MA和DA方案治疗成人急性髓细胞白血病疗效分析

目的:探讨MA方案对成人AML患者的疗效。方法:MA方案(米托蒽醌10 mg/d,静脉滴注,第1天~第3天;阿糖胞苷200 mg/d,分2次静脉滴注,第1天~第7天)治疗30例,DA方案(柔红霉素每天40 mg/m2静脉滴注,第1天~第3天;阿糖胞苷用法、用量同MA组)治疗29例,治疗2疗程后比较疗效。结果:两组2疗程后CR率为MA组72.3 %,DA组40 %,两组间差异有显著性意义(P<0.05),毒副作用均表现为骨髓抑制,粒细胞减少,MA组强于DA组(P<0.01)。结论:MA方案可作为AML(M4、M5)诱导治疗的一线方案应用。     

急性非淋巴细胞白血病中CD117表达与化疗疗效的关系

背景与目的：CD117是c-kit受体（c-kit receptor，c—kit R）膜外区分子表面抗原标志。研究表明，CD117在急性非淋巴细胞白血病（acute nonlymphoblastic leukemia，ANLL）高表达，可作为髓系白血病膜抗原标志物，对诊断ANLL有临床参考价值。但是，CD117的表达与ANLL化疗疗效的关系如何及其表达是否可作为判断ANLL预后的指标等问题尚无明确结论。本文旨在研究成人ANLL中CD117的表达与化疗疗效的关系，探讨CD117的表达与ANLL预后的关系。方法：采用流式细胞术（flow cytometery，FCM）分别检测初诊的38例急性淋巴细胞白血病（acute lymphoblastic leukemia，ALL）和8l例ANLL成人患者骨髓单个核细胞（BMMNC）CD117表达的阳性率和阳性水平。设立20例健康成人为对照组。ANLL的M3亚型采用全反式维甲酸（ATRA）治疗；其他亚型均采用DA方案或／和HA方案治疗。分析ANLL各亚型CD117表达及其化疗的完全缓解率（CR）。根据CD117表达的阳性与否，将ANLL分为CD117阳性（＋）组和CD117阴性（-）组，比较两组ANLL的CR。结果：对照组、ALL和ANLL CD117阳性表达率分别为0.13％（5／38）和70％（57／81），ANLL组CD117阳性率明显高于对照组和ALL组（P=0．000）。ANLL组CD117阳性细胞水平与对照组和ALL组比较均有显著差异（P=0．000）。CD117阳性细胞水平高低依次为M3／M1、M2／M6／M4、M5；CR高低依次如下：M3：80％（8／10）、M1—M2：73．9％（31／42）、M4-M5：57．9％（11／19）。CD117（＋）组和CD117（-）组CR率分别为51％（29／57）和67％（16／24）（P=0．192），两组CR率无统计学意义的差异。结论：CD117可作为急性白血病髓系免疫学标记之一。ANLL患者CD117阳性与否及其阳性水平的高低与化疗CR率之间没有必然的因果关系。CD117表达不是判断ANLL的疗效及其长期存活率的独立指标。     

TA和DA方案治疗急性单核细胞白血病的疗效比较

 目的　比较吡柔比星（THP）联合阿糖胞苷（Ara-C）（TA组）和柔红霉素（DNR）联合Ara-C（DA组）治疗初治急性单核细胞白血病的疗效。方法　对2001年1月至2007年12月收治的43例初治急性单核细胞白血病患者（M5），采用以TA或DA为主的联合化疗方案进行治疗，其中TA组22例，DA组21例。结果　TA组与DA组的完全缓解（CR）率分别为59.1 %、28.6 %，1个疗程CR率分别为27.3 %、9.5 %，总有效率分别为68.2 %、33.3 %，差异有统计学意义（P＜0.05）。结论　对初治的急性单核细胞白血病（M5），以THP为主的联合化疗方案（TA）比以DNR为主的联合化疗方案（DA）有更高的CR率，TA方案可作为治疗初发M5诱导治疗的一线方案。     

IA、MA和DA方案治疗急性髓系白血病临床疗效分析

[目的]观察IA、MA和DA方案治疗成人急性髓系白血病（AML）的疗效和不良反应。[方法]105例AML患者随机分为3组,其中IA组35例,MA组34例,DA组36例。以完全缓解率和总有效率作为临床疗效观察指标。[结果]IA、MA和DA组完全缓解率分别为82.9%、76.5%和52.8%,总有效率分别为94.3%、85.3%和61.1%。IA组与DA组、MA组与DA组完全缓解率和总有效率比较均有显著性差异（P〈0.05）。3组不良反应主要表现为骨髓抑制和恶心呕吐。MA组心脏毒性发生率低于IA和DA组（P〈0.05）;各组其它不良反应发生率无显著性差异（P〉0.05）。[结论]IA和MA方案疗效优于DA方案,不良反应可耐受。     

拓扑替康与足叶乙甙、环磷酰胺、阿糖胞苷联合治疗难治性急性非淋巴细胞白血病的临床研究

目的探讨拓扑替康(TPT)与足叶乙甙(VP-16)、环磷酰胺(CTX)、阿糖胞苷(Ara-c)组成的TECA方案治疗难治性急性非淋巴细胞白血病(ANLL)的疗效及毒副作用.方法采用TECA方案治疗难治性ANLL患者24例,一疗程后观疗效及毒副作用,并与柔红霉素联合阿糖胞苷(DA)方案进行对照.结果 TECA方案治疗组24例患者中有9例达完全缓解(CR),3例部分缓解(PR),12例未缓解;CR率为37.5%,总有效率为50.0%.主要毒副作用为骨髓抑制.TECA方案治疗组CR率、总有效率均优于DA方案,毒副作用无明显加重.结论 TECA方案治疗难治急性非淋巴细胞白血病疗效好,宜于临床推广.     

阿糖胞苷分别联合柔红霉素和去甲氧柔红霉素诱导治疗初治急性髓系白血病临床效果比较

目的：比较柔红霉素联合阿糖胞苷（DA）方案和去甲氧柔红霉素联合阿糖胞苷（IA）方案诱导治疗初治急性髓系白血病（AML）的临床疗效及患者不良反应。方法回顾性分析应用 DA 方案或 IA方案诱导缓解治疗的84例初治 AML（除外 M3）患者临床资料。 DA 组32例,其中男性17例,女性15例,中位年龄46岁;IA 组52例,其中男性29例,女性23例,中位年龄49岁。疗效指标为化疗1个疗程后的完全缓解（CR）率、总有效率和不良反应发生率。结果 DA 组 CR 率为65.6％（21／32）,总有效率为75.0％（24／32）;IA 组 CR 率为71.2％（31／52）,总有效率为80.8％（42／52）,两组 CR 率和总有效率差异均无统计学意义（均 P＞0.05）。两组患者中位生存时间和5年生存率差异均无统计学意义（DA 与IA 组中位生存时间：16.8个月比24.9个月,5年生存率：26%比44%,均 P＞0.05）。两组不良反应包括血液学（主要为骨髓抑制）和非血液学不良反应,两组间各不良反应发生率差异均无统计学意义（均 P＞0.05）。结论对于初治 AML 患者,DA 方案诱导治疗1个疗程的缓解率和总有效率与 IA 方案相当,且两方案的不良反应发生率无明显不同。     

MEA方案治疗急性髓系白血病67例疗效观察

近年来，虽DA，HA或HDA方案已成为治疗初治急性髓系白血病（acute myeloid leukemia AML)的第一线标准诱导缓解方案，但其完全缓解（CR）率尚不能令人满意，为54．3％－78．4％[1,2]。复发仍然是影响AML转归的严重问题之一，而且，有20％左右AML难治[3]，为提高CR率我们应用米托蒽醌（M），足叶乙甙（E）和阿糖胞苷（A）组成MEA方案，治疗67例AML，取得较满意结果。     

MT方案治疗急性单核细胞白血病的疗效及其与染色体核型的关系

 目的　研究米托蒽醌联合替尼泊苷（MT）方案在急性单核细胞白血病（M5）诱导缓解中的疗效及患者不良反应,并观察疗效与白血病染色体核型的关系。方法　将33例M5患者按治疗史分两组：初治组23例（A组）、DA（柔红霉素联合阿糖胞苷）或HDA（三尖杉酯碱、柔红霉素和阿糖胞苷） 1个疗程无效组10例（B组）。按核型预后分两组：预后中等组29例（C组）,预后不良组4例（D组）,均采用MT方案2个疗程诱导缓解,分别统计4组的临床疗效及患者不良反应。结果　MT方案对A、B组的M5诱导完全缓解（CR）率分别为83 %（19／23）及60 %（6／10）,有效率达91 %（21／23）及70 %（7／10）。C、D组CR率分别为83 %（24／29）及25 %（1／4）,有效率为88 %（26／29）及50 %（2／4）,其中复杂核型CR率为0（0／3）,非复杂核型的11q23染色体异常患者一次化疗达CR率100 %（4／4）。MT方案对M5化疗后白细胞最低点在第（7±3）天出现,为（0.4±0.2）×109／L,白细胞＜1×109／L时间达（8±5）d,未见化疗相关死亡病例。结论　MT方案简单有效、较安全,是治疗M5的较佳化疗方案,对1个疗程DA、HDA方案无效者亦可试用。MT方案化疗疗效与核型预后分组有关,对11q23染色体异常的M5患者疗效较好,对复杂核型患者疗效欠佳。     

DDP＋5—FU／CF同期应用于扰素、甲地孕酮治疗晚期鼻咽癌的临床研究

目的：研究DDP 5—FU／CF方案同期应用α-INF、MA治疗晚期鼻咽癌的治疗效果、毒副反应及生活质量改善情况。方法：治疗组28例患者采用DDP 5—FU／CF方案同期应用α-INF、MA；对照组32例患者单纯采用DDP十5—FU／CF方案。所有病例均接受2个疗程的化疗。结果：治疗组及对照组均无CR病例，总有效率分别为78．6％和46．9％，P＜0．05；中位缓解期分别为5．8个月(3-13个月)和4．6个月(2-11个月)，P＜0．05；在放疗和／或化疗后复发转移的病例中，治疗组和对照组的总有效率分别为73．1％(19／26)和41．4％(12／29)，P＜0．05。毒副反应主要表现在治疗组比对照组更多发生Ⅱ-Ⅳ度白细胞下降(P＜0．05)和短暂性寒战、发热症状(P＜0．01)；2组所发生的胃肠道反应、脱发和黏膜反应相当。结论：DDP 5—FU／CF同期应用α-INF、MA可明显提高晚期鼻咽癌的有效率，延长缓解期及提高生存质量。     

ACE预处理异基因骨髓移植治疗急性粒细胞白血病1例

1 病例介绍 患者，男性，35岁。2000年12月确诊为急性粒细胞白血病(AML-M2a)。曾予DA方案(柔红霉素、阿糖胞苷)化疗2个疗程后完全缓解(CR)，再原方案强化、巩固治疗3疗程，血型B型。供者为患者胞兄，38岁。无输血史，血型AB型，供受……     

Diagnostic concurrence in the subclassification of adult acute leukemia using French-American-British criteria

Using FAB criteria, we retrospectively classified 195 adult acute leukemia cases seen over a six-year period. Acute lymphoblastic leukemia (ALL) was separated from acute nonlymphoblastic leukemia (ANLL) by negative peroxidase. The dysmyelopoietic syndrome was separated from ANLL when the percentage of immature leukemic cells was less than 30%. The 55 cases of ALL and 140 cases of ANLL thus defined were initially independently subclassified with Wright's stained smears by three observers. Cases were then jointly reviewed by using all available information, and a final consensus diagnosis was reached. For ALL, there was complete agreement (of initial independent observations) about subtype in 32 of 55 (58%); for only one case was there total disagreement. For ANLL there was complete agreement in 89 of 140 (64%) and total disagreement in 5 of 140 (4%). Frequent disagreement of independent observations with the consensus diagnosis were L1 interpreted as 12, M5 interpreted as M4, L3 interpreted as L2, L2 interpreted as L1, M1 interpreted as M2 and M4 interpreted as M5. Although there appears to be variation between observers, all but 6 of 195 cases had at least two observers in agreement. Disagreement appeared to be partly based on varying interpretations of subjective criteria and partly on the variability in determining percentages of cell types present. The use of nonspecific esterase stain or lysozyme appeared to improve diagnostic agreement over that observed using Wright's stained slides alone in approximately 5% of cases of ANLL.     

MT与DA方案治疗初治急性单核细胞性白血病的疗效比较

 目的　比较MT方案（米托蒽醌联合替尼泊苷）和DA方案（柔红霉素联合阿糖胞苷）治疗初治急性单核细胞性白血病的疗效及患者不良反应。方法　将初治急性单核细胞性白血病患者40例随机（单纯随机抽样法）分成两组,MT组23例、DA组17例,分别采用MT、DA方案诱导缓解,比较两组的临床疗效及患者不良反应。结果　MT组、DA组第一次化疗完全缓解率分别为65 %（15／23）、18 %（3／17）,总完全缓解率为83 %（19／23）、47 %（8／17）,有效率分别为91 %（21／23）、59 %（10／17）,两组差异均有统计学意义（P＜0.05）。两组均出现明显的造血功能抑制,两组间白细胞最低点、白细胞＜1×109／L的持续时间差异无统计学意义（P＞0.05）,但MT组的白细胞最低点出现时间、白细胞＜1×109／L的开始、结束时间均较迟,两组差异有统计学意义（P＜0.01）。结论　MT方案治疗初治急性单核细胞性白血病完全缓解率、有效率均明显优于DA方案,方案较简单、有效,可作为初治急性单核细胞性白血病诱导缓解的较佳方案。两组骨髓抑制程度相当,但MT组骨髓抑制发生时间较DA组迟,治疗同时须注意适时加强抗感染、支持治疗。     

The clinical effect of low-dose Ara-C in patients with refractory acute nonlymphocytic leukemia and myelodysplastic syndrome

Twenty-one patients with refractory acute nonlymphocytic leukemia (ANLL) and myelodysplastic syndrome were treated with low-dose cytosine arabinoside (LDARC). LDARC was administered by subcutaneous injection every 12 hours at a dose of 10 mg/m2 (regimen A) or at a dose of 20 mg/m2 by continuous intravenous infusion (CIV) or continuous subcutaneous injection (CSC) (regimen B). Among 22 courses, two elderly patients with ANLL (M4 and M5) and one M4 patient with myelofibrosis obtained complete remission (CR) and three elderly patients with ANLL (one M1 and two M2) and one patient with ANLL developed from RAEB in transformation obtained partial remission (PR). The overall remission rate (CR + PR) was 31.8%. The CR durations were 2.5, 5 and 2 months, respectively. The plasma concentration of Ara-C determined in regimen B was 8.26 +/- 4.12 ng/ml. There was no difference in the plasma concentration of Ara-C between CIV and CSC. We consider that the major mode of action of LDARC lies in its cytotoxic effect, since all patients who obtained remission exhibited pancytopenia and bone marrow hypoplasia. However, in several patients, we observed transient monocytosis and granulocytosis which were considered to be suggestive evidence of differentiation of leukemia cells.     

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。     

Diversity of acute non-lymphocytic leukemia analyzed with monoclonal antibodies reactive with myeloid differentiation antigens

The expression of myeloid differentiation antigens on acute nonlymphocytic leukemia cells (ANLL) was analyzed with four distinctive monoclonal antibodies (MoAbs); YM-1, HL-1, 20.2 and 20.3. These four MoAbs were shown to recognize different stages of differentiation of myeloid progenitor cells (CFU-GM) and/or mature myeloid cells. Consequently, leukemia cells of 68 adult patients with ANLL were able to be divided into four groups according to their expression of the antigens defined by these MoAbs: group 1 HL-1(-), YM-1(-), 20.2(-), 20.3(-) (13 cases); group 2 HL-1(+), YM-1(-), 20.2(-), 20.3(-) (16 cases); group 3 HL-1(+), YM-1(+), 20.2(-), 20.3(-) (13 cases) and group 4 HL-1(+), YM-1/20.2/20.3(+/(-)) (26 cases). This classification elucidated not only the maturation stages of ANLL but also the diversity of ANLL. When compared with the morphological classification, acute myeloblastic leukemia (AML) cases (M1 and M2 of the FAB classification) were evenly distributed among all four groups. These data suggest that the AML group was composed of heterogeneous leukemias which expressed surface phenotypes of different maturation stages ranging from the most immature stage to the mature stage. In contrast, the mature type (group 4) was composed of not only AML (M1 and M2), but also acute monocytic leukemia (M4) and acute myelomonocytic leukemia (M5). The clinical courses of these 68 patients revealed that the complete remission rate, remission duration and survival time were not significantly different among the four groups.     

Combination chemotherapy of N(4)-behenoyl-1-beta-arabinofuranosylcytosine, aclarubicin, 6-MP, and prednisolone (BH-AC. AMP therapy) for adult acute non-lymphocytic leukemia

Sixteen of 20 patients(80%) with adult ANLL treated with B H-AC X AMP therapy attained complete remission (CR). According to the FAB classification, CR rate was 6 out of 8 (75%) for M1, 3 out of 5 (60%) for M2, 2 out of 2 (100%) for M3, and 5 out of 5 (100%) for M4. The median of remission duration in 16 patients who attained CR was 8 months and appeared to be longer in patients with M2, rather than other types, of leukemia than in those with the other types of leukemia. BH-AC X AMP therapy is highly effective for remission induction in adult ANLL and long term disease free survival could be expected by addition of appropriate maintenance therapy.     

Clinical value of long-term maintenance chemotherapy in 5-year survivors of acute leukemia

We investigated whether long-term follow-up of 5-year or longer survivors of acute leukemia might provide some information concerning cure-oriented chemotherapeutic strategy. By sending a questionnaire form to major medical institutions throughout the country, data of 2202 5-year or longer survivors of acute leukemia was obtained as of 30 June 1988. There were 1607 children and 595 adults. In order to investigate the data further, they were divided into four periods according to the year of diagnosis: before 1969, 1970-1974, 1975-1979 and 1980-April 1983. As regards remission induction regimens, vincristine plus prednisolone (VP) was the most popular in childhood acute lymphoblastic leukemia (ALL) throughout these four periods. In adult acute non-lymphoblastic leukemia (ANLL), daunomycin (DM), cytosine arabinoside (ard-C), 6-mercaptopurine (6MP), prednisolone (STH) (DCMP) or behenoyl ara-C, DM, 6-MP, STH (BH-AC.DMP) was the most popular since the latter half of the 1970s. Both in childhood ANLL and adult ALL, there was no predominant regimen whatsoever. In an analysis of survival curves for the above four periods, each survival plateau for childhood ALL rose over time with statistical significance, reaching over 90% in the 1980s, whereas those for adult ANLL were not so, suggesting that newer ANLL regimens in the 1980s did not play a successful role in cure-oriented therapy. Whether duration of post-remission chemotherapy could be a prognostic factor for these survivors was studied by dividing the duration as follows: less than one year, 1-2, 2-3, 3-5 and more than 5 years. A therapeutic gain, with a cure rate of over 90%, was observed in childhood ALL patients treated with chemotherapy for 5 years or longer. In adult ANLL patients, results were similar with chemotherapy groups of both less than one year and 5 years or longer. This suggests that risk-adapted therapy is an optimal strategy for cure of adult ANLL as well as childhood ALL.     

甲地孕酮联合NP方案与单纯NP方案治疗晚期非小细胞肺癌的比较

目的:探讨甲地孕酮在治疗晚期非小细胞肺癌化疗中的作用。方法:46例晚期非小细胞肺癌患者,随机分为治疗组与对照组,治疗组24例采用M-NP方案[MA(甲地孕酮)NVB(长春瑞滨)加PDD(顺铂)联合的化疗方案],和对照组22例采用单纯NP方案[NVB(长春瑞滨)加PDD(顺铂)联合的化疗方案]治疗,两组患者均以每4周为1个周期,观察两组患者的疗效,消化道反应,骨髓抑制及生活质量。结果:两组患者客观疗效(CR PR)分别为50%及45.5%,无显著性意义(P>0.05),两组消化道反应,骨髓抑制及生活质量改善情况间差别均有显著性意义(P<0.05),未见甲地孕酮引起的不良反应发生。结论:甲地孕酮配合NP方案和单纯NP方案治疗晚期非小细胞肺癌的客观疗效无明显差异性,但前者毒副反应小,患者生活质量改善明显。