地西他滨联合小剂量化疗治疗老年中高危骨髓增生异常综合征及急性髓系白血病的临床观察

目的观察地西他滨联合CAG方案治疗老年中高危MDS及AML的临床疗效及不良反应。方法应用地西他滨联合CAG方案治疗MDS及AML患者10例。1个疗程后评估疗效。结果10例患者,其中3例获得完全缓解（CR）30％,4例为部分缓解（PR）10％,1例获得骨髓缓解（mCR）40％。总有效率为80％。大多数患者出现了可以耐受的不良反应,主要表现为骨髓抑制。结论地西他滨联合CAG方案治疗中高危MDS和老年AML有较好的疗效和安全性。     

CHG方案治疗急性髓性白血病及高危骨髓增生异常综合征患者的疗效分析

目的:评价CHG方案治疗低增生、难治、复发急性髓性白血病(AML)及高危骨髓增生异常综合征(MDS)患者的疗效及不良反应.方法:对25例次AML和高危MDS患者实施CHG方案化疗.治疗前、治疗中及治疗后进行心电图、肝肾功能、外周血常规及骨髓细胞学检查,评估近期疗效及不良反应.结果:完全缓解率68%,部分缓解率8%;主要...     

增加地西他滨剂量治疗高危组骨髓增生异常综合征及急性髓系白血病20例分析

目的探讨增加地西他滨剂量治疗高危组骨髓增生异常综合征(MDS)及急性髓系白血病(AML)的疗效。方法收集2009年9月至2012年1月在苏州大学附属第一医院高危组MDS及AML患者20例,静脉滴注地西他滨20 mg/m2,每日1次,连用5 d治疗,然后行骨髓检查,根据患者骨髓增生程度、原始细胞数、骨髓小粒饱满情况,结合患者的一般情况、不良反应,酌情增加使用地西他滨,分析治疗1个疗程后缓解率和总反应率。结果 MDS患者1个疗程完全缓解(CR)+骨髓CR为3例(75%),总反应3例(75%);AML患者1个疗程CR+骨髓CR 3例(18.8%),总反应8例(50.0%),其中初治患者1个疗程CR+骨髓CR 1例(25.0%),总反应3例(75.0%),复发及难治患者1个疗程CR+骨髓CR 2例(16.7%),总反应5例(41.7%)。累积2年生存率为42%。结论剂量增加的地西他滨可被安全应用于高危组MDS及AML,1个疗程缓解率较高,值得进一步探索。     

小剂量国产地西他滨联合半量CAG方案治疗中高危骨髓增生异常综合征的临床研究

目的:探讨以国产地西他滨为主的方案治疗中高危组骨髓增生异常综合征(MDS)的临床疗效及不良反应。方法:回顾性分析接受国产地西他滨联合半量CAG方案治疗的34例中高危组MDS的临床资料,评价其疗效和不良反应。结果:34例MDS患者中,完全缓解6例,部分缓解11例,血液学改善9例,疾病进展6例,死亡2例,完全缓解率17.6%,有效率50.0%。血液学不良反应发生率100%,感染发生率94.1%,死亡率5.9%。结论:以国产地西他滨为主的化疗方案可有效治疗MDS,虽然血液学不良反应较重,感染的发生率较高,但患者基本上可耐受,给予相应抗炎及支持治疗可得到有效控制,与同类进口药物比较,具有明显的价格优势和相近的疗效。     

地西他滨联合半量CAG方案治疗老年急性髓系白血病的临床疗效

目的探讨去甲基化药物地西他滨联合半量CAG方案与单用CAG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40例老年AML患者按用药方法不同分为对照组和观察组,各20例。对照组单用传统的CAG方案治疗,观察组采用地西他滨联合半量CAG方案治疗。观察两组治疗效果及不良反应情况。结果观察组患者1个疗程后完全缓解9例(45%),9例部分缓解,2例完全无效,总有效率90%,中位无病生存时间和中位总生存分别为12个月和19个月;骨髓抑制15例,肺部感染8例。对照组治疗后完全缓解7例(35%),部分缓解6例,无效7例,总有效率65%,中位无病生存时间和中位总生存分别为6个月和13个月;骨髓抑制18例,肺部感染12例,肠道感染2例,败血症2例,1例死于脑出血,1例死于多脏器衰竭。观察组的总有效率、生存情况及不良反应均优于对照组(P0.05)。结论地西他滨联合半量CAG方案治疗老年AML有较好的治疗效果,不增加治疗风险。     

含地西他滨方案治疗老年急性髓系白血病26例疗效分析

目的:探讨地西他滨单药及联合CAG化疗方案治疗老年急性髓系白血病(AML)患者的临床疗效及不良反应等。方法:回顾性分析接受含地西他滨方案治疗的26例老年AML患者的临床特点,评估临床疗效及不良反应。结果:26例老年AML患者首程治疗后17例达完全缓解,3个疗程后18例达完全缓解,1例达部分缓解,总有效率73.1%。不良反应主要为骨髓抑制,其中17例出现肺部感染,2例出现败血症,3例出现粒细胞缺乏伴感染。结论:地西他滨单药及联合CAG方案治疗老年AML患者具有较高的缓解率和较低的不良反应,值得进一步探究及临床推广应用。     

CAG方案治疗低增生急性髓性白血病的疗效观察

目的观察CAG方案治疗低增生急性髓性白血病(AML)疗效。方法20例低增生AML患者采用CAG方案(阿糖胞苷10mg/m2,皮下注射,每12h1次;阿克拉霉素10～14mg/(m2.d),静脉注射;粒细胞集落刺激因子150～300μg/(m2.d),皮下注射,14d为1个疗程,观察化疗前后肝、肾功能,心电图,血生化及骨髓象变化。结果20例经1～2个疗程治疗后完全缓解11例(55.0%),部分缓解4例(20.0%),未缓解5例(25.0%),总有效率达75.0%。结论CAG方案可作为治疗低增生AML一线方案使用。     

CAG方案治疗难治性急性髓系白血病11例临床观察

目的:本研究观察CAG方案治疗的11例难治性急性髓系白血病(AML)患者的临床治疗过程及疗效,对CAG方案临床治疗特点及作用机制进行探讨。方法:观察我院2003年1月-2005年4月CAG方案治疗的11例难治性AML患者外周血、骨髓动态变化情况,以及不良反应。结果:CAG方案骨髓抑制不明显,不良反应低,1临床疗效好,完全缓解率27．27％,总有效率72．73％。结论:CAG方案对难治性AML疗效好,骨髓抑制不明显,不良反应较小,患者生存质量较高。外周血白血病变化与预后有关。     

CAG方案治疗中高危骨髓增生异常综合征疗效观察

目的观察CAG方案治疗中高危骨髓增生异常综合征（MDS）的临床疗效和不良反应。方法选择初治MDS患者36例,其中采用CAG方案[即阿糖胞苷、阿克拉霉素和粒细胞集落刺激因子]20例（观察组）,标准化疗方案16例（对照组）,均用一疗程后观察临床疗效。结果疗程结束后,观察组总有效率75.0%、相关病死率5.0%,对照组分别为62.5%、12.5%,观察组的总有效率与对照组比较无统计学差异（P〉0.05）,但其不良反应轻且少于对照组（P〈0.05）。结论 CAG方案治疗中高危MDS安全、有效。     

预激CAG方案治疗老年初治急性髓系白血病的临床分析

目的:评价CAG(阿糖胞苷、阿柔比星、粒细胞集落刺激因子)方案治疗老年初治急性髓系白血病(AML)的疗效及不良反应。方法:64例老年初治AML作为观察对象,其中39例患者予以CAG预激方案治疗,完全缓解(CR)后序贯予原方案、HA(高三尖杉酯碱和阿糖胞苷)、DA(柔红霉素和阿糖胞苷)、MA(米托蒽醌、阿糖胞苷)、中剂量阿糖胞苷巩固治疗至少2个循环;25例患者予以标准方案DA或HA方案化学治疗(化疗),CR后序贯予HA或DA、MA、中剂量阿糖胞苷至少2个循环。观察其疗效及不良反应。结果:CAG预激治疗组1个疗程CR 17例,2个疗程CR 6例,总CR率为59%,7例部分缓解(PR),总有效率77%。常规化疗组患者中1个疗程CR 7例,2个疗程CR 4例,总CR率为44%,2例PR,总有效率52%,与CAG预激治疗组相比差异有统计学意义(P<0.05);CAG组的胃肠道反应、感染、出血、脱发、肝功能及肾功能受损、心毒性、骨髓抑制不良反应发生率均明显少于常规化疗组,差异均有统计学意义(均P0.05)。结论:CAG预激方案治疗初治老年AML患者较之传统常规治疗具有有效率高、不良反应较小、患者生活质量高的优点,适合老年AML患者使用。     

维奈克拉联合阿扎胞苷与地西他滨联合预激方案治疗老年复发急性髓系白血病的疗效及安全性比较的初步观察

目的比较维奈克拉(venetoclax, VEN)联合阿扎胞苷(azacitidine, AZA)方案与地西他滨(decitabine/dacogen, DAC)联合预激方案治疗老年复发急性髓系白血病(acute myeloid leukemia, AML)的疗效及安全性。方法回顾性分析2018年1月至 2020年8月苏州大学附属第一医院血液科收治的45例老年复发AML患者的临床资料, 男性31例、女性14例, 年龄60～80岁, 中位年龄66岁, 其中18例采用VEN+AZA方案治疗, 27例采用DAC+预激方案治疗。比较两组患者的完全缓解率(complete remission, CR)、部分缓解率(partial remission, PR)、总有效率(overall response rate, ORR), 不良反应发生率以及总体生存(overall survival, OS)。结果 VEN+AZA组ORR为 14/18, 其中CR 11例、PR 3例;DAC+预激组ORR为37.0%(10/27), 其中CR 8例、PR 2例, 两组患者疗效差异有统计学意义(P=0.007)...     

The value of oral cytarabine ocfosfate and etoposide in the treatment of refractory and elderly AML patients

Twenty-one acute myeloid leukemia (AML) patients were enrolled and received oral induction therapy with cytarabine ocfosfate (SPAC) and etoposide (EP). The median age was 69 years (range: 33–86). There were 11 patients with de novo AML and 10 AML cases that had evolved from myelodysplastic syndromes. Seventeen patients had abnormal karyotypes including eight complex abnormalities, various complications, and 7 of 21 had a poor performance status (PS) with Eastern Cooperative Oncology Group (ECOG) scores of 3–4. All patients completed induction therapy without severe adverse events. Seven achieved complete remission (CR), and two achieved partial remission (PR). Uni- and multivariate analyses demonstrated a positive and significant correlation between the results of therapy (CR ± PR) and overall survival. The plasma concentrations of cytosine arabinoside (ara-C) in some cases were higher than those previously reported, indicating the accumulation of ara-C with increasing numbers of days of SPAC administration. We conclude that this therapy is well tolerated and useful for refractory and elderly AML patients.     

Therapy-related myelodysplastic syndrome with monosomy 5 after successful treatment of acute myeloid leukemia (M2)

We describe a patient who developed myelodysplastic syndrome over 2 years after achieving complete remission of acute myeloid leukemia (AML). The patient was treated in July 1998 with anthracycline, etoposide, and behenoyl cytarabine chemotherapy for AML (French-American-British classification, M2; World Health Organization classification, AML with maturation) and achieved complete remission. At presentation, no chromosomal abnormalities were detected. In December 2000, the patient's peripheral blood revealed pancytopenia, and his bone marrow was hypocellular with trilineage myelodysplasia and no blasts. Chromosomal analysis revealed complex karyotypic abnormalities, including monosomy 5. The patient was diagnosed with high-grade myelodysplastic syndrome (MDS)/refractory anemia with excess blasts (RAEB) subtype. The pancytopenia progressed rapidly, and he died 2 months after the diagnosis of MDS. Therapy-related MDS and AML (t-MDS/t-AML) developing after treatment for acute leukemia is unusual; the primary leukemia associated with most cases of t-MDS/t-AML is acute promyelocytic leukemia (APL). This unusual case suggests that AML excluding APL should be considered a primary hematologic malignancy for t-MDS/t-AML.     

A multicenter,open, non-comparative,phase II study of the combination of cladribine (2-chlorodeoxyadenosine), cytarabine,and G-CSF as induction therapy in refractory acute myeloid leukemia - a report of the Polish Adult Leukemia Group (PALG)

OBJECTIVES: To evaluate the efficacy and toxicity of cladribine (2-chlorodeoxyadenosine, 2-CdA), cytarabine (Ara-C), and granulocyte-colony stimulating factor (G-CSF) (CLAG) regimen in refractory acute myeloid leukemia (AML) in the multicenter phase II study. METHODS: The induction chemotherapy consisted of 2-CdA 5 mg/m2, Ara-C2 g/m2, and G-CSF. In the case of partial remission (PR), a second CLAG was administered. Patients in complete remission (CR) received two consolidation courses based on HD Ara-C, mitoxantrone or idarubicine, with or without 2-CdA. RESULTS: Fifty-eight patients from 11 centers were registered; 50 primary resistant and eight early relapsed (CR1 < 6 months). CR was achieved in 29 (50%) patients, 19 (33%) were refractory, and 10 (17%) died early. Forty of 50 primary resistant patients received daunorubicin (DNR) and Ara-C as the first-line induction therapy (DA-7), 10 received additional 2-CdA (DAC-7). The CR rates after CLAG were 58% and 10%, respectively in each group (P = 0.015). Five of six patients with myelodysplastic syndrome (MDS)/AML achieved CR. Hematologic toxicity was the most prominent toxicity of this regimen. The overall survival (OS, 1 yr) for the 58 patients as a whole, and the 29 patients in CR were 42% and 65%, respectively. Disease-free survival (DFS, 1 yr) was 29%. Only first-line induction treatment with DA-7 significantly influenced the probability of CR after CLAG. None of the analyzed factors significantly influenced DFS and OS. CONCLUSION: CLAG regimen has significant anti-leukemic activity and an acceptable toxicity in refractory AML. The addition of 2-CdA to the first-line induction treatment may worsen the results of salvage with CLAG. The high CR rate in patients with MDS preceding AML deserves further observation.     

p53 mutations are associated with resistance to chemotherapy and short survival in hematologic malignancies

We analyzed the prognostic value of p53 mutations for response to chemotherapy and survival in acute myeloid leukemia (AML), myelodysplastic syndrome (MDS), and chronic lymphocytic leukemia (CLL). Mutations were detected by single-stranded conformation polymorphism (SSCP) analysis of exons 4 to 10 of the P53 gene, and confirmed by direct sequencing. A p53 mutation was found in 16 of 107 (15%) AML, 20 of 182 (11%) MDS, and 9 of 81 (11%) CLL tested. In AML, three of nine (33%) mutated cases and 66 of 81 (81%) nonmutated cases treated with intensive chemotherapy achieved complete remission (CR) (P = .005) and none of five mutated cases and three of six nonmutated cases treated by low-dose Ara C achieved CR or partial remission (PR) (P = .06). Median actuarial survival was 2.5 months in mutated cases, and 15 months in nonmutated cases (P < 10(-5)). In the MDS patients who received chemotherapy (intensive chemotherapy or low-dose Ara C), 1 of 13 (8%) mutated cases and 23 of 38 (60%) nonmutated cases achieved CR or PR (P = .004), and median actuarial survival was 2.5 and 13.5 months, respectively (P < 10(-5)). In all MDS cases (treated and untreated), the survival difference between mutated cases and nonmutated cases was also highly significant. In CLL, 1 of 8 (12.5%) mutated cases treated by chemotherapy (chlorambucil and/or CHOP and/or fludarabine) responded, as compared with 29 of 36 (80%) nonmutated cases (P = .02). In all CLL cases, survival from p53 analysis was significantly shorter in mutated cases (median 7 months) than in nonmutated cases (median not reached) (P < 10(-5)). In 35 of the 45 mutated cases of AML, MDS, and CLL, cytogenetic analysis or SSCP and sequence findings showed loss of the nonmutated P53 allele. Our findings show that p53 mutations are a strong prognostic indicator of response to chemotherapy and survival in AML, MDS, and CLL. The usual association of p53 mutations to loss of the nonmutated P53 allele, in those disorders, ie, to absence of normal p53 in tumor cells, suggests that p53 mutations could induce drug resistance, at least in part, by interfering with normal apoptotic pathways in tumor cells.     

Efficacy and toxicity of low-dose melphalan in myelodysplastic syndromes and acute myeloid leukemia with multilineage dysplasia

Effective therapy of myelodysplatic syndromes and acute myeloid leukemia originating from myelodysplastic syndrome has remained an unresolved problem. Advanced age of the patients and persistent pancytopenia make the treatment difficult. Despite large number of therapeutic options none of them is satisfactory. Recently palliative treatment with low-dose melphalan has been reported to have certain activity. The aim of the study was to evaluate the efficacy of low-dose melphalan in high-risk myelodysplastic syndromes (MDS) and acute myeloid leukemia with multilineage dysplasia (AML). Twenty three patients were eligible for the study: 8 with MDS and 15 with AML with multilineage dysplasia. All of them received oral melphalan in a daily dose of 2 mg. Median total dose of the drug was 120 mg (40-840 mg). Ten patients responded to the therapy. We observed complete remission (CR) in 4, partial remission (PR) in 3 and stabilization of the disease in 3 patients. Thirteen patients did not respond to the therapy. The survival time of the patients from the day of diagnosis and from the beginning of the treatment with melphalan was longer in patients responding to the therapy (median 15 and 10 months, respectively) than in non-responders (4.5 and 4 months, p=0.003 and p=0.008, respectively). Low-dose melphalan shows significant activity in high-risk MDS and AML with multilineage dysplasia with acceptable toxicity.     

亚砷酸治疗老年恶性血液病的初步观察

目的探讨亚砷酸治疗老年恶性血液病的临床疗效及不良反应。方法对40例≥60岁的恶性血液病患者,应用亚砷酸治疗(10mg/d,静脉滴注,28d为1疗程,如不良反应明显则改为14d短疗程,间隔14d后再用14d,2次为1疗程)。观察其临床疗效及不良反应。结果急性早幼粒细胞白血病(APL)完全缓解(CR)8例,其他急性非淋巴细胞白血病(ANLL)CR1例,部分缓解(PR)1例,未缓解(NR)6例;慢性粒细胞白血病(CML)PR4例,NR2例;慢性淋巴细胞白血病(CLL)CR1例,PR1例;B细胞非霍奇金淋巴瘤(NHL)CR1例,PR2例,进步1例,无效1例;骨髓增生异常综合征(MDS)PR2例,进步2例,无效1例;慢性粒单细胞白血病(CMML)CR2例,PR2例;多发性骨髓瘤(MM)PR1例,进步1例。所有病例总有效率为75%。仅2例因严重肝损害、骨髓抑制而停药,无用亚砷酸相关死亡病例。结论对不能耐受强化疗的老年难治、复发的血液肿瘤患者,亚砷酸具有一定的治疗效果,且不良反应相对较低。     

Phase 2 clinical and pharmacologic study of clofarabine in patients with refractory or relapsed acute leukemia

In a phase 2 study, 62 patients with relapsed and refractory acute myeloid leukemia (AML; n = 31), myelodysplastic syndrome (MDS; n = 8), chronic myeloid leukemia in blastic phase (CMLBP; n = 11), and acute lymphocytic leukemia (ALL; n = 12) received 40 mg/m2 clofarabine intravenously over 1 hour daily for 5 days, every 3 to 6 weeks. Twenty patients (32%) achieved complete response (CR), 1 had a partial response (PR), and 9 (15%) achieved CR but without platelet recovery (CRp), for an overall response rate of 48%. In AML, responses were noted in 2 (18%) of 11 patients in first salvage with short first CR (相似文献   

Continuous intravenous administration of daunorubicin and cytarabine for remission induction of poor risk acute myelogenous leukaemias and myelodysplastic syndromes

Seventeen consecutively admitted poor risk acute myeloid leukaemia (AML) patients and 4 patients with myelodysplastic syndrome (MDS) were treated with a remission-induction regimen consisting of a 7-day continuous intravenous infusion of conventional doses of cytarabine and of three 24-h constant rate infusions of daunorubicin administered intermittently on days 1, 3 and 5. The diagnoses were: relapsed primary AML in 6 patients, secondary AML in 11 patients (9 untreated, 2 relapsed) and MDS in 4 patients. The median age was 50 yr. Five of 6 patients with relapsed primary AML, 3 of 11 patients with secondary AML and 2 of 4 patients with MDS achieved complete remission (CR). The overall CR rate was 48% with a median remission duration of 5 months (range: 0.25-20 months). Few acute toxic side effects were observed thanks to the constant rate of infusion of daunorubicin.