胰岛素受体在急性白血病中的临床意义

用放射分析法检测３０例急性白血病细胞胰岛素受体（ＩＮＳＲ），其中急性非淋巴细胞白血病２６例，急性淋巴细胞白血病４例。治疗前所有患者细胞膜ＩＮＳＲ数均高于正常对照，完全缓解者明显降低，未缓解者持续增高，甚至高于治疗前。完全缓解者ＩＮＳＲ稍有下降仍高于正常对照者于短期内复发。     

小儿急性白血病Ki-67表达及其临床意义研究

应用流式细胞术和抗Ｋｉ－６７单克隆抗体检测了４０例小儿急性白血病外周血白血病细胞的增殖情况，其中未经治疗的急性白血病３０例，完全缓解者１０例。结果表明：未经治疗的患儿Ｋｉ－６７表达值明显高于完全缓解组和正常对照组（Ｐ＜０．００５）。急性非淋巴细胞白血病组Ｋｉ－６７表达值高于急性淋巴细胞白血病组（Ｐ＜０．０５），Ｋｉ－６７表达值与流式细胞术检测的Ｓ期百分数成正相关。Ｋｉ－６７表达与ＤＮＡ倍体有关，ＤＮＡ异倍体组Ｋｉ－６７表达值高于ＤＮＡ二倍体组（Ｐ＜０．０５）。     

血清可溶性白细胞介素2受体,肿瘤坏死因子在小儿急性白血病中的意义

目的：了解急性白血病（ＡＬ）患儿血清中可溶性白细胞介素２受体（ＳＩＬ－２Ｒ）和肿瘤霈死因子α（ＴＮＦα）水平及其临床意义。方法：采用ＥＬＩＳＡ及ＲＩＡ测定２７例急性淋巴细胞白血病（ＡＬＬ）和３１便急性淋巴细胞细胞白血病（ＡＮＬＬ）及２０例２蝗血清ＳＩＬ－２Ｒ和ＴＮＦα水平。结果：ＡＬ患儿血清ＳＩＬ－２Ｒ和ＴＮＦα发病期明显高于正常儿童,后二者差异无统计意义。发病期经化疗完全缓解后降至正常水平,化疗     

急性白血病患者血清可溶性白细胞介素2受体水平测定

用双抗体夹心酶联免疫吸附试验检测５６例急性白血病（ＡＬ）患者血清可溶性白细胞介素２受体（ＳＩＬ－２Ｒ）水平。结果显示：ＡＬ初诊患者血清ｓＩＬ－２Ｒ水平显著高于正常对照，正常对照与完全缓解者之间无显著差异；不同类型ＡＬ患者血清ｓＩＬ－２Ｒ水平间无显著差异。急性白血病ｓＩＬ－２Ｒ水平与骨髓中白血病细胞百分数间有明显的相关性。血清ｓＩＬ－２Ｒ水平可作为ＡＬ病情监测、疗效观察及预后判断的有用指标之一。     

急性白血病患者血清可溶性肿瘤坏死因子受体Ⅰ型水平及其临床意义

目的了解急性白血病患者血清可溶性肿瘤坏死因子受体Ⅰ型（ｓＴＮＦＲⅠ）水平及其临床意义。方法采用双抗体夹心酶联免疫吸附法（ＥＬＩＳＡ）检测了急性白血病５７例（其中初发未治３１例,包括急性非淋巴细胞白血病２１例和急性淋巴细胞白血病１０例;复发难治１１例;骨髓缓解１５例）血清ｓＴＮＦＲⅠ水平。结果初发未治和复发难治者血清ｓＴＮＦＲⅠ浓度〔分别为（１．９２±１．８０）μｇ／Ｌ和（１．２９±０．３１）μｇ／Ｌ〕显著地高于正常对照和骨髓缓解者〔分别为（０．６２±０．３４）μｇ／Ｌ和（０．７３±０．４４）μｇ／Ｌ〕。且初发未治患者治疗前血清ｓＴＮＦＲⅠ＜２．０μｇ／Ｌ者治疗后的骨髓缓解率（６８．２％）显著较高。结论提示测定血清ｓＴＮＦＲⅠ有助于了解急性白血病患者异常的免疫状况并对预测和了解其治疗效果有一定的临床实用价值。     

小儿急性白血症Ki—67表达及其临床意义研究

应用流式细胞术和抗Ｋｉ－６７单克隆抗体检测了４０例小儿急性白血病外周血白血病细胞的增殖民政部其中未经治疗的白血症３０例，完全缓解者１０例。结果表明，未经治疗的患儿Ｋｉ－６７表达值明显高于缓解组和正常对照组（Ｐ〈０．００５）。急性非淋巴细胞白血症组Ｋｉ－６７表达值高于急性淋巴细胞白血病组（Ｐ〈０．０５），Ｋｉ－６７表达值与流式细胞术检测的Ｓ期百分数成正相关。Ｋｉ－６７表达与ＤＮＡ倍体有关，ＤＮＡ异倍     

急性白血病患者血清可溶性白细胞介素2受体测定及其临床意义

测定９８例急性白血病（ＡＬ）患者血清可溶性白细胞介素２受体（ｓＩＬ－２Ｒ）水平，各型ＡＬ患者ｓＩＬ－２Ｒ均明显升高，且ＡＬＬ〉Ｍ５〉Ｍ２〉Ｍ３。ｓＩＬ－２Ｒ水平与骨髓中原始细胞数、外周白血细胞数、外周成熟淋巴细胞绝对值无关。动态观察发现化疗后不能获得完全缓解（ＣＲ）患者治疗前ｓＩＬ－２Ｒ明显高于获得ＣＲ患者。各型ＡＬ患者化疗ＣＲ后，ｓＩＬ－２Ｒ水平较治疗前均明显下降，除急性淋巴细胞白血病外，Ｍ２、     

急性非淋巴细胞白血病完全缓解后小剂量阿糖胞苷维持治疗

急性非淋巴细胞白血病完全缓解后小剂量阿糖胞苷维持治疗孙常升，林茂芳，孙纯莹，周思文，林修基急性非淋巴细胞白血病（ＡＮＬＬ）在获得完全缓解（ＣＲ）后是否需要维持治疗（ＭＴ），国内外尚有争论。鉴于国内多数医院采用非强烈诱导缓解与巩固治疗方案。有人仍主张给...     

成人早期前体T急性淋巴细胞白血病（ETP-ALL）与非ETP-ALL的临床特点对比

目的:对比分析成人早期前体T急性淋巴细胞白血病（ETP-ALL）与非早期前体T急性淋巴细胞白血病（non-ETP-ALL）的临床特点。方法:回顾性分析于我科系统诊治的成人T细胞急性淋巴细胞白血病（T-ALL）患者19例，其中ETP-ALL 6例，non-ETP-ALL 13例，对比两组患者临床基本状况、血液及骨髓检测结果、免疫分型结果及诱导治疗后缓解情况。结果:ETP-ALL组患者白细胞水平显著低于non-ETP-ALL组患者，血小板水平显著高于non-ETP-AL组患者，主要见于pro-T-ALL，首次诱导治疗后完全缓解或接近完全缓解（CR/CRi）率显著低于后者。结论:ETP-ALL患者具有较独特的临床特点，对常规诱导治疗反应差，有必要积极探索新的治疗方法和药物。     

慢性粒细胞白血病患者脑脊液可溶性白细胞介素2受体水平测定

用双抗体夹心酶联免疫吸附试验检测１５例慢性粒细胞白血病（ＣＭＬ）患者脑脊液（ＣＳＦ）可溶性白细胞介素２受体（ｓＩＬ－２Ｒ）水平。结果显示：ＣＭＬ急变期患者脑脊液ｓＩＬ－２Ｒ水平显著高于正常对照，ＣＭＬ慢性期及加速期与正常对照组间均无显著差异。合并中枢神经系统白血病（ＣＮＳ－Ｌ）患者ＣＳＦ中ｓＩＬ－２Ｒ明显高于ＬＣＮＳ－Ｌ者，治疗达缓解后渐降至正常范围。合并ＣＮＳ－Ｌ者ｓＩＬ－２Ｒ水平升高与ＣＳＦ中白血病细胞浸润呈正相关。我们认为ｓＩＬ－２Ｒ可作为ＣＮＳ－Ｌ诊断的参考指标之一，并可用于监测病情，观察疗效。     

CFU-C abnormalities and cytochemical defects in bone marrow of adult patients during remission of acute leukemia

Twenty-three adult patients in complete remission (CR) from acute leukemia were investigated for the steady-state bone marrow (BM) CFU-C concentration and the cytochemical findings of neutrophils and monocytes. There was considerable variation in CFU-C concentrations among patients. Patients with abnormality high or low values tended to relapse earlier. Repeated assays revealed constant CFU-C values in individual long-term cases of remission (4 cases). One case of M4 (myelomonocytic) and the case of M5b (monocytic) leukemia revealed a complete lack of nonspecific esterase activity in CR monocytes as well as initial leukemic promonocytes; they also showed abnormally high or low concentrations of CFU-C and relapsed early. This finding suggests that hematopoiesis in CR bone marrow occurs from abnormal stem cells common to initial, acute leukemic clones in such cases.     

A phase II study of mitoxantrone in acute leukemia. Hanshin Cooperative Study Group of Hematological Disorders

A phase II study of mitoxantrone was conducted on acute leukemia. Mitoxantrone 4 mg/m2/day was administered for 5 consecutive days in most cases. For cases showing insufficient decrease of leukemic cells even at nadir, a second course of the same regimen was given. Enrolled were 38 cases in total, of which 34 were evaluable. In 14 cases for first remission induction, the drug efficacy was evaluated at the completion of the first or second course, then further combination drug therapy followed immediately. Of 14 cases for first remission induction, 6, or 43%, achieved CR and of 20 cases for reinduction of remission, 4, or 20%, achieved CR. Two out of 7 cases of ALL (29%) and 8 out of 27 cases of ANLL (30%) achieved CR. Of 19 cases with previous anthracycline therapy, 4 cases, or 21%, achieved CR, showing that the cross-resistance was partial. Gastrointestinal symptoms were the main side effects, but cases of symptoms severer than grade 3 were very rare. Cardiotoxicity occurred at a rate as low as 11%. Mitoxantrone thus appears to be a promising drug for the treatment of acute leukemia.     

治疗相关性白血病的治疗

目的探讨治疗相关性白血病的治疗方法.方法分析我所1985～2003年收治的48例治疗相关性白血病.结果临床各型占同期各类白血病的0.6%,占AML的7%.48例中放疗所致的相关性白血病全部为CML,化疗所致的相关性白血病全部为AML.化疗主要的药物为鬼臼类,烷化剂和蒽环类药物.但对Ph阳性的CML应用STI571,有2例病人获长期生存.APL应用三氧化二砷 ATRA双诱导治疗后全部获CR,1例无病生存7年.结论治疗相关性白血病对治疗反应较差,CR率极低.     

Evaluation of 58 patients with acute leukemia]

We made a retrospective study of 44 patients with acute non-lymphocytic leukemia (ANLL) and 14 patients with acute lymphocytic leukemia (ALL) admitted to our hospital from September 1984 to May 1991. The complete remission (CR) rate of ANLL was 90.9%, against 85.7% for ALL. The 5-year survival of ANLL was 50.7%, and that of ANLL under age 60 years was 70.3%. The 2-year median survival of ALL was 35.1%. These results were obtained with response-oriented individualized therapy, and intensive chemotherapy with a view to eradication of residual leukemic cells. Eight elderly patients with ANLL were treated with cytosine arabinoside in low doses. Complete remission was achieved in 6 patients, but these cases relapsed. These treatments should be reconsidered for long CR duration. Our schedules of response-oriented individualized therapy were too flexible to apply at another institute so they should be arranged for general application.     

High-dose cytosine arabinoside as the initial treatment of poor-risk patients with acute nonlymphocytic leukemia: a Leukemia Intergroup Study

Sixty-seven patients with newly diagnosed acute nonlymphocytic leukemia (ANLL) who were considered to be poor candidates for treatment with cytosine arabinoside (ara-C)/anthracycline antibiotic therapy were treated with high-dose ara-C (HDara-C) remission induction therapy. Thirty-four of the 67 patients had a hematologic disorder before developing acute leukemia or had a history of exposure to marrow toxins, 23 patients were greater than 70 years old, and 10 patients had medical problems that were felt to be a contraindication to therapy with an anthracycline antibiotic. Forty-two percent of patients entered complete remission (CR), whereas 22% failed to enter remission because of persistent leukemia. Treatment was associated with substantial toxicity varying from nausea and vomiting to irreversible cerebellar toxicity. Thirty-four percent of patients died during therapy. Poor performance status, a low serum albumin, and a low platelet count were associated with death during remission induction therapy, whereas a high pretherapy leukemic cell mass and a large number of residual leukemic cells in the marrow after six days of therapy were associated with treatment failure due to persistent leukemia.     

Therapy of advanced myelodysplastic syndrome with aggressive chemotherapy

Nine patients with advanced stages of myelodysplastic syndrome (MDS) received aggressive chemotherapy with high-dose cytarabine or with a standard acute myeloid leukemic regimen. Six of them were in frank acute myeloid leukemic phase. The mean age was 57 years (range 32-71). Seven patients obtained remission, 6 complete remission (CR) and 1 partial remission. The induction remission rate was 77.7%. There were 2 deaths in the aplasia period because of infectious complications. The mean duration aplasia was 36 days (range 21-69). In spite of this all responders received further consolidation chemotherapy. The mean duration of CR was 10 months. We concluded that patients with MDS with excess of blasts and blastic transformation may be treated with aggressive chemotherapy with low toxicity and high remission rate, similarly to de novo acute myeloid leukemia.     

Acute leukemia

Recent progress in the treatment of acute leukemia is so rapid and wide-ranged that it is difficult to detail the progress. Therefore we limit this paper focusing following items: 1) FAB classification and therapeutic response; 2) 5000 leukocyte differential and survival; 3) bone marrow transplantation; and 4) over all survival and 5-year survival. 1) FAB classification and therapeutic response: 59 cases of acute non-lymphocytic leukemia were classified according to FAB classification: (M5-16 cases. The differences in the complete remission rate, duration of remission and median survival were not significant among these groups. 2) 5000 leukocyte differential and survival: 86 cases with acute leukemia which achieved complete remission were divided into three groups according to the levels of remaining leukemic cells by 5000 leukocyte differential: 0-1/5000-39 cases, 2-4/5000-24 cases and 5-/5000-23 cases. A close correlation between the leukemic cell level during remission and survival of patients was observed. A marked tendency of longer survival was observed in cases in which leukemic cells decreased during remission and vice versa. 3) Bone marrow transplantation (BMT) therapy: Up to now, 15 patients have been treated and 4 of them are alive now. The longest survival is a case of a 9 year old boy with ALL, who is doing well after BMT for one year and a half. 4) Median survival and 5-year survival: Overall median survival of acute leukemia patients was 7 months (1970-1974) and 12 months (1975-1979). We have experienced 12 patients of 5-year survivors. Out of them, 7 patients are still in remission for more than 6 years. The 5-year survival rate was 0.5% before 1969, and 8.3% after 1970. This indicates a remarkable improvement in the treatment of acute leukemia.     

Acute Myeloblasts Leukemia with Minimal Myeloid Differentiation (FAB AML-M0): A Study of Eleven Cases

The main clinical, morphological, cytochemical, immunological features and therapy results of eleven patients diagnosed as acute myelobiastic leukemia M₀ (AML-M₀) are reported here. There were no clinical characteristics, abnormalities on physical examination or initial laboratory parameters that distinguished these eleven patients. Bone marrow aspirates were hypocellular in four patients. The leukemic cells were undifferentiated by light microscopy and myeloperoxidase (MPO) and /or Sudan Black B (SBB) stains were negative in all cases. Myeloid differentiation antigens were present on the leukemic cells of all eleven patients, whereas B and T cell markers were clearly negative except for CD4 and CD7 antigens. Whatever the treatment employed survival was very short. Eight of the eleven patients were treated and two achieved complete remission (CR) but only one of them is alive in continuous CR. Our results like those previously reported, suggest that AML-M₀ patients have a very poor prognosis with standard induction therapies and should perhaps be considered for experimental therapeutic approaches.     

Differential count of 5,000 leukocytes for acute nonlymphocytic leukemia patients during remission

In order to find the level of leukemic cells during remission a differential count of 5,000 leukocytes was made in 91 acute nonlymphocytic leukemia cases during their first complete remission. Patients were divided into three groups according to the level of leukemic cells, i.e., 0-1/5,000, 2-4/5,000 and 5-/5,000. A close correlation was observed between the survival of patients and the level of leukemic cells and their tendency to decrease or increase during remission. All patients in whom leukemic cells rose from 0-1/5,000 to a level higher than 8/5,000 suffered a documented relapse after 4-8 weeks. This method appears to be a good supportive examination for acute leukemia patients during remission.     

Improved results of treatment in 30 cases of acute nonlymphocytic leukemia in childhood

Thirty cases of childhood acute nonlymphocytic leukemia (ANLL) have been treated with intermittent, intensive multi-drug combinations during the past 5 years. Three patients never attained complete remission (CR) and 3 died of complications after less than one month of treatment. Twenty-four (86.7 %) attained CR with a median CCR of 26 months. The median for disease-free survival (DFS) among the total 30 cases was 15 months. Twelve out of the 24 CR patients have been disease-free for longer than 16 months, indicating significantly improved therapeutic results. Among the factors affecting prognosis, we found that patients with certain clonal abnormalities of leukemic cells and initial leukocytosis (greater than 40,000/microliter) had poor prognosis. Further revision of treatment should be considered for patients with high-risk ANLL.