贞芪扶正冲剂在UFTM联合治疗晚期胃癌中减毒作用的初步临床观察

本文报告贞芪扶正冲剂在ＵＦＴＭ和ＵＦＴ治疗晚期胃癌６例中的减毒作用，治疗设Ａ组为ＵＦＴＭ加贞芪，Ｂ组ＵＦＴＭ，Ｃ组ＵＦＴ加贞芪。ＵＦＴ总量２３－４０ｇ，ＭＭＣ总量４８－６０ｍｇ，贞芪１５ｇ２／日共８周，观察结果毒副反应者Ｂ＞Ａ＞Ｃ（Ｐ＜０．０５），白细胞血小板降低在Ｉ及Ｉ以上Ｂ＞Ａ＞Ｃ（Ｐ＜０．０５），近期疗效Ａ＞Ｂ＞Ｃ）Ｐ＜０．０５）提示贞芪冲剂在联合化疗中有减毒作用，从而可提高疗效。     

COMP和PBM化疗方案治疗晚期鼻咽癌的疗效分析

我们以ＣＴＸ＋ＶＣＲ＋ＭＴＸ＋ＤＤＰ（ＣＯＭＰ）和ＤＤＰ＋ＢＬＭ＋ＭＴＸ（ＰＢＭ）两种化疗方案治疗复发和转移的晚期鼻咽癌５８例。４９例可评价客观疗效。结果ＣＯＭＰ组取得ＣＲ３例、ＰＲ９例，有效率（ＣＲ＋ＰＲ）为５２．２％；ＰＢＭ组ＣＲ１例、ＰＲ９例，有效率（ＣＲ＋ＰＲ）为３８．５％。两者无显著性差异（Ｐ＞０．０５）．治疗后有效病例缓解期为５～５６月，中位缓解期为２５月。两种方案对鼻咽癌肺转移均较好，对肝转移疗效最差。ＣＯＭＰ方案对鼻咽癌远处转移疗效较好，对肺转移有效率为５８．３％（７／１２）．可作为鼻咽癌远处转移尤其是肺转移的首选。ＰＢＭ方案对鼻咽癌原灶复发疗效较好，对鼻咽癌复发有效率为４２．９％（３／７），可作为鼻咽癌原灶复发或放射治疗后辅助化疗首选方案。     

癌性渗出液中IL-2、IL-6、IL-8、TNFα·论著·和IFNγ活性分析

目的与方法应用ＥＬＩＳＡ法研究了１８例癌性渗出液（ＭＯＦ）中内源性ＩＬ－２、ＩＬ－６、ＩＬ－８、ＩＦＮγ和ＴＦＮα的生物学活性,并与恶性肿瘤病人（ＭＴＤ）血清、正常人、结核性胸膜炎（ＴＢＰ）和肝硬化病人（ＣＲＳ）进行了比较分析。结果ＭＴＤ血清中ＩＬ－６活性高于与正常成人组（Ｐ＜０．０５）;ＩＬ－２和ＩＦＮγ活性亦低下（Ｐ＜０．５）。ＭＴＤ血清中ＩＬ－２、ＩＬ－６ＴＮＦα活性显著低于ＴＢＰ（Ｐ＜０．００１）;ＩＬ－８和ＩＦＮγ活性亦降低（Ｐ＜０．０５）。ＭＯＦ中的ＩＬ－６、ＩＦＮγ水平显著高于ＴＢＰ组（Ｐ＜０．０１;Ｐ＜０．０５）;ＩＬ－２却明显降低（Ｐ＜０．０５）。ＭＴＤ血清中ＩＬ－２、ＩＬ－６低于ＣＲＳ组（Ｐ＜０．０５）;ＭＯＦ中ＩＬ－６、ＩＮＦγ水平高于ＣＨＡＤ组（Ｐ＜０．００１;Ｐ＜０．０５）;ＩＬ－２和ＩＬ－８则低于ＣＲＳ组（Ｐ＜０．０５;Ｐ＜０．０１）。结论ＭＴＤ血清和ＭＯＦ中ＩＬ－２、ＩＬ－６、ＩＬ－８和ＩＦＮγ活性反映了ＭＴＤ抗肿瘤免疫的功能状态。ＩＬ－６和ＩＬ－８活性对于ＭＴＤ预后的估计具有重要的意义。     

保尔佳在晚期乳腺癌治疗中的应用

１９９４年５月至１９９５年８月应用保尔佳配合化疗（治疗组）治疗晚期乳腺癌１８例，并以同期仅用化疗者（对照者）２０例做对照。结果显示两组的有效率（ＣＲ＋ＰＲ）分别为５０．０％及２８．６％（Ｐ＞０．０５）；稳定率（ＣＲ＋ＰＲ＋ＳＤ）分别为８３．３％及５７．２％（Ｐ＜０．０５）；２年生存率分别为９４．４％及４０％（Ｐ＜０．０１）；治疗组的生存质量也明显优于对照组（Ｐ＜０．０１）。认为保尔佳配合化疗能够改善晚期乳腺癌患者的预后和生存质量，值得推广应用。     

恶性淋巴瘤患者脑脊液可溶性白细胞介素2受体水平的动态观察及其临床意义

用双抗体夹心ＥＬＩＳＡ方法动态监测４６例恶性淋巴瘤（ＭＬ）患者脑脊液（ＣＳＦ）中可溶性白细胞介素２受体（ｓＩＬ－２Ｒ）水平变化。发现ＭＬ患者脑脊液中ｓＩＬ－２Ｒ比正常人显著升高（Ｐ＜０．００１），且６例有中枢神经系统（ＣＮＳ）浸润者ｓＩＬ－２Ｒ与无ＣＮＳ浸润者相比有显著性差异（Ｐ＜０．０１）；而治疗达ＣＲ或ＰＲ后ｓＩＬ－２Ｒ显著降低（Ｐ＜０．０５），与正常人者相比Ｐ＞０．０５，脑脊液ｓＩＬ－２Ｒ水平与血清中ｓＩＬ－２Ｒ水平无显著相关性。认为动态监测ＭＬ患者脑脊液ｓＩＬ－２Ｒ水平有助于估价病变严重程度、ＣＮＳ有无浸润及疗效评定     

COMP与PBM化疗方案治疗晚期鼻咽癌的疗效分析

我们以ＣＴＸ＋ＶＣＲ＋ＭＴＸ＋ＤＤＰ（ＣＯＭＰ）和ＤＤＰ＋ＢＬＭ＋ＭＴＸ（ＰＢＭ）两种化疗方案治疗复发和转移的晚期鼻咽癌５８例，４９例可评价客观疗效。结果ＣＯＭＰ组取得了ＣＲ３例，ＰＲ９例，有效率（ＣＲ＋ＰＲ）为５２．２％；ＰＢＭ组ＣＲ１例，ＰＲ９例，有效率（ＣＲ＋ＰＲ）为３８．５％。两者无显著性差异（Ｐ〉０．０５）。治疗后有效病例缓解期为５～５６月，中位缓解期为２５月。两种方案对鼻咽癌肺转移均较     

胃癌组织中肥大细胞与C－erbB－2癌基因蛋白

用俾士麦棕法和免疫组织化学方法检测了５７例胃癌组织中肥大细胞（ＭＣ）和Ｃ－ｅｒｂＢ－２癌基因蛋白。结果表明：（１）ＭＣ计数与胃癌的分化程度和转移有关，高、中分化腺癌高于低分化腺癌和未分化癌（Ｐ＜０．０５），无转移者高于有转移者（Ｐ＜０．０５）；（２）Ｃ－ｅｒｂＢ－２癌基因蛋白阳性表达与胃癌的分化程度和转移无关（Ｐ＞０．０５）；（３）Ｃ－ｅｒｂＢ－２癌基因蛋白阳性表达与ＭＣ计数有关，ＭＣ高计组，Ｃ－ｅｒｂＢ２癌基因蛋白阳性表达低于ＭＣ低计组（Ｐ＜０．０５）。     

保尔佳在复发性非霍奇金淋巴瘤再化疗中使用效果的研究

探讨保尔佳在复发性中、高度恶性非霍奇金淋巴瘤再化疗中的使用效果。选取有明确病理诊断且既往用过ＣＨＯＰ方案化疗的复发性非霍奇金淋巴瘤共４８例，随机分为两组，治疗组再次启用ＣＨＯＰ方案化疗，并在化疗前５天开始加用保尔佳针剂３０μｇ肌肉注射，１次／日×２０日，对照组应用ＰｒｏＭＡＣＥ－ＣｙｔａＢＯＭ方案，分别评定近期疗效、毒副反应、Ｔ细胞亚群分布状态。治疗组ＣＲ率达３７．５％，对照组为５０．０％，差异无显著性（Ｐ＞０．０５）；两组共有的毒副反应为骨髓抑制、消化道反应及心肌毒性，均能耐受。但治疗组Ⅲ度以上消化道反应低于对照组（Ｐ＜０．０５）；治疗组化疗后Ｔ细胞亚群中ＣＤ＋３、ＣＤ＋４水平明显高于对照组（Ｐ＜０．０１）。保尔佳在复发的ＮＨＬ再化疗中有明显的增敏作用，且能提高机体的细胞免疫功能     

妊娠性滋养细胞肿瘤P185和雌孕激素受体的表达及意义

以ＡＢＣ法检测了４０例妊娠性滋养细胞肿瘤石蜡标本Ｐ１８５及ＥＲ、ＰＲ的表达。其中绒毛膜癌２４例。侵蚀性葡萄胎１６例，Ｐ１８５阳性率为４０％，ＥＲ、ＰＲ阳性率分别为４５％，７５％，Ｐ１８５在侵蚀性葡萄胎中的阳性率均明显高于绒瘤（Ｐ＜０．０１）。病程小于１年者，Ｐ１８５的阳性率高于病程大于１年者（Ｐ＜０．０５），ＥＲ、ＰＲ阳性者，Ｐ１８５的阳性率分别高于其阴性者（Ｐ＜０．０５、Ｐ＜０．０１），Ｐ１８５阳性与阴性的患者，分别有８１．３％、５０％的患者于３疗程内血ｈＣＧ转阴（Ｐ＜０．０５）。资料提示：Ｐ１８５倾向于在滋养细胞肿瘤恶性转化的早期表达，Ｐ１８Ｓ阳性者对化疗较为敏感。     

早期鼻咽癌66例放射治疗结果和预后因素分析

目的　分析早期鼻咽癌治疗结果和预后影响因素。方法　采用 Ｋａｐｌａｎ Ｍｅｉｅｒ 及 Ｃｏｘ 回归方法回顾性分析接受放射治疗的早期鼻咽癌６６ 例。结果　全组５ 年无瘤生存率、局部控制率、远地转移率分别为７１ ．６ ％ ,８７ ．８ ％ 和１７ ．４ ％ 。鼻咽肿物放射治疗 Ｄ Ｔ ＜ ４０ Ｇｙ 消退者在生存率和远地转移的控制上均差于 Ｄ Ｔ ＞ ４０ Ｇｙ 消退者,二者差异有显著性（ Ｐ＜ ０ ．０５） ;在局部控制率上,二者差异无显著性;外周血血红蛋白低于１１０ ｇ／ Ｌ 者无瘤生存率、局部控制率均差于血红蛋白＞ １１０ ｇ／ Ｌ 者,且差异有显著性（ Ｐ＜ ０ ．０５） ;而二者远地转移率差异无显著性（ Ｐ＞ ０ ．０５） 。结论　鼻咽肿物对射线越敏感越容易发生远地转移,生存率越差;血红蛋白水平越低,局部控制率和生存率越差。     

恶性淋巴瘤自体骨髓移植后的远期并发症

报告２８例恶性淋巴瘤自体骨髓移植患者的远期并发症，其中１４例发生性腺功能减退，１例甲状腺功能低下，２例淋巴管阻塞，２例肌萎缩。分析认为远期并发症主要与ＡＢＭＴ预处理中大剂量放化疗有关。     

Dose Intensification of Etoposide in the BEAM ABMT Protocol for Malignant Lymphoma

We have previously demonstrated a dose response relationship in Hodgkin's disease for the combination of BCNU, VP16, Ara C and Melphalan, with the superior efficacy of the BEAM regimen requiring haemopoietic support, compared with miniBEAM.^1,2 To further exploit this, we have attempted to escalate the VP16 dose in BEAM. The standard etoposide dose is 200 mg/m² IV for four days. Thirty seven patients with refractory lymphoma received 400 mg/m²/day of etoposide, and 13 patients 600 mg/m²/day, in addition to BCNU, cytarabine, and melphalan. Toxicity and outcome parameters were compared in the preceeding 40 patients, who received 200 mg/m²/day etoposide. The toxic mortality with 400 mg/m²/day of etoposide (3%) was identical to that for the standard BEAM regimen (5%). Two procedure related deaths occurred in the highest VP16 dose group (15%). The morbidity of the lower etoposide dose regimens was comparable, but 600 mg/m²/day induced significantly greater gastrointestinal toxicity. Twelve of the 13 patients receiving this dose suffered grade II-IV mucositis, with stomatitis, dysphagia and prolonged diarrhoea; 5 haemodynamically significant gastrointestinal haemorrhage, and 1 fatal toxic colitis. Granulocyte colony stimulating factor did not influence the nonhaematological toxicity. The three month response rates were similar (91%) in all dose cohorts. The maximum tolerable etoposide dose within the BEAM regimen is thus 400 mg/m² for four days.     

Effects of interleukin 2 on engraftment following autologous bone marrow transplantation (ABMT) in dogs.

Beagle dogs were treated with recombinant human interleukin 2 (IL-2) 6 x 10(6) International Units (IU)/day for 7 consecutive days following conditioning with sublethal (200 cGy) or lethal (400 cGy) doses of high-dose rate whole body irradiation (WBI) and reconstitution with 2 x 10(8)/kg autologous bone marrow cells, in order to assess the effect of IL-2 on engraftment. Engraftment of dogs conditioned by lethal doses of WBI was not impaired following treatment with IL-2 6 x 10(6) IU/day. At an RIL-2 dose of 6 x 10(6) and 9 x 10(4) IU/day, enhanced engraftment of autologous bone marrow cells was observed in dogs irradiated with a sublethal WBI dose in comparison with controls not treated by IL-2(p < 0.05). We conclude that therapeutic doses of IL-2 may be safely utilized during hematopoietic reconstitution. Under certain conditions IL-2 may even enhance hematopoietic reconstitution following ABMT.     

Depressive symptoms in autologous bone marrow transplant (ABMT) patients with cancer: An exploratory study

The purpose of the study was to examine the prevalence of depressive symptoms and related psychosocial and medical factors in patients submitted to autologous bone marrow transplantation (ABMT) for solid tumors. Forty-four cancer inpatients were assessed for the presence of depression and psychological stress symptoms (Symptom Questionnaire) (SQ) on admission to the hospital (Time 1-T1) and after ABMT (Time 2-T2). Coping strategies (Mental Adjustment to Cancer scale), external locus of control and social support (Social Provision Scale) were also evaluated at T1. The prevalence of depression (‘cases’) declined from T1 to T2 (41% to 27%). Patients who were depressed at T2 had higher scores on Anxiety and Depression, External Locus of Control and lower scores on social support at T1 than non-depressed. Regression analysis indicated that depression and anxiety at T1 and days spent during isolation with fever were the best predictors of depression at T2. These preliminary findings strengthen the importance for clinicians to evaluating psychosocial and medical variables which may favour depression in cancer patients submitted to ABMT.     

自体骨髓移植治疗淋巴瘤预后因素的探讨

近年来，我院用自体骨髓移植（ＡＢＭＴ）治疗１０例晚期、复发、高度恶性型的淋巴瘤（其中４例确诊时已有骨髓浸润），均获完全缓解，现８例仍无病生存（中数随访３２月），最长者无病生存６５月以上。本文从临床实践结合文献探讨了与ＡＢＭＴ治疗淋巴瘤的疗效相关因素，如移植时病人的病情，移植前的病程及化疗疗程次数、移植时机的选择等。     

Gonadal function after MACOP-B or VACOP-B with or without dose intensification and ABMT in young patients with aggressive non-Hodgkin's lymphoma

BACKGROUND:: The late effects of chemotherapy of aggressive non-Hodgkin'slymphoma on gonadal function are largely unknown. PATIENTS AND METHODS:: In a retrospective study the gonadal function after chemotherapywith MACOP-B or VACOP-B with or without dose intensificationand ABMT in first remission was examined in patients with aggressivenon-Hodgkin's lymphoma by patient history and determinationof hormonal function. Thirty adult patients of age 40 or lessat diagnosis who were alive and free of relapse for at least1 year after completion of chemotherapy were included in thestudy. RESULTS:: With a median time of 28 months (range 11 to 62 months) aftercompletion of therapy, gonadal dysfunction was found in 1 of7 female and none of 15 male patients, or a total of 5% of patientstreated with chemotherapy alone. Of patients receiving doseintensification and ABMT in first remission, gonadal dysfunctionwas present in 2/6 (33%) treated with cyclophosphamide, BCNUand etoposide in 3/4 treated with cyclophosphamide and TBI. CONCLUSIONS:: Our data suggest that therapy of aggressive non-Hodgkin's lymphomaswith MACOP-B or VACOP-B has little impact on future fertilityand that fertility may be preserved in the majority of patientsreceiving dose-intensification with CBV in first remission.     

High-dose chemotherapy supported with autologous bone marrow transplantation (ABMT) in germ cell tumors: a phase two study.

In this paper, the first Italian multicentre experience with high-dose chemotherapy and ABMT in germ cell cancer is presented. Twenty-eight patients underwent treatment with a carboplatin-etoposide w/o ifosfamide high-dose combination. Seventeen patients were in progression of disease, 9 were responsive to salvage treatments or failed to achieve CR to front line, and 2 had stable disease (both with an elevated marker level) at the time of transplantation. Five patients, all of whom were in sensitive relapse at transplantation, are alive and disease-free at > 17 months' follow-up. Two patients died 15 days after ABMT, one of veno-occlusive disease and one of rapid uncontrolled tumor progression. In highly pretreated patients this schedule seems to provide an option of cure for a cohort of patients failing to achieve CR to standard salvage regimens for germ cell cancer. Definitive conclusions may eventually be drawn with a more homogeneous group of patients. This type of approach should continue to be taken in sensitive relapse patients only, as responses in progressive cases are very transient, with virtually no cures. The question of whether high-dose programs are better than standard chemotherapy will in any case be answered only in a randomized prospective trial.