硼替佐米序贯自体造血干细胞移植治疗多发性骨髓瘤的临床研究

目的探讨硼替佐米(bortezomib)应用于多发性骨髓瘤(MM)患者化疗缓解或部分缓解后行自体外周血造血干细胞移植(APBSCT)的可行性和疗效。方法 8例患者根据年龄及全身状态选择采用硼替佐米联合地塞米松(VD)或硼替佐米联合吡喃阿霉素和地塞米松(VTD)方案进行移植前化疗。疗程第1、4、8、11天给予硼替佐米1.3 mg/m2静脉注射。VD或VTD方案化疗4~6个疗程后,达到完全缓解(CR)、非常好的部分缓解(VGPR)或部分缓解(PR),随后行APBSCT,采用粒细胞集落刺激因子(G-CSF)动员。预处理方案为硼替佐米+马法兰。移植后以硼替佐米+沙利度胺维持。结果所有患者在移植前均达到CR、VGPR或PR,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。移植后采用硼替佐米+沙利度胺维持,随访8~68个月,死亡2例,其余患者均无病生存。结论 VD或VTD用于MM患者的治疗达VGPR、CR或PR后,进行APBSCT可行,为MM提供了一种新的治疗方案。移植后给予硼替佐米+沙利度胺维持治疗可延长患者无病生存时间。     

儿童化疗方案加甲磺酸伊马替尼治疗Bcr-abl融合基因阳性的成人急性淋巴细胞性白血病

目的分析儿童化疗方案加甲磺酸伊马替尼治疗成人bcr／abl融合基因阳性急性淋巴细胞白血病（ALL）患者的缓解率及长期生存状态。方法10例患者,中位年龄30岁（19-71岁）岁,经MICM分型确诊为bcr-abl阳性ALL。均予BFM90方案化疗加甲磺酸伊马替尼治疗。结果所有患者均获得完全缓解,中位随访时间为20月（4-24月）,6例患者持续CR。3例获得完全的细胞遗传学缓解。结论化疗方案加甲磺酸伊马替尼可以明显提高bcr／abl融合基因阳性ALL患者预后。     

微粒-TACE联合伊马替尼治疗进展期胃肠道间质瘤肝转移临床疗效观察

【摘要】 目的 评估应用明胶海绵微粒TACE（GSM-TACE）联合伊马替尼治疗进展期胃肠道间质瘤（GIST）肝转移的临床疗效及安全性 方法 2013年1月—2019年1月收治9例不能外科手术的胃肠道间质瘤肝转移患者,规律服用伊马替尼治疗进展后,选用GSMs-TACE联合伊马替尼治疗,对患者的临床资料,CT随访结果,介入治疗的并发症及预后等情况进行总结和分析。术后采用改良实体瘤评价标准（mRECIST）标准评估疗效,术后每月随访1次。结果 9例GIST肝转移均为接受伊马替尼治疗6～30个月进展的患者,且无外科根治性手术指征;9例患者共接受17次GSM-TACE治疗;根据mRECIST评价标准,完全缓解（CR）4例,部分缓解（PR）5例;中位生存时间（24±4.4）个月;无肝脓肿形成,未发生与介入相关的严重并发症。结论 GMS-TACE联合伊马替尼治疗胃肠道间质瘤肝转移是一种安全的、有效的治疗方法。     

酪氨酸激酶抑制剂治疗慢性粒细胞白血病的研究进展

伊马替尼已作为一线选择治疗慢性期CML,可以使大多数患者取得完全血液学的缓解和细胞遗传学缓解。大多数慢性期CML伊马替尼抑制患者治疗缓解后,转换用新的酪氨酸激酶抑制剂：达沙替尼和尼罗替尼。第二代酪氨酸激酶抑制剂达沙替尼,尼罗替尼对BCR／ABL融合基因（Bcr／Ablfusiongene）具有更强的抑制作用,并能够克服BCR／ABL激酶变异而产生的耐药（T315I变异除外）。通过伊马替尼预处理和尼罗替尼治疗CML病人,进行外周血造血干细胞移植。本文就此方面的研究进展作一综述。     

舒尼替尼治疗伊马替尼耐药晚期胃间质瘤9例

目的观察舒尼替尼治疗伊马替尼耐药晚期胃间质瘤的疗效及副作用。方法本组采用自身治疗前后对照,选择经胃镜、手术及病理证实为晚期胃间质瘤的患者9例,CT检查:7例肝转移、2例胰腺转移,9例均行姑息切除,术后使用伊马替尼400 mg/d口服,治疗6个月无效;而后改为舒尼替尼连续治疗37.5 mg1次/d,口服,每阶段治疗4周,停药2周;每阶段结束后复查血常规,肝肾功能,甲状腺功能,心电图,腹部CT,评价疗效及副作用。结果 9例患者舒尼替尼中位治疗时间为166周。按Choi标准进行疗效评估,获CR0例(0%),PR2例(22.2%),SD4例(44.4%),PD 3例(33.3%);客观有效率22.2%,疾病控制率为66.7%;治疗期间的主要不良反应有:恶心3例(33.3%)、疲乏4例(44.4%)、中性粒细胞减少2例(22.2%)。结论舒尼替尼治疗伊马替尼耐药胃间质瘤有较好疗效,副作用较少。     

利妥昔单抗免疫化疗联合自体外周血干细胞移植治疗CD20+B细胞性非霍奇金淋巴瘤的临床研究

目的 分析和探讨利妥昔单抗联合自体外周血造血干细胞移植(APBSCT)序贯维持治疗对CD20+B细胞非霍奇金淋巴瘤(NHL)的疗效.方法 搜集2005年1月—2011年1月诊断为侵袭性和(或)难治复发性CD20+B细胞NHL并接受APBSCT治疗的60例患者的临床资料.分为2组:治疗组(n=25),APBSCT前应用利妥昔单抗3～4次,采集自体干细胞前1d加用利妥昔单抗治疗1次(375mg/m2)体内净化干细胞,移植后每3～6个月应用利妥昔单抗联合白细胞介素-2(100万U/次,缓慢静滴)维持治疗3～4次;对照组35例,除未用利妥昔单抗以外,其他处理与治疗组相同.结果 利妥昔单抗在移植前、干细胞采集前及移植后巩固治疗中均未发现明显不良反应.治疗组和对照组采集单个核细胞数分别为(8.2±2.9)×108/kg和(8.4±3.9)×108/kg(P=0.822),CD34+细胞数分别为(12.3±12.7)×106/kg和(13.2±13.9)×106/kg(P=0.799).治疗组均顺利完成造血重建,对照组3例造血重建失败.两组中性粒细胞恢复时间和血小板恢复时间差异无统计学意义.移植后所有病例均达完全缓解(CR),中位随访22(2 ～ 81)个月,治疗组2例复发,对照组6例复发.治疗组3年总体生存率有高于对照组的趋势(91.6％ vs 69.5％,P=0.060).结论 侵袭性和(或)难治复发性CD20+B细胞NHL患者APBSCT前后应用利妥昔单抗不影响造血干细胞的采集和造血重建,且有望提高治疗效果、改善总体生存.     

伊马替尼新辅助治疗联合手术对中晚期胃肠道间质瘤的疗效观察(附92例报告)

目的 探讨伊马替尼及手术联合治疗中晚期胃肠道间质瘤的临床疗效.方法 回顾性分析解放军309医院2007年1月-2012年1月收治的92例中晚期胃肠道间质瘤患者的临床资料.其中男57例,女35例,年龄21～ 85岁,病程1个月～2.5年.病变位于胃41例,空肠11例,回肠9例,结肠17例,直肠14例.伊马替尼新辅助治疗方案为400mg/d口服,连用3～9个月.按Choi疗效评价标准评价客观疗效并观察不良反应.结果 92例患者获随访,随访时间9～50个月,其中完全缓解(CR)2例,部分缓解(PR)45例,稳定(SD)31例,进展(PD)14例,死亡6例.临床有效率(CR+PR)为51.1％(47/92),疾病控制率(CR+PR+SD)为84.6％(78/92).不良反应主要为不同程度的颜面部和下肢水肿、恶心呕吐等胃肠道反应以及白细胞减少等血液反应.新辅助治疗后54例患者进行了手术,手术切除率为58.7％(54/92).92例患者的1年生存率为100％,3年生存率为93.4％.结论 伊马替尼新辅助治疗对中晚期胃肠间质瘤的疗效较好,可延长患者生命,提高手术切除率,且不良反应较小,患者能长期耐受.     

原发胃弥漫大B细胞淋巴瘤合并急性髓系白血病1例报道及文献复习

目的 报道1例原发胃弥漫大B细胞淋巴瘤合并急性髓系白血病患者,提高对该类疾病诊治及预后的认识.方法 回顾性分析该例患者的诊治经过,并复习相关文献.结果 该患者经胃镜及病理活检确诊为胃弥漫大B细胞淋巴瘤,经骨髓涂片、免疫分型、基因检测等确诊合并急性髓系白血病,给予含利妥昔单抗并兼顾髓系淋系的联合化疗治疗,病情短暂缓解,因感染失去移植机会.之后患者急性白血病复发,且bcr/abl基因阳性,加用伊马替尼等酪氨酸激酶抑制剂治疗,终因衰竭死亡.结论 原发胃弥漫大B细胞淋巴瘤合并急性髓系白血病非常少见,无标准治疗方案,疗效较差,部分患者可因异基因造血干细胞移植受益.     

儿童慢性髓细胞白血病的临床特征及治疗方法分析

目的 探讨儿童慢性髓细胞白血病(CCMIL)的临床特征,包括疾病的病因及发病情况、临床特点、诊断标准、预后和治疗策略等.方法 结合本院1例CCML患者的病例资料,复习并分析了近20年国内外相关文献(共148例).结果 CCML是一种少见的儿童获得性造血干细胞恶性克隆增殖性疾病,分为成人型和幼年型,以成人型为主(占72.3%),其病因不明.临床表现以乏力、低热、贫血、肝脾及淋巴结肿大为主要特点;典型儿童慢性髓细胞白血病的实验室特点有白细胞计数高、嗜酸和嗜碱性粒细胞增多、骨髓不同阶段髓细胞分化和巨核细胞增多;免疫组化提示CD68( ),髓过氧化物酶( ),中性粒细胞碱性磷酸酶(NAP)积分明显减低,Ph染色体或BCR/ABL融合基因阳性,而幼年型CCML的Ph染色体常为阴性.传统的治疗方法疗效较甲磺酸伊马替尼(格列卫)及造血干细胞移植的疗效差.结论 CCML有其自身的临床特征,早期诊断及治疗是关键,格列卫联合造血干细胞移植是目前最佳的治疗方法.     

自体外周血干细胞移植联合自体骨髓移植治疗恶性血液病61例临床分析

目的　总结分析自体外周血干细胞移植 (APBSCT)联合自体骨髓移植 (ABMT)治疗恶性血液病的经验。方法　APBSCT联合ABMT治疗恶性血液病患者 6 1例 ,其中急性髓系白血病 (AML) 2 0例 ,急性淋巴细胞白血病 (ALL) 2 4例 ,非霍奇金淋巴瘤 (NHL) 17例。结果　AML ,ALL ,NHL组的 3年及 5年无病生存率分别为 (6 3.2± 10 .6 ) % ,(5 4.6±10 .3) % ;(32 .8± 12 .5 ) % ,(15 .4± 12 .4) % ;(75 .4± 11.3) % ,(73.2± 11.5 ) %。移植后造血重建时间 ,WBC恢复至 >0 .5× 10 9/L时中位天数 +12 .0d ,WBC >1.5× 10 9/L时中位天数 +14.0d。PLT最低降至 <30× 10 9/L者当恢复 >30× 10 9/L时的中位天数 +17.5d。全部患者移植相关死亡率为零。 6 1例中至今死亡 14例 ,皆死于复发 ,主要为ALL患者。移植相关并发症以发热、肝功能受损最常见。结论　APBSCT联合ABMT治疗恶性血液病的疗效优于常规化疗。     

Management of malignant melanoma: a retrospective analysis of 182 patients

The records of 182 patients, referred to the Regional Radiotherapy Centre, Newcastle upon Tyne between January 1975 and December 1980, have been reviewed to evaluate the results of different modes of treatment. Fifty-two patients were managed for Stage 1, 83 for Stage 2 and 47 for Stage 3 disease. Fifty-seven patients with 95 sites of disease were given chemotherapy. The overall response rate was 35% (complete response (CR) 14%, partial response (PR) 21%) (median duration of remission = 4 months). Sixty-three patients with 74 sites of disease were treated by radiotherapy. The overall response rate was 73% (CR 47%, PR 26%) (median duration of remission = 7 months). In Stage 2 disease, no significant difference in the disease-free or overall survival was found between four different treatment groups. In disseminated disease, chemotherapy had little impact on the survival of patients with visceral metastases, while those with skin and lymph node metastases had significantly better survival. Radiotherapy was tolerated better and had lower morbidity than chemotherapy. The role of both modes in the management of advanced disease is discussed.     

早期白血病细胞清除与成人急性淋巴细胞白血病

目的 探讨早期白血病细胞清除在成人急性淋巴细胞白血病中的临床意义.方法 45例成人急性淋巴细胞白血病患者以长春新碱、柔红霉素、环磷酰胺、泼尼松及左旋门冬酰胺酶方案诱导化疗,评估第15～21天期间骨髓白血病细胞比例,以白血病细胞占骨髓有核细胞5%以下作为早期白血病细胞清除标准,统计分析早期白血病细胞清除与成人急性淋巴细胞白血病临床结局的关系.结果 病例随访时间1～61个月,中位随访时间9个月.获得早期白血病细胞清除的病例占总数的57.8%,与性别无关(P=1.0),但年龄大不利于早期白血病细胞清除(P=0.0419).化疗后早期骨髓抑制有利于早期白血病细胞清除(P=0.018).早期白血病细胞清除与4周内完全缓解密切相关(P=0.000).未获早期白血病细胞清除者,几乎不可能达4周内完全缓解,这些病例4周以后获完全缓解的比例也不高(52.7%).早期白血病细胞清除组的总生存时间长于对照组(P=0.0076).但早期白血病细胞清除者的完全缓解持续时间、复发率、无病生存率、总生存率(1、2年)与未获早期白血病细胞清除者均无显著差异(P＞0.05).结论 早期白血病细胞清除是成人急性淋巴细胞白血病又一个有利的预后指标.     

Combined chemotherapeutic and radiotherapeutic treatment of limited pulmonary microcytoma

Between 1978 and 1983, 34 patients (32 evaluable) suffering from limited small cell lung carcinoma (SCLC-L) were treated following the protocol polychemotherapy (CAV) plus thoracic cobalt teletherapy and "precautionary" cranial irradiation (30 Gy in 2 weeks). Minimum follow-up was 30 months. After induction chemotherapy there was complete remission (CR) in 20% of cases whereas at the end of induction chemo-radiotherapy there was complete remission (CR) in 44% (p less than 0.05) of cases. Median duration of the responds was 12 months. Total median survival is 15 months, median NED survival 32 months (6-90 months). Seven out of 14 CR patients received consolidated thoracic radiotherapy (Rt); 6 of these survived disease-free for over 2 years. No salvage therapy carried out has proved useful. Only in one patient (3%) brain metastasis occurred. Iatrogenic toxicity was also kept within limits of brain level. The role Rt plays in increasing the CR percentage, in drastically diminishing the incidence of brain metastasis, in improving the quality of life by increasing the disease-free interval must be emphasized. Finally it should be noted that only CR patients have the possibility to become "long survivors".     

吉西他滨、顺铂双路径用药联合125Ⅰ粒子植入治疗Ⅲ期非小细胞肺癌的临床对照研究

目的 探讨吉西他滨、顺铂双路径用药联合125I粒子植入治疗Ⅲ期非小细胞肺癌的价值.方法 60例Ⅲ期非小细胞肺癌患者应用随机数字表法随机分为两组.A组(血管介入组)30例,第1天采用Seldinger法插管进行支气管动脉化疗灌注.用药剂量:吉西他滨1000 mg/m2;顺铂100 mg/m2,第1天灌注时取总量的1/3.余量顺铂于第2天和第3大静脉滴注.第8天吉西他滨1000 mg/m2静脉滴注,21 d为1个疗程.B组(血管介入+125I粒子植入组)30例,双路径用药同A组,于动脉灌注后第10天行局麻下125I粒子植入术,21 d为1个疗程.两组均至少完成2个疗程评价.患者治疗后的影像评价标准为完全缓解(CR)、部分缓解(PR)、稳定(SD)、进展(PD).有效率为(CR+PR)/30,临床获益率为(CR+PR+SD)/30.采用非参数秩和检验比较A、B组的近期疗效(治疗2个疗程),x2检验比较年生存率,Kaplan-Meier法计算中位生存期、log-rank法检验组间中位生存期差异.结果 近期疗效.A组:PR 17例,SD稳定9例,PD 4例,有效率为56.7%(17/30),临床获益率为86.7%(26/30);B组:CR 2例,PR 21例,SD 7例,有效率为76.7%(23/30),临床获益率为100%(30/30).B组效果优于A组,差异有统计学意义(P=0.036).1年生存率B组(76.7%,23/30)高于A组(46.7%,14/30),差异有统计学意义(P=0.017).2年生存率B组(63.3%,19/30)高于A组(36.7%,11/30),差开有统计学意义(P=0.039).B组中位生存期(27个月)高于A组(10个月),组间差异有统计学意义(P=0.006).结论 吉西他滨、顺铂双路径用药联合125I粒子植入治疗Ⅲ期非小细胞肺癌的疗效明显优于单纯同方案双路径用药的疗效.

Abstract：

Objective To assess the therapeutic effect of combination chemotherapy of gemcitabine and cisplatin by double way plus implantation of radioactive seed 125I implantation in treating stage Ⅲ non-small cell lung cancer. Methods Sixty cases with stage Ⅲ non-small cell lung cancer were randomly divided into two groups with random number table. In group A (in interventional treatment group, n = 30),the gemcitabine 1000 mg/m2 and one third of the cisplatin 100 mg/m2 was given using seldinger technique for transcatheter bronchial arterial infusion chemotherapy on day 1. Two-thirds of the cisplatin 100 mg/m2 was infused in veins on day 2 and 3. The gemcitabine 1000 mg/m2 was infused in veins on day 8, 21 days for a period. In group B (interventional - 125I groups), the method of combination chemotherapy of gemcitabine and cisplatin was the same as in Group A. After ten days of arterial perfusion, 125I seeds were implantated, 21 days for a period. All patients received at least 2 cycles. The imaging evaluation of patients after treatment standards included complete remission (CR), partial remission (PR), stable (SD),progressive disease (PD), effective rate (CR + PR)/30 and clinical benefit rate (CR + PR + SD)/30.Non-parametric rank sum test was used to compare short-term effect of the two groups treatment of two cycles.x2 test was used to compare year survival, Kaplan-Meier method was used to calculate median survival,log-rank test method was used to difference between the groups. Results In group A, there were 17 PR,9SD and 4 PD. The overall response rate was 56. 7% (17/30) and clinical beneficial rate was 86. 7% (26/30). In Group B, there were 2 CR, 21 PR, 7 SD. The overall response rate was 76.7% (23/30) and clinical beneficial rate was 100% (30/30). There was significant difference between the two groups (P =0. 036). In group A, the 1 year survival rate was 46. 7% (14/30) and the 2 year survival rate was 36. 7%(11/30), median survival time (MST) was 10 months . In group B, the 1 year survival rate was 76. 7%(23/30) and the 2 year survival rate was 63. 3% (19/30) , median survival time (MST) was 27 months.There was a significant difference between two group in 1 year survival rate (P = 0. 017), 2 year survival rate (P = 0. 039) and median survival time (P = 0. 006). Conclusion The treatment effects of Ⅲ stage non-small cell lung cancer by gemcitabine and cisplatin combination chemotherapy with double way plus radioactive seed 125I implantation was better than gemcitabine and cisplatin combination chemotherapy with double way.     

Treatment of neuroblastoma: role of total body irradiation

Advanced neuroblastoma, scarcely responsive to conventional therapies, can take advantage of high dose chemio-radiotherapic treatment followed by bone marrow transplant. Nineteen young patients underwent an ablative chemotherapy with high dose Vincristine and Melphalan plus Total Body Irradiation in Genoa, Italy; all of them underwent autologous bone marrow transplantation. Fourteen children were in complete remission (CR), 5 had residual disease. Thirteen are alive after a median of 7 months following transplant; 9 are in CR; 4 have disease; 1 died for toxicity; 5 for relapse. The results seem to suggest that ablative therapy should be given to patients in CR. Toxicity was not remarkable mainly as far as TBI is concerned.     

MR imaging of the brain in patients cured of acute lymphoblastic leukemia--the value of gradient echo imaging

BACKGROUND AND PURPOSE: Hemosiderin and white matter lesions are 2 of the most common neurologic complications found on MR imaging that may be related to cranial irradiation and intrathecal methotrexate (MTX) therapy in childhood acute lymphoblastic leukemia (ALL). We evaluated the brains of patients previously treated for ALL with cranial irradiation and intrathecal MTX with MR imaging and tested the hypothesis that these patients have more MR evidence of central nervous system (CNS) injury than control patients who are in complete remission following systemic chemotherapy without cranial irradiation. METHODS AND MATERIALS: ALL patients recruited from a pediatric cancer center data base were examined at 1.5T by using T1-weighted, T2-weighted, gradient echo (GE), and fluid-attenuated inversion recovery sequences. Patients treated in childhood for solid extracranial neoplasms were used as controls. RESULTS: Lesions consistent with old hemorrhage were detected in 23 (55%) of the ALL patients and in none of the control patients (P <.001). Of the 62 hemorrhages detected on the GE images, only 9 (15%) were shown on T2-weighted images. White matter abnormalities were found in 2 ALL patients (5%) and one control patient (5%). Old infarcts were seen in 2 ALL patients (10%). CONCLUSION: Cerebral hemorrhages related to radiation-induced vascular malformations, most of which are asymptomatic, are much more common in survivors of childhood ALL than previously thought. GE sequencing is more sensitive in detecting hemorrhagic lesions than T2-weighted sequencing and is to be included in imaging protocols for follow-up study of patients after cerebral radiation therapy.     

Treatment of non-small-cell bronchial carcinoma with cisplatin, ifosfamide, vindesine and VP 16

Hitherto, the objective of chemotherapy in case of the non-small cell bronchial carcinoma is only of a palliative nature. Thus a critical indication is necessary. This is confirmed by our investigations with the combinations of cis-platinum and ifosfamide (80 patients, remission rate 35%, median survival time of patients with remission 11,5 months), cis-platinum and vindesine (29 patients, remission rate 28%, median survival time of patients with remission 14,5 months), and ifosfamide and vepeside (63 patients, remission rate 27%, median survival time of patients with remission 12 months). The combination ifosfamide-vepeside was much better tolerated by the patients and, with its comparable remission rates and survival times, was superior to the cis-platine combinations. For the chemotherapy of the non-small cell bronchial carcinoma it has to be considered that the treatment result may be more influenced by tumor stage and activity index of the patient than by the therapy method.     

支气管动脉化疗栓塞结合同步放疗、静脉化疗治疗中心型肺癌

目的探讨支气管动脉化疗栓塞结合同步放疗、静脉化疗治疗中心型肺癌的疗效。方法178例中晚期中心型肺癌患者采用支气管动脉化疗栓塞,第2天行放疗。放疗总剂量60～70 Gy,6～7周完成。3～4周后采用长春瑞滨、顺铂或伊托铂苷、顺铂方案,共化疗2个周期。结果患者临床症状均有明显好转。CR 39.89%,PR 46.06%,有效率(CR+PR)85.95%,中位生存期为23.4个月,1、2、3年生存率分别为79.7%、45.3%、24.5%。无严重并发症发生。结论经支气管动脉化疗栓塞结合放疗、静脉化疗治疗中心型肺癌能延长患者的中位生存期,提高患者的生存率,具有较好的临床疗效。     

Effective bladder preservation strategy with low-dose radiation therapy and concurrent intraarterial chemotherapy for muscle-invasive bladder cancer

Purpose The aim of this study was to evaluate retrospectively the toxicity and response, bladder preservation, and survival of patients with muscle-invasive bladder cancer treated with multimodality therapy consisting of low-dose radiation therapy (RT) and concurrent intraarterial chemotherapy (IACT). Methods and materials Between November 1999 and July 2005, a total of 27 consecutive, previously untreated patients with muscle-invasive bladder cancer underwent transurethral bladder tumor resection followed by concurrent low-dose RT and IACT. Patients who achieved a complete response (CR) were followed up closely without further therapy, and patients who did not achieve a CR underwent further treatment. Results Complete response was achieved in 22 of 27 patients (81%). Of these 22 patients, 7 developed recurrences, and 3 died of their disease. In five patients who did not achieve CR, one died from bone metastases. The 3-year overall survival rate was 81%, with a median follow-up time of 27 months; and 22 of 27 patients (81%) with a preserved bladder were tumor-free at the last follow-up. Three patients (11%) developed grade 3 acute hematological toxicity. Conclusion Multimodality therapy consisting of low-dose RT and concurrent IACT for muscle-invasive bladder cancer can achieve survival rates similar to those in patients treated with radical cystectomy, with successful bladder preservation and minimal adverse effects.     

FLAG方案治疗难治复发急性白血病的临床应用研究

 目的 初步探讨大剂量阿糖胞苷(Ara-C)联合氟达拉滨(Flud)和粒细胞集落刺激因子(G-CSF)即FLAG方案治疗难治复发急性白血病(acute leukemia,AL)的疗效和不良反应.方法 32例AL均采用FLAG方案化疗,即Flud 50 mg/d,第1～5天;Ara-C 2 g/(m2·d),第1～5天;G-CSF 300 μg/d,化疗前1 d开始,完成1个疗程者进入疗效分析.结果 31例顺利完成化疗,有效率(CR+PR)为54.8%(17/31) ,CR为48.4%(15/31).9例复发AL的CR 率为66.7%,23例难治AL的CR率为 39.1%,其中AML CR率为58.3%,B-ALL 仅20%,2例T-ALL均CR.15例CR AL中3例进行异基因外周造血干细胞移植(allo-PBSCT).早期死亡4%.总中位生存时间14(3～43)个月.结论 包含大剂量阿糖胞苷的FLAG方案为难治复发AML的有效方案,耐受性好,而对B-ALL的敏感性差.