特尔立治疗恶性肿瘤化疗所致白细胞减少的疗效观察

目的　观察特尔立对恶性肿瘤化疗所致白细胞减少的疗效。方法　采用每天皮下注射特尔立15 0mg一次 ,治疗 40例恶性肿瘤化疗所致白细胞减少的患者 ,治疗前外周血白细胞总数平均值为 (2 2 0± 1 30 )× 10 9/L。结果　 40例患者治疗后外周血白细胞总数上升达显效 (16例 )或有效 (2 1例 )所需时间为 5 6± 4 4d ,有效率 92 5 %,无效 3例 ,占 7 5 %。结论　每天皮下注射特尔立 15 0mg ,可以明显减轻化疗过程中外周血白细胞下降程度 ,缩短白细胞在 4 0× 10 9/L以下的持续时间及恢复到 4 0× 10 9/L以上的时间 ,毒副反应轻微 ,安全可靠 ,价格便宜 ,临床可推广使用。     

重组IL-11治疗化疗后所致血小板低下的临床观察

目的 观察重组人白介素-11对化疗后所致血小板低下的治疗作用和不良反应.方法 化疗后血小板低于50×109/L的恶性肿瘤患者42例,随机分为两组,治疗组用IL-11 25 μg/(kg·d)皮下注射,连用7 d;对照组皮下注射生理盐水,以用药1周和14 d后外周血血小板的值进行对照.结果 用药1周后治疗组与对照组血小板的均值分别为(91.26±21.54)×109/L和(70.34±19.72)×109/L,14 d后血小板的均值分别为(145.67±88.92)×109/L和(87.39±13.56)×109/L,两者间差异有显著性(P＜0.05).治疗组血小板＞100×109/L者16例(76.2%),对照组3例(14.3%,P＜0.01).治疗组1例患者输注血小板,对照组3例患者输注血小板.主要不良反应为关节肌肉酸痛、乏力、水肿等,其他不良反应少见.结论 重组人白细胞介素-11可治疗化疗后血小板低下,缩短血小板下降的持续时间,减少血小板的输注次数,而且不良反应可以耐受,值得临床进一步观察.     

国产重组人白介素-11衍生物治疗化疗引起血小板减少的临床研究

目的观察国产重组人白介素-11衍生物(rhIL-11Ala10)对恶性肿瘤患者化疗所致血小板减少的疗效及其不良反应.方法采用自身对照试验的方法,对11例曾因化疗引起血小板减少的恶性肿瘤患者(外周血Plt<75×109/L),给予rhIL-11Ala10预防性治疗.第1周期单用化疗,第2周期化疗联合rhlL-11Ala10.rhlL-11Ala10按40ug/kg@d剂量每日皮下注射,连续10天.结果对照周期化疗后血小板最低均值44.6±12.2×109/L,血小板低于100×109/L平均天数9.8±3.4天,2例需输注血小板.研究周期化疗后血小板最低均值101.3±20.6×109/L(P<0.05),血小板低于100/L平均天数2.4±1.9天(P<0.05),无1例输注血小板.主要不良反应谷丙转氨酶升高(9.0%),尿素氮升高(9.0%),头痛(9.0%),乏力(27.3%),肌肉、关节痛(27.3%),结膜充血(9.0%).结论国产重组人白介素-11衍生物(rhIL-1lAla10)具有提升化疗后血小板的作用,预防性用药可减轻血小板下降的幅度及缩短血小板低下的持续时间;不良反应可耐受.     

重组人粒细胞集落刺激因子治疗10例恶性肿瘤化疗所致的Ⅳ度白细胞减少症

目的研究基因重组人粒细胞集落刺激因子(rhG-CSF,惠尔血)对化疗所致的白细胞减少症的疗效.方法用rhG-CSF治疗10例恶性肿瘤化疗所致Ⅳ度白细胞减少症.白细胞小于1.9×109/L或中性粒细胞绝对计数(ANC)小于0.9×109/L时开始用rhG-CSF150μg,皮下注射,每日1次,等白细胞回升5.0×109/L以上或ANC大于2.5×109/L时停药.结果rhG-CSF能使化疗后Ⅳ度白细胞减少症患者的白细胞回升至正常范围,平均时间为6.8天,感染发生率为60%(6/10).结论rhG-CSF可有效治疗化疗所致的Ⅳ度白细胞减少症,减少感染机会,有利于化疗顺利进行.     

国产重组人白细胞介素-11治疗恶性肿瘤患者化疗所致血小板减少的临床研究

目的评价rhIL-11(巨和粒)在化疗所致血小板减少治疗中的作用。方法将65例化疗后血小板减少的患者随机分为对照组(33例):予常规止血及对症、支持治疗;试验组(32例):除与对照组同样治疗外,加皮下注射巨和粒1.5mg/次,1次/d,比较两组治疗后外周血血小板计数变化及出血症状改善情况。结果试验组血小板计数回升、出血症状的改善较对照组快,血小板计数回升至100×109/L以上的平均时间比对照组短,分别为(5.5±0.5)d和(9.6±1.2)d,两组差异有显著性(P<0.01)。结论巨和粒对化疗所致血小板减少疗效显著,无明显副作用。     

胸内注射GM-CSF对序贯化疗后白细胞减少的治疗作用

对肺癌合并癌性胸水的治疗中我们发现GM-CSF胸内注射不但有利胸水吸收也对外周血白细胞有升高作用,为此本组作了对比观察,从1996年8月～1998年12月对本院肺癌合并癌性胸水病人38例进行观察.全部病人经组织病理学或细胞病理学证实为肺癌合并癌性胸水,病人均经序贯化疗(胸内置管排空胸水后注射DDP 100～120mg,水化2d经股动脉插管至胸主动脉灌注CTX 800～1000 mg,VP-16 300mg MMC 8～10mg)并隔日及查外周血象,肝肾功能.发现白细胞低于4.0×10~9/L后将病人随机分为2组:胸内注射GM-CSF组(胸内组)和皮下注射GM-CSF组(皮下组),前组胸内注射GM-CSF 300mg/隔日1次共2次,后组皮下注射GM-CSF 100mg/日共6次,用药期间观察血压、脉搏、体温及全身状况,结果:①外周血白细胞恢复情况;外周血白细胞恢复到4.0×10~9/L,以上所需时间,胸内组是(5.8±1.2)d,皮下组(8.4±1.8)d,两者差异显著(P<0.05).中性粒细胞恢复到2.8×10~9/L的时间胸内组(5.2±1.0)d,皮下组(8.0±1.6)d,两组比较差异显著(P<005).②毒副作用:     

重组人白细胞介素-11治疗非霍奇金淋巴瘤放化疗所致血小板减少的疗效和安全性

 目的　观察重组人白细胞介素-11（rhIL-11）对非霍奇金淋巴瘤患者因放、化疗所致血小板减少的疗效及患者不良反应。方法　对56例病理证实为非霍奇金淋巴瘤血小板＜75×109／L的患者给予每天rhIL-11 50 μg／kg皮下注射,观察外周血小板变化,血小板升至≥100×109／L时停药。结果　血小板升至≥100×109／L所需时间：Ⅱ度（3.5±1.0）d（8例）,Ⅲ度（5.6±1.1）d（32例）,Ⅳ度（11.6±1.5）d（16例）。主要不良反应为厌食、头晕、发热、结膜充血、水肿、心悸、心动过速、皮疹、注射部位疼痛等。结论　rhIL-11有升高放、化疗后血小板减少的作用,不良反应可耐受。     

恶性肿瘤联合化疗中Filgrastim(rhG-CSF)对中性白细胞保护作用的临床观察

为寻找恶性肿瘤联合化疗中对中性白细胞作用的有效用药方法,我们对Filgrastima(rhG-CSF)的作用进行了对比观察.从96年12月～97年4月我们对40例住院病人进行了观察,均为经组织病理、细胞病理学证实的恶性肿瘤病人,化疗方案用药为标准剂量,严格按体表面积计算.观察组为20例病人,方法为化疗用药结束后48小时用Filgrastim(rhG-CSF),剂量为 80～100μg/m~2,皮下注射,平均用药时间为 5～10天.对照组20例病人,为化疗用药结束后中性白细胞平均下降至 2.0×10~9L以下用Filgrastim(rhG-CSF),剂量为 80～100μg/m~2 ,皮下注射,至中性白细胞恢复至 4.0 ×10~9/L以上停药,平均用药时间为4～11天.观察组平均Filgrastim     

地榆生白片在肿瘤化疗中对骨髓保护作用的临床观察

 目的 观察地榆生白片在非小细胞肺癌化疗中预防化疗所致白细胞减少的疗效。方法 42例非小细胞肺癌患者随机分为观察组和对照组，观察组(21例)采用地榆生白片加PC(Paclitaxel+Carbo-platin)方案治疗，对照组(21例)采用PC方案化疗，观察二者骨髓抑制程度及集落刺激因子用量。结果 观察组Ⅲ度及Ⅳ度骨髓抑制发生率47．6％、显著低于对照组90．5％(P<0．05)；应用集落刺激因子均能使化疗后白细胞下降的患者白细胞上升至正常范围(>4×10^9／L)。但观察组和对照组白细胞升至正常范围的时间平均为(3．47±0．38)天和(5．29±1．10)天，观察组、对照组人均集落刺激因子(150μg)用量分别为(3．62±1．09)支和(6．90±0．62)支，差异有显著性(P<0．05)。结论 地榆生白片可减轻非小细胞肺癌化疗的骨髓抑制作用，加速外周血白细胞的恢复，减轻化疗风险，有利于化疗的顺利进行。且价格低廉，效果好，故可配合集落刺激因子广泛应用。     

吉粒芬治疗化疗所致粒细胞减少的临床研究

 目的　研究低剂量、短期使用吉粒芬治疗化疗所致粒细胞减少的临床疗效。方法　108例患者随机分A、B、C3组。A组吉粒芬75μg/qd×3d;B组吉粒芬75μg/qod×6d;C组吉粒芬75μg/qd×5d。均为皮下注射。结果　低剂量、短期使用吉粒芬在粒细胞降至1500×109/L以上时有效,副作用少,能使患者安然度过粒细胞下降易感染期,以B组隔日使用疗效最好。结论　低剂量、短期使用吉粒芬可在粒细胞未降至1500×109/L以上时使用有效,量不变隔日用效果更好。     

Leukocyte count as a predictor of death during remission induction in acute myeloid leukemia

Acute myeloid leukemia (AML) presenting with a high leukocyte count has been associated with an increase in induction mortality and poor results in a number of other survival measures. However, the level at which an elevated leukocyte count has prognostic significance in AML remains unclear. In this report on a series of 375 adult (non-M3) AML patients undergoing induction chemotherapy at a single institution, leukocyte count analyzed as a continuous variable is shown to be a better predictor of induction death (ID) and overall survival (OS) than a leukocyte count of ≥100×10⁹/L, a value characteristically associated with “hyperleukocytosis” (HL). In this patient cohort, a presenting leukocyte count of ≥30×10⁹/L had high sensitivity and specificity for predicting ID, and both performance status (PS) and leukocyte count more accurately predicted for ID than age. Considering these parameters in newly-diagnosed AML patients may facilitate the development of strategies for reducing induction mortality.     

岩舒减轻化疗不良反应的临床观察

目的观察复方苦参注射液(岩舒)在恶性肿瘤化疗中的增效减毒作用。方法83例确诊的恶性肿瘤患者随机分为两组。岩舒组(43例)于化疗的同时给予岩舒静脉滴注,每天1次,化疗药结束后仍连用7天;对照组(40例)单纯化疗。结果与对照组对比,岩舒组的胃肠道不良反应率、外周血白细胞、血小板降低程度小(P＜0.05)。结论岩舒辅助化疗有提高化疗疗效、增强机体免疫功能、降低化疗药物不良反应的作用。     

恶性肿瘤患者化疗前后血小板功能的变化观察

目的:观察恶性肿瘤患者化疗前后血小板计数及血小板功能的变化,了解化疗对恶性肿瘤患者血小板功能的影响.方法:采用比浊法和电阻抗法利用血小板聚集仪测定63名恶性肿瘤患者化疗前后血小板聚集功能.结果:恶性肿瘤患者化疗后血小板计数明显降低,差异有统计学意义(P<0.05);血小板聚集率较化疗前亦明显下降,差异有统计学意义,(P<0.05);且化疗前后血小板计数差值与血小板聚集功能差值呈正性相关(P<0.05).结论:化疗药物会导致恶性肿瘤患者血小板聚集功能下降,可能会增加患者的出血风险.     

Effect of medroxyprogesterone acetate on side effects of CAP therapy in gynecological malignant tumors

We concomitantly administered a large dose of medroxyprogesterone acetate (MPA) to gynecological malignant tumor patients undergoing CAP therapy (CAP). Hematological changes in the peripheral blood were compared between concomitant MPA patients and those not receiving MPA to examine the effect of MPA in reducing the marrow depression which is the major side effect of CAP. 1) Leukocyte count reached minimum at the second week of CAP in both groups. There was no significant difference in the count between the two groups. At the third week of CAP, the count improved to 84% of the pre-CAP level in patients receiving MPA and to 68% in those not receiving MPA, a significant difference (p less than 0.01). At the fourth week, leukocyte counts were 105% and 96% of pre-CAP levels, respectively. There was no difference between the two groups, but the leukocyte count returned to the pre-CAP level in the patients receiving MPA. 2) Platelet count showed changes similar to those in the leukocyte count. In patients receiving MPA, the count improved more rapidly within three weeks (118%, p less than 0.01), and was significantly higher at the fourth week (107%, p less than 0.05) than in patients not receiving MPA. 3) Reticulocyte count reached minimum in the first week, thereafter improving rapidly in both groups. No differences were noted between the two groups. 4) The periods needed for one course of CAP were 27.7 +/- 3.3 days in the patients receiving MPA and 29.5 +/- 3.7 days in the patients not receiving MPA, making for a significant difference between the two groups (p less than 0.05). These results show that MPA accelerates recovery from marrow depression caused by CAP. It is anticipated, therefore, that MPA will be helpful in the application of various chemotherapies which are expected to be frequently conducted in the future.     

Treatment of malignant carcinoid tumors: a randomized controlled study of streptozocin plus 5-FU and human leukocyte interferon

In a randomized controlled study, 20 patients with malignant carcinoid tumors were included. Ten patients received streptozocin plus 5-fluorouracil for 6 months and another 10 human leukocyte interferon (IFN). After 6 months of treatment, an objective tumor response was noted in five of the patients treated with IFN (50%) but in none of the patients on chemotherapy. Stable disease was found in five patients (50%) on IFN treatment and four (40%) on chemotherapy. Progressive disease was noted in six of the patients (60%) receiving chemotherapy. A statistical analysis using the chi-square test showed a significantly higher proportion of responders and stable disease in the IFN treated group (P = 0.0039). Furthermore, three of eight patients who had previously received chemotherapy showed later on an objective response to IFN. The objective responses were mainly noted in decreased tumor markers; however, two patients also showed a significant reduction of tumor size. Subjective responses were noted in 72% of patients treated with interferon, but only in 9% of those treated with streptozocin plus 5-fluorouracil. The results indicate that interferon treatment is superior to the combination of streptozocin plus 5-fluorouracil. Considering both the therapeutic effects and adverse reactions, human leukocyte interferon is a promising alternative for treatment of patients with malignant carcinoid tumors.     

艾迪注射液在恶性肿瘤放、化疗中增效减毒作用的临床研究

目的：观察艾迪注射液在恶性肿瘤放、化疗中的增效减毒作用。方法：136例确诊的恶性肿瘤患者随机分为两组。艾迪组（68例）于放、化疗的同时给予艾迪注射液50ml加生理盐水500ml静脉滴注，每天1次，连用28天；对照组单纯放、化疗。结果：与对照组对比，艾迪组的病变进展率、外周血WBC、PLT降低程度小（P〈0．05）；T细胞亚群CD8下降明显（P〈0．05）；CD4／CD8比值上升明显（P〈0．05）；血清IgG、IgM含量明显增高（P〈0．05）；治疗后艾迪组NK细胞明显高于对照组（P〈0．05）；Kamofsky评分艾迪组明显高于对照组（P〈0．05）。结论：艾迪注射液辅助放、化疗可抑制肿瘤进展，降低毒副反应，防治放、化疗所致的骨髓抑制，提高机体的免疫功能和改善生活质量。     

Canine transmissible venereal tumor and seminoma: a cytohistopathology and chemotherapy study of tumors in the growth phase and during regression after chemotherapy

In this study, 12 dogs affected by canine transmissible venereal tumor (CTVT) and testicular seminoma tumor were studied retrospectively. The cytological sample was smeared onto a glass slide and either air-dried for May-Grünwald-stain, and masses were surgically removed. The tumors were grossly examined, and sections of 4-μm thick were obtained from each sample and stained with H&E. For chemotherapy, vincristine sulfate was administered weekly as an infusion over 3 min via the cephalic vein at a dose of 0.025 mg/kg after diluting with physiological saline to a total amount of 10 ml. If no remission was observed after 8 weeks, chemotherapy was continued with weekly doxorubicin infusion at a dose of 1 mg/kg. All the tumor samples were divided into four cytohistopathologic groups, namely: multilobular (six cases), papillary (two cases), pedunculated (two cases), and tubular (two cases of seminoma). The most frequently represented tumor type was multilobular (6/10, 60 %) followed by pedunculated (2/10, 20 %), papillary (2/10, 20 %), and tubular (two cases of seminoma, 100 %). Cytological smears from eight tumors in regression after chemotherapy were poorly cellular, and many cells were fragmented. In two progressive tumors, there was an average of 1,406?±?972 CTVT 200 cells/μl or 96?·?71 % of total cells counted. Thus, tumor cells represented 96?·?71 % of total cells within the biopsy specimens and the leukocytes 4?·?29 % (leukocyte, tumor cell ratio?=?0?·?062?±?0?·?031). In eight regressive tumors, there was an average of 1,245?±?1,032 CTVT 200 cells/μl or 97?·?31 % of total cells counted. Thus, tumor cells represented 97?·?31 % of total cells and leukocytes 2?·?69 % (leukocyte, tumor cell ratio?=?0?·?071?±?0?·?174). Our data suggested that combination treatment with vincristine and doxorubicin in the future could be an excellent therapeutic alternative for the treatment of TVT for probably reducing the resistance to vincristine, and also, treatment success could easily be followed by the cytological changes.     

Weekly epoetin beta maintains haemoglobin levels and improves quality of life in patients with non-myeloid malignancies receiving chemotherapy

Objective: This study was aimed at investigating the effectiveness andsafety of once-weekly epoetin beta for anaemic cancer patientsreceiving chemotherapy. Methods: A total of 104 patients with a haemoglobin level of 11.0 g/dLwere enrolled. Patients received a once-weekly subcutaneousdose of 36 000 IU epoetin beta for 12 weeks. If the increasein the haemoglobin level was <1.0 g/dL after 6 weeks, ora red blood cell transfusion was required between days 15 and42, the dose of epoetin beta was increased to 54 000 IU fromthe subsequent week. The primary endpoint was the percentageof patients who achieved a haemoglobin increase of 2.0 g/dL;the haemoglobin response rate. Quality of life (QOL) was assessedusing the Functional Assessment of Cancer Therapy-Anaemia (FACT-An)questionnaire. Results: The haemoglobin response rate was 66.3% among the 98 patients(breast cancer: n = 25; malignant lymphoma: n = 21; ovariancancer: n = 20; lung cancer: n = 15; other cancers: n = 17)assessable for a haemoglobin response. Thirty-nine patients(39.8%) required a dose escalation to 54 000 IU. At the endof the study, QOL assessable patients (n = 96) showed a meanimprovement in the FACT-An total fatigue subscale score (FSS)of 0.3 points from baseline. Patients with a haemoglobin responsehad a mean change in the total FSS of +3.2, compared with –3.4for patients without a haemoglobin response. No serious adverseevent of epoetin beta was observed. Conclusions: Epoetin beta administered at an initial dose of 36 000 IU once-weeklywas well tolerated, with increased haemoglobin levels and improvedQOL in anaemic cancer patients receiving myelosuppressive chemotherapy.     

Multimodality therapy for CNS mixed malignant germ cell tumors (MMGCT): results of a phase II multi-institutional study

In order to improve outcomes for CNS mixed malignant germ cell tumors (MMGCT) we sought to increase complete responses (CR) to initial therapy, through intensifying neoadjuvant chemotherapy (CHT1) with added ifosfamide, encouraging second-look surgery, and administering dose-intensive, stem cell-supported chemotherapy (CHT2) to patients with residual tumor, all prior to radiation therapy (RT). Diagnosis was confirmed by biopsy or elevated germ cell tumor markers. After tumor staging was completed, patients received four cycles of chemotherapy (cisplatin, etoposide and ifosfamide, “CHT1”). In patients with <CR, second-look surgery was encouraged. Patients with residual tumor received two cycles of high dose, sub-ablative chemotherapy with carboplatin and cyclophosphamide (“CHT2”) with peripheral stem cell support. All patients then received RT: for localized tumors with CR before RT, 36 gray (Gy) whole ventricular radiation therapy (WVRT) plus 50.4 Gy boost to primary; for disseminated tumors or < CR before RT, craniospinal irradiation (CSI) plus boosts to primary site(s) and bulky metastases. 26 patients (19 M0, 7 M+) were enrolled. The diagnosis was established by histology (20) or elevated markers (6). Objective responses to CHT1 were complete in 12/22 patients with evaluable disease and partial in 10; 8 additional tumors were rendered CR prior to RT (5 surgical CRs: 3 initial, 2 second-look; 3 CRs to CHT2). Thus, 20/26 patients (77 %) were free of disease (CR) prior to RT. Six-year relapse-free survival was 63 ± 10 %; overall survival was 68 ± 9 %. Of 16 M0 patients who received only WVRT, four relapsed in the spine, outside the radiation field. The relatively high frequency (25 %) of relapse outside the initial RT volume highlights the limitations of initial staging criteria and the curative potential of conventional and high dose chemotherapy. CSI remains the standard of care for CNS MMGCT, even for patients with localized disease.     

Early versus late alternating chemotherapy in small-cell lung cancer

BACKGROUND: From 1984 to 1989, the Swiss Group for Clinical Cancer Research(SAKK) performed a randomized phase 111 trial comparing earlyversus late alternating chemotherapy in patients with small-celllung cancer. PATIENTS AND METHODS: 406 eligible patients were entered into the trial. Regimen Aconsisted of PAV(cisPlatin, Adriamycin, VP 16–213, andRegimen B of CyMOC (Cyclophosphamide, Methotrexate, Oncovin,CCNU). Cycles were repeated as rapidly as possible. Patientswere randomized to receive either ABABAB (early alternatingchemotherapy) or AAABBB (late alternating chemotherapy). Aftersix cycles patients with limited disease in complete or partialremission and those with extensive disease in complete remissionreceived irradiation to the primary (45 Gy) and the CNS (36Gy). RESULTS: The overall remission rate was 87%, with 31% complete remissions.The median survival of all 406 eligible patients was 346 days,with 15% of the patients alive at two years. The overall remissionrate, the rate of complete remission, the median survival andthe rate of long-term survival were not significantly differentin the two treatment arms. In limited disease the estimatedpercentages of survival at 2 years were 33% in the early and24% in the late alternating chemotherapy arms. Patients withextensive disease survived significantly longer with late alternatingchemotherapy than on the early alternation regimen (median survival336 days versus 301 days, p=0.01). In the latter patients thereceived dose intensities (RD1) of cisplatin, adriamycin andetoposide were significantly higher in the late-alternationarm. Patients treated with early alternating chemotherapy ratedtheir tumor symptoms, functional states, fatigue/malaise andrestriction of social activity significantly better, reflectingan improved subjective adjustment. CONCLUSIONS: Alternating chemotherapy with PAV-Cy-MOC plus consolidatingradiotherapy is a feasible and effective treatment for small-celllung cancer, with acceptable toxicity. Whereas patnts with earlyalternating chemotherapy achieve a better subjective adjustment,late alternating chemotherapy allows for a higher RDI of cisplatin,adriamycin and etoposide, which results in a significantly longermedian survival of patients with extensive disease. small-cell lung cancer, chemotherapy, alternating chemotherapy, quality of life, dose intensity