国产安吖啶联合治疗急性白血病30例临床观察

采用国产安吖啶联合方案治疗急性白血病（ＡＬ）３０例，急性淋巴细胞白血病（ＡＬＬ）６例，急性非淋巴细胞白血病（ＡＮＬＬ）２４例，初治２１例，复治９例，总的ＣＲ率为７６．７％；ＡＮＬＬ的ＣＲ率为７９．２％，初、复治病例的８０．９％，６６．７％。主要毒性为骨髓抑制，其次为脱发，食欲下降，恶心、呕吐，口腔粘膜炎、静脉炎等。     

吡柔比星联合化疗方案治疗急性白血病24例临床观察

本报告以吡柔比星为主方案治疗２４例急性白血病，包括急性淋巴细胞白血病１１例，急性非淋巴细胞性白血病１３例，结果表明：对ＡＬＬ组首用ＴＶＡＰ或ＴＶＣＰ方案，ＣＲ率６３．７％，ＰＲ１８．１％，总有效率８２．８％，对ＡＮＬＬ组首用ＴＨＡ方案总诱导ＣＲ率８２．１％，ＣＲ的１７例中，１疗程即达ＣＲ的１１例，２疗程达ＣＲ者６例，其中１１例持续ＣＲ，中位缓解期在ＡＬＬ和ＡＮＬＬ分别为６．６和４．２月，最长者分别     

联合去甲氧柔红霉素治疗急性白血病的临床研究

采用以４－去甲氧基柔红霉素（ＩＤＡ）为主组成的联合化疗方案，治疗３３例初发和复发的急性白血病，其中急性淋巴细胞白血病（ＡＬＬ）７例，急性非淋巴细胞白血病（ＡＮＬＬ）２６例。结果：总有效率７０％。初治２３例ＡＮＬＬ患者，完全缓解（ＣＲ）１６例，部分缓解（ＰＲ）２例，有效率为７９％。５例初治ＡＬＬ患者，４例ＣＲ，１例ＰＲ。而复发的２例ＡＬＬ和３例ＡＮＬＬ患者均未缓解。ＩＤＡ主要副作用表现为骨髓抑制及心脏毒性。认为以ＩＤＡ组成联合化疗方案治疗初发的急性白血病具有较好的疗效     

联合去甲氧柔红霉素治疗急性白血病的临床研究

采用以４－去甲氧基柔红霉素（ＩＤＡ）为主组成的联合化疗方案，治疗３３例初发和复发的急性白血病，其中急性淋巴细胞白血病（ＡＬＬ）７例，急性非淋巴细胞白血病（ＡＮＬＬ）２６例，结果：总有效率７０％，初始２３例ＡＮＬＬ患者，完全缓解（ＣＲ）１６例，部分缓解（ＰＲ）２例，有效率为７９％。５例初始ＡＬＬ患者，４例ＣＲ，１例ＰＲ，而复发的２例ＡＬＬ和３例ＡＮＬＬ患者均未缓解。ＩＤＡ主要副作用表现为骨髓抑制 及     

成人急性白血病P-糖蛋白表达的预后意义

目的探讨多药耐药（ＭＤＲ１）Ｐ糖蛋白（Ｐｇｐ）表达在成人初治急性白血病（ＡＬ）中的预后意义。方法采用流式细胞术及单克隆抗体ＵＩＣ２检测了１５１例成人急性髓细胞白血病（ＡＭＬ）、４７例成人急性淋巴细胞白血病（ＡＬＬ）患者的白血病细胞Ｐｇｐ表达。结果Ｐｇｐ＋在ＡＭＬ患者的完全缓解（ＣＲ）率为２０．５％,明显低于Ｐｇｐ患者的７８．５％（Ｐ＜０．００１）;Ｐｇｐ＋在ＡＬＬ患者的ＣＲ率为６６．７％,与Ｐｇｐ－患者的８０％相比,差异无显著性（Ｐ＞０．０５）。Ｐｇｐ＋患者的６个月复发率明显高于Ｐｇｐ患者（ＡＭＬ：６６．７％∶８．７％,Ｐ＜０．００１;ＡＬＬ：５０％∶９．５％,Ｐ＜０．０５）;Ｐｇｐ＋患者的平均无病生存期（ＤＦＳ）较Ｐｇｐ患者短（ＡＭＬ：５个月∶１３个月;ＡＬＬ：４个月∶１３个月）。结论Ｐｇｐ过度表达是成人ＡＬ的不良预后因素,是判断疗效及早期复发的一个重要指标。     

PCR扩增TCRγ基因重排检测急性淋巴细胞白血病微量残留病的研究

应用多聚酶链反应（ＰＣＲ）技术检测急性淋巴细胞白血病（ＡＬＬ）骨髓白血病细胞ＴＣＲγ基因重排，敏感性达１０＾－５水平以上。２７例急性期ＡＬＬ有２１例检测到约４００ｂｐ的扩增产物，阳性检出率为７７．８％（２１／２７）；７例完全缓解（ＣＲ）的ＡＬＬ有２例检测阳性，其中１例于检测后１．５月复发，另１例随访６个月仍ＣＲ；而其余５例检测阴性者于检测后平均随访７．１月均持续ＣＲ。提示本法对ＡＬＬ ＴＣＲγ基因     

急性非淋巴细胞白血病多药耐药基因与其免疫表型的关系

目的：探讨急性非淋巴细胞白血病（ＡＮＬＬ）多药耐药基因（ＭＤＲ１）与免疫表型表达的关系及意义。方法：应用反转录聚合酶链反应（ＲＴ－ＰＣＲ）和间接免疫荧光法对５２例初治ＡＮＬＬ患者进行了ＭＤＲ，基因及免疫表型的检测。结果：ＡＮＬＬ患者ＭＤＲ１阳性表达率为３０．７％，其中Ｍ３明显低于其他亚型。ＭＤＲ１阳性ＡＮＬＬ患者ＣＤ３４表达率显著高于ＭＤＲ１阴性者；而其安全缓解率（３７．５％）则低于后者（８８．８     

老年人急性非淋巴细胞白血病化疗疗效观察

报道了五年间收治的老年急性非淋巴细胞白血病（ＡＮＬＬ）２１例，采用ＤＡ（ＶＰ１６）与ＨＡ（ＶＰ１６）联合化疗，依据不同剂量，将其分为二组，二组总有效率为６６．６％。其中中等剂量组１４例，８例ＣＲ，平均生存时间为２６７天；２例（１８％）ＰＲ：小剂量组７例，２例（２８．５％）ＣＲ，２例（２８．５％）ＰＲ；结果提示：对老年白血病患者治疗应个体化，一般情况好者应在强有力支持治疗情况下采用中等剂量的化疗，相反宜小剂量化疗     

PCR扩增TCR_γ基因重排检测急性淋巴细胞白血病微量残留病的研究

应用多聚酶链反应（ＰＣＲ）技术检测急性淋巴细胞白血病（ＡＬＬ）骨髓白血病细胞ＴＣＲγ基因重排，敏感性达１０￣（－５）水平以上。２７例急性期ＡＬＬ有２１例检测到约４００ｂｐ的扩增产物，阳性检出率为７７．８％（２１／２７）；７例完全缓解（ＣＲ）的ＡＬＬ有２例检测阳性，其中１例于检测后１．５月复发，另１例随访６个月仍ＣＲ；而其余５例检测阴性者于检测后平均随访７．１月均持续ＣＲ。提示本法对ＡＬＬＴＣＲ＿γ基因重排的检测较具普遍性，可用于其微量残留病（ＭＲＤ）的检测，对ＡＬＬ预后的判断、复发的监测可能有重要意义。     

老年人急性非淋巴细胞白血病化疗疗效观察

报道了五年间收治的老年急性非淋巴细胞白血病（ＡＮＬＬ）２１例，采用ＤＡ（ＶＰ１６）与ＨＡ（ＶＰ１６）联合化疗，依据不同剂量，将其分为二组，二组总有效率为６６．６％，其中中等剂量组１４例，８例ＣＲ，平均生存时间为２６７天，２例（１８％），ＰＲ，小剂量组７例，２例（２８．５％），ＣＲ，２例（２８．５％）ＰＲ，结果提示：对老年白血病患者治疗应个体化，一般情况好者应在强有力支持治疗情况下采用中等剂量的化疗     

Acute leukemia expressing the normal human hematopoietic stem cell membrane glycoprotein CD34 (MY10)

Thirty-one cases of acute leukemia with blast cells greater than or equal to 70% positive for the hematopoietic stem cell Ag, CD34 (MY10, HPCA-1), were identified from the University of Nebraska Medical Center and The Johns Hopkins Oncology Center over an 18-month period. Fourteen of the cases were classified as early B-lineage ALL, 3 cases were other ALL subtypes, and 14 of the cases were ANLL. Five of the 17 cases of ALL expressed one or more myeloid-associated surface Ags, 3 ANLL cases expressed CD10 (CALLA, J5), and T-lymphoid Ags were present in 12 of 31 cases (1 T-cell ALL, 3 of 16 B-lineage ALL cases, and 8 of 14 ANLL cases). Eleven of 12 CD34+ ALL cases studied had abnormal karyotypes; only 7 of 12 CD34+ ANLL cases studied had abnormal karyotypes, and 3 of these were CD10+ ANLL. Six cases were Ph1 positive, including the one mature B cell ALL, 4 early B-lineage ALL, and 1 CD10+ ANLL case. Good and poor prognosis subgroups of high frequency of expression of CD34 leukemias could be identified, generally, as would have been predicted by previously defined criteria. Thus, of the 10 Ph1-negative early B-lineage ALL patients, 9 achieved CR (90%). At the other extreme, the CR rate of CD10- ANLL was 4 of 11 (36%). The leukemias characterized by greater than or equal to 70% of cells positive for CD34 form a relatively undifferentiated subset of the leukemias which may show features associated with more than one lineage, and if CD10- and myeloid morphology, may respond poorly to therapy.     

Treatment of Refractory and Relapsed Adult Acute Leukemia Using a Uniform Chemotherapy Protocol

Twenty-nine adult patients with relapsed (21) or refractory (8) de novo acute leukemia (12 ALL and 17 ANLL) were treated with a remission-induction salvage chemotherapeutic protocol including vindesine, mitoxantrone, cyclophosphamide, intermediate-dose cytosine arabinoside, prednisolone and methotrexate. Ten of seventeen (59%) ANLL and 8/12 ALL (67%) achieved complete remission (CR). Seven of eight (86%) cases refractory to first-line remission-induction therapy (3/4 ANLL and 4/4 ALL) entered complete remission. The most frequent non-hematologic side effects were gastrointestinal. All patients experienced severe pancytopenia, with median times to recovery of granulocyte and platelet counts of 28 and 29 days, respectively. Nine of twenty-nine (31%) patients suffered febrile episodes of unknown origin and 13/29 (45%) suffered documented infections. Five patients (17%) died while aplastic, four from infection and one from cardiotoxicity. Four patients who entered CR were submitted to a bone marrow transplantation (BMT), two autologous and two allogeneic BMT. Sixteen of the 18 patients who entered CR relapsed, with a median remission duration of 3.5 ± 2.9 months. Two patients remain in remission at 5+ and 17+ months. These results suggest that this protocol is an effective remission-induction salvage therapy for adult acute leukemias.     

Evaluation of 58 patients with acute leukemia]

We made a retrospective study of 44 patients with acute non-lymphocytic leukemia (ANLL) and 14 patients with acute lymphocytic leukemia (ALL) admitted to our hospital from September 1984 to May 1991. The complete remission (CR) rate of ANLL was 90.9%, against 85.7% for ALL. The 5-year survival of ANLL was 50.7%, and that of ANLL under age 60 years was 70.3%. The 2-year median survival of ALL was 35.1%. These results were obtained with response-oriented individualized therapy, and intensive chemotherapy with a view to eradication of residual leukemic cells. Eight elderly patients with ANLL were treated with cytosine arabinoside in low doses. Complete remission was achieved in 6 patients, but these cases relapsed. These treatments should be reconsidered for long CR duration. Our schedules of response-oriented individualized therapy were too flexible to apply at another institute so they should be arranged for general application.     

Mitoxantrone for refractory and relapsed acute leukemia

Seventy-seven patients with relapsed or refractory acute leukemia and three with acute blastic chronic myeloid leukemia (CML) were treated in an open Phase II study using mitoxantrone 12 mg/m2 intravenously daily X 5 days. Complete remission (CR) was achieved in 32 of 80 (40%), including 23/45 (52%) with relapsed acute nonlymmphocytic leukemia (ANLL), four of 12 (33%) with relapsed acute lymphocytic leukemia ALL, four of 17 (24%) with ANLL refractory to daunorubicin + cytosine arabinoside, and one of three (33%) with refractory ALL. None of the patients with acute blastic CML achieved CR. Median survival time for all patients was 121 days. Median duration of complete response was 303 days with ten of 32 patients in continuing CR for periods varying from 44+ to 1210+ days. Apart from moderately prolonged hematologic suppression toxicity was mild and subjective side effects were tolerable. Mitoxantrone is an active agent in the treatment of acute leukemia and demonstrates incomplete cross resistance with duanorubicin. Mitoxantrone should be considered for first-line therapy in ANLL.     

改良FLAG方案治疗33例难治复发性急性白血病的初步分析

背景与目的:FLAG方案用于治疗难治复发性急性非淋巴细胞性白血病(acute non-lymphocytic leukemia,ANLL)已有多年,大多报道的CR率为50%～64%.本研究探讨改良FLAG方案(减少合并应用Ara-C剂量并在化疗前不用G-CSF)能否达到同样疗效,并减轻不良反应.方法:33例成人急性白血病中难治性ANLL 16例,难治性急性淋巴细胞白血病(ALL)12例,复发性ALL 5例.全部病例接受氟达拉宾30 mg@(m2@d)-1,静滴,第1～5天;其中合并Ara-C 200 mg@d-1有18例,Ara-C 500 mg@d-1有5例,Ara-C 1 000 mg@d-1有10例,全部静脉滴注5～7天为1疗程.应用Ara-C 200 mg@d-1组和ALL组化疗前不用G-CSF,ALL患者每周加用长春新碱2 mg,共2次;强的松60～80 mg@d-1,共14天.化疗后WBC＜1.0×10 9/L者加用G-CSF,剂量均为300μg@d-1,皮下注射至WBC 3.0×10 9/L以上.每疗程完成后复查骨髓.结果:16例难治性ANLL的CR率为56.3%,而12例难治性ALL的CR率为8.3%(P＜0.01);难治性ANLL患者中Ara-C 200 mg@d-1组的CR率高于500～1 000 mg@d-1组(70%:33%),但无统计学差异(P＞0.05).化疗后WBC 0.6×10 9/L和血小板15.6×10 9/L的平均持续时间分别为5天和4.3天,Ara-C 200 mg@d-1组感染发生率明显低于500～1 000 mg@d-1Ara-C组(58.0%:85.7%)(P＜0.05).结论:与经典的FLAG方案相比,改良FLAG方案的CR率有增高、感染发生率降低.     

Prognostic significance of general immune competence in acute leukemia

The prognostic significance of lymphocyte transformation rate, E-RFC%, 29 degrees C E-RFC%, serum IgG, IgA, IgM and C3 levels were studied in 286 patients with acute leukemia. In acute lymphoblastic leukemia (ALL), the pretreatment immunological parameters were not related to whether the patients could achieve complete remission (CR), but the patients with E-RFC% greater than 30% before treatment or E-RFC% restored to normal after treatment had a significantly longer survival time. In acute nonlymphocytic leukemia (ANLL), pretreatment LTR and E-RFC% were significantly higher in patients who could achieve CR subsequently, the patients with higher pretreatment levels of LTR, E-RFC% or 29 degrees C E-RFC% survived significantly longer than patients with lower levels of these parameters, and the patients whose LTR could return to normal after treatment had a significantly higher CR rate and longer survival times. Except that the pretreatment IgM level was related to the survival of ANLL patients, serum levels of immunoglobulins and C3 had no prognostic value for both ALL and ANLL. In both ALL and ANLL, the immunological parameters changed significantly when relapse occurred.     

BH-AC.AMP protocol in the treatment of refractory childhood acute leukemia

Sixteen children with refractory hematological malignancies were treated with a combination of BH.AC, aclacinomycin-A, 6-MP and predonisolone (BH-AC.AMP protocol). They were ALL(6), ANLL(8), CML(1) and NHL(1). The CR ratio was 17% in ALL, 50% in ANLL, and blast crisis of CML was treated successfully but NHL failed in the induction remission. Major complications were vomiting, nausea, gastrointestinal bleeding, hematuria and hemorrhagic cystitis. More than 10 days or 120 mg/m2 administration of aclacinomycin-A was thought to induce more severe side effects.     

Immunohistochemical classification of acute leukemias using peripheral blood smears

Immunophenotypic classification of the acute leukemias (AcL) is of well documented value in those of lymphoid or uncertain origin and of increasing importance in those of nonlymphoid origin. Most of these studies have been performed on viable cell suspensions. To study the efficacy of a simpler immunohistochemical approach to the classification of the acute leukemias requiring only peripheral blood smears, 15 AcL (including three CGL-BC) were studied using an immunoalkaline phosphatase method and a panel of anti-lymphoid and anti-myeloid monoclonal antibodies. Routine cytochemistries were also performed (Sudan black, PAS). Using immunohistochemistry, five cases marked as common ALL (four were undifferentiated by cytochemistry, one ALL), eight cases as ANLL (all ANLL by cytochemistry) and two cases marked only with anti-HLA-DR (AUL by cytochemistry). These results show that immunophenotypic analysis of AUL, ALL and ANLL can be successfully performed even when only air dried peripheral blood smears are available.     

成人急性白血病中CD117与CD34共表达的临床意义

背景与目的:c-kit受体(c-kitreceptor,c-kitR,CD117)是干细胞因子受体。CD117在急性非淋巴细胞白血病(acutenon-lymphoblasticleukemia,ANLL)中高表达,可作为髓系免疫学标记物,对诊断ANLL有一定参考价值。但是,CD117也可在部分急性淋巴细胞白血病(acutelymphoblasticleukemia,ALL)中表达。CD34为造血干(祖)细胞抗原标记物,在ANLL和ALL中均有高表达。本研究旨在探讨CD117和CD34在急性白血病中共表达的临床意义。方法:采用流式细胞术(flowcytometery,FCM)分别检测92例ALL和81例ANLL初诊患者骨髓单个核细胞(BMMNC)CD117的阳性率和阳性细胞水平;比较ALL和ANLL患者CD117/CD34共表达率的差异,并比较ALL患者中CD117和CD117/CD34共表达率的差异。设立20例健康成人为对照组。结果:在ALL和ANLL患者中CD117阳性率分别为15.2%和71.6%,CD117/CD34共表达率分别为5.4%和55.5%,差异有显著性(P<0.001)。ALL患者中CD117表达率和CD117/CD34共表达率分别为15.2%和5.4%,差异有显著性(P=0.029)。结论:CD117可作为急性白血病的MIC分型诊断之髓系免疫学标志,用以协助ANLL的临床诊断;较之CD117表达,CD117/CD34在ALL中的共表达率更低,可籍此协助排除ALL。