PCR方法检测慢性粒细胞白血病bcr／abl mRNA

应用筑巢式递转录／聚合酶链反应方法对３２例慢性粒细胞白血病患者的ｂｃｒ／ａｂｌ ｍＲＮＡ进行检测，发现３１例有融合ｂｃｒ／ａｂｌ ｍＲＮＡ表达，其中１９例表达为ｂ３ａ２型，９例表达为ｂ２ａ２型，３例同时表达为ｂ３ａ２、ｂ２ａ２型，慢性粒细胞白血病临床分期与ｂｃｒ／ａｂｌ ｍＲＮＡ表达类型有关，加速期和急变期，同时表达两种类型居多，即易发生选择性拼接，该法灵敏度高达１０＾－６水平。     

PCR方法检测慢性粒细胞白血病 bcr/abl mRNA

应用筑巢式递转录／聚合酶链反应方法对３２例慢性粒细胞白血病患者的ｂｃｒ／ａｂｌｍＲＮＡ进行检测，发现３１例有融合ｂｃｒ／ａｂｌｍＲＮＡ表达。其中１９例表达为ｂ３ａ２型，９例表达为ｂ２ａ２型，３例同时表达为ｂ３ａ２、ｂ２ａ２型。慢性粒细胞白血病临床分期与ｂｃｒ／ａｂｌｍＲＮＡ表达类型有关，加速期和急变期，同时表达两种类型居多，即易发生选择性拼接，该法灵敏度高达１０－６水平。     

双特异抗体介导的CD3AK对人小细胞肺癌细胞株的细胞毒作用

目的：研究在双特异性抗体的介导下ＣＤ３ＡＫ细胞（ＣＤ３单克隆栓激活的杀伤细胞）对人小细胞肺癌细胞株ＬＴＥＰ－ｓｍｌ的细胞毒作用。方法：用＾３１Ｃｒ－Ｎａ２ＣｒＯ４释放试验检测单抗（２Ｄ６、ＵＣＨＴ１）和双特异性抗体（ＷＳＴ－Ｈ７）与ＣＤ３ＡＫ共同对人小细胞肺癌细胞株的杀伤活性。持异性抗体体外能明显增强ＣＤ３ＡＫ细胞对人小细胞肺细胞株ＬＴＥＰ－ｓｍｌ的杀伤活性结论：与单纯ＣＤ３ＡＫ相比,加入双特异性     

33例头颈部恶性肿瘤患者局部过继免疫治疗的疗效观察

目的评价ＩＬ－２／ＬＡＫ细胞局部过继免疫疗法在头颈部恶性肿瘤治疗中的疗效。方法对３３例头颈部恶性肿瘤患者进行局部过继免疫治疗,采用ＩＬ－２每日１０～２０万单位局部注射,共１０天;于ＩＬ－２治疗的第４～８天同时于局部注射ＬＡＫ细胞１．０×１０８～５．０×１０８／ｄ。结果完全缓解１例,部分缓解６例,好转２０例,稳定６例,治疗总缓解率２１．２％,总有效率８１．８％。治疗后１,２,３年生存率分别为９６．３％、８３．３％、和７５．０％。组织病理学检查证实免疫治疗后肿瘤局部大量ＣＤ３、ＣＤ４阳性Ｔ淋巴细胞浸润。治疗过程中未见严重的毒副作用。结论局部应用ＬＡＫ细胞与ＩＬ－２治疗头颈部恶性肿瘤疗效明显,方法安全。     

全血细胞减少性急性白血病

本文报道我院１９８８年３月至１９９３年２月未经治疗的全血细胞减少性急性白血病４８例。该组病例症状以贫血、出血、感染较常见。外周血全血细胞减少，而骨髓像大多呈明显活跃或极度活跃。要和再生障碍性贫血、骨髓增生异常综合征、低增生性白血病鉴别。小剂量化疗组１４例（Ａｒａ－ｃ１０ｍｇＢｉｄ×１４～２１天，维甲酸、活性Ｄ３）获ＣＲ３例（２１．４％），ＰＲ２例（１４．３％），死亡４例（２８．６％），总有效率３５．７％；常规方案化疗组２２例（ＡＮＬＬ用ＨＯＡＰ、ＣＯＡＰ、ＨＡ、ＤＡ方案，ＡＬＬ用ＶＡＰ、ＶｍＰ、ＶＬＰ、ＣＯＰ等方案），获ＣＲ９例４０．９％、ＰＲ１例（４．５％），死亡１例（４．５％）总有效率４５．４％。该文提示常规方案化疗比小剂量化疗的疗效好，完全缓解率高，死亡率低。     

高氧刺激下ＰＡＣ１诱导乳腺癌细胞凋亡的机制探讨

目的　初步探讨高氧刺激下ＰＡＣ１对人乳腺癌细胞株ＭＤＡ-ＭＢ４３５的凋亡诱导作用及其机制。方法　通过脂质体法转染目的质粒ｐｃＤＮＡ３.１（＋）／ＰＡＣ１进入人乳腺癌细胞株ＭＤＡ ＭＢ４３５,筛选稳定表达ＰＡＣ１的细胞克隆,并使用Ｗｅｓｔｅｒｎｂｌｏｔｔｉｎｇ法鉴定高表达ＰＡＣ１的ＭＢ４３５细胞克隆。应用台盼蓝染色法检测不同细胞在Ｈ２Ｏ２处理后的存活率变化,同时进一步使用Ｗｅｓｔｅｒｎｂｌｏｔｔｉｎｇ法检测ＭＢ４３５／ＰＡＣ１细胞克隆经Ｈ２Ｏ２处理后其ＥＲＫ１／２磷酸化的水平。结果　在细胞克隆ＭＢ４３５／ＰＡＣ１-Ｃ２和ＭＢ４３５／ＰＡＣ１-Ｃ６中均有高水平的ＰＡＣ１表达,这些高表达ＰＡＣ１的肿瘤细胞经高氧化合物Ｈ２Ｏ２刺激后细胞存活率相对于对照组均明显降低（Ｐ＜０.０１）,而且ＰＡＣ１的高表达可以引起细胞内ＭＡＰＫ激酶ＥＲＫ１／２的活性受到抑制,使磷酸化水平降低。结论　ＰＡＣ１可以通过抑制ＥＲＫ１／２的磷酸化水平而介导细胞对高氧刺激的反应,从而诱导细胞发生凋亡。     

异体外周血造血干细胞移植治疗白血病的研究

报告用ＨＬＡ相合的同胞异基困外周血造血干细胞移植治疗白血病３例，１例为ＣＭＬ－ＣＰ，１例为ＡＬＬ－ＣＲ１，１例为ＡＭＬ－Ｍ２ＣＲ１，预处理方案均为环磷酰胺６０ｍｇ／ｋｇ×２天，全身６０Ｃｏ照射４Ｇｙ×３天，供者于－５日起间步每日给予Ｇ－ＣＳＦ５μｇ／ｋｇ，－５日后即－１日用ＢａｘｅｒＣＳ３０００血细胞分离机分离单个核细胞（ＭＮＣ）其ＭＮＣ为７．７０、３．４４及２．４６×１０８／ｋｇ，ＬＤ３４＋细胞为２５．７及１９．２×１０６／ｋｇ，ＣＤ３４＋／ＣＤ３３－细胞为１．１１及０．５９×１０６／ｋｇ，ＣＤ３＋细胞为９４．９及１３６．８×１０６／ｋｇ，血循环量为１０升分离后给思考静脉输注（在ＴＢＩ４小时以后）．次日（０日）再分离一次ＭＮＣ输注给病人，认为Ａｌｌｏ－ＰＢＳＣＴ可以使造血细胞植入恢复得快，感染及出血的机会减少，抗菌素的使用天数减少，急性ＧＶＨＤ并不增多、对Ａｌｌｏ－ＰＢＳＣＴ的有关问题讨论。     

泰素为主联合化疗治疗晚期乳腺癌及卵巢癌10例

我科于１９９７年９月至１９９８年５月，应用美国百时美施贵宝公司生产的泰素联合化疗，治疗１０例晚期癌患者，现将治疗结果报告如下。１材料与方法１．１临床资料１０例中乳腺癌６例，均行根治术以后行辅助性放化疗后复发和（或）转移的患者，其中有２例在复发转移后曾用过ＡＤＭ、ＣＢＰ、ＣＴＸ、５－ＦＵ联合化疗。卵巢癌４例行手术以后复发，其中３例用过ＰＤＤ、５－ＦＵ、ＶＰ－１６联合方案化疗２～３疗程，１例未用过化疗。１０例病例的年龄２７～６０岁，中位４８岁。１．２用药方法泰素联合ＣＦ或ＣＯＦ方案化疗，每次用量为Ｃ…     

碳酸锂对抗黄曲霉素B_1诱导大鼠肝癌前病变过程中P~(21)、Bcl-2蛋白的表达

采用肝癌发生的动物模型,观察了碳酸锂（Ｌｉ２ＣＯ３）对抗黄曲霉素Ｂ１（ＡＦＢ１）诱发的大鼠肝癌前病变的组织形态学变化及其Ｐ２１、Ｂｃｌ－２蛋白的表达状况。Ｗｉｓｔａｒ大鼠１４４只随机分为Ａ、Ｂ、Ｃ、Ｄ４组,分别为阴性、阳性对照及Ｌｉ２ＣＯ同时给药和Ｌｉ２ＣＯ３先期给药组。于实验第６、９、１０ｗｋ分批断头处死动物,取动物的肝脏进行组织形态学检查及免疫组织化学染色。结果发现：Ｃ、Ｄ两组动物健康状况明显改善,肝癌前病变程度明显减轻;Ｐ２１、Ｂｃｌ－２蛋白在诱癌早期（实验第６ｗｋ）即有表达,第９、１０ｗｋ显著提高,呈Ｂ组＞Ｃ组＞Ｄ组＞Ａ组的趋势,与各组肝脏组织形态学变化一致。提示：Ｌｉ２ＣＯ３具有明显地对抗和预防化学诱导肝癌的作用,Ｐ２１、Ｂｃｌ－２蛋白的动态检测有助于肝癌的早期发现及判断预后。     

多元耐药基因（MDRI）在急性白血病细胞中表达的意义

观察多元耐药ＭＤＲ１基因在急性白血病细胞中的表达及其意义。方法取１５例急性白血病（ＡＭＬ１２例，ＡＬＬ３例）患者的骨髓细胞通过ＲＴＰＣＲ等法，检测ＭＤＲ１，分析其表达情况以及与临床治疗效果。结果９／１５例（ＡＭＬ８例，ＡＬＬ１例）的ＭＤＲ１表达阳性（阳性率６０％）。其中６／９例经化疗不缓解。１／９例部分缓解，２／９例完全缓解，在ＭＤＲ１表达阴性者中，５／６例完全缓解，１／６例不缓解。结论急性白血病患者的ＭＤＲ１基因表达和化疗的效果有密切联系。     

氟达拉滨联合阿糖胞苷及粒细胞集落刺激因子治疗儿童难治及复发性急性白血病

 【摘要】　目的　观察氟达拉滨（Flud）联合阿糖胞苷（Ara-C）及粒细胞集落刺激因子（G-CSF）（FLAG）方案治疗儿童难治及复发性急性白血病（AL）的疗效及患者不良反应。方法　9例复发及难治性AL患儿接受了FLAG方案治疗,Flud 每天30 mg／m2,第1天至第5天,静脉滴注30 min;Ara-C每天2 g／m2,Flud应用后4 h静脉滴注,第1天至第5天。G-CSF 5 μg?kg-1?d-1,中性粒细胞＜0.5×109／L时开始应用,用至中性粒细胞 ≥1×109／L。9例患儿中急性髓系白血病（AML）8例,急性淋巴细胞白血病（ALL）1例;难治性AL 5例,复发性AL 4例。结果　9例患儿中经1个疗程化疗达完全缓解（CR）6例,部分缓解（PR）2例,总有效（CR+PR）率 88.9 %（8／9）。6例CR患者中2例行造血干细胞移植,现均无瘤生存;患者主要不良反应是感染、骨髓抑制和胃肠道反应。结论　FLAG方案治疗儿童难治及复发性AL缓解率高,不良反应可以耐受,是治疗儿童难治及复发性AL的一个选择,为后续的造血干细胞移植提供了机会。     

乙双吗啉致急性白血病6例临床分析

目的 :探讨乙双吗啉引起急性白血病的临床特点。方法 :观察 6例乙双吗啉引起急性白血病患者的临床表现及预后。结果 :6例患者 ,2例诱导缓解阶段死亡 ,1例 5个诱导方案未缓解 ,2例缓解后 18、2 4个月复发 ,1例未治。结论 :乙双吗啉引起的急性白血病治疗效果差 ,预后欠佳 ,应引起临床医生注意     

Relapse of leukemia and lymphoma after marrow transplant: a review of cases with extramedullary relapse

We review our cases of leukemia and lymphoma relapse after allogeneic marrow transplant and describe here a series of 10 patients with extramedullary (EM) relapse. In the 13 relapses in acute myeloid leukemia, 5 cases had EM involvement. There were 3 EM involvement out of 13 acute lymphoblastic leukemia relapses, one EM disease in 11 chronic myeloid leukemia relapses and one case of lymphoma with EM relapse. A common observation is that in some of these cases, EM relapse occurred in the presence of continuous marrow remission, In those cases with both marrow and EM involvement marrow remission could often be achieved and maintained temporarily while EM disease progressed despite chemotherapy or immunotherapeutic measures such as immunosuppressant withdrawal and donor lymphocyte infusion. Survival in partial remission after relapse could be prolonged in some cases but eventual death from progressive disease was often the case.     

Low-dose 4N-behenoyl-1-beta-D-arabinofuranosylcytosine (BHAC) in the treatment of atypical leukemia

Four cases of hypoplastic leukemia, one of acute myelocytic leukemia (M2) and one of RAEB-t were treated with a low-dose 4N-behenoyl-1-beta-D-arabinofuranosylcytosine (LD-BHAC) regimen, in which 50 mg BHAC was administered daily intravenously by one-hour drip infusion for 14 days. Among the 6 cases, three (2 hypoplastic leukemia and one M2) obtained complete remission and one (hypoplastic leukemia), partial remission. Response rates were 66.6% of all cases, and 75% of cases of hypoplastic leukemia. During treatment, cytopenia was observed in all cases and a decrease in bone marrow nucleated cell counts was recognized in the aged M2 patient with remission. Although side effects of the drug on the digestive system such as anorexia and nausea were observed in some cases, they were all controllable by conventional treatments. The serum concentration of ara-C was measured in 4 cases. The peak level of serum ara-C concentration, 3.62-18.9 ng/ml (mean: 11.74 ng/ml), was observed at the time of cessation of infusion of BHAC, and an ara-C level of 2.75-4.89 ng/ml (mean: 3.54 ng/ml) was still present in the blood 6 hours after the cessation of infusion. It was concluded that LD-BHAC was useful in the clinical management of atypical leukemia and acute myelocytic leukemia in the aged.     

Sequential combination of high-dose cytosine arabinoside and L-asparaginase in the treatment of refractory acute leukemia and malignant lymphoma

Clinical effects of sequential administration of high-dose cytosine arabinoside with L-asparaginase were studied in 5 cases of refractory acute leukemia and 2 cases of non-Hodgkin's lymphoma. A total 12 courses were carried out on these 7 patients and complete remission was obtained in 2 courses and partial remission in 3 courses. Two cases of lymphoma with pleural effusion or CNS invasion achieved partial and complete remission, respectively. The side effects associated with this sequential therapy were nausea, vomiting, diarrhea, fever and conjunctivitis, although these were tolerable. These observations suggest that high-dose cytosine arabinoside combined with L-asparaginase is a useful regimen for refractory leukemia and lymphoma.     

Serum complement level in patients with leukemia

The serum complement level was studied in 94 cases of patients with myelogenous and lymphogenous leukemia, including long-term survivors. Studies on serial changes in the serum complement level at exacerbation stage and at remission stage in 10 patients with acute leukemia were carried out separately. In two cases of acute myelogenous leukemia, serum complement levels were followed up during the course of the clinical stage. Serum complement levels in the majority of cases of chronic leukemia patients studied remained within the range of healthy control complement levels, while wide variations were noted in acute leukemic patients, especially in those at the stage of exacerbation. In lymphogenous leukemic patients, complement levels showed a larger variation with a trend of either higher or lower values as compared to those of both healthy control subjects and myelogenous leukemia. The serum complement levels showed a tendency to fluctuate in accordance with the exacerbation and the remission of the disease, and in the majority of cases a normal serum complement level was seen at the stage of remission. Correlation between C'H₅₀ values and C'I-A₅₀ values in patient sera was not found among the limited number of cases studied.     

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。     

化疗联合单倍体淋巴细胞输注治疗难治性白血病

背景与目的:常规化疗治疗难治性白血病的缓解率低于50%,增加化疗强度常因严重并发症导致患者死亡,我们既往的研究表明单倍体淋巴细胞在体外具有较强杀伤白血病细胞效应。本研究旨在观察常规化疗联合经7.5Gyγ射线照射的单倍体淋巴细胞输注治疗难治性白血病的效果和不良反应。方法:16例难治性白血病患者在化疗后,当白细胞降至最低时平均输注1×108/kg(0.8～1.2×108/kg)经7.5Gyγ射线照射的单倍体淋巴细胞,观察难治性白血病的缓解率和单倍体淋巴细胞输注的不良反应。结果:13例难治性急性非淋巴细胞白血病经该治疗后,11例达完全缓解,2例达部分缓解。3例难治性急性淋巴细胞白血病患者,2例完全缓解,1例无效。全组16例患者的总缓解率为81.2%。单倍体淋巴细胞输注后患者感觉良好,无一例长时间骨髓抑制,无输注相关的移植物抗宿主病。结论:化疗联合单倍体淋巴细胞输注可以提高难治性白血病的缓解率,减少化疗引起的并发症。     

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.     

改良的HAMPT方案治疗难治性急性淋巴细胞性白血病

我们将常规的ＨＡＭＰＴ方案中的氨甲喋呤（ＭＴＸ）剂量改为大剂量组成良的ＨＡＭＰＴ方案治疗难治性急性淋巴细胞白血病（ＡＬＬ）２０例，１７例完全缓解，３例部分缓解。其中１６／１７例一疗程则获完全缓解（ＣＲ），ＣＲ率８５％，诱导缓解时间平均１７天。本方案疗效较满意，副作小用，可作为难治作ＡＬＬ治疗的较好方法。