FMD方案治疗惰性淋巴瘤的临床观察

 目的　分析FMD方案初治惰性淋巴瘤的疗效及毒副作用。方法　24例确诊惰性淋巴瘤患者初治采用FMD方案：氟达拉滨（Flu）25～30 mg·m-2·d-1,静脉滴注30 min,第1天至第3天;米托蒽醌（Mit）10 mg·m-2·d-1,静脉滴注30 min,第1天;地塞米松（Dxm）40 mg／d,静脉滴注,第1天至第5天。结果　24例患者中,完全缓解（CR）54.1 ％,部分缓解（PR）29.1 ％,有效率为83.2 ％。主要毒副作用是骨髓抑制。结论　FMD方案初治惰性淋巴瘤临床效果好,患者可以耐受,是一种安全有效的较理想的方案     

米托蒽醌联合治疗儿童难治性复发性急性白血病的临床疗效观察

 目的 观察总结米托蒽醌（MTZ）联合治疗儿童难治性复发性急性白血病（RRAL）的疗效。方法 RRAL 12例,急性淋巴细胞白血病（ALL）9例,急性髓性白血病（AML）3例;ALL用VMLP／Dex方案（长春新碱、米托蒽醌、左旋门冬酰胺酶、泼尼松／地塞米松）2～4周;AML用MAE方案（米托蒽醌、阿糖胞苷、依托泊苷）或大剂量阿糖胞苷+依托泊苷。结果 9例ALL,CR 7例,PR 1例,1例未复查;3例AML,CR 2例,NR 1例。总CR率为81.8 %（9／11）,总有效率90.9 %（10／11）。用药后骨髓抑制较明显,大部分病例ANE≤0.1×109／L持续1～2周,轻微肝功能损害,未见药物相关的心脏损害。结论 MTZ不失为治疗儿童难治性复发性急性白血病的有效药物之一,用药后要注意预防和治疗骨髓抑制后出现的各种感染和出血。     

VMALP方案治疗成人急性淋巴细胞白血病

目的:探讨成人急性淋巴细胞白血病(ALL)的治疗。方法:应用VMALP方案治疗成人ALL32例,方案组成为:长春新碱(VCR)1.4 mg/m2(第1天、第8天、第15天)、米托蒽醌(Mx)10 mg(第1天~第3天)、阿糖胞苷(Ara蛳C)150 mg ~ 200 mg(第1天~第7天)、泼尼松(Pred)45 mg ~ 60 mg(第1天~ 第14天)、左旋门冬酰胺酶(Lase)1×104 U(第8天~第17天),如骨髓增生低下,去掉上述方案中的Ara蛳C,如一疗程未达完全缓解(CR)重复上述方案一疗程,两疗程未缓解视为无效,达CR后休息2周~ 3周重复VMALP方案2个疗程或改用其他方案进行巩固与维持治疗。结果:32例患者中CR26例(81.3 %),PR4例(12.5 %),NR2例(6.2 %),总有效率93.8 %,CR的26例中1疗程即达CR者16例(61.5 %),持续CR的11例患者中有9例是1疗程达CR的(81.8 %)。结论:VMALP联合化疗方案治疗成人急性淋巴细胞白血病疗效明显,毒副作用轻微,值得临床推广使用。     

米托蒽醌联合用药治疗成人急性白血病临床观察

目的：观察米托蒽醌（MTZ）治疗初治、复发急性白血病（AL）的临床疗效和毒副作用。探索以MTZ为主要药物作为一线治疗药物的可行性。方法：急性髓细胞白血病（AML）诱导治疗采用MTZ和阿糖胞苷（Ara-C)。急性淋巴细胞白血病（ALL）诱导治疗采用长春新碱（VCR）、MTZ、异环磷酰胺（IFO）和强的松（Pred),条件允许时加用左旋门冬酰胺酶（L－ASP）。结果：37例患者中29例取得完全缓解（CR）,CR率78．4％。对20例AML患者进行了随访,治疗多于6疗程以上的10例患者,有8例持续CR（CCR）,中位缓解期为15．5月。结论：米托蒽醌联合用药治疗急性白血病有较好的疗效,其毒副作用可以耐受。该方案可以作为一线方案用于AL的诱导治疗。     

COMEP方案治疗急性淋巴细胞白血病、非霍奇金淋巴瘤疗效观察

我院于1999年1月-2003年1月应用COMEP方案(环磷酰胺、长春新碱、米托蒽醌、足叶乙苷、泼尼松)治疗成人初治急性淋巴细胞白血病40例,复发性难治性非霍奇金淋巴瘤12例,取得了较好的疗效.现将结果报告如下.     

米托蒽醌与阿霉素治疗中晚期非霍奇金淋巴瘤62例疗效对比观察

[目的]研究米托蒽醌与阿霉素治疗非霍奇金淋巴瘤的疗效与毒副作用。[方法]随机将62例中晚期非霍奇金淋巴瘤患者分成两组，一组CNOP方案，以环磷酰胺（CTX）第1天静脉滴注650mg/m^2，米托蒽醌（NVT）第1天静脉滴注10mg/m^2，长春新碱（VCR）第1天静脉滴注1.4mg/m^2，泼尼松（PDN）100mg/m^2口服第1－5天，21天为1周期，连用4周期。另一组CHOP方案则用阿霉素（ADM）第一天静脉滴注50mg/m^2，代替米托蒽醌（NVT），其余同CNOP方案。[结果]CNOP方案的有效率为66.7%，CHOP方案的有效率为62.62%，P＞0.05，两组主要毒性反应是骨髓似，CHOPⅠ度ECG异常18.5%；CNOP组无ECG改变，其Ⅰ度脱发占33.3%；CHOP的Ⅰ、Ⅱ、Ⅲ度脱发分别为50％、28.1%、21.9%，两组的差异有统计学意义（P＜0.05）。[结论]米托蒽醌治疗非霍奇金淋巴瘤的疗效同阿霉素，但可降低毒副作用，提高患者生存质量。     

小剂量米托蒽醌＋足叶乙甙＋阿糖胞苷治疗老年急性髓系白血病疗效观察

目的 探讨应用小剂量与常规剂量米托蒽醌 足叶乙甙 阿糖胞苷治疗老年急性髓系白血病(AML)的疗效.方法 将42例老年AML患者分为两组,治疗组用米托蒽醌5 mg/d,静脉滴注,第1～3天;足叶乙甙100 mg/d,口服,第1～5天;阿糖胞苷100～150 mg/d,第1～7天,静脉滴注.对照组米托蒽醌10 mg/d,第1～3天;足叶乙甙100 mg/d,静脉滴注,第1～5天;阿糖胞苷150～200 mg/d,第1～7天,静脉滴注.结果 治疗组完全缓解(CR)率57.1%,总有效率80.9%,对照组CR率52.4%,总有效率76.2%.两组CR率差异无显著性(P＞0.05).治疗组粒细胞缺乏发生率、粒细胞缺乏持续时间及发热持续时间均低于对照组,差异有显著性(P＜0.05).结论 小剂量米托蒽醌 足叶乙甙 阿糖胞苷治疗老年急性髓系白血病疗效确切,毒副作用少.     

氟达拉滨联合异环磷酰胺治疗复发性惰性非霍奇金淋巴瘤临床观察

 目的 观察氟达拉滨联合异环磷酰胺治疗复发性惰性非霍奇金淋巴瘤（NHL）的临床疗效。方法 30例复发性惰性NHL患者分为两组。16例用COP方案（环磷酰胺600 mg·m-2·d-1,静脉滴注,第1、8天;长春新碱1.5 mg·m-2·d-1,静脉推注,第1、8天,泼尼松1 mg·kg-1·d-1,连续口服2周为1疗程）治疗至少3个疗程。14例用FI方案（氟达拉滨30 mg·m-2·d-1,静脉滴注,第1天至第5天;异环磷酰胺1.2 g·m-2·d-1,静脉滴注,第1天到第5天为1疗程）治疗至少3疗程。结果 16例用COP方案的患者中,CR3例,PR5例,有效率50.0 %。14例用FI方案的患者中CR6例,PR6例有效率85.7 %。两组有效率比较差异有统计学意义（P＜0.05）。两组患者治疗后的主要不良反应是骨髓抑制,FI方案发生粒细胞减少者为71.4 %,COP方案为68.7 %。结论 FI方案治疗复发惰性NHL的近期疗效较COP方案更好,患者具有较好的耐受性。     

硼替佐米联合VMCLP方案治疗复发难治性急性淋巴细胞白血病一例并文献复习

 【摘要】　目的　探讨硼替佐米联合VMCLP方案（简称VMCLP-硼替佐米方案）治疗复发难治性急性淋巴细胞白血病（ALL）的疗效。方法　采用VMCLP-硼替佐米方案（米托蒽醌 10 mg 第1天至第3天,长春地辛 4 mg 第1、8天,泼尼松片 80 mg 第1天至第8天,环磷酰胺 0.8 g 第2、5天,左旋门冬酰胺酶 1万U 第2天至第7天,硼替佐米 2.25 mg 第7、10、14、17天）治疗1例复发难治性ALL,并结合相关文献对其作用机制进行讨论。结果　应用VMCLP-硼替佐米方案治疗1个疗程后,患者取得完全缓解,患者的体能状况评分令人满意。结论　VMCLP-硼替佐米方案为复发难治性ALL的治疗提供了新的治疗策略。     

去甲氧柔红霉素为主的联合化疗治疗急性白血病

 目的　分析去甲氧柔红霉素（IDA）和柔红霉素（DNR）治疗急性白血病（AL）的疗效和毒副作用。方法　59例AL患者,初治43例,复发难治16例。急性非淋巴细胞白血病（ANLL）39例,用IA方案化疗;急性淋巴细胞白血病（ALL）18例,用IDA联合长春新碱、异环磷酰胺、泼尼松方案化疗;急性混合细胞白血病（MAL）2例,用IDA联合长春新碱、环磷酰胺、阿糖胞苷方案化疗。同期48例患者采用DNR为主的方案治疗。结果　IDA为主方案的完全缓解（CR）43例,部分缓解（PR）4例,总有效率79.7 %;初治43例中,CR 34例,PR 3例,总有效率86.1 %;复发难治16例中,CR 9例,PR 1例,总有效率62.5 %;39例ANLL中,CR 28例,PR 3例,总有效率79.5 %;18例ALL中,CR 15例,PR 1例,总有效率88.9 %;DNR为主方案的总有效率为80.4 %。结论　IDA是疗效确切、安全、可靠的抗白血病药物。     

HyperCVAD/MA方案治疗难治/复发成人急性淋巴细胞白血病疗效分析

目的:评估HyperCVAD/MA方案治疗难治/复发成人急性淋巴细胞白血病(ALL)的疗效和安全性.方法:回顾性分析21例2010年1月至2016年6月应用HyperCVAD/MA方案治疗的难治/复发成人ALL患者的有效性和安全性.结果:21例患者的完全缓解(CR)率为47.6％,部分缓解(PR)率为23.8％,总有效率为71.4％.所有患者均发生Ⅲ/Ⅳ度的骨髓抑制,未发生危及生命的出血现象,其他不良反应包括感染、肝肾毒性、胃肠道反应、皮疹等,无治疗相关死亡发生.结论:HyperCVAD/MA方案治疗难治/复发成人ALL的疗效满意,不良反应可控,但长期缓解率仍有待进一步观察.     

Childhood T-cell acute lymphoblastic leukemia: the Dana-Farber Cancer Institute acute lymphoblastic leukemia consortium experience.

PURPOSE: T-cell acute lymphoblastic leukemia (T-ALL) accounts for 10% to 15% of newly diagnosed cases of childhood acute lymphoblastic leukemia (ALL). Historically, T-ALL patients have had a worse prognosis than other ALL patients. PATIENTS AND METHODS: We reviewed the outcomes of 125 patients with T-ALL treated on Dana-Farber Cancer Institute (DFCI) ALL Consortium trials between 1981 and 1995. Therapy included four- or five-agent remission induction; consolidation therapy with doxorubicin, vincristine, corticosteroid, mercaptopurine, and weekly high-dose asparaginase; and cranial radiation. T-ALL patients were treated the same as high-risk B-progenitor ALL patients. Fifteen patients with T-cell lymphoblastic lymphoma were also treated with the same high-risk regimen between 1981 and 2000. RESULTS: The 5-year event-free survival (EFS) rate for T-ALL patients was 75% +/- 4%. Fourteen of 15 patients with T-cell lymphoblastic lymphoma were long-term survivors. There was no significant difference in EFS comparing patients with T-ALL and B-progenitor ALL (P =.56), although T-ALL patients had significantly higher rates of induction failure (P <.0001), and central nervous system (CNS) relapse (P =.02). The median time to relapse in T-ALL patients was 1.2 years versus 2.5 years in B-progenitor ALL patients (P =.001). There were no pretreatment characteristics associated with worse prognosis in patients with T-ALL. CONCLUSION: T-ALL patients fared as well as B-progenitor patients on DFCI ALL Consortium protocols. Patients with T-ALL remain at increased risk for induction failure, early relapse, and isolated CNS relapse. Future studies should focus on the identification of and treatment for T-ALL patients at high risk for treatment failure.     

Outcome of treatment with Hyper-CVAD regimen in Chinese patients with acute lymphocytic leukemia

Modern intensive chemotherapy regimens have improved the prognosis for adult patients with acute lymphocytic leukemia (ALL). With these regimens, the complete response (CR) rates are approximately 75% and long-term disease-free survival (DFS) rates are about 20-35%. For patients with high-risk ALL, DFS rates are only 20% or less. Hyper-CVAD regimen is effective in ALL and aggressive non-Hodgkin lymphomas (NHL) with increased CR rates and DFS rates. Between June 2002 and October 2006, 53 consecutive adult patients with newly diagnosed adult ALL were treated with Hyper-CVAD regimen for six to eight cycles. The alternating courses were given every 3-4 weeks or earlier if count recovery occurred. CR rates of 73.6% were achieved in 39 patients, the estimated 2-year survival rate was 82.9% and the estimated 2-year event-free survival (EFS) rate was 87.3%. Side effects were as expected, mostly attributed to myelosuppression. Analysis of prognostic factors suggested that some previously well-established poor prognostic factors such as the degree of leukocytosis and central nervous system (CNS) or testicular involvement were less important with this dose-intensive regimen. However, patients with mediastinal disease had lower CR rates (P<0.05), with the presence of hepatomegaly and t(9;22) abnormalities had poor survival (P<0.05). Compared with other established adult ALL regimens, Hyper-CVAD regimen was associated with significantly better CR rates, overall survival and EFS rates. The long-term follow-up results of Hyper-CVAD were favorable.     

改良Hyper-CVAD/MA方案治疗25例淋巴系统恶性肿瘤的临床分析

  目的  评价改良Hyper-CVAD/MA方案治疗国内成人急性淋巴细胞白血病（ALL）和非霍奇金淋巴瘤（NHL）的疗效及安全性。  方法  对2006年5月至2011年6月接受改良Hyper-CVAD/MA方案治疗的17例成人ALL和8例NHL共25例的疗效和不良反应进行回顾性分析。  结果  25例共完成40个周期A方案与29个周期B方案化疗,1年总体生存（OS）为（61.3±10.2）%。17例ALL 1年OS为（62.6±12.2）%。接受2~4个周期该方案化疗的患者与仅接受1个周期该方案化疗的患者相比,中位OS时间延长（P=0.046）。8例NHL 1年OS为（60.0±18.2）%。接受4~7个周期该方案化疗的患者与接受2个周期该方案化疗的患者相比,中位OS时间延长（P=0.021）。主要不良反应是骨髓抑制及感染,不良反应可控制,B方案的延长并未减低不良反应。  结论  改良Hyper-CVAD/MA方案用于淋巴系统恶性肿瘤的治疗,疗效满意,治疗相关不良反应可控制,值得推广。      

Risk of Thrombosis in Adult Philadelphia-Positive ALL Treated with an Asparaginase-Free ALL Regimen

Background: venous thromboembolism (VTE) is a well-known complication in adults with acute lymphoblastic leukemia (ALL), especially in patients treated with asparaginase (ASNase)-including regiments. However, VTE risk in adult Philadelphia-positive ALL (Ph+ve ALL) patients treated with non-hyperCVAD chemotherapy is unclear. In this study, we examined VTE incidence in adult Ph+ve ALL patients treated with imatinib plus a pediatric-inspired asparaginase (ASNase)-free regimen modified from the Dana Farber Cancer Institute (DFCI) ALL protocol. Methods: a single centre retrospective review of Ph+ve ALL patients treated at Princess Margaret Cancer Center (PMCC) from 2008–2019 with imatinib plus modified DFCI protocol was conducted. Results: of the 123 patients included, 30 (24.3%) had at least 1 radiology confirmed VTE event from diagnosis to the end of maintenance therapy. 86.7% (26/30) of the VTE events occurred during active treatment. Of all VTE events, the majority (53.3%) were DVT and/or PE while another significant portion were catheter-related (40.0%). Major bleeding was observed in 1 patient on VTE treatment with low molecular weight heparin (LMWH). Conclusion: a high VTE incidence (24.3%) was observed in adults Ph+ve ALL patients treated with imatinib plus an ASNase-free modified DFCI pediatric ALL protocol, suggesting prophylactic anticoagulation should be considered for all adult Ph+ve ALL patients including those treated with ASNase-free regimens.     

改良的德国多中心成年人急性淋巴细胞白血病研究组方案临床应用研究

 目的　分析改良的德国多中心成年人急性淋巴细胞白血病研究组（GMALL）方案治疗成年人急性淋巴细胞白血病（ALL）的疗效和安全性。方法　2005年1月至2009年12月共37例新诊断的ALL患者,接受改良的GMALL方案单纯化疗,对其进行回顾性分析,并与同期接受该院常规方案治疗的44例成年ALL患者进行对比分析。结果　改良GMALL方案的累积完全缓解（CR）率为89.2 %（33／37）,1、2、3及4年累积总生存（OS）率分别为77.5 %、48.0 %、40.0 %和40.0 %。主要不良反应为3～4级血液学毒性和感染,不良反应易于控制,治疗相关死亡率低。改良GMALL方案组的OS优于该院常规方案组。结论　改良的GMALL方案治疗成年人ALL疗效满意,不良反应可以耐受,值得临床推广。     

A study of combination chemotherapy (BHAC-ACVP) for adult acute lymphocytic leukemia. Hanshin Co-operative Study Group of Hematological Malignancies]

Twenty-nine adult patients with acute lymphocytic leukemia (ALL) were treated with combination chemotherapy consisting of behenoyl-ara-C, adriamycin, cyclophosphamide, vindesine and prednisolone (BHAC-ACVP regimen). Complete remission (CR) was obtained in 7 of 13 (54%) of the previously untreated, and 4 of 16 (25%) of the previously treated patients. Six of 10 (60%) L1 and 5 of 17 (29%) L2 patients achieved CR. Side effects such as nausea, GPT elevation and fever were observed, but these were not severe in most cases. The result indicates that BH-AC is useful for the treatment of adult patients with ALL.     

以吡柔比星为主的联合化疗方案治疗急性淋巴细胞白血病72例临床分析

目的探讨以吡柔比星为主的联合化疗方案治疗急性淋巴细胞白血病的疗效及不良反应。方法回顾性分析郑州大学第一附属医院血液科2006年1月至2010年1月住院治疗的急性淋巴细胞白血病患者72例,均接受了以吡柔比星为主的化疗方案治疗,其中初治组11例,复发难治组8例,强化组53例。结果初治组中以吡柔比星为主的联合化疗方案诱导缓解治疗1疗程的完全缓解率为72.7%;难治复发组中以吡柔比星为主的治疗方案治疗1疗程的完全缓解率为37.5%;强化治疗组中,应用以吡柔比星为主的化疗方案治疗后仍处于完全缓解者占88.7%,应用含吡柔比星化疗方案后2个月内11.3%复发。吡柔比星的主要不良反应是骨髓抑制,其他的心脏毒性,肝肾功能损害多可以耐受。结论以吡柔比星为主的化疗方案用于初治及复发急性淋巴细胞白血病的诱导缓解治疗及缓解后治疗,疗效显著且不良反应多可以耐受。     

Persistence of peripheral blood and bone marrow blasts during remission induction in adult acute lymphoblastic leukemia confers a poor prognosis depending on treatment intensity.

Our objectives were to evaluate the prognostic implications of persistence of peripheral blood blasts on day 7 (D7PBb) and of bone marrow blasts >5% on day 14 (D14Mb) after initiation of induction chemotherapy in adults with acute lymphoblastic leukemia (ALL) treated with two different chemotherapy regimens. Records of 365 consecutive newly diagnosed adult ALL patients treated with: (a) vincristine-, doxorubicin-, and dexamethasone-based chemotherapy (VAD, n = 219; 1984-1992); or (b) fractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone, alternating with methotrexate/high-dose cytarabine (HCVAD, n = 146; 1993-1996), were analyzed. The complete remission (CR) rates were 73% with VAD and 91% with HCVAD (P<0.0001). Three-year event-free survival (EFS) rates were 23 and 40%, respectively (P = 0.00003). The impact of D7PBb and D14BMb on outcome varied with the induction regimen. Patients treated with VAD who had D7PBb had similar EFS rates compared with patients without D7PBb (P = 0.12), but EFS was inferior if they had persistent D14BMb compared with those patients without D14BMb (P = 0.00006). In HCVAD-treated patients, EFS was significantly worse in patients with persistent D7PBb (P = 0.003) but not in patients with D14BMb (P = 0.19). By multivariate analysis, D14BMb was an independent adverse feature for patients treated with VAD, whereas D7PBb was an independent adverse feature for EFS in HCVAD-treated patients. Early clearance of leukemia cells from blood and bone marrow is associated with improved outcome in adult ALL, but the prognostic significance of D7PBb and D14BMb clearance varies with treatment efficacy.     

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.