth (pattern ll). Patients with growth pattern I had a significantly higher complete remission (CR) rate clinically than those with growth pattern I. A serial study of 23 patients during induction treatment showed three different patterns: (1) colony growth, (2) persistence of clusters, and (3) persistence of no growth. The prognosis of the patients with the first pattern was most favourable, 11 of 13 patients achieved CR on an average of 24 days after first detection of colony formation. The data from 152 cultures showed that the colony forming ability had a negative correlation with the percentage of marrow blasts. Karyotype analysis with G-banding technique was successfully performed in 26 patients, in 14 of whom abnormal clones were detected. There was no difference in CR rates between groups NN, A A and AN, although CR was more easily achieved in patients with t(8; 2l). No relationship was seen between growth pattern and karyotype.     

Bacille Calmette-Guérin as maintenance therapy for non-Hodgkin''s lymphoma.

Following complete remission of non-Hodgkin's lymphoma by chemotherapy, irradiation or both, 44 patients were studied to assess the value of bacille Calmette-Guérin (BCG) as maintenance therapy. Patients with stage LI, EI or EII disease were allocated at random to receive BCG or no further maintenance therapy, and those with stage LII, LIII, EIII or IV disease received BCG therapy or orally administered cyclophosphamide. BCG had no effect on the duration of remission or the overall survival from the time of randomization. However, after the first recurrence there was a significant improvement in survival in the patients who had received BCG maintenance therapy.     

急性白血病凝血与纤溶指标的临床观察

本文采用发色多肽底物法及常规出凝血试验方法,测定20例未治疗AL的BPC、TFA、PLG、PK、Fbg,FDP等凝血与纤溶指标,结果:AL组TFA、PLG、PK与正常对照组无显著差别,提示多数AL不伴纤溶系统的激活;但AL组FDP、Fbg升高较正常对照组相差非常显著。重度出血组纤溶活性较无出血组明显增强,提示纤溶亢进可能是重度出血的主要原因之一。3例AL各指标的动态观察结果为,AL病情缓解后,FDP、Fbg均呈下降趋势,提示FDP与Fbg动态测定对临床观察病情有一定帮助。     

Treatment of acute myeloblastic leukemia in adults: remission induction with a combination of cyclophosphamide, cytarabine and vincristine

A regimen of intravenous cyclophosphamide, cytarabine and vincristine, given over a four-day period and repeated every two to three weeks, was used to treat 33 patients with acute myeloblastic leukemia. Of the 30 evaluable patients 9/18 previously untreated patients achieved complete remission and two others marked improvement, and 4/12 previously treated patients achieved complete remission. Twelve of 16 patients under the median age of 38 responded while only 3/14 patients over this age responded. There was no difference in response between those with elevated muramidase levels and those with normal levels. Three patients developed a previously unrecognized syndorme of fever, malaise, rash and orbital suffusion. Cytarabine was probably responsible.

At least four courses of treatment are required before abandoning this regimen of therapy. Patients who achieve a complete remission and live for more than 150 days spend about 25% of their total survival time from diagnosis in hospital.

     

血小板数量的动态变化在预测急性髓系白血病诱导化疗后完全缓解中的意义

目的研究血小板（platelet,PLT）数量变化在预测急性髓系白血病患者完全缓解中的意义。方法回顾性分析58例接受诱导化疗的急性髓系白血病患者（其中初诊患者49例,再诱导9例）在接受化疗后PLT水平的动态变化。以血常规、骨髓细胞学等检查作为评估患者完全缓解的依据。分析PLT数量在化疗后回升的时间及数量的动态变化和完全缓解的相关性。结果在骨髓恢复早期,38例达完全缓解的患者中,36例达完全缓解患者PLT〉20×10^9／L;而20例未达到完全缓解患者中,仅3例PLT〉20×10^9/L（P〈0．05）;其中,16例达完全缓解患者PLT〉50×10^9／L,未达完全缓解组均未〉50×10^9／L（P〈0．05）。通过动态监测化疗前后PLT的变化,在骨髓功能恢复早期以及完全恢复期,完全缓解组38例患者的PLT计数均明显高于未缓解组20例患者的PLT计数（P〈0．05）。结论PLT数量的动态变化对于预测急性髓系白血病造血功能恢复和完全缓解有重要的意义。