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。     

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。     

CAG方案治疗老年急性髓细胞白血病的临床观察

 目的 观察CAG方案对老年急性髓细胞白血病（AML）的疗效。方法 老年初治AML患者25例,以CAG方案进行诱导缓解化疗,观察有效率和副作用。结果 CR率48 %,PR率12 %,总有效率60 %;结论 CAG方案可作为初治老年AML的有效方案。     

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。     

CAG方案治疗老年急性髓细胞白血病临床观察

目的观察CAG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16例老年AML患者均接受CAG方案治疗1～2疗程,CAG方案：阿柔比星（阿克拉霉素）每天6mg／m^2,静脉滴注,第1～8天;阿糖胞苷10mg／m^2,皮下注射,1次／12h,第1～14天;G—CSF每天200μg／m^2,皮下注射,第1～14天。结果16例患者中完全缓解（CR）9例．部分缓解（PR）2例,总有效率69％。除血象及骨髓象受抑制外,无严重感染及脏器损伤。结论CAG方案对老年AML治疗有确切疗效,且耐受良好.     

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     

急性髓细胞白血病细胞CD34抗原表达的临床及生物学意义

为研究ＣＤ３４在急性髓细胞白血病（ＡＭＬ）中的临床及生物学意义，用流式细胞术检测了１０７例ＡＭＬＣＤ３４表达。结果显示４８．５％的患者ＣＤ３４阳性表达，Ｍ３（１５．８％）低于其他亚型（ｐ〈０．０５）。ＣＤ３４＾＋者肝脾肿大常见。ＣＤ３４表达在ｔ（８；２１）、正常核型及ｔ（１５；１７）组分别为７２．０％、４０?７％及１７．６％。ＣＤ３４＾＋者的完全缓解率（４１．９％）明显低于ＣＤ３４＾－者的５９．６     

老年急性髓系白血病治疗进展

 由于老年患者本身的特点及疾病的生物学特征,老年急性髓系白血病（AML）患者的疗效及预后均较差。近年老年AML患者的治疗取得许多进展诸如标准化疗方案的改良、新化疗药物的应用、免疫治疗、表观遗传学治疗药物及靶向治疗药物的研发等,临床试验结果提示部分患者疗效改善。     

MA方案治疗老年急性髓系白血病

老年急性髓系白血病,强力化疗早期死亡率高,小剂量化疗2.5年生存率为0[1].国外报道米托蒽醌加阿糖胞苷(MA)方案治疗老年急性髓系白血病(AML)有较好疗效[2].     

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。     

影响老年急性髓系白血病患者预后的危险因素分析

目的 探讨影响老年急性髓系白血病患者预后的危险因素.方法 回顾性分析121例老年急性髓系白血病患者的临床资料.对比不同临床资料患者的完全缓解率和中位生存期.通过多因素Cox模型分析统计影响老年急性髓系白血病患者预后的危险因素.结果 本研究患者的中位生存期为131 d(95%可信区间109~154 d),诱导化疗后的完全缓解率为29.75%.年龄≤70岁、PS评分﹤2分、原发急性髓系白血病、骨髓原始细胞比例≤50%、接受标准化疗以及白细胞CD34表达阴性患者的完全缓解率升高(P﹤0.05);年龄≤70岁、PS评分﹤2分、原发急性髓系白血病、初治时的白细胞计数≤50×109/L、骨髓原始细胞比例≤50%、接受标准化疗以及白细胞CD34表达阴性患者的中位生存期延长(P﹤0.05);多因素Cox模型分析结果显示,年龄、PS评分、初治时白细胞计数以及治疗方案是影响老年急性髓系白血病患者预后的危险因素(P﹤0.05).结论 年龄、PS评分、初治时白细胞计数以及治疗方案是影响老年急性髓系白血病患者预后的危险因素.临床应通过整体评估,制定个体化的化疗方案,以改善患者的预后.     

微移植联合化疗治疗老年急性髓系白血病临床观察

目的:观察微移植联合化疗治疗老年急性髓系白血病患者的临床疗效及安全性.方法:回顾性分析我院35例老年急性髓系白血病患者经单纯诱导化疗(n=16)或联合微移植(n=19)的治疗过程及转归情况.结果:微移植联合化疗组14例(73.7%)完全缓解(CR),单纯诱导化疗组6例(37.5%)CR;微移植组中性粒细胞、血小板中位恢复时间分别为11.5 d、16 d,而单纯诱导化疗组则分别为15 d、22 d(P<0.05);微移植组无重症感染及相关死亡发生,单纯化疗组因重症感染死亡3例.结论:微移植联合化疗治疗老年急性髓系白血病提高了疾病缓解率,降低了化疗相关死亡率.     

国产地西他滨治疗老年急性髓系白血病的疗效及安全性

目的:探讨以国产地西他滨为基础的化疗方案治疗老年急性髓系白血病（AML）的临床疗效及安全性。方法:回顾性分析2013年1月-2016年2月收治的老年急性髓系白血病患者29例,根据其是否使用国产地西他滨分组,对比评定疗效。结果:地西他滨组和传统方案组的完全缓解率分别为60.0%（6/10）和35.7%（5/14）,差异有统计学意义（P＜0.05）;同时比较两组的总生存期（OS）,差异有统计学意义（P＜0.05）。80%的老年AML患者在使用以国产地西他滨为基础的化疗方案治疗过程出现不同程度的不良反应,多为Ⅰ-Ⅱ级,少数患者发生了Ⅲ-Ⅳ级不良反应,主要为中性粒细胞减少和血小板减少。结论:以国产地西他滨为基础的化疗方案有较高的缓解率,且延长生存期。     

HAA方案治疗难治、复发老年急性髓系白血病的临床观察

目的:探讨HAA方案治疗难治、复发老年急性髓系白血病（acute myeloid leukemia,AML）的疗效及毒副反应。方法:回顾性分析首次接受HAA方案(HHT 2.0 mg/m2 qd,d1~7;Ara-C 100~200 mg/m2 qd,d1~7;Acla 12 mg/m2 qd,d1~7;根据情况调整具体天数)挽救治疗17例难治、复发老年AML患者的疗效及毒副反应,统计长期生存情况。结果:17例难治、复发老年AML患者中,3例达完全缓解（complete remission,CR）,3例达部分缓解(partial remisson,PR),11例未缓解(none remisson,NR),临床有效率(CR+PR)35.3%。无1例患者出现早期死亡。中位生存时间为6.2个月(0.5~32.0个月)。结论:HAA方案治疗难治、复发老年AML患者疗效与地西他滨方案相近,且安全性高,但由于样本量较小,需进一步开展多中心随机对照试验证实。     

Arsenic trioxide and low-dose cytarabine in older patients with untreated acute myeloid leukemia, excluding acute promyelocytic leukemia

BACKGROUND: Acute myeloid leukemia (AML) carries a dismal prognosis in older patients. In this study, the authors evaluated the safety and efficacy of arsenic trioxide combined with low-dose cytarabine in untreated patients aged >or=60 years with AML. METHODS: In a phase 1/2 design, arsenic trioxide was administered intravenously at a dose of 0.25 mg/kg on Days 1 through 5 and on Days 8 through 12, and low-dose cytarabine was given subcutaneously twice daily on Days 1 through 14 in escalating doses to a target of 10 mg/m(2) per dose. Of 64 patients who had pathologically confirmed AML, excluding patients with acute promyelocytic leukemia and using World Health Organization criteria, the median age was 71 years, 10 patients (16%) had treatment-related AML, 40 patients (63%) had an antecedent myelodysplastic syndrome or myeloproliferative disorder, and 35 patients (55%) had unfavorable cytogenetics. Thirty-four patients (53%) had an Eastern Cooperative Oncology Group performance status of 2 or 3. RESULTS: Complete remission was achieved in 21 of 61 patients (34%), including 15 of 50 patients (30%) who had secondary or treatment-related AML, 10 of 33 patients (30%) who had unfavorable cytogenetics, and 6 of 34 patients (18%) who had a poor baseline performance status. The mortality rate within the first 4 weeks was 8%. Neutropenic fever was observed in >80% of patients, and 41% of patients had bacteremia. Nonhematologic toxicity generally was mild and reversible and included fatigue, nausea, diarrhea, rash, peripheral edema, and elevated transaminases. There were no clinically significant cardiac arrhythmias. CONCLUSIONS: The addition of arsenic trioxide to low-dose cytarabine appeared to improve responses in elderly patients who had AML compared with either agent alone, and a randomized trial of the combination versus single-agent low-dose cytarabine is ongoing.     

Comorbidity is an independent predictor of complete remission in elderly patients receiving induction chemotherapy for acute myeloid leukemia

BACKGROUND.: Elderly patients with acute myeloid leukemia (AML) have a poor prognosis, which is explained by the disease itself and by host-related factors. The objective of this study was to determine the prognostic role of comorbidities in this population. METHODS.: For this single-center, retrospective study, the authors analyzed the outcome of 133 patients aged >/=70 years who received induction chemotherapy for nonpromyelocytic AML between 1995 and 2004. Comorbidities were evaluated by using an adapted form of the Charlson comorbidity index (CCI). RESULTS.: The median patient age was 73 years. The CCI score was 0 for 83 patients (68%), 1 for 16 patients (13%), and >1 for 23 patients (19%). The complete remission (CR) rate was 56%, and the median overall survival was 9 months. In multivariate analysis, 4 adverse prognostic factors for CR were identified: unfavorable karyotype, leukocytosis >/=30 g/L, CD34 expression on leukemic cells, and CCI >1. A score could be generated to allow the stratification of patients into low-, intermediate-, and high-risk groups with CR rates of 87%, 63%, and 37%, respectively. The risk of early mortality and the probability of survival also were different in the 3 risk groups (P = .02 and P = .01, respectively). CONCLUSIONS.: The results from this study indicated that associated comorbidities are independent factors that may influence achievement of CR in elderly patients with AML. Such a scoring system may be useful in the prognostic staging systems that are used to identify patients with AML who can benefit from induction chemotherapy.     

Treatment of acute myeloid leukemia in older patients

Acute myeloid leukemia carries a dismal prognosis in patients over 60 years of age and, despite many clinical trials of both novel and conventional agents, there has been no significant improvement in overall survival during the last 30 years. Combinations of anthracyclines and cytarabine remain the cornerstone of therapy and produce complete remission in 45–55% of older patients, with a median survival of only 8–12 months. These statistics become even worse in patients over 70 years and those with unfavorable cytogenetics and/or poor performance status. Deciding which older acute myeloid leukemia patients would benefit from intensive chemotherapy is difficult and efforts are underway to improve existing risk-assessment tools. Many new agents are under development, including signal transduction inhibitors, farnesyl transferase inhibitors, antibodies and novel chemotherapeutics. To date, small-molecule inhibitors and targeted therapies have had limited single-agent efficacy and have required combination with chemotherapy. The role of hematopoietic stem cell transplantation in older patients is under investigation. All patients over 60 years of age with acute myeloid leukemia should be encouraged to participate in a clinical trial if possible.     

Genetic alteration patterns and clinical outcomes of elderly and secondary acute myeloid leukemia

To illustrate the clinical and genetic features of elderly and secondary acute myeloid leukemia (AML) patients, we compared 145 elderly AML (e‐AML) and 55 secondary AML (s‐AML) patients with 451 young de novo AML patients. Both e‐AML and s‐AML patients showed lower white blood cell (WBC) and bone marrow (BM) blasts at diagnosis. NPM1, DNMT3A, and IDH2 mutations were more common while biallelic CEBPA and IDH1 mutations were less seen in e‐AML patients. s‐AML patients carried a higher frequency of KMT2A‐AF9. In treatment response and survival, e/s‐AML conferred a lower complete remission (CR) rate and shorter duration of event‐free survival (EFS) and overall survival (OS) compared with young patients. In multivariate analysis, s‐AML was an independent risk factor for OS but not EFS in the whole cohort. Importantly, intensive therapy tended to improve the survival of e/s‐AML patients without increasing the risk of early death, and hematopoietic stem cell transplantation (HSCT) could rescue the prognosis of s‐AML, which should be recommended for the treatment of fit patients.