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1.
Objective To evaluate the therapeutic effect of the fludarabine and cytarabine (FA) regimen on acute myeloid leukemia (AML) at different
phases during treatment.
Methods A total of 185 patients with AML were divided into 4 groups based on the outcome of previous treatments. Patients in Group
1 had no remission after the first course of induction chemotherapy (n = 55). Patients in Group 2 had no remission after no less than two courses of induction chemotherapy (n = 41). Patients in Group 3 had early relapse (n = 40). Patients in Group 4 had late relapse (n = 49). Patients in groups 2, 3 and 4 had refractory AML or AML with relapse. We assessed the efficacy and toxicity of FA
combination chemotherapy in each of these 4 groups.
Results The complete remission (CR) rates of Groups 1, 2, 3 and 4 were 74.5% (41/55), 45.9% (19/41), 17.5% (7/40) and 38.8% (19/49),
respectively. The CR rate was higher in Group 1 than in the other 3 groups (34.6%, 45/130) (P = 0.000). A significant correlation was found between CR rate and the number of chemotherapeutic courses (P = 0.023). The main adverse reactions included bone marrow suppression and secondary infection.
Conclusion FA regimen is a good choice for patients with AML, especially those who have failed to achieve CR after the first course of
induction chemotherapy.
Supported by a grant from the Planned Science and Technology Project of Guangzhou (No. 2006Z3-E0401). 相似文献
2.
Hyperglycemia in patients with acute myeloid leukemia is associated with increased hospital mortality 总被引:1,自引:0,他引:1
Ali NA O'Brien JM Blum W Byrd JC Klisovic RB Marcucci G Phillips G Marsh CB Lemeshow S Grever MR 《Cancer》2007,110(1):96-102
BACKGROUND: Hyperglycemia is often observed in medically ill patients. Previous studies have shown that patients with hyperglycemia during induction therapy for acute lymphoblastic leukemia develop more infections and have shorter disease-free survival. The authors hypothesized that hyperglycemia may be associated with adverse outcomes in patients with acute myeloid leukemia (AML) and sought to determine whether this association exists in this population. METHODS: The authors performed a retrospective cohort study to examine the relation between hyperglycemia and hospital mortality in patients with the diagnosis of AML. Two hundred eighty-three adult patients were treated over a 3-year period. All hospitalizations were reviewed during the study period, and glucose exposure and outcomes were quantified. RESULTS: Hyperglycemia during a patient's hospitalization was associated with increased hospital mortality (OR, 1.38; 95% CI, 1.23-1.55; P < .001) after adjusting for covariates, including disease state, treatment type, and response. The rise in mortality was evident at even mild levels (110-150 mg/dL) of glucose elevation. Although the odds of developing severe sepsis (OR, 1.24; 95% CI, 1.13.-1.38; P < .001) or severe sepsis with respiratory failure (OR, 2.04; 95% CI, 1.44-2.91; P < .001) were increased with hyperglycemia, sepsis did not appear to be the main factor responsible for the negative impact of hyperglycemia on hospital mortality. CONCLUSIONS: This study demonstrated an association between hospital mortality and even modest levels of hyperglycemia in AML patients. Prospective studies are needed to confirm this association and to discern causal pathways that mediate this effect. 相似文献
3.
Xingnong Ye Dan Chen Yan Zheng Cai Wu Xiaoqiong Zhu Jian Huang 《Hematological oncology》2019,37(4):438-446
To determine the incidence, risk factors, and relative survival of acute myeloid leukemia (AML) secondary to myelodysplastic syndrome (MDS) in the Surveillance, Epidemiology, and End Results (SEER) database. Retrospective analysis of all patients with new MDS onset in the SEER‐18 database from 2001 to 2013. We identified 36 558 patients with primary MDS. The rate of secondary AML (sAML) was 3.7% among patients 40 years or younger and 2.5% among those older than 40 (P = .039). The median transformation interval was significantly shorter for the younger group (4.04 vs 13.1 mo; P < .001). For both age groups, median overall and cancer‐specific survival were significantly longer for patients who did not develop sAML. Although the younger patients survived longer than the older patients, sAML development had a more negative effect on the survival of younger patients. Female sex, age, and World Health Organization (WHO) type MDS with single lineage dysplasia (MDS‐SLD) were associated with a decreased risk of sAML for older but not younger patients. Among older patients with MDS, a married status, Black race, female sex, shorter time to sAML, and WHO type MDS‐SLD or MDS with ringed sideroblasts were favorable prognostic factors for survival. In the SEER database, the rate of sAML among patients with MDS is lower than that in previous reports, but these patients still have worse survival. Risk assessment should include clinical and demographic factors. 相似文献
4.
急性髓系白血病(acute myeloid leukemia,AML)是一种异质性髓系恶性肿瘤,目前化疗联合造血干细胞移植是主要治疗方法,但是总体预后较差。吉妥珠单抗(gemtuzumab ozogamicin,GO)是一种人源化抗CD33单抗与卡奇霉素结合的抗体偶联药物,主要用于治疗CD33阳性AML。虽然研究发现GO可以改善CD33阳性AML患者的预后,但是仍有部分AML患者并未获益。GO治疗AML的疗效主要与CD33表达及单核苷酸多态性(single nucleotide polymorphism,SNP)、ATP 结合盒亚家族B成员1(ATP-binding cassette subfamily B member 1,ABCB1)基因及SNP、特异的分子生物学和细胞遗传学等因素有关。本文就GO对AML疗效影响因素的研究进展进行综述。 相似文献
5.
Gemtuzumab ozogamicin (GO) is a chemotherapeutic agent that consists of a humanized anti-CD33 antibody (hP67.6) linked to N-acetyl-calicheamicin 1,2-dimethyl hydrazine dichloride, a potent enediyne antitumor antibiotic. GO was approved conditionally by the Federal Drug Administration in May 2000 as single-agent therapy for first recurrence of acute myeloid leukemia (AML) in patients over the age of 60 years who are unfit for conventional cytotoxic therapy. In this setting, it produces a complete response (CR) rate of 13%, with another 13% achieving CR with inadequate platelet recovery (CRp). The most common adverse effects associated with GO are infusion-related reactions and myelosuppression. GO monotherapy at the dose of 9 mg/m(2) is complicated with hepatic veno-occlusive disease in approximately 5% of cases, particularly prior to or following stem cell transplantation. Attenuated doses of GO or fractionated doses appear to be equally effective and better tolerated. GO has shown remarkable activity in acute promyelocytic leukemia, particularly for the elimination of minimal residual disease. Combinations of GO with chemotherapy as induction or post-remission therapy are promising, and phase III trials are ongoing. 相似文献
6.
Final results of a phase 2 trial of clofarabine and low‐dose cytarabine alternating with decitabine in older patients with newly diagnosed acute myeloid leukemia 下载免费PDF全文
Farhad Ravandi MD Elias Jabbour MD Guillermo Garcia‐Manero MD Gautam Borthakur MD Alessandra Ferrajoli MD Marina Konopleva MD PhD Jan Burger MD PhD Xuelin Huang Xuemei Wang Sherry Pierce Mark Brandt Jennie Feliu Jorge Cortes MD Hagop Kantarjian MD 《Cancer》2015,121(14):2375-2382
7.
Psychological mobile app for patients with acute myeloid leukemia: A pilot randomized clinical trial
Areej El-Jawahri MD Marlise R. Luskin MD Joseph A. Greer PhD Lara Traeger PhD Mitchell Lavoie BS Dagny Marie Vaughn BS Stephanie Andrews BS Daniel Yang BS Kofi Y. Boateng BS Richard A. Newcomb MD Nneka N. Ufere MD Amir T. Fathi MD Gabriela Hobbs MD Andrew Brunner MD Gregory A. Abel MD Richard M. Stone MD Daniel J. DeAngelo MD PhD Martha Wadleigh MD Jennifer S. Temel MD 《Cancer》2023,129(7):1075-1084
8.
Iman Abou Dalle MD Hagop M. Kantarjian MD Farhad Ravandi MD Naval Daver MD Xuemei Wang MS Elias Jabbour MD Zeev Estrov MD Courtney D. DiNardo MD Naveen Pemmaraju MD Alessandra Ferrajoli MD Nitin Jain MBBS Sa A. Wang MD Nadya Jammal PharmD Gautam Borthakur MD Kiran Naqvi MD Sarah Pelletier RN Sherry Pierce RN BS Michael Andreeff MD Guillermo Garcia-Manero MD Jorge E. Cortes MD Tapan M. Kadia MD 《Cancer》2021,127(11):1894-1900
9.
Health care utilization and end‐of‐life care for older patients with acute myeloid leukemia 下载免费PDF全文
Areej R. El‐Jawahri MD Gregory A. Abel MD MPH David P. Steensma MD Thomas W. LeBlanc MD MA Amir T. Fathi MD Timothy A. Graubert MD Daniel J. DeAngelo MD PhD Martha Wadleigh MD Karen K. Ballen MD Julia E. Foster NP Eyal C. Attar MD Philip C. Amrein MD Andrew M. Brunner MD Richard M. Stone MD Jennifer S. Temel MD 《Cancer》2015,121(16):2840-2848
10.
Johanna Flach Evgenii Shumilov Gertrud Wiedemann Naomi Porret Inna Shakhanova Susanne Bürki Myriam Legros Raphael Joncourt Thomas Pabst Ulrike Bacher 《Hematological oncology》2020,38(4):425-431
Relapse of acute myeloid leukemia (AML) remains a major determinant of outcome. A number of molecularly directed treatment options have recently emerged making comprehensive diagnostics an important pillar of clinical decision making at relapse. Acknowledging the high degree of individual genetic variability at AML relapse, next-generation sequencing (NGS) has opened the opportunity for assessing the unique clonal hierarchy of individual AML patients. Knowledge on the genetic makeup of AML is reflected in patient customized treatment strategies thereby providing improved outcomes. For example, the emergence of druggable mutations at relapse enable the use of novel targeted therapies, including FLT3 inhibitors or the recently approved IDH1/2 inhibitors ivosidenib and enasidenib, respectively. Consequently, some patients may undergo novel bridging approaches for reinduction before allogeneic stem cell transplantation, or the identification of an adverse prognostic marker may initiate early donor search. In this review, we summarize the current knowledge of NGS in identifying clonal stability, clonal evolution, and clonal devolution in the context of AML relapse. In light of recent improvements in AML treatment options, NGS-based molecular diagnostics emerges as the basis for molecularly directed treatment decisions in patients at relapse. 相似文献
11.
Current treatment strategies for measurable residual disease in patients with acute myeloid leukemia
Patients with acute myeloid leukemia (AML) who achieve a morphologic complete remission still can have measurable residual disease (MRD) detected by multiparametric flow cytometry, molecular methods, or cytogenetics. Such patients with MRD have a high risk of disease recurrence over a short timeframe, but optimal treatment strategies are unknown. Outcomes with conventional treatment, including allogeneic hematopoietic cell transplantation, are worse than those for patients without MRD. Herein, the authors review current strategies, including novel clinical trials, targeted toward patients with MRD. 相似文献
12.
James M. Foran MD Zhuoxin Sun PhD Catherine Lai MD MPH Hugo F. Fernandez MD Larry D. Cripe MD Rhett P. Ketterling MD Janis Racevskis PhD Selina M. Luger MD Elisabeth Paietta PhD Hillard M. Lazarus MD Yanming Zhang MD John M. Bennett MD Ross L. Levine MD PhD Jacob M. Rowe MD Mark R. Litzow MD Martin S. Tallman MD 《Cancer》2023,129(16):2479-2490
13.
Prognostic significance of acquired copy‐neutral loss of heterozygosity in acute myeloid leukemia 下载免费PDF全文
Christine M. Gronseth Scott E. McElhone Barry E. Storer PhD Kathleen A. Kroeger Vicky Sandhu MD Matthew L. Fero MD Frederick R. Appelbaum MD Elihu H. Estey MD Min Fang MD PhD 《Cancer》2015,121(17):2900-2908
14.
Tapan M. Kadia MD Hagop Kantarjian MD Steven Kornblau MD Gautam Borthakur MD Stefan Faderl MD Emil J. Freireich MD Raja Luthra PhD Guillermo Garcia‐Manero MD Sherry Pierce Jorge Cortes MD Farhad Ravandi MD 《Cancer》2012,118(22):5550-5559
BACKGROUND:
Activating mutations in RAS are frequently present in patients with acute myeloid leukemia (AML), but their overall prognostic impact is not clear.METHODS:
A retrospective analysis was performed to establish the clinical characteristics of patients with RAS‐mutated (RASmut) AML, to analyze their outcome by therapy, and to describe the proteomic profile of RASmut compared with wild‐type RAS (RASWT) AML.RESULTS:
Of 609 patients with newly diagnosed AML, 11% had RASmut. Compared with RASWT, patients with RASmut AML were younger (median age, 54 years vs 63 years; P = .001), had a higher white blood cell count (16K mm?3 vs 4K mm?3 ; P < 0.001) and bone marrow blast percentage (56% vs 42%; P = .01) at diagnosis, and were less likely to have an antecedent hematologic disorder (36% vs 50%; P = .03). The inv(16) karyotype was overrepresented in patients with RASmut and the ?5 and/or ?7 karyotype was underrepresented. RAS mutations were found to have no prognostic impact on overall survival or disease‐free survival overall or within cytogenetic subgroups. There was a suggestion that patients with RASmut benefited from cytarabine (AraC)‐based therapy. Proteomic analysis revealed simultaneous upregulation of the RAS‐Raf‐MAP kinase and phosphoinositide 3‐kinase (PI3K) signaling pathways in patients with RASmut.CONCLUSIONS:
RAS mutations in AML may delineate a subset of patients who benefit from AraC‐based therapy and who may be amenable to treatment with inhibitors of RAS and PI3K signaling pathways. Cancer 2012. © 2012 American Cancer Society. 相似文献15.
Ashley M. Nelson PhD Hermioni L. Amonoo MD MPP Alison R. Kavanaugh NP Jason A. Webb MD Vicki A. Jackson MD MPH Julia Rice BA Mitchell W. Lavoie BS Amir T. Fathi MD Andrew M. Brunner MD Joseph A. Greer PhD Jennifer S. Temel MD Areej El-Jawahri MD Thomas W. LeBlanc MD MA MHS 《Cancer》2021,127(24):4702-4710
16.
Kunhwa Kim MD MPH Abhishek Maiti MBBS Sanam Loghavi MD Rasoul Pourebrahim MD PhD Tapan M. Kadia MD Caitlin R. Rausch PharmD Ken Furudate PhD DMD Naval G. Daver MD Yesid Alvarado MD Maro Ohanian DO Koji Sasaki MD Nicholas J. Short MD Koichi Takahashi MD PhD Musa Yilmaz MD Guilin Tang MD Farhad Ravandi MBBS Hagop M. Kantarjian MD Courtney D. DiNardo MD MSCE Marina Y. Konopleva MD PhD 《Cancer》2021,127(20):3772-3781
17.
Hagop M. Kantarjian MD Elias J. Jabbour MD Guillermo Garcia-Manero MD Tapan M. Kadia MD Courtney D. DiNardo MD Naval G. Daver MBBS Gautam Borthakur MD Nitin Jain MD Jane B. Waukau RN BSN Monica I. Kwari RN BSN CCRP Farhad Ravandi MD Barry D. Anderson MD PhD Kenzo Iizuka PhD Cheng Jin MD PhD Chun Zhang MD PhD William K. Plunkett PhD 《Cancer》2019,125(10):1665-1673
18.
The clinical significance of soluble CD86 levels in patients with acute myeloid leukemia and myelodysplastic syndrome 总被引:4,自引:0,他引:4
Hock BD McKenzie JL Patton WN Haring LF Yang Y Shen Y Estey EH Albitar M 《Cancer》2003,98(8):1681-1688
BACKGROUND: Levels of the soluble form of CD86 (sCD86) are elevated in a proportion of patients with leukemia. Although it is a potential modulator of antitumor responses, the significance of sCD86 in patients with hematologic malignancies is unknown. METHODS: The authors evaluated sCD86 levels by enzyme-linked immunosorbent assay in patients with acute myeloid leukemia (AML) (n = 57 patients) and patients with myelodysplastic syndrome (MDS) (n = 40 patients) and analyzed the relation between sCD86 levels and various clinical parameters. RESULTS: Levels of sCD86 were elevated (> 2.32 ng/mL) relative to normal donors (0.22-2.32 ng/mL; n = 51 patients) in 25% of patients with AML and in 27% of patients with MDS. Patients with AML who had elevated sCD86 levels had significantly lower complete remission (CR) rates compared with patients with AML who had normal sCD86 levels. In multivariate analysis using sCD86 as a continuous variable and including the interaction of age and sCD86 as a variable, sCD86 was a significant prognostic factor (P = 0.014) independent of cytogenetics. Further analysis demonstrated that, in patients with AML age 60 years and younger, but not in patients older than 60 years, elevated sCD86 levels were associated with significantly shorter survival (P = 0.04). There was no correlation between sCD86 levels and CR rates or survival in patients with MDS. CONCLUSIONS: The presence in patients with AML of elevated levels of circulating sCD86 were associated with lower CR rates and poor survival. The prognostic significance of sCD86 was independent of cytogenetics but was modulated by age, in that it was independently significant only in younger patients. The results suggest that sCD86 may play a role in modulating immune responses associated with the progression of AML. 相似文献
19.
20.
Sangeetha Venugopal MD Mahran Shoukier MD Marina Konopleva MD PhD Courtney D. Dinardo MD MSCE Farhad Ravandi MD Nicholas J. Short MD Michael Andreeff MD PhD Gautam Borthakur MD Naval Daver MD Naveen Pemmaraju MD Koji Sasaki MD PhD Guillermo Montalban-Bravo MD Kayleigh R. Marx DPharm Sherry Pierce RN Uday R. Popat MD Elizabeth J. Shpall MD Rashmi Kanagal-Shamanna MD Guillermo Garcia-Manero MD Hagop M. Kantarjian MD Tapan M. Kadia MD 《Cancer》2021,127(19):3541-3551