真性红细胞增多症合并肺癌广泛转移一例报告并文献复习

回顾分析1例真性红细胞增多症（polycythemia verra,PV）合并肺癌广泛转移病例的诊治过程.经血常规、骨髓等确诊为PV的63岁男性患者,给予羟基脲化疗5年后,合并肺癌广泛转移.先后经含吉西他滨加铂类、紫杉醇加铂类药方案治疗均无效,改用吉非替尼（Irressa）后,病情好转.初步研究结果提示,细胞遗传学的异常、癌基因的存在,以及抗代谢药（羟基脲等）损伤染色体,产生异常的克隆,可能是发生第二肿瘤的原因.单药Iressa对常规化疗无效者,仍可起到一定的疗效.     

顺铂时辰与常规给药合并羟基喜树碱治疗晚期非小细胞肺癌的临床观察

目的探索顺铂(DDP)时辰给药与常规给药合并羟基喜树碱(HCPT)治疗晚期非小细胞肺癌的疗效和毒副作用。方法59例ⅢB-Ⅳ期非小细胞肺癌患者随机分为2组,顺铂时辰给药合并羟基喜树碱组(时辰化疗组)和顺铂、羟基喜树碱常规给药组(常规化疗组),两组顺铂和羟基喜树碱的剂量相同,顺铂(DDP)14mg/(m~2·d),羟基喜树碱(HCPT)6mg/(m~2·d),2药连用5天,21天为1周期,时辰化疗组顺铂18:00用药,其他用药时间相同。每例连用2周期以上评价疗效。结果时辰化疗组PR 13例,SD 13例,PD 4例,有效率(CR PR)43.3%(与常规组比较P=0.051),中位生存期6.62个月,12个月生存率30.4%(9/30例),18个月生存率13.3%(4/30)。常规化疗组PR 9例,SD 17例,PD 3例,有效率31.0%,中位生存期5.06个月,12个月生存率24.1%(7/29),18个月生存率3.4%(1/29)。毒副作用两组相仿,但时辰化疗组的有效率和生存期较常规组有优势。结论顺铂时辰给药合并羟基喜树碱治疗晚期非小细胞肺癌有一定的临床应用价值。     

老年晚期非小细胞肺癌个体化治疗临床分析

目的 分析老年非小细胞肺癌个体化治疗方式.方法 将我院1995年1月至2005年1月收治的有完整资料98例(年龄≥60岁)老年非小细胞肺癌患者分为单药化疗组、铂类为基础的联合化疗和非铂类的联合化疗三组,对其临床资料及治疗效果进行回顾性对照分析.结果 单药化疗组21例,铂类为基础的联合化疗64例,非铂类的联合化疗组13例.单药化疗组心、肝、肾等基础疾病合并率(100.0%)明显高于其他两组(P=0.01).铂类联合化疗组有效率(39.1%)与非铂类联合化疗组(38.5%)差异无显著性,但明显高于单药化疗组(23.8%);但铂类联合化疗组CR-(12.5%)明显高于其他两组(P-0.04).铂类联合化疗组中位生存期(MST)11个月,疾病进展时间(TTP)7个月,1年生存率37.5%,2年生存率18.8%,均显著高于其他两组(P＜0.05).铂类联合化疗组Ⅲ～Ⅳ度副反应发生率及平均每次住院天数(40d)与非铂类联合化疗组差异无显著性(P＞0.05),但明显高于单药化疗组(P＜0.05).结论 高龄并非化疗禁忌,一般情况良好的老年非小细胞肺癌应行铂类为基础的联合化疗,一般情况较差者,可行单药化疗.     

小细胞肺癌治疗现状分析

美国学者Spigel对小细胞肺癌治疗情况进行了分析后认为,小细胞肺癌是侵袭性较强的肿瘤,诊断时常已经有广泛转移包括脑转移。局限期小细胞肺癌标准治疗方案为含铂两药化疗,常用依托泊苷,同步放疗。一开始就同步化疗有时导致化疗周期难以完成,近期研究显示,可先单纯化疗1个     

复发或难治性小细胞肺癌的化疗进展

复发或难治的SCLC预后差,化疗对其缓解率低,中位生存时间为4个月[1].广泛期的.所有患者或局限期的大多数患者,肿瘤进展后需要二线化疗.对于复发的SCLC,仍有多种药物具有抗肿瘤活性,如紫杉类的紫杉醇(PTX)、泰索帝,拓扑异构酶Ⅰ的抑制剂拓扑替康(TPT)、伊立替康(CPT-11),异环磷酰胺、足叶乙苷(VP-16)、顺铂及卡铂等.复发或转移后的二线化疗尚无公认的统一标准治疗.目前应用较多的化疗方案包括:TPT单药化疗,TPT PDD,TPT IFO,TPT PTX等的联合化疗;CPT-11 IFO、CPT-11 PDD、CPT-11 CBP、CPT-11 PDD VP-16的联合化疗;PTX CBP、PTX IFO的联合化疗;国内应用HCPT代替TPT及CPT-11联合化疗等.含阿霉素的联合化疗,在铂类及VP-16失败后几乎无效.     

复发或难治性非小细胞肺癌的化疗进展

对含铂类药物治疗后复发的非小细胞肺癌,单药泰索帝为标准的二线化疗药物,可明显延长病人的生存时间及改善生活质量.一项泰索帝的Ⅲ期随机对照研究证实,多靶点叶酸抑制剂的抗代谢药Alimta二线化疗治疗非小细胞肺癌,其疗效、中位生存时间及1年生存率与泰索帝相似,可替代泰索帝成为晚期NSCLC的二线化疗药物.泰索帝与健择、卡铂、伊立替康、EGFR-TK抑制剂及抗血管生成剂联合化疗,有一定的疗效.TXT为复发的NSCLC常用的二线标准治疗方案.Alimta为备用的二线治疗方案.Iressa单药对铂类及泰索帝失败后的晚期非小细胞肺癌仍然有效.     

肺癌脑转移的治疗及预后分析

为探讨提高肺癌脑转移疗效的方法及影响预后的因素 ,1995年 5月 -2 0 0 0年 5月收治的 64例肺癌脑转移患者行手术加放疗、放疗加化疗和单纯放疗。放疗采用6 0 Coγ线或 6MV X线全脑照射 ,多发灶全脑照射 40～ 5 0Gy 4～ 5周 ,2Gy 次 ,5次 周 ;单发灶全脑照射 40Gy后局部野增加 10～ 2 0Gy。化疗采用威猛 (Vm 2 6) 10 0mg ,静脉滴入d1 ～d3;顺铂 (DDP) 5 0mg ,d1 ～d3;CCNU 12 0mg ,口服 ,d1 或CAP(环磷酰胺、多柔比星、顺铂 ) +CCNU方案 ,3～ 4周重复。手术加放疗的中位生存期和 1年生存率分别为 13个月和 71 4% ,明显放疗加化疗的 8个月和 40 % ,而放疗加化疗又明显高于单纯放疗的 5个月和 15 6% ,三者比较差异有显著意义 ,P <0 0 1。手术加放疗和放疗加化疗的综合治疗对肺癌脑转移有较好的疗效     

小细胞肺癌的治疗进展与现状

肺癌为一种恶性程度较高的肿瘤性疾病,其病死率居各种恶性肿瘤之首,发病率逐年上升,近年随着禁烟教育力度的增强和普及,发病率已出现下降势头。小细胞肺癌(SCLC)是一种以生长迅速、早期转移、高度侵袭性为特点的肺癌类型。小细胞肺癌的肿瘤细胞对化疗和放疗都非常敏感,但几十年来多方案的临床试验并没能找到彻底治愈小细胞肺癌的有效方法,多数患者在一线治疗以后仍会复发或转移。局限期小细胞肺癌的一线治疗包括双药化疗(足量EP方案:依托泊甙 顺铂/卡铂)联合胸腔放射治疗(TRT)。当联合方案达完全缓解(CR)或疗效较好的部分缓解(PR)患者,应后续应用预防性脑照射(PCI),可明显降低未来复发性脑转移的风险。日本和德国的临床研究显示含有伊立替康的IP方案及IC方案(伊立替康 顺铂/卡铂)治疗广泛期小细胞肺癌效果可比标准EP方案。各种强化疗法并不能提高小细胞肺癌患者的生存率。胸腔放疗方案的研究显示局限期小细胞肺癌患者早期同步应用超分割放疗方案配合化疗可以改善预后,可能与放疗越早介入越能有效减少耐药克隆株的发生有关。对于小细胞肺癌复发患者,可依据是敏感复发或是难治复发相应选择再次应用首次化疗方案或用二线单药化疗方案。培美曲塞联合铂类方案已应用于SCLC的一线及二线治疗。PET-CT的应用对小细胞肺癌的精确分期非常重要。真正符合Ⅰ_A期及Ⅰ_B期(TNM分期)的小细胞肺癌患者可考虑手术治疗,术后应行正规化疗。生物靶向治疗小细胞肺癌的若干研究性试验正在进行之中,这些生物制剂及其衍生物有可能会为未来小细胞肺癌的治疗带来一线曙光。     

真性红细胞增多症合并凝血功能异常二例

 【摘要】　目的　观察真性红细胞增多症（PV）合并凝血功能异常患者经过红细胞单采后血细胞及凝血功能恢复情况。方法 应用血细胞分离机采集2例PV合并凝血功能异常患者的红细胞,全血流速平均为 75 ml／min（70 ～80 ml／min）,抗凝剂与全血体积比为 1∶9。同时给予羟基脲0.5 g,3次／d,口服。结果 2例患者经过一次采集红细胞后临床症状缓解,红细胞计数和血细胞比容接近正常水平,复查凝血常规凝血酶原时间、活化部分凝血酶时间均恢复正常。口服羟基脲 6个月,随访情况良好,复查血常规及凝血常规基本正常。结论 对PV合并凝血功能异常患者选择红细胞单采联合羟基脲治疗有效。     

非小细胞肺癌脑转移的放射治疗--附32例报告

收集 1995年 6月～ 2 0 0 2年 6月非小细胞肺癌 (non smallcelllungcancer ,NSCLC)脑转移住院患者 3 2例 ,采用放疗或放疗加化疗等综合性治疗 (颅内转移病灶采用全颅二侧野对穿照射 ,中线剂量 :3 0～ 40Gy/15～ 2 0次 ,后缩野追加肿瘤量 16～ 2 0Gy/8～ 10次 ,同时给EP、NP等方案化疗的综合方法治疗 )观察其疗效。初步研究结果提示 ,所有患者在顺利完成治疗后 ,平均存活期达 7个月。肺癌脑转移采用放疗、化疗的综合治疗 ,可延长生存时间 ,提高生存质量     

真性红细胞增多症转急性粒细胞白血病未分化型1例并文献复习

目的：报道1例真性红细胞增多症（PV）治疗10年后转化为急性粒细胞白血病未分化型（M。）的病例,以提高临床对真性红细胞增多症的诊断、治疗、预后判断及转归的认识。方法：取患者外周血及骨髓液,分析其临床及实验室检查特点,并对其进行文献复习。结果：该患者第1次骨髓穿刺符合国内真性红细胞增多症（PV）诊断标准,10年后骨髓形态学检查及细胞免疫分型检查提示转化为急性粒细胞白血病未分化型。结论：PV转化为M1,复习相关文献了解到其转化原因可能是疾病发展的自然病程也可能是长期应用羟基脲治疗所致,其相关的预后判断有待于进一步研究。     

Malignant histiocytosis occurring with acute myelogenous leukemia in a patient with longstanding polycythemia vera

A 52-year-old man with polycythemia vera of 20 years duration with progression to myelofibrosis developed a mass arising from the sternum. The mass consisted of large poorly differentiated cells infiltrating skeletal muscle, with cytochemical and ultrastructural features of malignant histiocytosis. At autopsy 6 weeks later, his bone marrow and spleen were involved by acute myelogenous leukemia. This is the first reported case of malignant histiocytosis occurring in a patient with polycythemia vera, and the second report of its association with acute myelogenous leukemia. There is suggestive evidence in this case that the malignant histiocytosis may possibly have arisen from the polycythemia vera clone.     

Prolonged remission of leukemia associated with polycythemia vera.

A patient with polycythemia vera (PV) received successive treatment by phlebotomies, radioactive phosphorus, myleran and cyclophosphamide. Sixteen years after the diagnosis, he developed acute myeloblastic leukemia. A complete remission was achieved following two courses of COAP (cyclophosphamide, vincristine, Cytosine Arabinoside, and prednisone) therapy. Four months later, while still in leukemic remission, he became mildly polycythemic again and the treatment with phlebotomies and cyclophosphamide was resume. The patient has subsequently been in complete remission of leukemia for over three years and his polycythemia is controlled by small doses of cyclophosphamide. This appears to be a unique case of such a prolonged remission of leukemia in the course of PV, with a return to a mild polycythemia state.     

Emergence of Chronic Myelogenous Leukemia From a Background of Myeloproliferative Disorder: JAK2V617F as a Potential Risk Factor for BCR-ABL Translocation

We report the emergence of chronic myelogenous leukemia (CML) in a patient with JAK2V617F-positive polycythemia vera after 15 years of phlebotomy. The polycythemia vera clinical and molecular findings were suppressed at the time of CML diagnosis, only to re-emerge after the leukemia was successfully treated with imatinib. We explored the potential association between myeloproliferative disorders and CML in the context of the current literature and found a higher-than-expected coincidence based on known epidemiologic data for each specific condition. We hypothesize that myeloproliferative disorder (JAK2V617F or molecular events that cause JAK2V617F) is a risk factor for CML (BCR-ABL translocation). Because of therapeutic implications, clinicians should be aware that the conditions co-occur more frequently than once thought.     

Erythrocytosis caused by giant chromophobe renal cell carcinoma: a case report indicating a 9-year misdiagnosis of polycythemia vera

Background:Erythrocytosis,a rare paraneoplastic syndrome,generally occurs in patients with clear cell renal cell carcinoma and has never been reported in patients with chromophobe renal cell carcinoma.Case presentation:We report a case of a young man suffering from a giant (22-cm) mass on his left kidney.Because of a history of polycythemia vera,the patient had been treated for the condition for 9 years.Radical nephrectomy was successfully performed,and the postoperative pathologic examination confirmed a diagnosis ofchromophobe renal cell carcinoma.Unexpectedly,the symptom of erythrocytosis disappeared after the surgery.Further examination and analysis were performed,and we finally attributed his erythrocytosis to chromophobe renal cell carcinoma.Conclusions:Chromophobe renal cell carcinoma could cause erythrocytosis,but the clear-cut mechanism needs further research.Secondary erythrocytosis such as those related with renal tumors should be taken into consideration during the diagnosis of polycythemia vera.     

Twelve-year remission of polycythemia vera following Hodgkin's disease and chemotherapy

Polycythemia vera is a condition characterized by the overproduction of red blood cells, and in many cases of leukocytes and platelets as well, in the absence of hypoxia or other known inciting factors. The association of polycythemia vera and acute leukemia is well known, but the author is unaware of prior reports of polycythemia vera and Hodgkin's disease concurrent in the same patient.     

Concomitant primary polycythemia vera and follicle center cell non-Hodgkin lymphoma: a case report and review of the literature

The association of myeloproliferative and lymphoproliferative disorders is well known after cytotoxic drug or radiation exposure, while it is remarkably rare prior to therapy. We report on a patient simultaneously diagnosed as having polycythemia vera and II3A follicle center cell non-Hodgkin lymphoma (grade 1). At this timepoint, he is on 12-year follow-up, characterized by post-polycythemia myeloid metaplasia with myelofibrosis and persistent complete remission of lymphoma. The conventional marrow cytogenetic analysis performed during the course of the disease demonstrated an abnormal karyotype with deletion of the long arm of chromosome 20 and trisomy 8, while molecular analysis failed to detect BCR-ABL rearrangement in peripheral blood cells. To the best of our knowledge based on a computer-aided review of the literature (MED-LINE 1966-2002), this is the sixth case of concomitant primary polycythemia vera and lymphoma of non-Hodgkin type. Besides, there is a single literature report on polycythemia vera coexisting with the Hodgkin's lymphoma. In our case as well as in the recorded ones, two independent malignant clones of myeloid and lymphoid origin, respectively, seem to have arisen. Further reports, supported by chromosomal and molecular studies, could improve our knowledge on this extremely infrequent disease association.     

Coexistent chronic lymphocytic leukemia and polycythemia vera requiring no treatment

Simultaneous presentation of chronic lymphocytic leukemia and polycythemia vera is reported in a previously untreated patient. The course was remarkably mild with almost no treatment, suggesting control of each disease by the other. The association of polycythemia vera (PV) and lymphoid neoplasms in the same patient is very unusual in the absence of previous cytotoxic therapy. Six cases of PV and chronic lymphocytic leukemia (CLL) have been reported, in which the occurrence of the two disorders was simultaneous, or sequential but spontaneous. We describe an additional patient in whom the presence of the two malignancies was clearly established, and who needed almost no therapy for more than 3 yr.     

Life expectancy of patients with chronic nonleukemic myeloproliferative disorders

This study determines, within the frame of current therapeutic possibilities, the impact of chronic nonleukemic myeloproliferative disorders on expected survival. The survival data for 1067 patients (454 with polycythemia vera, 247 with essential thrombocythemia, and 366 with idiopathic myelofibrosis) were collected from 38 Spanish institutions. The actuarial survival probability of each group of patients was compared with that of the age-matched and sex-matched control population. The survival of the patients with polycythemia vera and essential thrombocythemia did not differ from that of the control population (P = 0.92 and, 0.22, respectively), whereas the survival of the patients with idiopathic myelofibrosis was strikingly reduced with respect to the control population (P = 0.0000000007). Thus, in terms of survival, current therapeutic procedures may be considered as quite satisfactory in patients with polycythemia vera and essential thrombocythemia. On the other hand, due to poor survival of patients with idiopathic myelofibrosis, new therapeutic approaches for this condition are clearly needed.