沙利度胺引起血小板增多1例

本文描述一例沙利度胺引起血小板增多,进而引起急性冠脉事件的不良反应案例     

沙利度胺治疗套细胞淋巴瘤1例

套细胞淋巴瘤属于非霍奇金淋巴瘤的一种特殊类型,目前无标准的治疗方案,化疗疗效差,预后不良。沙利度胺作为一种血管生成抑制剂,已在治疗难治性多发性骨髓瘤方面取得良好的效果。本文对1例套细胞淋巴瘤患者使用沙利度胺治疗后获得了一定的效果,改善了MCL患者的生存质量。     

Management of older patients with multiple myeloma

For many years, the oral combination melphalan-prednisone (MP) has been considered the standard of care for patients with multiple myeloma (MM) not eligible for autologous stem cell transplantation. In the era of novel agents, the introduction of immunomodulatory drugs and proteasome inhibitors has challenged the role of MP and led to new standards of care for this disease. Five randomized phase III studies compared the traditional MP with the MP plus thalidomide (MPT). All these studies showed a prolonged time to progression (TTP) with the 3-drug combination. However, in only two of these trials this advantage translated into an improvement in overall survival (OS). In another randomized trial, MP plus bortezomib (VMP) was correlated with an increase in both TTP and OS compared with MP. Preliminary data showed the superiority of the association of VMP plus thalidomide followed by bortezomib-thalidomide maintenance (VMPT-VT) vs VMP and melphalan-prednisone-lenalidomide followed by lenalidomide maintenance (MPR-R) compared to MP. Promising results have also been reported with the combination of lenalidomide plus low-dose dexamethasone. The availability of different efficacious regimens provided clinicians with the opportunity of tailoring the proper and specific approach for each patient. The choice should be based on patients' comorbidities and biologic age, while taking into account the expected toxicity profiles of each treatment regimen. Moreover, an accurate management of therapy-related adverse events and a gentler approach, particularly for patients older than 75 years, with appropriate age-adjusted dose reductions, should be considered to further improve outcome.     

沙利度胺联合VAD方案治疗多发性骨髓瘤的疗效观察

目的探讨沙利度胺联合VAD方案治疗多发性骨髓瘤（MM）的临床疗效及不良反应。方法 47例多发性骨髓瘤患者随机分为VAD组（23例）：长春新碱＋阿霉素＋地塞米松;联合治疗组（24例）：沙利度胺＋VAD方案。结果联合治疗组总有效率为83.3%,明显优于对照组总有效率（60.9%,P〈0.05）;两组治疗后M蛋白、骨髓瘤细胞、β2-微球蛋白均明显下降（P〈0.05）,联合治疗组下降更为明显（P〈0.05）;两组患者血红蛋白明显上升（P〈0.05）,联合治疗组上升更为明显（P〈0.05）。副反应程度均可耐受。结论沙利度胺联合VAD方案治疗MM具有副作用少、耐受性好、给药方便、疗效明显的优点,值得临床推广应用。     

沙利度胺对小鼠食管癌血管形成的影响

目的 研究沙利度胺对食管癌血管形成的影响,并初步探讨其抑瘤机制.方法 建立裸鼠食管癌原位移植瘤模型,将30只小鼠随机分为3组,每组10只.种植后3d开始,分别腹腔注射生理盐水(0.5 ml/d,对照组)、环磷酰胺[30 mg/(kg·d),环磷酰胺组]、沙利度胺[50 mg/ (kg·d),沙利度胺组],1次/d,持续...     

自体周血干细胞移植治疗多发性骨髓瘤研究进展

与传统化疗相比,自体干细胞移植患者完全缓解（CR）、非常好的部分缓解（VGPR）、无进展生存期及总生存期均明显提高,已成为65岁以下初治多发性骨髓瘤患者一线治疗。新药沙利度胺、来那度胺和硼替佐米联合地塞米松用于移植前的诱导化疗、预处理和维持治疗,显示出良好疗效,已逐步取代传统化疗方案,在复发和进展患者中亦显示出明显的疗效。初步研究提示来那度胺和硼替佐米可克服不利遗传学异常影响。     

高能聚焦超声治疗联合沙利度胺对原发性肝癌血流供应的影响

目的了解高能聚焦超声(HIFU)治疗联合沙利度胺对原发性肝癌血流供应的影响。方法将原发性肝癌患者43例,随机分为2组,即HIFU刀单纯治疗组和HIFU刀+沙利度胺联合治疗组。每组治疗前后分别检测患者外周血中血管内皮生长因子受体(VEGF)水平,彩色多普勒血流显影和瘤体大小指标并进行组内及组间比较。结果 HIFU联合沙利度胺组治疗前后瘤体大小、VEGF、彩色多普勒血流显影水平下降,与单纯HIFU相比,VEGF、彩色多普勒血流显影水平下降更明显(P<0.05)。结论 HIFU联合沙利度胺能有效阻断原发性肝癌血流,与单纯HIFU刀相比作用更强。     

A severe Whipple disease with an immune reconstitution inflammatory syndrome: An additional case of thalidomide efficiency

We report the case of a 38-year-old man who presented with severe diarrhea, weight loss of 10 kg, ankles paresthesia and severe motor weakness in the left fibular nerve territory after introduction of azathioprine and corticosteroid for proteinuria. Coloscopy and gastroscopy revealed a typical aspect of Whipple disease (WD), associated with both positive PAS staining and specific immunohistochemistry. T. whipplei PCR results were positive in blood, faeces, saliva and duodenal biopsy specimens. Diagnosis of WD with systemic manifestations was retained and doxycycline plus hydroxychloroquine therapy were started. This treatment improved joint pain, and skin and intestinal symptoms. One month later, our patient presented with fever and an important inflammatory syndrome (CRP 150 mg/dL and 16.8 10⁹/L leukocytes), while no infection was found despite a thorough review. We concluded it was an immune reconstitution inflammatory syndrome (IRIS). Manifestations persisted despite increasing corticosteroids and thalidomide (200 mg/day) was introduced with good efficacy on these symptoms. WD may be revealed by non-specific symptoms such as weight loss or arthralgia, but also by many other misleading signs. Our observation illustrates the highly polymorphic clinical presentation of WD, and the diagnostic difficulties that may arise. This is also a new report of thalidomide effectiveness in IRIS in WD.     

Inhibitory Effects of Arsenic Trioxide and Thalidomide on Angiogenesis and Vascular Endothelial Growth Factor Expression in Leukemia Cells

Acute myeloid leukemia (AML) is a blood disorder characterized by uncontrolled proliferation of myeloidprogenitors and decrease in the apoptosis rate. The vascular endothelial growth factor (VEGF) promotes blood vesselregeneration which might play important roles in development and progression of neoplasia. Our previous studiesfocused on cytotoxicity and anticancer effects of arsenic trioxide (ATO) and thalidomide (THAL) as an anti-VEGFcompound in the AML cell model. ATO also affects regulatory genes involved in cell proliferation and apoptosis. Theaim of present study was to examine the effects of ATO and THAL alone and in combination on U937 and KG-1 cells, with attention to mRNA expression for VEGF isoforms. Growth inhibitory effects was assessed by MTT assay andapoptosis induction was determined by Annexin/PI staining. mRNA expression levels were evaluated by real-timePCR. Our data indicated that ATO (1.618μM and 1μM in KG-1 and U937 cell lines respectively), THAL (80μM and60μM) and their combination inhibited proliferation and induced apoptosis in our cell lines. mRNA expression ofVEGF (A, B) decreased while C and D isoforms did not show any significant changes. Taken together, according tothe obtained results, the VEGF autocrine loop could be a target as a therapeutic strategy for cases of AML.