利用白消安致BALB/c小鼠生殖毒性建立NOA疾病模型

目的利用白消安对BALB/c雄性小鼠生殖毒性,建立不同损伤程度的NOA(non-obstructive azoospermia,NOA)动物模型。方法本研究取6~8周龄性成熟的BALB/c雄性小鼠共45只,随机分为3组:0 mg/kg组、30 mg/kg组、40 mg/kg组,每组15只。每2周观察并记录小鼠体重,睾丸和附睾湿重,睾丸体积,及生精细胞损伤程度。通过HE染色,判断生精细胞受损情况;通过免疫组化技术检测受损生精细胞停滞的减数分裂阶段,该法主要借助生精细胞减数分裂过程中的三个标记蛋白:STRA8(Stimulated by Retinoic Acid 8,STRA8)减数分裂启动标记蛋白,SCP3(Synaptonemal Complex Protein 3,SCP3)减数分裂中标记蛋白,TNP1(Transition Protein 1,TNP1)减数分裂后标记蛋白。结果注射白消安后小鼠存活良好,注射白消安2周时,生精细胞开始损伤,30 mg/kg组轻于40 mg/kg组;4周时,40 mg/kg组呈唯支持细胞样变化;6-10周时,生精功能开始恢复,30 mg/kg组恢复明显快于40 mg/kg组;40 mg/kg组STRA8、SCP3、TNP1表达在注射4周最低,第8周开始恢复到正常水平。结论白消安40 mg/kg组单次注射4周时,可建立为唯支持细胞型NOA生精障碍模型;单词注射4-8周期间,可建立损伤程度不同的NOA生精障碍模型,为睾丸组织体外培养提供稳定的研究组织。     

大剂量口服白消安在异基因造血干细胞移植预处理患者体内药动学研究

 目的 研究异基因造血干细胞移植（ allo-HSCT ）预处理患者口服大剂量白消安 (Bu) 的药动学特征。 方法 allo-HSCT 预处理患者口服 Bu 1 mg· kg^-1 ， q6h ，共 16 剂。在首剂和第 9 剂给药时，分别于给药前及给药后不同时间点采集血样，用高效液相色谱法测定血浆 Bu 浓度；用 DAS 软件进行药动学房室模型拟合，计算药动学参数。 结果 首剂和第 9 剂给药后 Bu 在 allo-HSCT 预处理患者体内血药浓度 - 时间曲线均符合一室模型，其主要药动学参数分别为： <> t _1/2 ( 133.0 ± 30.6) 与 (131.4 ± 28.2)min ， <> K _e （ 0.005 ± 0.001 ）与（ 0.006 ± 0.001 ） min^-1 ， <> V _d /<>F （ 0.56 ± 0.12 ）与（ 0.46 ± 0.08 ） L·kg^-1 ， <> CL /<>F （ 0.003 ± 0.001 ）与（ 0.002 ± 0.001 ） L·min^-1·kg^-1 ， AUC_0-t （ 910.3 ± 146.9 ）与（ 1 158.5 ± 139.0 ） μmol·min·L^-1 ， AUC_{0- ∞} （ 1 401.9 ± 243.2 ）与 （ 1 689.0 ± 312.4 ） μmol·min·L^-1 ； Bu 平均稳态血浆浓度为（ 3.29 ± 0.39 ） μmol·L^-1 。 结论 口服大剂量 Bu 在 allo-HSCT 预处理患者体内过程符合一室药动学模型，主要药动学参数个体差异大，多次给药后药物清除率发生改变。     

Phase 2 Study of an Intravenous Busulfan and Melphalan Conditioning Regimen for Autologous Stem Cell Transplantation in Patients with Multiple Myeloma (KMM150)

This prospective study evaluated the efficacy and toxicity of intravenous busulfan and melphalan as a conditioning regimen for autologous stem cell transplantation (ASCT) in patients with multiple myeloma (MM). A total of 99 patients with MM, enrolled between January 2013 and March 2016, received intravenous busulfan (9.6?mg/kg) and melphalan (140?mg/m²) before ASCT. The median time to transplant was 6.2 months, and 90 (90.9%) patients underwent ASCT within 12 months of the diagnosis. The overall response rate after ASCT was 94.0%, including 43.5% with a stringent complete response/complete response, 27.3% with very good partial response, and 23.2% with partial response. The most common severe nonhematologic toxicity (grade 3 to 4) was infection (26.3%) and stomatitis (15.2%). Three (3.2%) patients developed veno-occlusive disease. No treatment-related mortality was observed. After a median follow-up of 26.1 months, the median progression-free survival was 27.2 months (range, 13.0 to 41.4 months) and median overall survival was not reached. In conclusion, a conditioning regimen of intravenous busulfan and melphalan was effective and tolerable.ClinicalTrials.gov. number: NCT01923935     

High-dose chemotherapy with autologous stem cell rescue followed by posterior fossa irradiation for local medulloblastoma recurrence or progression after conventional chemotherapy

BACKGROUND: The objective of the current study was to determine the outcome of children with local recurrence or progression of medulloblastoma in patients who received high-dose chemotherapy (HDC) and posterior fossa (PF) irradiation. METHODS: HDC consisted in busulfan at a dose of 600 mg/m(2) and thiotepa at a dose of 900 mg/m(2) followed by autologous stem cells transplantation (ASCT). PF radiotherapy was delivered at doses from 50 grays (Gy) to 55 Gy on Day +70 after ASCT. Twenty-seven patients developed local recurrence of an initially completely resected medulloblastoma. Twelve patients had local residual disease after surgery and were enrolled into the salvage protocol at the time of local disease progression under conventional chemotherapy. RESULTS: Acute toxicity consisted mainly in hepatic veno-occlusive disease (33% of patients) and bone marrow aplasia. Two toxic deaths (5%) from infections were reported. The 5-year overall survival rate after this salvage treatment (OS(5y)) for the 39 children who were treated was 68.8% (95% confidence interval [95% CI], 53-81.2%). In the group of patients who were treated for local recurrence, the OS(5y) was 77.2% (95% CI, 58.3-89.1%). Patients with local residual disease who were treated at the time of disease progression had an OS(5y) after salvage treatment of only 50% (95% CI, 25.4-74.6%; P = .09). CONCLUSIONS: The treatment strategy that was used in this study had manageable immediate toxicity and resulted in a high overall survival rate in the setting of young children with medulloblastoma who developed local recurrence or disease progression.     

Testosterone administration promotes regeneration of chemically impaired spermatogenesis in rats

AIM: It has been proposed that gonadotropin-releasing hormone (GnRH) analog administered after testicular damage stimulates the recovery of spermatogenesis. However, GnRH analogs suppress the function of sex accessory organs. In this study, we investigated whether testosterone also stimulates the regeneration of rat spermatogenesis after exposure to busulfan. METHODS: Male Fisher rats were divided into three groups of five each and all rats were treated with busulfan, 25 mg/kg, intraperitoneally at week 0. Group A served as the control. The other two groups received testosterone enanthate, 8 mg/kg, subcutaneous injections at 3 week intervals two times before (group B) or three times after (group C) busulfan. States of spermatogenesis were evaluated by histology and by the number of spermatid nuclei per testis at week 25. RESULTS: The mean percentage of 'recovered' seminiferous tubules plus or minus standard deviation was 10.3 +/- 7.8% in group A and 2.1 +/- 1.2% in group B. In both groups, more than 80% of the tubules remained degenerated. However, testes of group C rats showed an improvement of up to 37.1 +/- 20.5% (P < 0.05). The significant recovery of spermatogenesis was also demonstrated in group C by counting the number of spermatid nuclei per testis ([78.8 +/- 57.5] x 106). However, the count was only (7.6 +/- 13.5) x 106 and (0.52 +/- 1.0) x 106 in group A and B, respectively. CONCLUSIONS: Testosterone administration after severe testicular damage enhanced the regeneration of spermatogenesis in rats. We assumed that supplementary doses of testosterone would be more practical for clinical application than GnRH analogs, because exogenous testosterone maintains androgenicity.