美罗华联合化疗治疗B细胞非霍奇金淋巴瘤46例临床分析

目的 探讨美罗华联合化疗治疗B细胞非霍奇金淋巴瘤的临床疗效.方法 选择2004年1月-2009年11月收治于我院的B细胞非霍奇金淋巴瘤患者92例.随机分为观察组(46例)和对照组(46例),观察组采用美罗华联合CHOP化疗治疗,对照组采用单纯CHOP方案化疗,比较两组治疗效果.结果 观察组总有效率89.1%,对照组总有效率88.7%,比较差异有显著性(P<0.05);观察组不良反应7例,对照组发生8例,比较差异无显著性(P>0.05).结论 美罗华联合化疗治疗B细胞非霍奇金淋巴瘤,具有临床疗效好、不良反应少、生存率高等优点.值得推广应用.     

美罗华联合化疗治疗B细胞非霍奇金淋巴瘤46例临床分析

目的 探讨美罗华联合化疗治疗B细胞非霍奇金淋巴瘤的临床疗效.方法 选择2004年1月-2009年11月收治于我院的B细胞非霍奇金淋巴瘤患者92例.随机分为观察组(46例)和对照组(46例),观察组采用美罗华联合CHOP化疗治疗,对照组采用单纯CHOP方案化疗,比较两组治疗效果.结果 观察组总有效率89.1%,对照组总有效率88.7%,比较差异有显著性(P<0.05);观察组不良反应7例,对照组发生8例,比较差异无显著性(P>0.05).结论 美罗华联合化疗治疗B细胞非霍奇金淋巴瘤,具有临床疗效好、不良反应少、生存率高等优点.值得推广应用.     

美罗华联合化疗治疗B细胞非霍奇金淋巴瘤46例临床分析

目的探讨美罗华联合化疗治疗B细胞非霍奇金淋巴瘤的临床疗效。方法选择2004年1月-2009年11月收治于我院的B细胞非霍奇金淋巴瘤患者92例,随机分为观察组（46例）和对照组（46例）,观察组采用美罗华联合CHOP化疗治疗,对照组采用单纯CHOP方案化疗,比较两组治疗效果。结果观察组总有效率89．1％,对照组总有效率88．7％,比较差异有显著性（P〈0．05）;观察组不良反应7例,对照组发生8例,比较差异无显著性（P〉0．05）。结论美罗华联合化疗治疗B细胞非霍奇金淋巴瘤,具有临床疗效好、不良反应少、生存率高等优点,值得推广应用。     

利妥昔单抗联合CHOP化疗方案对淋巴瘤患者免疫球蛋白的影响

目的探讨利妥昔单抗联合CHOP化疗对非霍奇金淋巴瘤(Non-Hodgkin lymphoma,NHL)患者免疫球蛋白的影响。方法将96例NHL患者按随机数字表法分为2组,对照组48例,实施CHOP方案化疗。观察组48例,在对照组治疗基础上,加用375 mg/m2利妥昔单抗治疗,3周为1个周期,持续治疗6个周期,治疗前、每个周期结束后,采用快速免疫消浊比浊法测定患者IgA、IgG、IgM等免疫球蛋白水平变化。结果观察组总缓解率为85.42%,高于对照组的64.58%(P<0.05);观察组发热、寒战等发生率为39.58%,高于对照组的10.42%(P<0.01);2个周期后观察组IgA、IgG、IgM开始低于对照组(P<0.05)。结论 R-CHOP方案治疗NHL疗效显著,但易导致免疫球蛋白下降。     

Combination of surgery and chemotherapy for small-cell bronchial carcinoma

In several test model systems using spontaneous metastasizing experimental tumours, convincing data indicate the importance of the tumour burden left after surgery for the efficacy of the combination of surgery and chemotherapy. Early removal of the primary tumour by radical surgery for cure seems to improve the conditions for chemotherapy. Since 1979, in nine different departments of thoracic surgery, patients with small-cell carcinoma of the lung (SCCL) have been randomized after surgery for cure to receive a new sequential intermittent polychemotherapy (sq.CT) of 3 different alternating drug combinations given intermittently over 1 year, or one 4-drug combination chemotherapy (CT) given intermittently over 3 years. The calculation of their life table curves at 1 August 1984 indicated an improvement in the 4-year survival rate of 23 patients receiving sq.CT to about 50%, compared with a survival rate of about 30% for 29 patients receiving CT. The number of patients is still too small for firm conclusions to be drawn, but it is concluded that surgery for SCCL seems to be an advisable measure for the efficacy of aggressive intermittent long-term polychemotherapy. However, this can only be proved in large cooperative studies.     

贝伐珠单抗联合化疗治疗晚期肺腺癌

目的观察贝伐珠单抗联合化疗在晚期肺腺癌一线治疗方面的疗效和安全性。方法 94例初治晚期肺腺癌患者随机分为贝伐珠单抗联合化疗组(联合化疗组,n=44)和单纯化疗组(n=50)。联合化疗组给予贝伐珠单抗(7.5 mg·kg-1)+培美曲塞(500 mg·m-2)+卡铂(300 mg·m-2)治疗,单纯化疗组给予培美曲塞(500 mg·m-2)+卡铂(300 mg·m-2)治疗,两组患者均以21 d为一个周期,用药6个周期,均为化疗第1日静脉给药。比较两组的疗效、不良反应及肿瘤标志物肿瘤特异性生长因子(TSGF)、癌胚抗原(CEA)和细胞角蛋白19片段(CK-19)的变化。结果联合化疗组与单纯化疗组的缓解率分别为57%和34%,疾病控制率分别为86%和64%(P<0.05);中位无进展生存期分别为8.4个月和6.1个月,中位总生存期分别为15.1个月和11.9个月(P<0.01),一年生存率分别为55%和34%(P<0.05)。联合化疗组治疗后的TSGF、CEA和CK-19水平均显著低于单纯化疗组(P<0.01)。联合化疗组较单纯化疗组增加的不良反应主要是高血压,但均为Ⅰ~Ⅱ度,经治疗后均可控制。结论贝伐珠单抗联合化疗在晚期肺腺癌一线治疗中疗效明显,且未增加严重不良反应,具有很好的临床应用前景。     

Combination chemotherapy for acute lymphoblastic leukaemia in adults.

Fifty-one adults with acute lymphoblastic leukaemia were entered into a trial of intense initial chemotherapy and early "prophylaxis" of the central nervous system (CNS). Initial treatment with OPAL (Oncovin (vincristine), prednisolone, adriamycin (doxorubicin), and L-asparaginase (colaspase)) followed by craniospinal or cranial irradiation and intrathecal methotrexate produced remission in 36 patients (71%). Seventeen of these patients relapsed three to 18 months after the start of remission; the remainder had been in remission for 12 to 52 months by the end of the study. The predicted median duration of complete remission was 18.5 months. None of the four patients who initially had clinical evidence of CNS disease, three of whom also had leukaemic cells identical to those found in Burkitt's lymphoma, achieved remission. Those patients who initially had hepatomegaly or splenomegaly had a shorter remission than those without. The predicted median survival was 27 months in those who achieved complete remission, one month in those who did not, and 21 months overall. The addition of colaspase and doxorubicin to vincristine and prednisolone and the use of early CNS treatment clearly improved the remission rate among adults with acute lymphoblastic leukaemia, though the presence and length of remission was affected by the extent of disease at presentation. Burkitt-like leukaemia, which had a poor prognosis, is probably a separate disease and may benefit from a different therapeutic approach.     

化疗联合胸腺肽α1治疗乳腺癌的基础与临床观察

目的评价观察化疗联合胸腺肽α1对乳腺癌患者毒副作用及免疫功能的影响。方法87例乳腺癌患者随机分为治疗组43例和对照组44例。对照组单用化疗。治疗组采用胸腺肽α1＋化疗,胸腺肽α1给药方案：化疗当天开始1．6mg／周,皮下注射,直至患者完成2个疗程的化疗。结果2组均按期完成化疗计划。化疗期间,治疗组19例,对照组有31例WBC〈4×10^9／L。2组WBC〈4×10^9／L患者的例数差异有统计学意义（x^2=6．14,P〈0．05）。对照组有26例患者,治疗组有34例出现胃肠道不良反应。2组胃肠道不良反应发生率差异有统计学意义（x^2=4．06,P〈0．05）。治疗组化疗后细胞免疫指标水平高于对照组,差异有统计学意义（P〈0．05或P〈0．01）。结论胸腺肽α1配合化疗能提高患者的免疫功能,改善患者生活质量。     

Combination of chemotherapy with radiotherapy: review of previous studies and new perspectives

A review is made of the effectiveness of various combinations of radio- and chemotherapy in head and neck cancers and it is suggested that cisplatin combined with radiotherapy is likely to produce the most favourable results.     

Combination therapy versus single agent chemotherapy in non-small cell lung cancer

There is proven evidence of improved symptom control with platinum-based chemotherapy in the palliation of non-small cell lung cancer, and small but definite improvements in progression-free and overall survival when compared with best supportive care. The newer chemotherapy agents vinorelbine, gemcitabine, docetaxel and paclitaxel all have single agent activity, and in combination with cisplatin these provide superior quality of life and/or survival compared with the single agents, albeit with some increase in haematological toxicity. Doublet chemotherapy consisting of a new agent combined with platinum, cisplatin by preference where tolerated, has become the standard of care for advanced disease. The use of a functional assessment of fitness, rather than chronological age alone, is appropriate in the treatment of elderly patients. Although in this group there is evidence that doublets are superior to single agents, treatment should be undertaken with caution. In the second line setting where patients are unlikely to tolerate combination therapy, single agents have proven superiority over best supportive care. Patients with poor performance status (PS2) without comorbidity may tolerate combination therapy, but currently available evidence is insufficient to allow a definitive recommendation for combination or single-agent chemotherapy.     

Combination therapy versus single agent chemotherapy in non-small cell lung cancer

There is proven evidence of improved symptom control with platinum-based chemotherapy in the palliation of non-small cell lung cancer, and small but definite improvements in progression-free and overall survival when compared with best supportive care. The newer chemotherapy agents vinorelbine, gemcitabine, docetaxel and paclitaxel all have single agent activity, and in combination with cisplatin these provide superior quality of life and/or survival compared with the single agents, albeit with some increase in haematological toxicity. Doublet chemotherapy consisting of a new agent combined with platinum, cisplatin by preference where tolerated, has become the standard of care for advanced disease. The use of a functional assessment of fitness, rather than chronological age alone, is appropriate in the treatment of elderly patients. Although in this group there is evidence that doublets are superior to single agents, treatment should be undertaken with caution. In the second line setting where patients are unlikely to tolerate combination therapy, single agents have proven superiority over best supportive care. Patients with poor performance status (PS2) without comorbidity may tolerate combination therapy, but currently available evidence is insufficient to allow a definitive recommendation for combination or single-agent chemotherapy.     

替加氟、奥沙利铂和亚叶酸钙联合用药在直肠癌化疗中的应用观察

目的 探讨替加氟、奥沙利铂和亚叶酸钙联合用药在直肠癌化疗中的应用效果.方法 选取2012年4月至2014年5月我院收治的直肠癌病人89例,并按照随机数字表法分为对照组(n=44)和观察组(n=45).对照组FOLFOX4方案治疗,观察组替加氟、奥沙利铂和亚叶酸钙联合治疗,对比两组直肠癌化疗效果.结果 观察组近期疗效总有效率40.0％,对照组38.6％,差异无统计学意义(x2=0.017,P＞ 0.05).观察组血液系统毒性反应总例数为9例,对照组11例,差异无统计学意义(x 2=0.319,P＞0.05).观察组不良反应例数为27例,对照组25例,差异无统计学意义(x 2=0.093,P＞0.05).结论 在直肠癌化疗中,替加氟、奥沙利铂和亚叶酸钙联合用药方案化疗效果有效、安全,与经典的FOLFOX4化疗方案相似.     

利妥昔单抗联合化疗治疗回盲部弥漫大B细胞淋巴瘤的临床分析

目的探讨利妥昔单抗(美罗华)联合化疗治疗回盲部弥漫大B细胞淋巴瘤的疗效及毒副作用。方法 6例经病理检查证实为回盲部弥漫大B细胞淋巴瘤患者,5例采用利妥昔单抗联合CTNP方案化疗,1例采用CTNP方案化疗,每21天为1个周期,观察治疗前后的毒副作用及疗效。结果 5例利妥昔单抗联合化疗治疗的患者有4例达完全缓解,1例达部分缓解;另1例单纯化疗患者死于疾病进展。结论利妥昔单抗联合化疗治疗回盲部弥漫大B细胞淋巴瘤可取得较好疗效,对于高龄患者利妥昔单抗无需减量,但需注意调整化疗剂量,并监测不良反应。     

XELOX与FLO方案治疗晚期胃癌的近期疗效及毒副反应比较

目的比较奥沙利铂联合卡培他滨方案(XELOX)与奥沙利铂联合5-FU/LV(FLO)方案治疗的晚期胃癌的近期疗效和毒副反应。方法通过查阅病例资料回顾分析2007年5月～2009年4月期间该科收治的62例采用XELOX和FLO化疗方案治疗的晚期胃癌,其中奥沙利铂联合卡培他滨(XELOX)A组33例,奥沙利铂联合5-FU/LV(FLO组)B组29例。结果 A组总有效率48.48%,疾病进展时间5.92个月,B组为44.83%和5.70个月,两组之间差异无统计学意义;A组中性粒细胞减少发生率15.2%,明显低于B组48.3%(P=0.006<0.01);A组神经毒性发生率15.2%明显低于B组58.6%(P=0.000<0.01);A组的手足综合症发生率(48.5%)明显高于B组13.8%(P=0.006<0.01),大多数为轻度,主要为I～Ⅱ度。结论 XELOX方案与FLO方案的疗效相近,但XELOX方案毒副反应较轻、耐受性良好、临床使用方便等优点。     

Mechanism of action of rituximab

Rituximab, the humanized chimeric anti-CD20 monoclonal antibody, represents a powerful tool for treating B-cell malignancies and is licensed for the treatment of relapsed or chemorefractory low-grade or follicular non-Hodgkin's lymphoma (NHL). It has a unique mode of action and can induce killing of CD20+ cells via multiple mechanisms. The direct effects of rituximab include complement-mediated cytotoxicity and antibody-dependent cell-mediated cytotoxicity, and the indirect effects include structural changes, apoptosis, and sensitization of cancer cells to chemotherapy. In vitro studies have made a significant contribution to the understanding of these mechanisms of action and have led to the development of innovative and effective treatment strategies to optimize patient response. The most significant of these strategies is the combination of rituximab and CHOP chemotherapy (cyclophosphamide, doxorubicin, vincristine and prednisone), which is proving a highly effective combination in the treatment of NHL. However, all patients do not respond equally well to rituximab, and in vitro studies have identified a possible mechanism of resistance involving the anti-complement inhibitors CD55 and CD59. Neutralizing antibodies to CD55 and CD59 can overcome resistance to rituximab-mediated complement-mediated cytotoxicity in vitro. This paper overviews our understanding of the mechanisms of action of rituximab and identifies how this knowledge could be applied in a clinical setting to maximize response in both sensitive and resistant patients.     

Mechanism of action of rituximab

The CD20 antigen is strongly and stably expressed on cells of the B-cell lineage, but not on stem cells, and is thus an ideal target antigen for antibody therapy of B-cell malignancies. Rituximab is a human-mouse chimeric monoclonal antibody to the CD20 antigen that kills B-cells by a number of different effector mechanisms. The human IgG component of the antibody is able to bind human complement and also interact with effector cells to kill cells by antibody-dependent cell-mediated cytotoxicity. Some investigators have also shown direct effects of the antibody on human tumor cell lines expressing CD20. These effects include inhibition of proliferation, induction of apoptosis and increased sensitivity to chemotherapeutic agents, although the extent to which each of these mechanisms may contribute to the anti-tumor action of rituximab remains to be determined. Rituximab thus acts by additional mechanisms compared to conventional chemotherapeutic agents. The chimeric nature of the antibody results in minimal immunogenicity and allows repeat use. The antibody may be combined with conventional chemotherapy, with potential for increased efficacy with minimal added toxicity.     

Combination chemotherapy for invasive fungal infections: what laboratory and clinical studies tell us so far.

Despite potential benefits, few objective clinical data (with the exception of cryptococcocal meningitis) are available supporting the routine use of combination antifungal regimens in patients with invasive mycoses, importantly aspergillosis or candidiasis. There is considerable debate on what constitutes synergy or antagonism in vitro and whether these laboratory findings are translated to beneficial interactions in patients. Given the lack of rigorous clinical data, a better understanding of the important concepts for the justification of the clinical and pharmacoeconomic threshold of antifungal therapy is needed. Such concepts include standardized methods for screening antifungal combinations in culture or in animals and collaborative efforts to collect clinical data on the efficacy and safety of combination regimens.     

Combination chemotherapy: interaction of 5-methoxymethyldeoxyuridine with trifluorothymidine, phosphonoformate and acycloguanosine against herpes simplex viruses

Methoxymethyldeoxyuridine (MMUdR) when used in combination with either trifluorothymidine (F3TdR) or phosphonoformate (PFA) showed synergistic activity against herpes simplex virus type 1 and type 2 (HSV-1 and HSV-2) in vitro, whereas MMUdR and acycloguanosine (ACG) combination was antagonistic against herpes viruses. HSV-1 mutants resistant to ACG, arabinofuranosyladenine (Ara-A), MMUdR or PFA were isolated. Drug-resistant HSV-1 virus mutants were analyzed for cross sensitivity to ACG, Ara-A, F3TdR, MMUdR, MMUdR-5'-monophosphate (MMUdR-MP) and PFA. The Ara-A-resistant (Ara-AR) virus exhibited 3-fold resistance to MMUdR-MP (ID50 = 105 microM). The ACG-resistant (ACGR) mutant was 160-fold less sensitive to MMUdR (ID50 greater than 1138 microM). The MMUdR-resistant (MMUdRR) mutant remained sensitive to all other antiviral drugs in vitro. Ara-A provided protection against HSV-1 encephalitis in immunosuppressed mice inoculated with a low dose (200 PFU/mouse) of MMUdRR virus or wild-type HSV-1. F3TdR decreased incorporation of tritiated deoxyuridine [( 3H]UdR) in RK-13 cells by 50% at 0.068 microM. Under similar conditions, MMUdR (up to 600 microM) and PFA (up to 208 microM) were without effect on incorporation of [3H]UdR into DNA. In combination chemotherapy experiments, MMUdR (up to 300 microM) used along with F3TdR (up to 1.08 microM) neither decreased nor enhanced cytotoxicity of F3TdR as measured by incorporation of [3H]UdR into cellular DNA. Similarly, MMUdR (up to 300 microM) in combination with PFA (up to 166 microM) was nontoxic to host cells.