地西他滨联合预激改良IAG方案治疗MDS相关急性髓系白血病的临床效果

目的 观察地西他滨(DAC)联合预激改良IAG方案治疗骨髓增生异常综合征(MDS)相关急性髓系白血病(AML)的临床效果.方法 选取2014年1月—2019年10月泉州市第一医院收治的MDS相关AML患者28例,均接受DAC联合IAG方案治疗.分析治疗效果与不良反应发生情况,并分析影响不良反应发生的因素.结果 患者疗效...     

小剂量HAG预激方案治疗难治性或复发性急性髓系白血病疗效观察

目的:观察小剂量HAG[高三尖杉酯碱(HHT)、阿糖胞苷(A ra-C)、G-CSF]预激方案对难治性急性髓系白血病(AM L)的近期临床疗效。方法:选择16例难治性AM L(原发难治性AM L 13例,骨髓增生异常综合征(M DS)转AM L 2例,慢性粒细胞白血病转AM L 1例。应用小剂量HAG方案治疗,其中14例治疗2个疗程,其余2例治疗1个疗程。结果:8例达完全缓解(CR),3例达部分缓解(PR),5例未缓解(NR),CR率为50%(8/16),总有效率68.8%(11/16)。结论:小剂量HAG预激方案是治疗难治性或复发性AM L患者的有效治疗方案。     

环孢素A联合CAG方案治疗骨髓增生异常综合征转化的急性白血病疗效观察

目的探讨环孢素A(CsA)联合CAG方案治疗骨髓增生异常综合征(MDS)转化的急性髓系白血病(AML)的疗效和不良反应。方法对16例MDS/AML患者实施CsA联合CAG方案诱导治疗,1个疗程后评估疗效,无效者退出,有效者继续接受下1个疗程治疗。随访分析患者生存期,评判CsA联合CAG方案的长期疗效。结果 16例MDS/AML患者,1疗程后4例达完全缓解(CR)(25%),6例达部分缓解(PR)(38%),4例治疗失败(NR)(25%),死亡2例;2疗程CR 44%,总有效率62%。7例≥60岁的老年患者中,2疗程1例达CR,2例达PR,2例NR,2例早期死亡,有效率3/7。随访14例患者中位生存时间11个月,1年、2年的生存率分别为50%、21%。临床不良反应主要为骨髓抑制,其中中性粒细胞<0.5×109/L发生率88%,血小板<20×109/L发生率81%。结论 CsA联合CAG方案治疗MDS/AML安全有效,疗效较为满意。     

CAG方案治疗MDS转化的急性白血病疗效观察

目的观察小剂量阿糖胞苷、阿克拉霉素和粒细胞集落刺激因子联合（CAG方案）治疗骨髓增生异常综合征转化的急性髓细胞性白血病（MDS／AML）的临床疗效及不良反应。方法应用CAG方案治疗MDS／AML13例,1个疗程后评估疗效,无效者退出,有效者继续接受下1个疗程治疗。结果13例患者中3例1疗程后达CR（23．1％）,2例2疗程后达CR（15．3％）,3例达PR（23．1％）,总有效率为61．5％。13例患者均有不同程度的骨髓抑制,其余不良反应较轻。结论CAG方案治疗MDS／AML安全有效,疗效较为满意。     

预激方案治疗急性髓细胞白血病23例疗效观察

目的:观察预激方案治疗急性髓细胞白血病(AML)的临床疗效。方法:对23例AML患者采用CAG/HAG方案治疗,如1疗程未缓解,可接受第2疗程治疗。监测临床症状、体征、肝肾功能、骨髓细胞学检查及心电图。结果:23例经1～2个疗程治疗后完全缓解13例(56.5%),部分缓解5例(21.7%),未缓解5例(21.7%),总有效率78.2%。结论:预激方案治疗AML疗效较肯定,不良反应小。     

沙利度胺联合G-HA方案诱导缓解老年或低增生急性髓细胞白血病26例的临床观察

目的探讨初治的老年或低增生急性髓细胞白血病（AML）患者采用沙利度胺联合粒细胞集落刺激因子（G-CSF）预激的小剂量高三尖杉酯碱（HHT）和阿糖胞苷（Ara-c）（G-HA）方案诱导缓解的疗效及毒副作用。方法选择年龄〉60岁或低增生AML初治患者共26例,采用沙利度胺联合G-HA方案诱导缓解治疗。沙利度胺100mg/d服3～4天后加量至200mg/d连续口服。G-CSF：200μg/m2d0～14天,治疗中白细胞计数〉20×109/L减量或停用,HHT：1mg/m2d1～14天,Ara-c：10mg/m2d1～14天皮下注射q12h。对完全缓解者（CR）后期可选择不同方案巩固疗效。对部分缓解者（PR）再经过第2疗程该方案治疗。结果第1疗程后11例患者获得（CR）,8例患者获得（PR）,7例患者未缓解（NR）。8例PR患者有3例患者经过第2疗程的治疗后获得CR,总有效率为73%,完全缓解率53.8%。结论初治老年人或低增生急性髓细胞白血病使用沙利度胺联合G-CSF预激的HA方案疗效较理想,毒副作用轻,值得进一步探讨及临床使用。     

超小剂量地西他滨治疗骨髓增生异常综合征和急性髓系白血病11例疗效观察

目的 分析超小剂量地西他滨治疗骨髓增生异常综合征(MDS)和急性髓系白血病(AML)的近期临床疗效和不良反应.方法 观察11例接受超小剂量地西他滨治疗的患者临床疗效和不良反应发生率.其中,6例中危-Ⅰ组MDS患者接受地西他滨5~7 mg· m-2· d-1,连用5~6 d的超小剂量方案;2例中危-Ⅱ组和1例高危组MDS患者接受地西他滨联合半程CAG治疗方案;1例高危组MDS患者接受地西他滨联合HA治疗方案;1例AML患者接受地西他滨联合DA治疗方案.结果 11例接受地西他滨治疗的患者中,3例完全缓解,4例部分缓解,1例血液学改善,2例疾病无进展,1例死亡.总有效率为72.7%,完全缓解率为27.3%.3例患者出现肺部感染,1例出现消化道出血.3例出现Ⅱ级血液学不良反应,3例出现Ⅲ级血液学不良反应,均治疗后好转.结论 超小剂量地西他滨治疗方案在中高危组MDS患者中安全有效,耐受性好,且感染及血液学不良反应发生率较低,可在临床进一步推广.     

老年急性髓系白血病的诱导缓解方案疗效对比研究

目的:比较CAG预激方案与DA方案对老年急性髓系白血病(AML)的诱导缓解疗效及毒副反应。方法:选择21例老年AML患者,在诱导缓解期分别行两种化疗方案治疗,13例行CAG预激治疗方案:粒细胞集落刺激因子(G-CSF)200μg/d,d1-d14,阿克拉霉素(Acla)20 mg/d,d1-d4,阿糖胞苷(Ara-C)每12 h 10 mg/m2,d1-d14;8例行DA方案化疗:柔红霉素(DNR)每日40 mg/m2,d1-d3,Ara-C每日100 mg/m2,d1-d7,观察两组的疗效与不良反应。结果:CAG预激组6例达完全缓解(CR:46%),2例达部分缓解(PR:15%),总有效率61%。DA化疗组4例达完全缓解(CR:50%),1例达部分缓解(PR:13%),总有效率63%。组间比较差异无统计学意义(P>0.05)。两组主要不良反应为骨髓抑制、感染,CAG组感染发生率为46%(6/13),DA组感染发生率为75%(6/8),组间比较差异有统计学意义(P<0.05)。两组间血液学4级毒性反应的发生率差异无统计学意义,DA组口腔溃疡发生率明显高于CAG组。结论:CAG预激方案可有效治疗老年AML患者,且不良反应小,感染发生率低。     

FLAG方案治疗难治复发的急性白血病的临床观察

目的初步探讨氟达拉滨(FDR)、高剂量阿糖胞苷(Ara-C)和粒细胞刺激因子(G-CSF)即FLAG方案在急性髓细胞白血病(AML)再诱导化疗中的疗效及不良反应。方法 12例经标准DA、HA、MA及MAE方案化疗2个疗程未达完全缓解(CR)、骨髓原始细胞下降低于60%的AML患者,予FLAG方案再诱导化疗,即FDR30mg/(m2?d)静脉滴注,d1⁵;Ara-C1 g/m2静脉滴注,每12 h 1次,d15;Ara-C1 g/m2静脉滴注,每12 h 1次,d1⁵;G-CSF300μg/d皮下注射,第0天开始至白细胞恢复正常。结果 9例(75%)患者获得完全缓解(CR),3例(25%)患者获得部分缓解(PR)。主要不良反应为骨髓抑制,非血液学不良反应不明显。结论 FLAG方案再诱导化疗AML耐受性良好,有效率较高,不良反应可耐受。     

急性髓细胞白血病临床治疗研究

目的观察氟达拉滨(Fludarabine,F-ara-A)、阿糖胞苷(Ara-C)及粒细胞集落刺激因子(G-CSF)(FLAG方案)治疗难治、复发性急性髓细胞白血病(AML)的疗效及不良反应。方法采用FLAG方案(F-ara-A50mg/d,第1~5d,30min内静脉滴注完毕;Ara-C 2g/d,第1~5d,G-CSF 300μg/d,皮下注射,第1天开始直至白细胞数>1×109/L)治疗20例难治、复发性AL。结果两个疗程治疗后20例难治性及复发性白血病患者完全缓解率65%,部分缓解率10%,总有效率75%,主要不良反应为骨髓抑制,化疗期间无1例患者死亡。结论FLAG方案治疗难治或复发AML病死率低,为常规化疗无效和移植后复发的患者提供了治疗选择和接受造血干细胞移植的时机。     

地西他滨联合CAG治疗初治未缓解急性髓细胞白血病的疗效分析

目的：探讨地西他滨联合阿克拉霉素+阿糖胞苷+粒系集落刺激因子（CAG）方案治疗初治未缓解急性髓细胞白血病（AML）的疗效。方法：回顾性分析2013年1月～2014年6月在本院血液科接受地西他滨联合CAG方案治疗的11例初治未缓解AML患者的临床资料,评价其疗效和不良反应。结果：完全缓解7例,部分缓解1例,无效3例,总有效率72．7％（8/11）;血液学不良反应发生率为100％,感染发生率为72．7％（8/11）,轻度肝功能损伤率9.0％（1/11）,无严重出血、恶心呕吐不良反应。结论：地西他滨联合CAG可有效治疗初治未缓解急性髓细胞白血病,虽然血液学不良反应较重,感染的发生率较高,但患者基本上可耐受,给予抗炎及支持治疗可得到有效控制。     

Azacitidine: a review of its use in the management of myelodysplastic syndromes/acute myeloid leukaemia

Azacitidine (Vidaza?) is a pyrimidine nucleoside analogue of cytidine. This article reviews the clinical efficacy and tolerability of azacitidine in the treatment of patients with myelodysplastic syndromes (MDS)/acute myeloid leukaemia (AML), as well as summarizing its pharmacological properties. The randomized, multicentre Cancer and Leukemia Group B 9221 trial compared the efficacy of subcutaneous azacitidine with that of supportive care alone in patients with MDS fulfilling French-American-British (FAB) classification criteria. The overall response rate, the complete response rate and the complete plus partial response rate were significantly higher in patients receiving azacitidine than in those receiving supportive care alone. The randomized, open-label, multicentre AZA-001 trial compared the efficacy of subcutaneous azacitidine with that of conventional care in adults with higher-risk (i.e. International Prognostic Scoring System intermediate-2-risk or high-risk classification) MDS/AML. Prior to randomization, investigators preselected patients to the conventional care strategy considered most appropriate (i.e. best supportive care, low-dose cytarabine or intensive chemotherapy). The median duration of overall survival was significantly prolonged by 9.4 months in patients with higher-risk MDS receiving azacitidine versus those receiving conventional care. The survival benefit seen with azacitidine versus conventional care was maintained across various patient subgroups (e.g. in patients aged ≥75 years, in those who did not achieve complete remission and in patients with WHO-defined AML). The efficacy of subcutaneous or intravenous azacitidine was also shown in a noncomparative trial in Japanese patients with MDS fulfilling FAB classification criteria, and registry programmes in various countries support the efficacy of azacitidine in patients with MDS. Azacitidine was generally well tolerated in patients with MDS, including in the elderly. Across trials, peripheral cytopenias were the most commonly occurring adverse event in azacitidine recipients, with gastrointestinal adverse events (e.g. nausea, vomiting and diarrhoea) and injection-site reactions among the most commonly occurring non-haematological adverse events. In conclusion, azacitidine is an important agent for use in the treatment of patients with MDS/AML.     

地西他滨治疗骨髓增生异常综合征和急性髓细胞白血病临床观察

目的探讨地西他滨治疗骨髓增生异常综合征（MDS）和急性髓细胞白血病（AML）的临床疗效和安全性。方法收集2011年1月至2013年7月接受地西他滨[15mg／（m2·d）,第1—5天,静脉滴注持续1h以上1单药或联合CAGf阿糖胞苷（Ara-C）、阿克拉霉素（Acla）、粒细胞集落刺激因子（G-CSF）]方案治疗的20例MDS和AML患者的临床资料,评价其疗效和不良反应。结果20例患者中完全缓解（CR）4例,部分缓解（PR）8例,稳定（SD）及进展（PD）8例,总有效率为60．0％（12／20）。其中12例AML患者中CR2例,PR5例,总有效率为58.3％（7／12）,8例MDS患者中CR2例,PR3例,总有效率为62．5％（5／8）。1例MDS．难治性贫血伴环状铁粒幼细胞患者和2例慢性粒一单核细胞性白血病患者输血依赖情况有所改善。14例患者出现Ⅲ－Ⅳ度骨髓受抑,发生率为70．O％（14／20）。总感染率为35．0％（7,20）,其中肺部感染率为20．0％（4／20）,患者经积极抗感染、刺激造血及输血等支持治疗后感染控制。1例患者出现化疗相关死亡。20例患者均未出现严重肝功能损害及出血。结论地西他滨单药或联合CAG方案治疗MDS和AML有一定疗效,可廷缓疾病进展;患者对化疗不良反应均能耐受．且化疗相关病死率低。     

较小剂量柔红霉素诱导老年急性髓细胞白血病临床观察

目的：探讨较小剂量柔红霉素（DNR）诱导老年急性髓细胞白血病（AML）缓解的临床疗效。方法：将80例老年AML患者随机分为治疗组（40例）和对照组（40例）,两组患者均采用DA化疗方案,治疗组患者柔红霉素采用较小剂量30mg/（m2·d）,对照组患者柔红霉素采用标准剂量45mg/（m2·d）,随访2个疗程,比较两组患者的临床疗效和Ⅲ度以上骨髓抑制、感染、胃肠道反应等药物不良反应。结果：治疗组患者完全缓解16例,缓解率为40%,对照组患者完全缓解18例,缓解率为45%,两组患者完全缓解率比较差异无统计学意义（P〉0.05）;治疗组患者不良反应11例,占28%,对照组患者不良反应18例,占45%,对照组不良反应发生率明显高于治疗组,两组患者比较差异有统计学意义（P〈0.05）。结论：较小剂量柔红霉素诱导老年AML,疗效满意,药物不良反应少,值得临床推广。     

Spotlight on histamine dihydrochloride in acute myeloid leukaemia

Histamine dihydrochloride (Ceplene?) is a synthetic derivative of the biogenic amine histamine. Histamine dihydrochloride inhibits the formation of reactive oxygen species that suppress the activation of T cells and natural killer (NK) cells. When given in addition to the cytokine interleukin (IL)-2, histamine dihydrochloride enables the activation of T cells and NK cells by IL-2, resulting in the killing of cancer cells, including those of acute myeloid leukaemia (AML). In a large, 3-year, randomized, open-label, multicentre, phase III trial in adult patients with AML in first or subsequent remission, those who received subcutaneous histamine dihydrochloride and concomitant subcutaneous IL-2 as maintenance therapy had a significantly longer leukaemia-free survival (LFS; primary endpoint) than patients receiving no treatment. This difference was also shown for the subgroup of patients in first remission. The between-group difference in overall survival (OS) was not significant, although this trial was not powered to detect such a difference. Histamine dihydrochloride and IL-2 therapy had an acceptable tolerability profile in patients in the phase III trial. The majority of reported adverse events were of grade 1 or 2 severity. The most commonly reported grade 3 adverse events with active treatment were thrombocytopenia, headache, neutropenia, pyrexia, eosinophilia and diarrhoea; grade 4 adverse events were thrombocytopenia and leukopenia not otherwise specified. Serious adverse events were mostly relapse related. Histamine dihydrochloride and IL-2 as maintenance therapy significantly prolonged LFS compared with no treatment and had an acceptable tolerability profile in a large phase III trial in patients with AML. Although some issues remain to be addressed, most notably the effects of therapy on OS and the efficacy of treatment in older patients (who represent the majority of AML patients), histamine dihydrochloride in addition to IL-2 appears to be a useful maintenance therapy option for adult patients with AML in remission.     

老年急性髓系白血病的不同方案临床疗效及预后分析

目的观察老年急性髓系白血病（AML）的临床生物学特点、不同治疗方案的疗效及对生存的影响。方法回顾性分析北京大学人民医院北京大学血液病研究所2008年2月至2013年2月初诊年龄≥60岁的老年AML,除外急性早幼粒细胞白血病进行化疗的70例患者。根据治疗方法不同,分为去甲基化药物组（9例）、标准化疗组（18例）和小剂量化疗组（43例）。比较接受不同诱导方案的3组患者的疗效及预后差异,并对70例患者的生存进行单因素和多因素分析。结果第一疗程化疗达完全缓解患者33例（47．1％）,部分缓解11例（15．7％）,不缓解26例（37．1％）;死亡8例（11．4％）;3例一般状况差未再化疗,进行支持治疗。进入第二疗程化疗患者59例,完全缓解42例,部分缓解3例,不缓解14例,死亡3例。第二疗程缓解率60．0％（42／70）,总缓解率67．1％（47／70）,难治患者14例（20．0％）。年龄〉65岁[比值比=2．36,95％置信区间为1．09—5．10],不良染色体预后（比值比=2．24,95％置信区间为1．01～4．94）,标准方案诱导化疗（比值比=2．48,95％置信区间为1．25～4．92）是影响生存的主要因素。结论老年初诊的AML患者应进行危险度分层,采取个体化治疗策略。65岁以下的中低危患者可以选择标准化疗,而65岁以上的高危患者可考虑去甲基化药物治疗。     

Histamine dihydrochloride: in the management of acute myeloid leukaemia

Histamine dihydrochloride (Ceplene) is a synthetic derivative of the biogenic amine histamine. Histamine dihydrochloride inhibits the formation of reactive oxygen species that suppress the activation of T cells and natural killer cells. When administered in addition to the cytokine interleukin (IL)-2, histamine dihydrochloride enables the activation of T cells and natural killer cells by IL-2, resulting in the killing of tumour cells of various cancers, including acute myeloid leukaemia (AML). In a 3-year, randomized, multicentre, phase III trial in adult patients with AML in first or subsequent remission, those who received subcutaneous histamine dihydrochloride and concomitant subcutaneous IL-2 as maintenance therapy had a significantly longer leukaemia-free survival (LFS; primary endpoint) than recipients of no treatment. This difference was also shown for the subgroup of patients in first remission. The between-group difference in overall survival (OS) was not significant, although this trial was not powered to detect such a difference. Histamine dihydrochloride and IL-2 therapy had an acceptable tolerability profile in patients in the phase III trial. The majority of reported adverse events were grade 1 or 2 of the National Cancer Institute Common Toxicity Criteria. The most commonly reported grade 3 adverse events with active treatment were thrombocytopenia, headache, neutropenia, pyrexia, eosinophilia and diarrhoea; grade 4 adverse events were thrombocytopenia and leukopenia not otherwise specified. Serious adverse events were mostly relapse related. Histamine dihydrochloride and IL-2 as maintenance therapy significantly prolonged LFS compared with no treatment and had an acceptable tolerability profile in a large phase III trial in patients with AML. Although some issues remain to be addressed, most notably the effects of therapy on OS and the efficacy of treatment in older patients, histamine dihydrochloride in addition to IL-2 appears to be a useful maintenance therapy option for adult patients with AML in remission.     

利妥昔单抗联合ESHAP方案治疗复发非霍奇金淋巴瘤临床观察

目的 观察利妥昔单抗(Rituximab)联合ESHAP方案(依托泊苷、甲基强的松龙、顺铂、阿糖胞苷)治疗复发的CD20阳性B细胞性非霍奇金淋巴瘤(non-Hodgkinslymphoma,NHL)的临床疗效及安全性.方法 回顾性分析我院以利妥昔单抗联合ESHAP方案及单用ESHAP方案治疗复发的CD20阳性B细胞性非霍奇金淋巴瘤的临床资料.32例复发的CD20阳性的B细胞非霍奇金淋巴瘤患者,随机分为利妥昔单抗联合ESHAP方案组(治疗组)及单用ESHAP方案组(对照组),每21 d为1个周期,重复治疗.全部32例患者完成4个周期化疗后进行疗效评价.结果 治疗组完全缓解率(CR)为37.5%,总有效率为87.5%;对照组分别为25%、56.3%,两组有效率有显著性差异(P<0.05).两组患者不良反应主要为轻中度骨髓抑制、脱发和消化道反应.不良反应发生率相近(P>0.05),均可耐受.治疗组1例(6.25%)出现利妥昔单抗输注相关的不良反应,经对症处理后好转.结论 利妥昔单抗联合ESHAP方案治疗复发的CD20阳性B细胞性非霍奇金淋巴瘤安全有效,患者耐受良好,应推荐使用.     

环孢菌素A治疗15例骨髓增生异常综合征疗效观察

目的研究环孢茵素A治疗骨髓增生异常综合征（MDS）的疗效。方法对15例MDS患者采用环孢茵素A口服治疗，即环孢茵素A2-6mg／（kg·d），疗程3周～18个月。观察患者血常规、骨髓细胞形态学等指标变化。结果9例获血液学进步，1例获部分缓解，1例因不能耐受环孢茵素A药物不良反应而退出研究，4例无效，总有效率为66．7％。纽系细胞、中性粒细胞、血小板升高反应率分别为60．0％（9／15）、33．3％（5／15）、40．0％（6／15）。结论环孢茵素A治疗MDS对改善患者血细胞减少有明显疗效。