MAE方案联合化疗治疗CD_7~+急性髓性白血病疗效观察

目的 :探讨应用米托蒽醌 +阿糖胞苷 +足叶乙甙 (MAE)方案治疗 CD7+急性髓性白血病 (CD7+ AML)的有效性。方法 :采用 MAE方案联合化疗治疗经细胞形态学、细胞化学及细胞免疫学分型诊断为 CD7+ AML 1 2例 ,并监测化疗后骨髓像变化及化疗相关毒性反应。结果 :1 2例中 , 7例达完全缓解 , 1例达部分缓解 ,总 有效率为 66. 7%,持续缓解时间 6～ 3 6个月。化疗相关毒性略大于 HA和 DA方案 ,主要特征为骨髓抑制期延长。 结论 :MAE方案可提高 CD7+AML的缓解率 ,尽管化疗后骨髓抑制期延长 ,但能被患者耐受     

CD7^＋急性髓细胞性白血病临床及实验室特征分析

CD7抗原是T细胞性急性淋巴细胞性白血病(acute lymphoblastic leukemia,T-ALL)最敏感的检测指标之一,但其特异性不强,在10%~20%的急性髓细胞性白血病(acute myeloid leukemia,AML)中也有表达[1~2],且AML中CD7+常与多药耐药相关,提示疾病恶性度高、预后差[3~5]。本文报道本院新近收治的1例CD7+AML并复习已知文献,对CD7抗原在AML中的表达及其临床意义进行总结。临床资料患者男性,51岁。2005年11月21日因“低热、乏力、面色苍白1月余”入院。既往史及体格检查均无特殊。入院后查肝功能、肾功能、电解质、尿常规、粪常规及出凝血功能…     

普通剂量MAE方案治疗难治性急性髓细胞性白血病临床分析

联合化疗使急性髓细胞性白血病（ＡＭＬ）完全缓解率有了明显提高,完全缓解时间明显延长,但仍有部分患者不能获得完全缓解（ＣＲ）或缓解后再复发,复发难治性ＡＭＬ的治疗始终是白血病治疗的难题。我们采用普通剂量ＭＡＥ（米托恩醌、阿糖胞苷、Ｖｐ１６）方案治疗２２...     

MEA方案治疗急性髓细胞性白血病67例疗效观察

我们应用ＭＥＡ方案 (米托蒽醌、足叶乙甙和阿糖胞苷 )治疗 6 7例急性髓细胞性白血病 (ＡＭＬ) ,取得较满意效果。一、资料和方法1 病例 :1997年 10月～ 1999年 5月 ,住院ＡＭＬ患者用ＭＥＡ方案治疗 6 7例 ,均经临床 ,细胞形态学、细胞化学和免疫组化而确诊。其中初治组 42例 ,男 2 4例 ,女 18例 ,年龄15～ 6 5岁 ,中位数年龄 2 9岁。按ＦＡＢ分型计 :Ｍ2 2 0例 ,Ｍ4 5例 ,Ｍ517例。复发、难治组 2 5例 ,男 13例 ,女 12例 ,年龄16～ 5 0岁 ,中位数年龄 34岁。复发指完全缓解 (ＣＲ)后骨髓原始细胞 >0 2 0 ,15例中早期复发 10例 ,晚期复发 …     

不同化疗方案治疗老年人急性髓系白血病疗效观察

４５例老年人急性髓系白血病经不同化疗方案治疗，ＨＡ方案剂量个体化组治疗１９例，完全缓解（ＣＲ）率５２６％；ＤＡ方案组治疗８例，ＣＲ率５０％；ＨＯＡＰ方案组治疗９例，ＣＲ率４４４％；小剂量阿糖胞苷（ＬＤＡｒａＣ）组治疗９例，ＣＲ率１１１％。ＨＡ方案剂量个体化组ＣＲ率显著高于ＬＤＡｒａＣ组（Ｐ＜００５）。骨髓抑制的发生率和治疗相关病死率分别为３６８％和５６％（ＨＡ）、７５％和３７５％（ＤＡ）、４４４％和２２２％（ＨＯＡＰ）、３３３％和１１１％（ＬＤＡｒａＣ），ＤＡ方案组治疗相关病死率显著高于ＨＡ方案剂量个体化组（Ｐ＜００２５）。联合化疗治疗３６例，ＣＲ率为５０％，高于单用ＬＤＡｒａＣ组（Ｐ＜００５），骨髓抑制发生率为４７２％（１７／３６），治疗相关病死率为１６７％（６／３６），同ＬＤＡｒａＣ组比较无显著性（Ｐ＞００５）。     

米托蒽醌为主的联合化疗治疗急性髓细胞性白血病126例疗效分析

目的 评估以米托蒽醌为主的联合化疗方案,治疗成人急性髓细胞性白血病的疗效。方法 对本所１９９３年１月－１９９７的１２月住院的成人急性髓细胞性白血病患者,采用以米托蒽醌为主的联合化疗方案进行治疗,共１２６例。其中初治８５例,难治复发５１例。结果实治组与复发难治组的完全缓解率分别为４４．７％,２７．５％;部分缓解率２０．０％,９．８％。     

MAG方案治疗老年急性髓性白血病的临床观察

近年来,老年急性髓系白血病(AML)有逐渐增多的趋势,但由于老年急性白血病病情重,治疗效果差,并发症多且严重,化疗相关的早期死亡率高,已日益引起临床重视。为此,我院自1999～2002年采用MAG方案治疗16例老年AML患者,现报告如下。     

TA化疗方案治疗急性髓细胞性白血病20例疗效分析

目的观察吡柔比星(THP)联合阿糖胞苷(Ara-C)治疗急性髓细胞白血病(AML)的临床疗效和毒副反应。方法 20例AML患者(含初治者8例,复发者2例,巩固强化者10例),化疗方案采用TA治疗。结果 2例复发者均为一疗程获完全缓解(CR);8例初治者2例获CR,其中1例为二疗程获CR,1例化疗结束后因颅内出血死亡;10例巩固强化者外周血三系列造血细胞均有不同程度的下降。毒副反应示85%有骨髓抑制,55%～95%有消化道反应,但患者均能耐受。结论 TA方案治疗AML疗效肯定,副反应轻微。     

Mylotarg治疗第一次复发的CD33^＋急性髓系白血病患者的疗效和安全性

Mylotarg(Gemtuzumab Ozogamicin,CMA-676)是人源化抗CD33单克隆抗体与抗肿瘤抗生素Calicheamicin偶联而成的一个新的抗体导向化疗药药。作者报告单用该药治疗第一次复发未治CD33~+急性髓系白血病(AML)的疗效及安全性。 方法 北美及欧洲多中心研究观察142(男84、女58)例,CD33~+AML(CD33~+白血病细胞大于80％)第一次复发患者,中位年龄61(22～84)岁。Mylotarg每次9mg/m~2,持续静滴2h,每次用药间隔不少于14天,不超过28天,最多     

急性髓细胞性白血病和急性早幼粒细胞性白血病的治疗进展

2003年12月5～9日第45届美国血液学年会(ASH) 在美国召开,与会代表2万多人,我国有100多位代表参加了会议.上海第二医科大学瑞金医院王振义院士(the first speaker from Asia to serve as the Ham-Wasserman Lecturer)在大会上作了"Treatment of Acute Leukemia by Inducing Differentiation and Apoptosis"的专题发言,引发了热烈的讨论.现将该次年会中有关急性髓细胞性白血病(AML)和急性早幼粒细胞性白血病(APL)治疗的进展作一介绍.     

Biological characteristics of CD7 positive acute myelogenous leukaemia

We studied the biological characteristics of CD7+ acute myelogenous leukaemia (AML). We diagnosed nine out of 88 consecutive AML cases as CD7+ AML based on myeloperoxidase positivity and surface antigen expression. In eight of these nine cases more than 20% of leukaemic blasts were found to coexpress both CD7 and a myeloid-associated antigen, CD33, by a two-colour flow-cytometric assay, while in the remaining case more than 90% of blasts were positive for CD7 and myeloperoxidase. CD7+ AML was most frequently observed in M1 among AML subtypes according to the FAB classification. An early stage-specific antigen, CD34 was also expressed on leukaemic blasts from eight of these nine cases. Neither the T-cell receptor (TcR)-beta nor the TcR-gamma gene was clonally rearranged in any of the cases. We then studied the proliferative responses to stimulation by various growth factors. Among interleukin-3 (IL-3), granulocyte/macrophage colony-stimulating factor (GM-CSF), and granulocyte-CSF (G-CSF), IL-3 showed the strongest stimulatory effect on DNA synthesis and leukaemic blast colony formation in 8/9 and 6/8 CD7+ AML cases examined, respectively. On the other hand, the strongest stimulatory effect exerted by IL-3 on blast colony formation was observed in only six out of the 33 CD7- AML cases examined. Furthermore, CD7+ AML blasts could proliferate in response to stem cell factor (SCF); SCF alone showed stimulatory effects on blast colony formation (7/8 cases), and in 5/7 SCF-responding cases, stimulatory effects of SCF were more potent than those of IL-3. In addition, SCF enhanced blast colony formation synergistically with IL-3 in four of these seven cases. These data suggest that progenitor cells of CD7+ AML may possess the biological properties characteristic of immature haematopoietic stem cells.     

Intensive short-term chemotherapy for patients with acute myelogenous leukemia: long-term follow-up

Our pilot study addresses the problem of early relapse from complete remission in young adults with acute myelogenous leukemia (AML). Twelve patients with AML, 16-58 years of age, were entered in a study of four intense courses of cytotoxic chemotherapy using the following drugs: cytarabine, daunorubicin, 5-azacitidine, and 6-thioguanine. They received no maintenance therapy. Nine of 12 patients achieved complete response. With a minimum follow-up of 35 months, the observed disease-free survival at 2 years was 67% (14 +/- SE) and the actuarial disease-free survival at 4 years was 38% (17 +/- SE). It appears that brief intensive chemotherapy early in the management of AML can produce prolonged remission without the need for maintenance therapy.     

Thrombotic thrombocytopenic purpura subsequent to acute myelogenous leukemia chemotherapy

A woman in complete remission from acute myeloblastic leukemia developed thrombotic thrombocytopenic purpura (TTP) subsequent to the third intensive consolidation cycle of cytosine arabinoside and daunorubicin chemotherapy. The constellation of clinical manifestations indicative of TTP were recognized only in retrospect, as they were initially attributed to more usual complications of bone marrow-ablative chemotherapy. The manifestations, probably fueled by numerous red cell and platelet transfusions, increased at the time of recovery of hematopoiesis. At postmortem examination, characteristic microvascular lesions were found in most organs. Similar thrombotic microangiopathy has been described with mitomycin-based chemotherapy regimens and with the combination of cisplatin, vinblastine, and bleomycin. Successful management of this serious complication of chemotherapy requires increased awareness and earlier recognition.     

CD7 false-positive acute myelogenous leukemia and promyelocytic leukemia cell line HL-60: characterization of CD7 epitopes by four monoclonal antibodies.

Phenotypes of cells from 12 patients with acute myelogenous leukemia (AML) were analysed by means of a fluorescence-activated cell sorter utilizing a panel of monoclonal antibodies (MAbs). A majority of the cells from peripheral blood coexpressed the antigens against MAbs CD11, CD13, and CD33 but did not express the antigens against CD1, CD3, CD4, CD5, CD8, CD19, CD20, CD21, CD41 and 42, and glycophorin A. Three out of the 12 cases expressed CD7 antigen. However, one of them showed no reaction with Tp40 MAb, whereas the others showed reaction with Leu9 and T55. The discrepancy of reactivities between Leu9 and Tp40 MAbs prompted us to study the promyelocytic leukemia cell line HL-60, which showed similar reactions against Leu9 and Tp40 MAbs. Leu9, OKT16, and T55 MAbs reacted strongly with HL60 cells, whereas Tp40 MAb, which reacted strongly with T-cell leukemia cell line Jurkat, showed no reaction. The reactivity of Leu9, OKT16, and T55 MAbs with HL-60 cells was completely inhibited after preincubation with aggregated human immunoglobulin G (AHIG), which clearly shows the existence of nonspecific binding between these 3 MAbs and HL-60 cells via Fc gamma R. On the basis of our experiments, we conclude that HL-60 cells bind nonspecifically with Leu9, OKT16, and T55 MAbs via FcRI, and this is suggestive that de novo AML cells probably behave in the same fashion. Hence, we recommend that the utilization of murine IgG2a and IgG3 MAbs should be avoided especially in cell surface analysis of myeloid leukemic cells.     

Intensive chemotherapy is the treatment of choice for elderly patients with acute myelogenous leukemia

One-hundred and seven patients with acute myelogenous leukemia (AML) ranging in age from 15 to 82 yr who were previously untreated, received a 70 day high-dose remission induction regimen consisting of daunorubicin, cytarabine, and thioguanine (TAD). Identical complete remission rates of 65% were observed for 33 patients 60 yr of age and older and for 74 patients age 15-59 yr. Median remission duration and survival were 14 mo and 22 mo for patients 60 yr and older, and 16 mo and 22 mo for patients 15-59 yr. These differences are not significant. These data indicate that older patients respond to intensive chemotherapy in a similar manner to younger patients with this disease.     

Long-term outcome of high-dose cytarabine-based consolidation chemotherapy for adults with acute myelogenous leukemia.

Modern induction chemotherapy produces 60% to 80% complete remissions in adults with newly diagnosed acute myelogenous leukemia. A major challenge is to eradicate subclinical disease in remission and prevent leukemic relapse. We analyzed the long-term results of high-dose cytarabine-anthracycline consolidation chemotherapy without maintenance treatment and examined the effect of major prognostic factors, including age, sex, history of preleukemia, and cytogenetics. Two hundred twenty-seven patients with newly diagnosed acute leukemia were enrolled on two sequential studies conducted from 1982 to 1991. One hundred fifty-one patients (67%) achieved a complete remission. One hundred twenty-three patients were eligible for high-dose cytarabine-based consolidation administered in two to three courses. After a median follow-up of 4.8 years, 40 patients remain alive, with 28 in continued remission. Median remission duration for all eligible patients is 12.8 months, and actuarial leukemia-free survival (LFS) at 5 years is 26% +/- 8%. Advanced age and male sex were negative prognostic indicators for LFS. For patients < or = 45 years of age, 5-year LFS was 35% +/- 13%, as compared with 18% +/- 11% for patients greater than age 45 (P = .03). Toxicity of consolidation chemotherapy included treatment-related death in nine patients and serious neurotoxicity in five. Our results show an improved LFS for younger patients treated with high-dose cytarabine-based consolidation. There was no apparent benefit for older patients compared with reported data with less intensive regimens.     

Timed sequential induction chemotherapy and risk-adapted postremission therapy for acute myelogenous leukemia

Cytogenetic analysis at the time of diagnosis predicts outcome in patients with acute myelogenous leukemia (AML). For those patients with favorable risk cytogenetics, stem cell transplant can be delayed until the time of relapse. For those patients with nonfavorable cytogenetic risk profiles, stem cell transplant may be required for optimal survival benefit. We treated patients with de novo AML and age less than 60 years first with etoposide, mitoxantrone, cytarabine, and G-CSF (EMA-G) to induce remission. Patients in complete remission were assigned to treatment with chemotherapy alone if they had favorable risk cytogenetics defined as the identification of a core-binding factor translocation. Patients with any other cytogenetic profile were assigned to treatment with either autologous or allogeneic stem cell transplant depending on the availability of an HLA-matched donor. Following EMA-G, 33 of 40 patients (83%) achieved CR. Of the 25 patients who actually were treated with postremission chemotherapy, 21 were treated with their assigned risk-adapted therapy. Of the 33 patients in remission, 5 year relapse-free survival (RFS) and overall survival (OS) was 46 and 38%, respectively. Our intensive and risk-adapted, stem cell transplant approach to the treatment of patients with AML requires a better definition of risk and does not appear to substantially improve results compared with more standard approaches.