非霍奇金淋巴瘤患者血清CA125水平与疗效关系的临床观察

目的:探讨非霍奇金淋巴瘤(NHL)患者的血清CA125水平与其他临床特点的关系。方法:分析40例NHL的患者在诊断治疗过程中血清CA125的变化。结果:在40例NHL患者中,血清CA125升高占总人数的48%。在低度恶性NHL中,7例(30%)血清CA125水平升高,在进展期NHL患者中,12例(71%)血清CA125水平升高。CA125水平升高和疾病进展,病理类型,骨髓浸润,结外浸润,体能下降,B症状的出现,血清乳酸脱氢酶的升高有一定相关性。所有患者中,完全缓解率(CR)达63%,低度恶性NHL患者中,CA125正常者,81%达到CR,CA125升高者,29%达到CR(P<0.05)。进展期NHL患者中,CA125正常者,60%达到CR,CA125升高者,58%达到CR(P>0.05)。结论:血清CA125是NHL患者的一项重要预后指标,CA125水平升高和疾病进展,临床分期,病理类型,化疗反应率降低等密切相关。对于低度恶性NHL,CA125正常的患者比CA125升高的患者的缓解率高。     

血清白蛋白在经典型霍奇金淋巴瘤的临床意义

探讨血清白蛋白（ALB）水平在经典型霍奇金淋巴瘤（CHL）患者预后中的意义。方法：收集2001年5月至2008年12月在中山大学肿瘤防治中心经病理确诊初治的96例经典型霍奇金淋巴瘤患者的临床资料进行回顾性分析。根据ALB水平比较患者的总生存率（OS）和无失败生存率（FFS）。结果：治疗前96例经典型霍奇金淋巴瘤患者中有17例ALB<35 g/L及79例ALB≥35g/L。比较两组患者的基线临床特征,结果显示在年龄、性别、Ann Arbor分期、巨大肿块、结外侵犯、淋巴结区域、LDH水平比较均无统计学差异（P>0.05）。ALB<35 g/L和ALB≥35 g/L患者的5年FFS分别为60.1%和91.6%（P=0.022）,但OS并无统计学意义（P=0.131）。多因素分析结果示仅ALB<35 g/L是FFS的独立预后不良因素（P=0.030）,而OS的独立预后因素为年龄≥60岁（P=0.020）。结论：本研究结果显示治疗前ALB水平对判断CHL患者的预后有一定临床意义,其可能成为一项新的预后指标用于早晚期CHL患者。     

IVPP方案治疗难治性非霍奇金淋巴瘤近期疗效观察

目的　观察IVPP方案治疗难治性非霍奇金淋巴瘤的疗效。方法　采用IFO 1.5 g .m-2 ,静滴 ,d1-3 ;Mesna0 .4g ,静注 ,于IFO静滴后 0、4、8小时各一次 ,d1-3 ;VDS 2 .5mg .m-2 ,静注 ,d1、8;DDP 2 0mg .m-2 ,静滴 ,d1-5;PDN 3 0mg .m-2 ,口服 ,d1-14 。以上方案每 3～ 4周重复 ,连用 2～ 3个周期。结果　全组 2 2例 ,CR 3例 ,PR 15例 ,总有效率 81.8%。毒副反应主要是血液学毒性 ,白细胞和血小板下降发生率分别为 10 0 %、40 .9% ,白细胞Ⅲ、Ⅳ度毒性为 2 7.3 %、13 .6%。结论　IVPP方案治疗难治性非霍奇金淋巴瘤的疗效比较满意 ,虽然有较明显的血液学毒性 ,但在小剂量G csf支持下还是比较安全可行的。     

血清LDH值与非霍奇金淋巴瘤临床关系分析

目的分析血清乳酸脱氢酶(LDH)值与非霍奇金淋巴瘤(NHL)的病理分型、分期、治疗及预后的关系.方法采用乳酸酶为底物的酶促反应法测定108例NHL患者血清中LDH值.结果108例患者中低、中度恶性LDH值差异无显著意义,高度与中度恶性和高度与低度恶性LDH值差异有显著意义,P<0.05.Ⅰ+Ⅱ期与Ⅲ+Ⅳ期LDH值差异有显著意义,P<0.05.108例中95例曾行放疗和/或化疗,其中肿瘤负荷明显缩小的63例中,治疗前后LDH值差异有显著意义,P<0.05.肝脾或骨髓受侵者LDH增高的阳性率较高.生存率可评价56例,Ⅰ+Ⅱ期与Ⅲ+Ⅳ期LDH增高与LDH正常的2年生存率差异无显著意义,P>0.05;4年生存率差异有显著意义,P<0.05.结论LDH值对NHL患者的预后及疗效判断有重要的临床价值.     

全程营养支持治疗对宫颈癌患者急性放射反应、耐受性和疗效影响的临床观察#br# #br#

目的探讨全程营养支持治疗对宫颈癌患者急性放射反应、治疗耐受性和疗效的影响。 方法将经营养风险筛查 2002（NRS 2002）且评分≥3分的98例行根治性同步放化疗的局部晚期宫颈癌患者随机分成实验组（全程营养支持治疗+同步放化疗）46例和对照组（同步放化疗）52例。记录放疗前、后的体质量指数（BMI）、白蛋白（ALB）、前白蛋白（PA）及生活质量评分（KPS评分）,并在放疗结束时对两组患者急性放射反应、治疗耐受性（放疗总疗程、放疗中断率、化疗完成次数）和疗效进行评价。 结果实验组均按计划完成治疗,仅13例曾经出现放疗中断;对照组52例中有45例曾经出现放疗中断,其中9例未能按计划完成放疗。实验组放疗中断率低于对照组（2826％ vs. 8654％）,实验组化疗完成次数多于对照组（496±021 vs. 431±073）,实验组放疗总天数低于对照组（6313±647 vs.8523±1928）,差异均有统计学意义（P＜005）。实验组放疗后ALB 、PA均优于对照组（P＜005）。实验组急性放射性直肠炎、急性胃肠道反应及骨髓抑制的发生率与发生程度均低于对照组（P＜005）。实验组患者的总有效率（RR）明显高于对照组（9348％ vs. 7442％）,差异均有统计学意义（P＜005）。 结论全程营养支持治疗能显著降低宫颈癌根治性同步放化疗患者急性放射反应,改善患者营养状况和生活质量,提高治疗耐受性和放疗疗效。     

EPOCH方案治疗侵袭性非霍奇金淋巴瘤近期疗效观察

目的观察EPOCH方案治疗侵袭性非霍奇金淋巴瘤（NHL）的疗效和副作用。方法31例非霍奇金淋巴瘤患者采用EPOCH方案治疗。EPOCH方案：依托泊苷（VP-16）50mg／m2,表柔比星（E．ADM）12mg／m2,长春新碱（VCR）0．4mg／m2,溶解于生理盐水500ml中,持续静滴24h,第1～4天;环磷酰胺（CTX）750mg／m2静脉推注,第5天;强地松60mg／m2,口服,第1～5天,21天为1个周期,共进行4—6个周期。结果31例患者总有效率为90．3％,完全缓解（CR）率为64．5％,部分缓解（PR）率为25．8％,主要不良反应为骨髓抑制、脱发、黏膜炎。结论EPOCH方案是NHL经济、有效的治疗方案,毒性可耐受,值得在临床上推广应用。     

IHEP方案治疗难治性复发性非霍奇金淋巴瘤近期疗效观察

目的 探索难治性复发性非霍奇金淋巴瘤（ＮＨＬ）的有效化疗方案。方法 １８例难治性复发性ＮＨＬ患者，其中男性１４例，女性４例；年龄９￣７５岁，中位年龄４５岁；属难治性者１２例，复发性者６例；均有病理学诊断。用ＩＨＥＰ方案化疗，即异环磷酰胺９ＩＦＯ）１．５／ｍ＾２静滴，第１至５天；阿霉素（ＡＤＭ）３０￣４０ｍｇ／ｍ＾２静滴，第１天；足叶乙甙（Ｖｐ１６）０．１／ｍ＾２静滴，第１至５天；强的松（ＰＤＮ）１     

IHEP方案治疗难治性复发性非霍奇金淋巴瘤近期疗效观察

探索难治性复发性非霍奇金淋巴瘤 (NHL)的有效化疗方案。方法　 18例难治性复发性NHL患者 ,其中男性 14例 ,女性 4例 ;年龄 9～ 75岁 ,中位年龄 45岁 ;属难治性者 12例 ,复发性者 6例 ;均有病理学诊断。用IHEP方案化疗 ,即异环磷酰胺 (IFO)1.5 /m2 静滴 ,第 1至 5天 ;阿霉素 (ADM ) 30～ 40mg/m2 静注 ,第 1天 ;足叶乙甙 (Vp16 ) 0 .1/m2 静滴 ,第 1至 5天 ;强的松 (PDN) 10 0mg/日口服 ,第 1至 5天 ;2 1～ 2 8天为一个疗程。结果　 18例可评价疗效的患者中 ,CR 2例 ,PR 12例 ,NC 3例 ,PD 1例。CR PR为 14例。总有效率 77.8%。主要毒副反应为骨髓抑制、脱发、消化道反应 ,亦见轻度心脏毒性。结论　IHEP方案治疗难治性复发性NHL是疗效较满意的方案。     

Pediatric hodgkin lymphoma: maximizing efficacy and minimizing toxicity

Historically, both adult and childhood Hodgkin lymphoma (HL) were treated with full-dose (35-45 Gy) extended-field radiation therapy (RT). Although this treatment was the first to produce reliable disease control, the resulting late toxicity led pediatric oncologists to pioneer the use of combined chemotherapy and low-dose (15-25 Gy) involved-field RT for all stages of HL. Currently, standard treatment of childhood HL is risk adapted; those with favorable risk disease typically receive 2 to 4 cycles of multi-agent chemotherapy with low-dose IFRT, whereas those with higher-risk disease receive more intensive chemotherapy before IFRT. This approach produces long-term survival rates >90% while limiting exposure to anthracyclines, alkylators, and radiation to normal tissues. In contrast to adult HL, IFRT remains an important component of the treatment of advanced-stage HL in pediatric patients. Current clinical trials for children with HL aim to further segregate patients into risk strata such that those who are highly curable can receive less toxic therapy, whereas high-risk patients can receive augmented therapy. Response-adapted therapy, in which overall treatment intensity is modified according to the initial response to chemotherapy, is emerging as a potential means of further reducing therapy for some while maintaining high cure rates. The challenge is to refine therapy in a rare disease in which long-time intervals are necessary to observe an adequate number of events (treatment failure or late effects) to answer judicious questions.     

恶性淋巴瘤患者血清乳酸脱氢酶、β_2-微球蛋白测定的临床意义

目的　探讨血清乳酸脱氢酶、β2 微球蛋白对恶性淋巴瘤患者测定的临床意义。方法　对 46例恶性淋巴瘤患者分别采用速率法及放免法测定血清乳酸脱氢酶 ,β2 微球蛋白水平。统计学分析采用t检验。结果　Ⅰ Ⅱ期与Ⅲ、Ⅳ期恶性淋巴瘤患者LDH值差异无显著 (P >0 .0 5 ) ,而 β2 MG差别显著。高度恶性与中、低度恶性淋巴瘤患者的LDH值有显著性差异 (P <0 .0 5 ) ,β2 MG值无显著性差异。对有肿瘤负荷组 ,血清LDH、β2 MG值明显升高 ,而经化疗缓解患者两者水平显著下降 (P <0 .0 5 )。结论　血清乳酸脱氢酶、β2 微球蛋白可能与恶性淋巴瘤患者分期、恶性程度、预后及疗效判断有参考价值     

Clinical significance of autorosette-forming cells in T-cell lymphoma

The capability to form rosettes with sheep erythrocytes (E), antibody-complement-sensitized ox erythrocytes (EAC) and autologous erythrocytes (ARFC), and surface immunoglobulin determinations were studied using 21 lymph nodes and one tonsil with pathologically-proven non-Hodgkin's lymphoma and 10 lymph nodes with benign pathology. Fourteen of 22 non-Hodgkin's lymphoma patients (64%) had a high incidence of E-rosette formation and they were further differentiated into ARFC-positive and ARFC-negative lymphomas. The clinicopathological findings of the latter were compatible with those of adult T-cell leukemia. ARFC-positive lymphoma was regarded as non-Hodgkin's lymphoma of T-cell type and one patient showed lymphoblastic lymphoma with high ARFC counts. ARFC counts were very low in B-cell and non-T, non-B lymphomas. The results from benign lymph nodes were too variable to draw any conclusion, although ARFC counts were relatively high in lymphadenitis and hyperplasia.     

Clinical significance of tryptophan catabolism in follicular lymphoma

The enzyme, indoleamine 2,3-dioxygenase 1 (IDO), catabolizes tryptophan (Trp) in the kynurenine (Kyn) pathway, and is important in suppressing antitumor immune responses in the tumor microenvironment. With regard to previously untreated patients with follicular lymphoma (FL), we sought to establish the prognostic significance of Trp catabolism in this disease. Serum Trp and Kyn levels in 110 patients with FL were quantified, and their relationship to different clinical parameters studied. IDO expression in the lymph nodes of affected patients was studied. Study participants included 54 males and 56 females (age range 39–86, median 62 years), showing a 5-year overall survival (OS) rate of 78.5%. Patients with a high Kyn level (5-year OS, 65.0% vs. 81.7%; p = 0.026), high Kyn/Trp ratio (71.1% vs. 81.7%; p = 0.002), and low hemoglobin (Hb) level (<12.0 g/dL; p = 0.001; a component of FL international prognostic indexes) demonstrated a significantly shorter OS. Multivariate analysis included the following 10 variables: age, sex, serum β2-microglobulin, Hb, longest diameter of the largest involved node, Ann Arbor stage, serum lactate dehydrogenase, histologic grading, B symptoms, and serum Kyn/Trp ratio; a lower Hb level and a high Kyn/Trp ratio (HR, 3.239; 95% CI, 1.296–8.096) led to a significantly inferior OS. In the microenvironment, some CD11c-positive myeloid dendritic cells but not FL tumor cells were found to produce IDO. Overall, measuring levels of serum Kyn and Trp in individual patients with FL contributed to predicting their prognosis.     

Clinical significance of tryptophan catabolism in Hodgkin lymphoma

Indoleamine 2,3‐dioxygenase 1 (IDO) is an enzyme catabolizing tryptophan (Trp) into the kynurenine (Kyn) pathway. The purpose of the present study was to determine the clinical significance of Trp catabolism in newly diagnosed Hodgkin lymphoma (HL) patients. We quantified serum Trp and Kyn in 52 HL patients, and analyzed their associations with different clinical parameters including serum soluble CD30 concentration. The IDO expression was evaluated in the patients’ affected lymph nodes. The cohort comprised 22 male and 30 female patients (age range, 15‐81 years; median, 45 years), with a 5‐year overall survival (OS) of 88.6%. The OS was significantly shorter for patients with a high Kyn/Trp ratio (OS at 5 years, 60.0% vs 92.2%), for those with stage IV disease, and for those with lymphocytopenia (<600/mm³ and/or <8% white blood cell count). The latter two parameters are components of the international prognostic score for advanced HL. In contrast, there were no significant differences in OS according to age, serum albumin, hemoglobin, sex, white blood cell count, or serum soluble CD30 (≥ or <285.6 ng/mL). Multivariate analysis using the three variables stage, lymphocytopenia, and serum Kyn/Trp ratio showed that only the latter significantly affected OS. Indoleamine 2,3‐dioxygenase 1 was produced by macrophages/dendritic cells, but not by HL tumor cells, and IDO levels determined by immunohistochemistry had a significant positive correlation with the serum Kyn/Trp ratio. In conclusion, quantification of serum Kyn and Trp is useful for predicting prognosis of individual HL patients.

     

治疗前血中性粒细胞数目和白蛋白水平预测鼻咽癌预后的临床意义

  目的  研究治疗前中性粒细胞、淋巴细胞、单核细胞及白蛋白水平与鼻咽癌患者预后的相关性。  方法  选取401例在中山大学肿瘤医院进行初次诊断的鼻咽癌患者。记录患者免疫相关参数值及白蛋白水平。Kaplan-Meier和Log-rank分析比较总生存期和无进展生存期。采用Cox回归风险模型来确定预后因素。  结果  治疗前高中性粒细胞>5.20×109/L（n=172）患者在总生存期和无进展生存期上均小于治疗前低中性粒细胞≤5.20×109/L（n=229）患者（P=0.014,P=0.009）。治疗前高白蛋白水平组>43.00 g/L（n=253）在总生存期和无进展生存期均高于治疗前低白蛋白组≤43.00 g/L（n=148）（P < 0.001,P=0.006）。多因素分析发现治疗前中性粒细胞数目是鼻咽癌患者无进展生存期的独立预后因素,治疗前白蛋白水平是鼻咽癌患者总生存期的独立预后因素。  结论  治疗前外周血中性粒细胞数目与白蛋白水平可作为鼻咽癌患者生存的独立预后因素。      

Radiotherapy of hodgkin lymphoma: indications, new fields, and techniques

In recent years, radiotherapy in patients with Hodgkin lymphoma has evolved considerably because of sophisticated imaging technologies and radiation delivery techniques. Even more recently, a new radiation field concept has emerged to ensure better normal tissue protection while preserving an excellent clinical outcome. The role of radiation therapy is also rapidly changing because the concept of a risk-adapted treatment strategy, in which combined-modality treatments were the order of the day, is now expanding into a concept of response-adapted treatments.     

血清IL-3、GM—CSF、TGF—β1水平变化在非霍奇金淋巴瘤诊断治疗中的意义

目的:探讨IL-3、GM-CSF、TGF-β1在非霍奇金淋巴瘤(NHL)诊断、治疗中的意义.方法:采用酶联免疫试验(ELISA)测定136例NHL患者血清IL-3、GM-CSF、TGF-β1水平.结果:NHL初诊患者血清IL-3、TGF-β1水平明显低于正常对照组 (P<0.05),GM-CSF水平明显高于正常对照组 (P<0.05),I-II期与III-IV期患者IL-3、GM-CSF、TGF-β1差异有显著性.治疗有效的患者IL-3、GM-CSF、TGF-β1水平恢复正常;无效及复发患者血清IL-3、GM-CSF、TGF-β1水平与初诊患者无明显差异(P>0.05).GM-CSF水平与TGF-β1呈负相关,与IL-3呈正相关.结论:IL-3、GM-CSF、TGF-β1可作为NHL患者诊断、临床分期、疗效评定及预后的辅助指标.     

恶性淋巴瘤患者血清乳酸脱所酶，β2—微球蛋白测定的临床意义

目的探讨血清乳酸脱氢酶、β