老年急性白血病26例临床分析

198 9年 1月～ 2 0 0 0年 12月 ,我们收治老年急性白血病2 6例。现报告如下。临床资料 :本组男 16例 ,女 10例 ,年龄 6 0～ 79岁 ,中位年龄 6 6岁。均符合急性白血病诊断及分型标准。 AL L3例 ,ANL L 2 3例。临床表现为贫血 2 4例 ,出血 12例 (颅内出血 3例 ) ,发热 15例 ,淋巴结肿大 5例 ,肝大 6例 ,脾大 4例。本组2 6例老年急性白血病患者中 ,合并心血管病 4例 ,脑血管病 2例 ,糖尿病 3例 ,慢性支气管炎 3例。发病至确诊时间为 5～135天 ,平均为 45天。 2 6例患者治疗前查血 WBC1.3× 10 9/ L～ 87× 10 9/ L,中位数 9.1× 10 9/ L;…     

老年急性白血病101例临床分析

老年急性白血病疗效及预后差、病死率高、生存期短,目前仍无最合适的治疗选择.如何提高老年急性白血病患者的疗效、改善生活质量及延长生存期是当前研究的热点问题.现对我科2003年1月-2007年6月收治的101例老年急性白血病患者的病例资料进行回顾性分析,总结如下.     

老年急性白血病26例误诊分析

随着人口的老龄化,老年人恶性肿瘤的发病率较高,仅次于心脑血管疾病。近些年来老年人急性白血病的发病率有上升的趋势,且老年人急性白血病的临床表现常复杂多样,易被误诊。我院自1988年来诊治的老年急性白血病48例中误诊26例,误诊率达542%,现就误诊的原因讨论分析如下。1　临床资料1.1　一般资料　我院自1988～1998年间门诊及住院的老年急性白血病患者48例,其中误诊26例,男19例,女7例,年龄60～74岁,平均67岁。误诊时间2ｄ～2月。1.2　临床表现　老年病人的起病隐袭,症状多不典型。本组病人可归纳为下列5类。1.2.1　以发热、咽痛、咳嗽为主要…     

老年急性白血病43例临床分析

老年急性白血病,尤其是急性非淋巴细胞白血病临床并不少见,由于年龄的因素及这一群体固有的生物学特点治疗上较棘手,为制定合理治疗方案,改善老年人的生活质量及提高无病生存率,本文对我院收治的43例老年白血病的临床资料进行分析.     

老年急性早幼粒细胞白血病的临床及预后

目的探讨老年急性早幼粒细胞白血病（APL）与年轻APL患者的临床表现、对治疗反应性及长期生存情况,明确老年患者在现有砷剂联合维甲酸及化疗的治疗模式下的有效性和安全性。方法收集北京大学人民医院血液病研究所的247例APL病例,其中老年组21例、年轻组226例,统计临床资料并分析缓解率、复发率、死亡率、存活时间。结果（1）老年APL在性别、白细胞、血红蛋白、血小板、弥散性血管内凝血（DIC）、中枢神经系统白血病（CNSL）及免疫表型上与年轻患者未见明显差异。（2）老年组完全缓解（CR）率、诱导期死亡率稍优于年轻组（100.0%vs 95.1%,0.0%vs 4.4%）,但差异均无统计学意义（P＝0.301,P＝0.325）;复发率及CR期死亡率稍高于年轻组（19.0%vs 16.3%,4.8% vs 1.9%）,差异亦无统计学意义（P＝0.744,P＝0.095）。（3）4年、6年和7年总存活率及无事件存活率与年轻组比较均无显著差异（P＞0.05）。结论老年APL与年轻APL在临床特点、对治疗的反应性及长期生存上无明显差异,现有治疗模式对老年患者安全、有效。     

老年急性白血病45例临床分析

目的：分析老年急性白血病临床特点，免疫表型，CD34阳性率及化疗方案，疗效等。方法：对近3年间初治老年急性白血病45例进行临床分析，年龄60-83岁，中位年龄66岁，男28例，女17例，治疗予NA、HA、TA、AA及NAOP方案进行联合化疗。结果：总完全缓解率31．25％，死亡率82．2％，2年生存率12．5％。结论：老年急性白血病总体缓解率低，死亡率高，化疗耐受性差，染色体异常表达率高，且与预后有关。     

老年性急性白血病60例临床分析

现将我院１９８６～１９９５年１０年收治的老年人急性白血病６０例,就其特点、血象、骨髓象、并发症,治疗与转归分析如下：１　临床资料１．１　一般资料　６０例老年人急性白血病（下简称急白）均系１９８６～１９９５年我院住院患者,全部病例皆经临床、血象、骨髓象及常规组化确诊。男３８例,女２２例,男∶女＝１．７４∶１,年龄６０～８７岁,中位年龄６５岁,６０～６９岁者５３例,占８８．３３％。１．２　白血病类型　诊断系按１９７８年全国标准（草案）评定,并参照ＦＡＢ方法分型。ＡＮＬＬ４４例（Ｍ１６例,Ｍ２ａ２０例…     

老年慢性粒单核细胞白血病21例分析

慢性粒单核细胞白血病（ chronic myelomonocytic leukemia,CMML）在WHO分类中被归类到骨髓增生异常（ myelodysplastic syndromes , MDS ）/骨髓增殖性肿瘤（myeloproliferative neoplasms,MPN）[1],其表现既有骨髓病态造血的特征,同时又有骨髓增殖的特征。造血干细胞移植（hematopoietic stem cell transplantation,HSCT）是根治CMML唯一的方法,但对老年患者而言,HSCT并不是常规使用的治疗方法,其他对CMML有效的治疗并不多。对老年CMML患者来说,如何选择治疗方式和治疗时机对能否延长生存和提高生活质量是非常重要的问题。     

老年急性白血病38例分析

老年急性白血病３８例分析张凌岩（山东省立医院血液科，济南２５００２１）杨春杰（宁津县人民医院）左翠娥（肥城市人民医院）作者简介：张凌岩，女，３５岁，主治医师，硕士近年来，老年急性白血病有增加趋势。我院自１９９１～１９９６年共收治急性白血病２８９例，其...     

老年急性髓系白血病56例临床分析

目的探讨老年急性髓系白血病（AML）的FAB亚型分布情况、临床特点及个体化治疗的临床疗效。方法对56例初治老年AML患者的临床特点、诱导缓解及化疗进行回顾性分析;同时随机抽取非老年AML患者45例作为对照,观察二者临床特点及疗效的差异。结果老年AML组与非老年AML组FAB亚型分布均以AML-M2a为主。诱导缓解化疗1～2个疗程,老年AML组、非老年AML组完全缓解率分别为57.1%（32/56）、71.1%（32/45）,两组完全缓解率比较差异无统计学意义（P〉0.05）。老年AML组、非老年AML组诱导期病死率分别为10.7%（6/56）、6.67%（3/45）,两组病死率差异无统计学意义（P〉0.05）;死亡原因主要为颅内出血和感染性休克。结论老年AML患者FAB亚型分布以AML-M2a为主,采取个体化治疗可显著提高缓解率。     

Acute lymphoblastic leukemia in the elderly: The Edouard Herriot Hospital experience

Data on all patients with acute lymphoblastic leukemia (ALL) aged 60 or older, referred to our institution over a 18-year period, were studied to determine the incidence and range of clinical and biological subtypes, and the outcome of different therapeutic approaches. Sixty-nine ALL cases (median age: 68 years) were diagnosed between 1980 and 1998 (18% of all adult ALL seen during this period). Ten of them (14%) had a past history of previous malignancy. Karyotypic analysis was performed successfully in 42 cases. Ten patients were diagnosed as Philadelphia chromosome positive (Ph(+)) ALL. Immunophenotyping was performed in 63 cases. Fifty-six patients had B-cell lineage ALL. T lymphoid markers were observed only in 5 cases. Co-expression of myeloid markers was observed in 19% of tested cases. Five patients died before any chemotherapy could be given. All other patients received "curative" treatment according to different protocols used during the period of study. Overall complete remission (CR) rate of these patients was 62% (95% confidence interval (CI): 50-74%). Thirty-nine patients achieved CR after one course of chemotherapy and 4 patients after salvage therapy. Median disease-free survival (DFS) of the entire cohort was 8.3 months (95% CI: 5-12.8 months) and median overall survival was 7 months (95% CI: 6-10 months). In multivariate analysis, the presence of hemorrhage (P = 0.02) was a poor prognostic for CR achievement. Higher WHO performance status (P = 0.003) and the presence of hemorrhage (P = 0.01) at diagnosis were poor prognostics for overall survival. When patients were stratified into three groups according to the time of admission, survival appeared significantly longer for patients admitted between July 1992 and December 1998 (median overall survival at 10 months) than for patients admitted before July 1992 (P = 0.04). "Age-adapted" therapy appeared superior to "young adult-like" therapy in terms of CR rate (96% versus 60%; P = 0.007). However, "age-adapted" therapy did not show any advantage in terms of DFS or overall survival, making the difference in CR rates questionable. We conclude that the pejorative overall outcome in elderly ALL points to the need for new therapeutic trials taking into account the specific characteristics of ALL in this age group.     

Acute lymphoblastic leukemia in the elderly

We report our findings in 18 patients with acute lymphoblastic leukemia (ALL) aged 60 years or older. A preleukemic syndrome was observed in 2 patients. Compared to younger adults with ALL, L3 morphology was unexpectedly frequent (4/16). T-ALL was not observed. Other criteria of poor prognosis (high white blood cell count, CNS involvement, organomegaly, high serum LDH) were similar to those reported in young adults. 12 patients were treated with an OPAL-derived regimen, 4 with the MAV regimen, 1 with vincristine and prednisone, 1 with 6-mercaptopurine. Complete remission was achieved in 8 patients but proved short-lived. 5 patients died in aplasia and 5 failed to achieve remission. Median survival for the whole group was 3 months. ALL in the elderly raises the dilemma of an aggressive disease in patients with poor tolerance to intensive therapy.     

老年住院患者急性肾衰竭的临床分析

目的探讨65岁及以上老年人急性肾衰竭(ARF)的特点、病因、预后及其相关因素。方法收集我院1995年1月至2005年12月11年间诊断的老年ARF共150例,统计分析老年人ARF的特点、病因、预后及其相关影响因素。结果老年人ARF占同期全部ARF患者总数33%,老年人医院内获得性ARF(HA-ARF)的发生率为54%,明显高于社区获得性ARF(CA-ARF,P<0.05)。老年ARF的发生有逐年增高的趋势。老年ARF以肾前性ARF为主,多因素综合病因分析显示:与感染(56%)相关为首位病因,其次与低血容量(30.7%)、肿瘤(26%)、心功能衰竭(25.3%)、肾毒性药物(22%)、手术(14%)、肾脏疾病(14.7%)及肾后性疾病(8.7%)相关。单因素病因分析显示与低血容量相关为首位病因(21.6%)。老年ARF多由多种病因共同导致,其死亡率高达53.3%,HA-ARF死亡率是CA-ARF死亡率的1.87倍。结论老年人易患ARF。HA-ARF的增多是主要原因。感染、低血容量、肿瘤、心功能衰竭、肾毒性药物及手术是老年人ARF的常见原因。加强原发病的整体治疗,尽早发现并治疗ARF,有助于改善预后。     

老年急性髓系白血病的特点及疗效分析

目的:分析我国老年急性髓系白血病(AML)的临床、生物学特点,疗效及预后,为临床诊治提供参考。方法:回顾性分析1995年4月-2008年2月收住院诊治的AML患者共167例,采用FAB及MICM分型诊断标准确诊。运用SPSS15.0软件进行统计学分析。率的比较采用χ2检验,生存分析采用生命表法及Kaplan-Meier法,不同组别的差异采用log-rank法检验。采用Cox回归分析影响生存的预后因素。结果:①我国老年AML以M2(M2a)、M5为主,染色体核型预后良好组比例低,并发慢性疾病较多,具有多种不良的预后因素。②58例接受标准3+7方案诱导化疗的非M3患者完全缓解(CR)率达70.7%,中位总生存(OS)期为6.8(0.6~100.2)个月。41例CR患者中位无病生存(DFS)期为5.2(0.2~99.0)个月。1年DFS概率为41%,1年OS概率为51%。早期死亡率12.9%。③分析细胞生物学特征与疗效的关系,发现前驱血液病史、骨髓病态造血及染色体核型对CR率的影响具有统计学意义。结论:我国老年AML以M2(M2a)、M5为主,具有多种不良的预后因素。部分患者可受益于强诱导化疗。影响疗效的主要因素有...     

成人急性巨核细胞白血病13例临床分析北大核心CSCD

目的分析成人急性巨核细胞白血病(acute megakaryoblastic leukemia,AMKL)患者临床资料,以期了解AMKL的诊治现状,提高该病的诊断准确性。方法收集2010年1月至2020年10月在中国医学科学院血液病医院(中国医学科学院血液学研究所)初诊为AMKL的13例成人AMKL患者临床特征及实验室检查结果、治疗及转归情况,并进行文献复习。结果13例患者中位年龄57(15~68)岁,临床症状以乏力、发热、皮肤黏膜出血为主,可见肝脾大。骨髓涂片有5例患者原始细胞比例低于20%,但综合巨核细胞免疫化学染色(CD41阳性)、流式细胞免疫分型分析(CD36阳性、CD41阳性、CD42b阳性或CD61阳性)或病理活组织免疫化学染色结果(CD41阳性或CD61阳性)考虑诊断为AMKL。13例患者中位生存期为2.5(1.0~13.0)个月。结论成人AMKL发病率低、预后差。流式细胞免疫分型结合骨髓细胞形态、巨核酶标及免疫组化有助于AMKL的诊断。     

老年急性髓系白血病的治疗现状

急性髓系白血病（AML）随着年龄的增长发病率逐渐升高。由于老年AML患者化疗完全缓解率低,治疗相关死亡率高,长期生存率低,预后差,尚缺乏统一有效的治疗策略。本文就目前老年AML治疗现状作简单综述,探讨传统化疗、造血干细胞移植及新的靶向药物在老年AML治疗中的应用。     

Hypocellular acute myeloid leukemia in adults: analysis of the clinical outcome of 123 patients

Background

The hypocellular variant of acute myeloid leukemia accounts for less than 10% of all cases of adult acute myeloid leukemia. It is defined by having less than 20 percent of cellular bone marrow in a biopsy at presentation. It is unclear in the literature whether the outcome of hypocellular acute myeloid leukemia differs from that of non-hypocellular acute myeloid leukemia.

Design and Methods

We retrospectively analyzed all the cases reported to be hypocellular acute myeloid leukemia between 2000 and 2009. A second pathology review was conducted and the diagnosis was confirmed in all cases.

Results

One hundred twenty-three (9%) patients were identified: patients with hypocellular acute myeloid leukemia were older than those with non-hypocellular acute myeloid leukemia (P=0.009) and more frequently presented with cytopenias (P<0.001). Forty-one patients with hypocellular acute myeloid leukemia had an antecedent hematologic disorder and 11 patients had received prior chemo-radiotherapy for non-hematopoietic neoplasms. On multivariate analysis, overall survival, remission duration and event-free survival were comparable to those of other patients with acute myeloid leukemia.

Conclusions

The outcome of hypocellular acute myeloid leukemia does not differ from that of non-hypocellular acute myeloid leukemia.     

乌鲁木齐地区58例老年重症肺炎临床分析

目的总结老年重症肺炎临床及诊治特点。方法对我院收治的乌鲁木齐地区58例老年重症肺炎的临床资料进行分析。结果临床治愈：9例,占15．5％,好转：19例,占32．8％,死亡：30例,占51．7％。结论老年重症肺炎的临床症状不典型,死亡率高,早期诊断和及时给予经验性用药是有效治疗的关键。