短期化疗长期缓解急性白血病3例

1 病例介绍1.1 例1,女,18岁,1992年7月10日因头晕、乏力、齿龈出血入院。查体:体温37 ℃,P 87次/min,R 18次/min,BP 14.7/10.7 kPa。贫血外观,皮肤无出血,左颌下触及1 cm×2 cm肿大淋巴结,齿龈肿胀,有少量出血。心肺正常,腹软,肝脾未触及。外周血检查:血红蛋白73 g/L,白细胞2.3×109/L,早幼粒0.08、中幼粒0.01、杆状分叶0.06、中幼红0.02、淋巴0.82、血小板58×109/L。骨髓检查示急性早幼粒细胞白血病M3型。应用全反式维甲酸每日80 mg治疗,50 d时达完全缓解。随之应用DNR 60 mg×3 d、Ara-C 200 mg×7 d,1疗程治疗,随之又应用H 4 …     

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     

成人急性白血病长期存活9例分析

近10年来，随着抗白血病新药的问世，联合化疗的改进，支持疗法的加强，急性白血病的诱导缓解已取得瞩目的进步，但成人急性白血病的五年生存率仍小于20%现将我院长期存活五年以上9例成人急性白血病其中已超过十年的5例作一临床分析，并就这些病例能长期存活的一些体会讨论如下。     

成人急性白血病长期存活3例

目前急性白血病的诱导缓解治疗已取得了很大的进步，成人急性白血病长期存活的病例已有少数报道，现将院三例报道如下。     

成人急性白血病550例疗效探讨

1972年以来,我们以剂量较小的联合化疗,配合中医中药及非特异性自动免疫疗法综合治疗成人急性白血病,总的完全缓解率(简称CR)为60.2％,5年生存率13.6％,8人存活逾10年,仍健在。现将成人急性白血病550例治疗结果及预后因素,报告如下: 研究对象和方法病例治疗达1疗程,可资分析疗效550例中,急性淋巴细胞白血病(ALL)150例,急性非淋巴细胞白血病(ANLL)400例,两者之比为1:2.7。诊断时年龄16～68岁,平     

CEA方案治疗成人难治性急性髓细胞白血病

1999年5月10日～2003年1月30日，我们用环磷酰胺(CTX)、依托泊苷(Vp-16)、阿糖胞苷(Ara-c)组成CEA方案治疗成人难治性急性髓细胞白血病((acute myelocytic leukemia，AML)37例，取得较好疗效，报道如下。     

DA方案骨髓腔给药诱导缓解急性非淋巴细胞白血病的临床研究

 目的 比较柔红霉素联合阿糖胞苷骨髓腔给药诱导缓解急性非淋巴细胞白血病（简称急非淋）的疗效和毒副反应。方法 用随机对照的方法将40例初治急非淋患者分为骨髓腔给药组（A组,20例）和静脉给药组（B组,20例）,观察两组的疗效和毒副反应。结果 A组与B组完全缓解率分别为70 %,35 %。总有效率分别为85 %,50 %。两组比较,差异均有统计学意义（P＜0.05）。两组心脏毒性、胃肠道反应发生率比较,差异有统计学意义（P＜0.05）。两组骨髓抑制发生率比较,差异无统计学意义（P＞0.05）。结论 骨髓腔给药诱导缓解急非淋具有较好的治疗效果,毒副反应小。     

吡柔比星联合化疗治疗急性白血病32例

目的观察吡柔比星（THP）联合化疗方案对急性白血病（AL）的疗效。方法治疗组AL患者32例,其中急性非淋巴细胞白血病（ANLL）患者20例,采用THP联合阿糖胞苷（Ara—C）（TA方案）。急性淋巴细胞白血病（ALL）患者12例,采用THP联合长春新碱（VCR）、泼尼松（Pred）（VTP方案）。对照组36例,其中ANLL患者24例,ALL患者12例,用柔红霉素（DNR）替代THP。结果治疗组有效率87．5％,对照组有效率87．3％（P〉0．05）。治疗组完全缓解率62．5％,对照组完全缓解率47.2％,两组差异有统计学意义（P〈0．05）。治疗组骨髓抑制较对照组明显,感染发生率高（P〈0．05）。结论吡柔比星联合化疗方案可作为治疗急性白血病一线治疗方案,其完全缓解率高,但骨髓抑制明显。     

HAE、DAE、MAE方案治疗急性单核细胞白血病的临床比较

目的比较HAE、DAE、MAE三种化疗方案治疗急性单核细胞白血病(M5)的临床疗效与副作用.方法对初治的M5型白血病分别采用HAE、DAE、MAE三种不同的方案进行化疗.结果HAE、DAE、MAE三种化疗方案的有效率分别为50%、80%、90%.MAE方案骨髓抑制的发生率高,但心脏、消化道等方面的副作用略低于其它两组.结论MAE方案可作为急性单核细胞白血病诱导化疗的一线方案.     

吡喃阿霉素方案治疗初治年轻患者急性髓性白血病

背景与目的：含有蒽环类抗生素的方案已经成为了治疗急性髓性白血病的标准治疗。本研究以米托蒽醌方案为对照,探讨了含有吡哺阿霉素（perarubicin,THP）的联合化疗方案在年轻急性髓性白血病的患者治疗中的疗效与毒性。方法：129例初治急性髓性白血病人组,年龄≥16岁而〈60岁,诱导化疗给予常规剂量的阿糖胞苷及THP或米托蒽醌（MIT）。完全缓解（CR）后,患者接受两个疗程的原诱导方案的化疗：此后,交替应用含有THP及MIT的方案进行巩固治疗,三周一个疗程,共四个疗程。在持续缓解的情况下,维持治疗共三年。结果：在42例接受THP诱导缓解治疗的患者中,26例（61．90％）患者达到CR;73例以MIT作为诱导缓解治疗的患者中,有48例（65．75％）达到CR。两者比较,无显著的统计学意义（P〉0．05）。在THP进行诱导治疗的患者中,9例（34．61％）患者在一年内出现复发;而MIT治疗的患者其一年内的复发率为22．92％;但经统计分析后发现,两者之间无统计学意义（P=0．28）。对诱导化疗中两种方案阿糖胞苷（Ara—C）加THP或Ara．C加MIT的副作用进行比较发现,除脱发发生率THP组（26．19％）低于MIT组（42．47％）外（P〈0．01）,其它毒副反应如感染、恶心、呕吐及心脏事件,发生率几乎相同（P〉O．05）。结论：THP加Ara—C的方案能够用于年轻成人的初治白血病的诱导化疗,但其并不优于含有MIT的方案：在完全缓解后,THP和MIT可用于巩固治疗中。     

Comorbidity is an independent predictor of complete remission in elderly patients receiving induction chemotherapy for acute myeloid leukemia

BACKGROUND.: Elderly patients with acute myeloid leukemia (AML) have a poor prognosis, which is explained by the disease itself and by host-related factors. The objective of this study was to determine the prognostic role of comorbidities in this population. METHODS.: For this single-center, retrospective study, the authors analyzed the outcome of 133 patients aged >/=70 years who received induction chemotherapy for nonpromyelocytic AML between 1995 and 2004. Comorbidities were evaluated by using an adapted form of the Charlson comorbidity index (CCI). RESULTS.: The median patient age was 73 years. The CCI score was 0 for 83 patients (68%), 1 for 16 patients (13%), and >1 for 23 patients (19%). The complete remission (CR) rate was 56%, and the median overall survival was 9 months. In multivariate analysis, 4 adverse prognostic factors for CR were identified: unfavorable karyotype, leukocytosis >/=30 g/L, CD34 expression on leukemic cells, and CCI >1. A score could be generated to allow the stratification of patients into low-, intermediate-, and high-risk groups with CR rates of 87%, 63%, and 37%, respectively. The risk of early mortality and the probability of survival also were different in the 3 risk groups (P = .02 and P = .01, respectively). CONCLUSIONS.: The results from this study indicated that associated comorbidities are independent factors that may influence achievement of CR in elderly patients with AML. Such a scoring system may be useful in the prognostic staging systems that are used to identify patients with AML who can benefit from induction chemotherapy.     

苦参碱注射液在急性髓细胞白血病治疗中作用研究

目的:探讨苦参碱在急性髓细胞白血病患者治疗中疗效及其作用机制。方法:选择初治急性髓细胞白血病（APL除外）患者80例,随机分成2组,每组40例患者。实验治疗组:使用DA（3+7）方案 +苦参碱注射液。对照治疗组:单纯采用DA（3+7）方案。对比两组患者治疗前后卡氏评分、感染发生率,粒细胞缺乏持续时间、肝损害程度、诱导治疗缓解率、血清survivin水平。结果:两组患者在卡氏评分、感染发生率、粒细胞缺乏持续时间及肝损害程度、血清survivin水平表达差异均有统计学意义。完全缓解率无统计学意义,但总有效率有明显提高。结论:苦参碱联合化疗,能明显改善急性髓细胞白血病患者生存质量,具有良好护肝作用,可降低感染发生率,缩短粒细胞缺乏持续时间。苦参碱可影响急性髓细胞白血病患者血清survivin蛋白表达,从而抑制白血病细胞增殖、促进白血病细胞凋亡,联合化疗,可提高治疗效果。     

Management of adult patients with acute lymphoblastic leukemia in first complete remission

BACKGROUND:

The optimal postremission therapy in adults with acute lymphoblastic leukemia (ALL) is still a matter of debate. The objective of this study was to compare the various potential therapeutic options for patients who achieved first complete remission.

METHODS:

The authors conducted a systematic review and meta‐analysis of randomized trials, including patients with standard‐risk (SR) All and high‐risk (HR) ALL who received first postremission therapy. Outcomes assessed were all‐cause mortality (ACM), disease recurrence (relapse), and nonrelapse mortality (NRM). Relative risks (RRs) with 95% confidence intervals (CIs) were estimated and pooled.

RESULTS:

Overall, there was a significant reduction in ACM in the allogenic stem cell transplantation (alloSCT) arm (RR, 0.88; 95% CI, 0.8‐0.97) compared with autologous stem cell transplantation (ASCT) or chemotherapy. Subgroup analyses revealed a similar pattern among SR patients (RR, 0.8; 95% CI, 0.68‐0.94) but a nonsignificant advantage for alloSCT among HR patients (RR, 0.88; 95% CI, 0.76‐1.01). There was an increase in NRM (RR, 2.99; 95% CI, 1.37‐6.53) and a decrease in the relapse rate in the alloSCT arm (RR, 0.52; 95% CI, 0.33‐0.83). There was no difference in ACM or the relapse rate between the ASCT and chemotherapy arms.

CONCLUSIONS:

Overall, alloSCT was superior to ASCT or chemotherapy for patients with ALL in first complete remission. The survival advantage was of greater statistical significance for patients with SR ALL than for patients with HR ALL. Cancer 2010. © 2010 American Cancer Society.     

Combination chemotherapy and radiotherapy for acute lymphocytic leukemia in adults: Results of CALGB protocol 7113

One hundred and forty-nine adult patients with acute lymphocytic leukemia (ALL) were treated with protocol defined combination chemotherapy-radiotherapy by 25 member institutions of the Cancer and Leukemia Group B. Induction of remission was attempted with vincristine (V), prednisone (P), L-asparaginase (A), with or without intrathecal methotrexate (IT-MTX) and followed by daunorubicin (D) in those patients not in complete remission after 4 weeks. The overall complete remission (CR) rate was 72%; daunorubicin was needed to achieve CR in 20 of the 107 remitting patients. The administration of IT-MTX during remission induction, especially when given simultaneously with A, was found to increase toxicity without therapeutic benefit. Remissions were maintained with either parenteral courses of 6-mercaptopurine (6-MP), and methotrexate (MTX), plus intermittent doses of V, P, and bis-β-chloroethylnitrosourea(BCNU) or with daily oral 6-MP, weekly oral MTX, and periodic VP reinforcements. All patients remaining in remission for 3 months or longer received CNS chemoradiotherapy. Median remission duration was 15 months. Continuous oral maintenance proved at least equivalent to intermittent parenteral remission therapy. Median survival was 17 months for all patients and 29 months for qualified patients achieving CR. Frequency and duration of response, and duration of survival were independent of age between ages 30 and 60. Above age 60 the prognosis is significantly less good. Thirty-two percent of the responders (life table estimate) remain in continuous first remission at 5 y. Toxicity was acceptable, except for an excessive frequency and severity of infections: (1) when V, P. A, and IT-MTX were given simultaneously; and (2) early in remission when full doses of maintenance chemotherapy were employed prior to complete recovery of normal bone marrow function. Results of treatment of ALL in adults have improved markedly during the last decade but lag behind those observed in children for reasons as yet unexplained.     

急性白血病化疗患者抑郁状况调查分析

目的：探讨急性白血病化疗患者的抑郁状况及其影响因素。方法：用抑郁自评量表（serf-rating depression scale,SDS）及自行设计的多项目调查表对81例急性白血病患者进行化疗前后评定。结果：急性自血病患者存在轻重不等的抑郁症状,化疗前占45．5％,化疗后占33．3％。虽然化疗后评分有降低趋势,但化疗前后SDS评分无显著性差异（P〉0．05）。多元线性逐步回归分析提示情绪低落、纳差、易怒、疲乏是影响急性白血病患者抑郁症状的重要因素。结论：抑郁是急性白血病患者普遍存在的症状,并受多种因素影响。因此,在急性白血病患者化疗过程中,选用高效低毒的化疗药物,同时辅助有效心理干预措施,对缓解抑郁情绪可能具有重要意义。     

急性早幼粒细胞白血病处理中的共识和争议

急性早幼粒细胞白血病的正确处理包括如下方面使用全反式维甲酸和蒽环类为基础的化疗联合治疗,恰当的支持治疗,从细胞和分子遗传水平证实诊断,正确分析治疗反应及通过分子监测评估疾病复发的危险性。本文综述初治APL患者现代处理方法,并提出一些尚有争议的问题供探讨。     

Conventional and high‐dose daunorubicin and idarubicin in acute myeloid leukaemia remission induction treatment: a mixed treatment comparison meta‐analysis of 7258 patients

Previous meta‐analyses suggested that acute myeloid leukaemia induction regimens containing idarubicin (IDA) or high‐dose daunorubicin (HDD) induce higher rates of complete remission (CR) than conventional‐dose daunorubicin (CDD), with a possible benefit in overall survival. However, robust comparisons between these regimens are still lacking. We conducted a mixed treatment comparison meta‐analysis regarding these three regimens. Mixed treatment comparison is a statistical method of data summarization that aggregates data from both direct and indirect effect estimates. Literature search strategy included MEDLINE, EMBASE, Cochrane, Scielo and LILACS, from inception until August 2013 and resulted in the inclusion of 17 trials enrolling 7258 adult patients. HDD [relative risk (RR) 1.13; 95% credible interval (CrI) 1.02–1.26] and IDA (RR 1.13; 95% CrI 1.05–1.23) showed higher CR rates than CDD. IDA also led to lower long‐term overall mortality rates when compared with CDD (RR 0.93, 95% CrI 0.86–0.99), whereas HDD and CDD were no different (RR 0.94, 95% CrI 0.85–1.02). HDD and IDA comparison did not reach statistically significant differences in CR (RR 1.00; 95% CrI 0.89–1.11) and in long‐term mortality (RR 1.01, 95% CrI 0.91–1.11). IDA and HDD are consistently superior to CDD in inducing CR, and IDA was associated with lower long‐term mortality. On the basis of these findings, we recommend incorporation of IDA and HDD instead of the traditional CDD as standard treatments for acute myeloid leukaemia induction. The lack of HDD benefit on mortality, when compared with CDD in this study, should be cautiously addressed, because it may have been susceptible to underestimation because of statistical power limitations. Copyright © 2014 John Wiley & Sons, Ltd.     

重组粒细胞集落刺激因子在儿童急性粒白血病中的应用

目的研究用重组粒细胞集落刺激因子(rhG-CSF)对强烈化疗后急性白血病患儿中性粒细胞严重低下的治疗作用.方法比较强烈化疗后急性白血病患儿用重组粒细胞集落刺激因子组(n=136)与对照组(n=65)中性粒细胞绝对值(ANC)的降低时间、感染发生率及严重程度.结果ANC≥0.5×109/L的时间,治疗组比对照组明显者缩短(P＜0.05),感染发生率和严重程度明显亦降低.结论应用重组粒细胞集落刺激因子后可使粒细胞计数和功能恢复快,感染发生率和严重程度减少,并可减少经济负担.