得力生联合化疗治疗急性髓性白血病疗效观察

目的:观察得力生注射液联合化疗治疗急性髓性白血病的疗效。方法:将62例患者随机分为治疗组和对照组,治疗组给予得力生注射液联合化疗,对照组单用化疗,观察临床疗效及造血恢复时间。结果:在第一疗程化疗后完全缓解率、部分缓解率、总有效率两组无显著性差别;达到完全缓解所需时间两组分别为25.9±6.6天、30.0±7.6天,治疗组短于对照组(P<0.05);治疗组骨髓抑制期也明显短于对照组(P<0.05)。结论:得力生注射液可提高急性髓性白血病的化疗效果,保护骨髓、促进造血恢复。     

DCIK细胞治疗急性髓细胞性白血病的疗效观察

摘 要　目的: 评价DCIK细胞过继免疫治疗急性髓细胞性白血病（acute myeloid leukemia，AML）的临床疗效。方法：选取苏州大学附属第一医院2006年1月至2007年12月所收治的10例确诊AML患者，经常规化疗后处于完全缓解中，经院伦理委员会批准和患者知情同意，用血细胞分析仪分离外周血中单个核细胞(peripheral blood mononuclear cells，PBMC)，在体外诱导培养成DCIK细胞；以流式细胞术检测DCIK细胞的表型，以MTT法检测DCIK细胞对人红白血病细胞K562的杀伤活性，确认质量合格后回输给患者进行抗肿瘤免疫治疗；治疗后评价其近期临床疗效、免疫学活性及不良反应等。结果：体外成功诱导培养DCIK细胞，其对白血病细胞株K562的杀伤率为(58.3±3.3)%；DCIK细胞群中，CD3+CD56+ 占(38.4±9.42)%。10例患者经治疗后，7例持续完全缓解（continuous complete remission，CCR），占70%；患者回输DCIK后外周血中的CD4+ 、CD8+ 、CD56+ 的比例均有明显提高(P<0.05或P<0.01)；无一患者出现严重不良反应。结论：DCIK能诱导机体产生特异性的免疫反应，对急性髓细胞性白血病的治疗有较好的临床疗效。     

急性髓细胞性白血病靶向治疗的研究进展

急性髓细胞性白血病(AML)是一种危及生命的血液系统恶性疾病.近年来,随着治疗方案的改进,患者预后有所改善,但仍难以解决高危患者预后差的问题.针对AML特定基因或白血病细胞表面靶抗原的靶向治疗是克服耐药性并改善AML预后的新希望.近年来,用于治疗AML的新型靶向药物数量空前增长,包括B细胞淋巴瘤/白血病-2抑制剂、FM...     

低分化型急性髓细胞性白血病

1987年,Lee等首先报告了10例低分化型急性非淋巴细胞白血病(MD-ANLL),认为它们是一型独特的白血病。国内对该型白血病尚未见报告。本院对196例急性白血病(急白)细胞表面标记和常规形态学(FAB)观察过程中,发现该型白血病8例(4％),现报告如下。材料与方法一、病例 1987年6月～1991年6月来本院诊治的儿童或外院送检细胞表面标记的成人病例各4例,均为男性。形态学诊断:急性淋巴细胞白血病(ALL)L_1型2例,L_2型4例,L_3型2例。二,标本 1例(例5)在当地医院经CODP(环磷酰胺+长春新碱+柔红霉素+泼尼松)治疗1     

THA方案治疗高白细胞性急性髓细胞性白血病近期疗效观察

高白细胞性白血病属于高危型的白血病,常规化疗缓解率相对较低.吡柔比星(THP)是新一代蒽环类抗癌抗生素,我院自1996年5月-2002年1月采用国产THP为主的方案治疗了高白细胞性急性髓细胞性白血病(AML)18例,收到较好疗效,现将结果报告如下.     

急性髓细胞白血病早期病死高危因素及高白细胞髓性白血病首交化疗策 …

目的 :探讨急性髓细胞白血病 (acutemyelogenousleukemia ,AML)早期病死 (earlydeath ,ED)的高危因素以及高白细胞髓性白血病 (hyperleukocyticacutemyelogenousleukemia ,HAML)的首次化疗策略。 方法 :采用回顾性病例对照、多因素分析的方法对 30 1例AML、31例HAML进行研究。结果 :白细胞计数 (≥ 10 0× 10 9/L)、骨髓增生度 (极度活跃 )、体温 (≥ 39℃ )、血小板计数 (≤ 2 0× 10 9/L)及白血病类型 (M5)等指标进入Logistic多元回归方程 (P =0 0 0 0 0 ) ,OR值分别约 5 0、4 9、3 3、3 2和 2 2 ;HAML的首次化疗 ,采用常规剂量 (平均相对剂量强度≥ 0 5 )、含蒽环类方案 (DA)化疗发生ED的危险性分别为小剂量 (平均相对剂量强度 <0 5 )、其它方案 (HA或HOAP)化疗的 12倍 (P =0 0 34 6 )和 7 5倍 (P =0 0 479)。结论 :白细胞计数 (≥ 10 0× 10 9/L)、骨髓增生度 (极度活跃 )、体温 (≥ 39℃ )、血小板计数 (≤ 2 0× 10 9/L)及白血病类型 (M5)等 5个指标为AMLED的高危因素 ,其中以HAML最为重要 ,而HAML首次化疗 ,采用小剂量、非蒽环类方案化疗 ,可能有助于降低ED率。     

小剂量HA方案治疗老年急性髓细胞性白血病临床观察

[目的]研究小剂量HA方案治疗老年急性髓细胞白血病（AML）的临床疗效及安全性。[方法]应用小剂量HA方案（高三尖杉酯碱每天1mg,静脉滴注,第1-14d;阿糖胞苷12．5mg,皮下注射每12h一次．第1～14d;4周为1个疗程）治疗初发的老年急性髓细胞性白血病患者10例,1个疗程后观察疗效及毒副反应。[结果]10例患者中,完全缓解6例（60％）,部分缓解1例（10％）．总有效率为70％。骨髓抑制相对较轻,未见严重的非血液系统毒副反应。[结论]小剂量HA方案诱导缓解治疗老年AML具有较好的有效率,毒副反应耐受较好,可作为年龄较大、一般状况较差、有多种或较重合并症的老年AML患者的初始治疗方案选择。     

HAA方案治疗急性髓细胞白血病临床观察

目的：观察ＨＡＡ方案治疗急性髓细胞白血病化疗效果。方法：初治急性髓细胞白血病１６例，应用ＨＡＡ方案诱导化疗。给药方法：高三尖杉酯碱（ＨＨＴ）３～４ｍｇ／日，静脉滴注（ｉｖ），连用７天；阿糖胞苷（Ａｒａ－Ｃ）１５０ｍｇ／ｍ２／日，ｉｖ，连用７天；阿克拉霉素（ＡＣＲ）４０ｍｇ／ｍ２／日，静脉注射，第１～３天，两疗程间休息２～３周。结果：完全缓解（ＣＲ）１４例，ＣＲ率８７．５％，１６例中１２例（７５％）１疗程即达ＣＲ。结论：ＨＡＡ方案是治疗急性髓细胞白血病的一种有效方案，该方案毒副作用可以耐受。ＨＴＴ和ＡＣＲ之间可能有协同作用。     

中剂量阿糖胞苷治疗急性髓细胞性白血病46例疗效观察

目的探讨中剂量阿糖胞苷（ＩＤ－Ａｒａ－Ｃ）对急性髓细胞性白血病（ＡＭＬ）的治疗效果。方法用ＩＤ－Ａｒａ－Ｃ方案对４６例ＡＭＬ患者进行化疗,其中用于完全缓解（ＣＲ）后强化治疗３６例,用于难治、复发ＡＭＬ诱导缓解治疗１０例。结果强化治疗组中位ＣＲ期为１６（３～５６）个月;预期３ａ和４ａ无病生存率（ＤＦＳ）分别为４９．７％及３３．１％。２例（２０％）难治、复发ＡＭＬ病人取得ＣＲ。结论ＩＤ－Ａｒａ－Ｃ用于ＡＭＬ的强化治疗能延长病人的ＤＦＳ,降低复发率;用于难治、复发ＡＭＬ的治疗也有一定效果。     

老年急性髓细胞白血病的疗效观察

 目的 研究老年急性髓细胞白血病（AML）的临床特点,寻求治疗的有效策略。方法 回顾性分析30例老年AML,在积极支持治疗下,按个体差异采取不同的化疗方案进行化疗。结果 小剂量阿糖胞苷（LD-Ara-C）组治疗7例,完全缓解（CR）率14.3 %;MA组治疗6例,CR率50.0 %;DA组治疗7例,CR率42.8 %;CAG组治疗10例,CR率60.0 %。结论 老年AML对化疗反应差,CR率低,治疗应选择积极合理、个体化的化疗方案。CAG方案CR率高,毒副作用小,治疗老年AML有一定的优势。     

In vitro effect of r-verapamil on acute myelogenous leukemia blast cells: studies of cytokine secretion and cytokine-dependent blast proliferation

The in vitro effect of the dextroisomer r-verapamil on blast cells derived from patients with acute myelogenous leukemia (AML) was studied. R-verapamil caused a dose-dependent inhibition of AML blast proliferation in the presence of stem-cell factor, leukemia inhibitory factor, interleukin 4, interleukin 6, and interleukin 10 when these cytokines were tested both alone and in different combinations. R-verapamil also inhibited the growth of clonogenic AML blast cells. The antiproliferative effect was not specific for AML blast cells, because r-verapamil also inhibited cytokine-dependent proliferation of blast cells derived from patients with acute lymphoblastic leukemia. The inhibitory effects of r-verapamil and anti-IL1 serum were additive, suggesting that the antiproliferative effect of r-verapamil does not depend solely on inhibition of IL1-mediated effects. Although r-verapamil inhibited spontaneous AML blast proliferation, for a majority of patients it caused only minimal, if any, inhibition of spontaneous cytokine secretion (IL1, IL1, TNF, IL6) by AML blast cells. Thus, although inhibition of IL1 effects may contribute in certain patients to the antiproliferative effect of r-verapamil, mechanisms other than IL1 inhibition seem to be more important in mediating the effects of r-verapamil.Abbreviations ALL Acute lymphocytic leukemia - AML acute myelogenous leukemia - cpm counts per minute - ELISA enzyme-linked immunosorbent assay - G-CSF granulocyte colony-stimulating factor - GM-CSF granulocyte-macrophage colony-stimulating factor - IL interleukin - IF leukemia inhibitory factor - PBMC peripheral blood mononuclear cells - RR relative response - SCF stem cell factor - TNF tumor necrosis factor      

Estimation of the prevalence of Fanconi anemia among patients with de novo acute myelogenous leukemia who have poor recovery from chemotherapy

We speculated that some individuals with de novo acute myelogenous leukemia (AML) may have undiagnosed Fanconi Anemia (FA). Data from patients enrolled on AML protocol CCG-2961, published FA cohort studies, SEER, and Bayes rule were used to estimate the probability of FA among all newly diagnosed AML cases, and among those who had no or delayed recovery of the absolute neutrophil count following initial chemotherapy. We determined that the probability of undiagnosed FA in patients in a treatment trial for newly diagnosed patients was around 0.18%, and around 0.83% in the subset who had poor marrow recovery. We suggest that FA or other inherited bone marrow failure syndromes be considered prior to treatment, or certainly among those with poor recovery.     

Short-term remission induction and consolidation therapy for adult acute myelogenous leukemia

One hundred and ninety two adults (median age 44 years) with de novo or secondary (n = 17) acute myelogenous leukemia (AML) were managed with a maximum of six intended courses with adriamycin 25 mg/m2/d for three days, plus cytarabine 200 mg/m2/d and 6-thioguanine 200 mg/m2/d for seven days (short-term therapy, STT). Twenty eight patients not in remission after the first course were given cytarabine 2 g/m2/bd for six days, a treatment that was highly toxic and gave a low CR rate. One hundred and twenty-six patients overall (66 per cent) achieved a complete remission (CR), 117/164 (71 per cent) after one to three standard courses (median 1), and 9/28 (32 per cent) after high-dose cytarabine. Median CR duration was 12 months. By multivariate analysis, younger age, blast count less than or equal to 50 x 10(9)/L, and de novo AML were associated with a better outcome (p less than 0.05). CR duration correlated favourably with FAB M3 morphology and total number (five or six) of cycles (p less than 0.05). In patients receiving five or six total courses, median CR length resulted 15.5 months and leukemia-free survival at 3 years 37 per cent. Therapy was curtailed in one fourth of CR patients because of unacceptable toxicity, and there were nine early deaths attributable to therapy-related complications among 126 CR cases. STT may be a worthwhile form of treatment for patients with de novo non-hyperleukocytic AML that are able to tolerate five or six consecutive induction-like chemotherapy courses.     

复发/难治急性髓系白血病患者P-糖蛋白的表达及功能分析

 目的 研究复发／难治急性髓性白血病（AML）患者P-糖蛋白表达及其功能。方法 用免疫组化方法检测CD34表达,RT-PCR方法检测P-gp的表达,用流式细胞术检测P-gp的功能。结果 CD34表达与P-gp表达、功能呈正相关（r =0.621,P＜0.001;r =0.496,P＜0.001）,P-gp表达与功能呈正相关（r = 0.574,P＜0.01）;复发／难治组CD34阳性率（66.7 %）高于初治组（32.6 %）（P＜0.05）;复发／难治组P-gp功能阳性率（66.7 %）高于初治组（25.6 %）（P＜0.01）。结论 CD34表达、P-gp表达和P-gp功能三者间呈正相关;复发／难治AL组 CD34阳性率、P-gp功能阳性率高于初治组;P-gp功能的检测更具有临床指导意义。     

Postremission therapy with two different dose regimens of cytarabine in adults with acute myelogenous leukemia

Sixty-seven out of 105 (64%) adults with de novo acute myelogenous leukemia (AML), achieving complete remission after induction chemotherapy, entered two successive postremission treatment protocols. Between 1987 and 1989, 35 patients received an intermediate dose of cytarabine (IDAC) along with other drugs. Between 1990 and 1993, 32 patients received high dose cytarabine (HIDAC) with similar other drugs. Patients treated with IDAC had a median survival of 13.8 months (95% Cl 11.2–23.1 months) and a 2 year survival of 34.3 ± 8.0%. Patients receiving HIDAC had a median survival of 35.5 months (95% Cl, lower limit 29.8 months) and a 2 year survival of 71.6 ± 9.4% (P < 0.002). The 2 year actuarial leukemia-free survival (LFS) was 17.8 ± 6.6% in the IDAC group and 67.3 ± 10.0% months in the HIDAC group (P = 0.004). The HIDAC group had a significant 2 year survival advantage over the IDAC group only in patients younger than 45 years. The 2 year survival in the first group was 83.3 ± 10.8% versus 23.5 ± 10.3% in the IDAC group (P = 0.0001). In patients older than 45 years, no significant differences in 2 year survival was noticed (52.9 ± 15.78 versus 44.4 ± 11.7, P = 0.8). Censoring the 21 patients who underwent bone marrow transplantation (BMT) at BMT did not change significantly the survival analysis of the patients in each group. This study is consistent with previous reports favoring HIDAC intensification in the postremission treatment of young patients with AML.     

急性髓系白血病合并慢性淋巴细胞白血病一例报道及文献复习

 目的 探讨急性髓系白血病（AML）合并慢性淋巴细胞白血病（CLL）的临床特点、病因、诊断、治疗及预后。方法 临床诊断1例AML合并CLL,并就相关文献进行复习。结果 患者经MA方案（米托蒽醌10 mg／d第1 ~ 3天,阿糖胞苷150 mg／d第1,3,5,7天,200 mg第2,4,6天）化疗后取得完全缓解,但CD19阳性的淋巴细胞（表达CD20,CD23,SIgM,部分表达CD5,CD22,CD25）仍然存在,于9个月后AML复发未能再次缓解而死亡。结论 AML合并CLL为一种具有特殊生物学特征的罕见疾病,免疫分型和细胞遗传学技术在疾病的诊断和认识中发挥重要作用,治疗应以AML为主。     

LD-HA联合诱导治疗高白细胞性急性非淋巴细胞性白血病

目的：观察小剂量高三尖杉酯碱-阿糖胞苷（LD-HA）联合诱导治疗高白细胞性急性非淋巴细胞性白血病的疗效和不良反应。方法：将78例高白细胞性急性非淋巴细胞性白血病患者随机分为A组（41例）及B组（37例）。A组给予LD-HA（高三尖杉酯碱2mg/日,阿糖胞苷25mg2次/日,D1-14）联合诱导治疗。B组在应用羟基脲降白细胞的基础上进行常规化疗。结果：A组完全缓解（CR）率显著高于B组;死亡率明显降低。骨髓抑制程度两组无明显差异;心、肝、肾、消化道功能损害发生率A组低于B组。结论：LD-HA联合诱导治疗高白细胞性急性非淋巴细胞性白血病疗效好,不良反应轻。     

白细胞介素-11防治急性髓系白血病化疗后血小板减少的临床研究

  目的 观察重组人白细胞介素-11（rhIL-11）防治急性髓系白血病化疗后血小板减少的疗效及其不良反应。方法 采用自身对照研究的方法，对21例因化疗引起血小板减少（＜50×109／L）急性髓性白血病患者给予rhIL-11预防性治疗。第1周期单用化疗；第2周期化疗联合rhIL-11，即化疗结束后24 h开始用rhIL-11，25μg／kg，皮下注射，1次／d，连续用药14 d或连续2次检查血小板计数≥300×109／L停药。结果 共入选21例患者，2例因第1周期化疗后疾病进展，中止化疗而剔除，19例可评价疗效和毒性反应。对照周期：化疗后血小板最低值（31.9±9.2）×109／L，血小板＜50×109／L平均天数（8.9±3.3）d，输注同型异体血小板7例次。研究周期：化疗后血小板最低值（56.4±17.8）×109／L（P＜0.05），血小板＜50×109／L平均天数（4.6±2.9）d（P＜0.05），输注同型异体血小板3例次。结论rhIL-11可提高血小板最低值，缩短血小板减少持续时间、减少血小板输注量，耐受性良好。     

Mitoxantrone-associated acute myelogenous leukemia in a patient with high-risk adenocarcinoma of the prostate: a case report and brief review

Background: Mitoxantrone, a topoisomerase II-targeted drug, is used to treat several conditions and is a Food and Drug Administration approved chemotherapeutic agent for the treatment of advanced carcinoma of the prostate. Case Report: A 64-year-old male with high-risk prostate cancer was treated with adjuvant mitoxantrone (12 mg/meter²) every 3 weeks for 6 cycles. Approximately 10 months after finishing therapy, he was diagnosed with an inv [16] Acute Myelogenous Leukemia (AML). Despite aggressive treatment and support, the patient had a rapidly fatal clinical course. Conclusion: Despite its regular use in this setting, this is the first reported case of treatment-associated AML after mitoxantrone in prostate cancer.     

依马替尼对c-Kit+急性髓细胞白血病骨髓细胞凋亡的作用

目的观察依马替尼(STI571)体外对干细胞受体阳性(c-Kit )急性髓细胞白血病(AML)患者骨髓细胞凋亡的作用。方法用RT-PCR法检测c-Kit AML细胞抑凋亡基因SurvivinmRNA和促凋亡基因SmacmRNA的表达水平。结果抑凋亡基因SurvivinmRNA的表达水平下降,促凋亡基因SmacmRNA的表达水平上升。结论STI571能诱导c-Kit AML细胞促凋亡基因SmacmRNA上调,抑凋亡基因SurvivinmRNA的表达水平下降,发挥促凋亡作用。