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1.
秦丹  王利 《现代肿瘤医学》2018,(21):3462-3466
目的:评价氟达拉滨代替环磷酰胺的移植前预处理方案对髓系白血病的疗效及安全性。方法:计算机检索筛选获取所有移植前预处理方案为白消安+环磷酰胺(BU+CY)或白消安+氟达拉滨(BU+FLU)的临床对照研究,评价纳入研究的质量并进行资料提取后,采用Stata 12.0软件进行Meta分析。结果:共纳入9篇文献,其中2篇随机对照试验,7篇病例对照研究,Meta分析结果显示:BU+FLU预处理方案恶心呕吐反应比BU+CY方案较小(P=0.031);肝脏毒性、心脏毒性均小于BU+CY组(P=0.009,P=0.004),且5年OS优于BU+CY组(P=0.000)。结论:BU+FLU的预处理方案或许可以取代传统的BU+CY方案。  相似文献   

2.
异基因造血干细胞移植两种预处理方案的比较   总被引:3,自引:1,他引:2  
Zhang GC  Zheng D  Guan XX  Luo SK  Li J  Peng AH  Tong XZ  Lai FZ  Tan EX  Hong WD 《癌症》2003,22(6):620-623
背景与目的:预处理方案是造血干细胞移植成功的关键因素之一。本研究的目的是比较异基因造血干细胞移植两种预处理方案治疗白血病的优缺点。方法:21例采用白消安(busulfan,BU)16mg/kg加环磷酰胺(cyclophosphamide,CY)120mg/kg方案(BU/CY组);23例采用全身照射(totalbodyirradiation,TBI)7.5~8.5Gy加CY120mg/kg方案(TBI/CY组)。结果:BU/CY组和TBI/CY组3年无病生存率分别为61.5%与64.7%,复发率分别为23.8%与26.0%,两者差异无显著性(P>0.05)。BU/CY组肝脏毒性发生率高于TBI/CY组,分别为80.9%与54.3%(P<0.05),均无发生肝静脉闭塞病。BU/CY组口腔和胃肠道毒性发生率(33.3%与42.9%)则明显低于TBI/CY组(78.2%与78.2%)(P<0.05);膀胱和肺毒性的发生率两组相似,前者为23.8%与26.0%,后者为14.3%与13.0%(P>0.05),但TBI/CY组发生1例致死性的Ⅳ级肺毒性。两组均未发生心脏、肾和中枢神经系统不良反应。结论:BU/CY组疗效与TBI/CY组相当。BU/CY组预处理方案易于实施,患者耐受好,髓外毒性低。  相似文献   

3.
目的探讨HLA相合同胞供者异基因造血干细胞移植(allo-HSCT)治疗慢性粒细胞白血病(CML)的疗效及预后因素。方法35例CML患者,11例行HIA相合同胞供者异基因骨髓移植(allo-BMT),24例行异基因外周血干细胞移植(allo-PBSCT)。全身照射(TBI)+环磷酰胺(CY)方案预处理8例,白消安(BU)+CY方案预处理27例。结果造血重建34例(97.1%),3年无病生存率(DFS)为60.0%,5年累积生存率为57.1%。复发2例,移植相关死亡12例。并发症包括出血性膀胱炎(HC)5例,肝静脉闭塞病(HVOD)1例,急性移植物抗宿主病(GVHD)18例,慢性GVHD 17例。单因素分析显示,年龄≤30岁、慢性期移植、Ⅰ和Ⅱ度急性GVHD患者3年DFS分别高于年龄〉30岁、加速期移植及Ⅲ和Ⅳ度急性GVHD患者。多因素Cox回归分析结果表明,年龄、疾病状态、急性GVHD的严重程度是allo-HSCT患者长期生存的独立影响因素。结论年龄≤30岁、慢性期、轻度GVHD的CML患者行allo-HSCT治疗,可获得较高的长期生存率。  相似文献   

4.
 目的 探讨干细胞移植(HSCT)在骨髓增生异常综合征(MDS)治疗中的疗效以及预处理方式的选择。方法 对13例MDS患者行异基因造血干细胞移植 (allo-HSCT)(包括HLA配型全相合10例、半相合2例、脐血移植1例)。输注单个核细胞(MNC) 6.92(2.65~21.33)×108/kg,CD34细胞4.47(1.49~10.22)×106/kg。其中,5例选择全身照射+氟达拉滨+环磷酰胺(TBI+Flud+Cy)方案预处理,3例白消安(BU)/Cy预处理,3例TBI+CY,2例采用阿糖胞苷(Ara-C)+BU+Cy+替尼泊苷(VM26)预处理。移植物抗宿主病(GVHD)的预防:2例HLA配型半相合者给予抗胸腺细胞球蛋白(ATG)联合环孢素A(CsA)加短程甲氨蝶呤(MTX)治疗,并于移植后1~28 d持续给予霉酚酸酯(MMF),其他病例仅给予CsA加短程MTX。结果 13例患者中9例造血完全重建,移植相关死亡4例。结论 HSCT是可以治愈MDS的有效方法。预处理选择应采取个体化。  相似文献   

5.
目的 探讨氟达拉滨替代改良BuCy方案中环磷酰胺的预处理方案在异基因造血干细胞移植中的安全性及有效性.方法 对45例急性白血病患者进行异基因造血干细胞移植,其中23例采用改良BuCy预处理化疗,22例采用BuFlu方案(氟达拉滨每天40 mg/m2,用5d,来替代改良BuCy方案中的环磷酰胺)进行预处理化疗.移植均采用外周血造血干细胞移植.移植后观察比较两组预处理方案相关不良反应、植入、移植物抗宿主病(GVHD)、感染发生和长期随访下的无病生存情况.结果 除改良BuCy组1例患者死于预处理后脑出血,其余患者均获得成功植入.两组患者预处理不良反应发生率差异无统计学意义(P>0.05);BuFlu组患者病毒感染较改良BuCy组高(P=0.009),而Ⅲ~Ⅳ度急性GVHD发生率较低[26.1%(6/23)比4.5%(1/22),P=0.046].中位随访41个月,改良BuCy组非复发死亡4例(17.4%),BuFlu组非复发死亡2例(9.1%)(P=0.665).两组复发率分别为30.3%(7/23)和40.9%(9/22)(P=0.474);5年总生存率分别为(55.1±l 1.9)%和(61.4±10.8)%(P=0.659),无事件生存率分别为(44.5±12.1)%和(22.1±12.3)%(P=0.747).结论 氟达拉滨替代改良BuCy方案中环磷酰胺的预处理化疗耐受性较好,严重GVHD发生率低,总生存率无明显差异.应用时应注意移植中感染及复发的风险.  相似文献   

6.
目的:系统性评价骨髓增生异常综合征(MDS)患者在异基因造血干细胞移植(allo-HSCT)前接受不同治疗方案对移植后长期复发及生存的影响。方法:检索Ovid、Cochrane Library、PubMed、Embase、中国期刊全文数据库、中文科技期刊数据库、万方数据库和中国生物医学文献数据库中从建库至2019年12月MDS患者行allo-HSCT前接受不同方案治疗的文献。对符合纳入标准的文献,由2名研究者按Cochrane系统评价方法,独立进行资料提取、质量评价并交叉核对。按治疗方法,将纳入文献中的病例分为去甲基化药物(地西他滨或阿扎胞苷)治疗组(去甲基化治疗组)和传统方案治疗组(包括化疗和支持治疗)(传统治疗组)。采用RevMan 5.3软件对各组总生存(OS)、复发、无复发死亡率(NRM)、无复发生存(RFS)进行分析。结果:共纳入10篇文献。Meta分析结果显示,传统治疗组中,化疗组与支持治疗组间3年OS率[44.6%(146/327)比35.5%(138/389); OR=0.93,95% CI 0.38~2.27, P=0.87]、复发率[32.4%(106/327)比37.3%(145/389); OR=1.00,95% CI 0.49~2.05, P=0.99]、NRM[26.3%(86/327)比27.0%(105/389); OR=1.05,95% CI 0.75~1.49, P=0.77]、RFS率[9.2%(30/327)比12.6%(49/389); OR=0.74,95% CI 0.26~2.10, P=0.57]差异均无统计学意义。去甲基化治疗组与传统治疗组间3年OS率[40.7%(165/405)比45.9%(290/632); OR=0.98,95% CI 0.71~1.36, P=0.28]、复发率[32.6%(132/405)比38.3%(242/632); OR=1.05,95% CI 0.79~2.05, P=0.25]、NRM[27.2%(110/405)比24.8%(157/632); OR=0.81,95% CI 0.59~1.11, P=0.68]、RFS率[46.7%(189/405)比42.2%(267/632); OR=0.84,95% CI 0.63~1.12, P=0.85]差异均无统计学意义。无论去甲基化治疗组与化疗组间、还是去甲基化治疗组与支持治疗组间,3年OS率、复发率、NRM、RFS率差异均无统计学意义(均 P>0.05)。 结论:MDS患者allo-HSCT前接受不同方案治疗对于移植后生存和复发均无明显影响。  相似文献   

7.
目的:探讨并明确不同剂量白消安(BU)联合环磷酰胺(CY)预处理方案对小鼠造血系统功能的影响情况,为造血干细胞移植基础研究提供一种可靠的药物性非清髓性预处理方案。方法:BALB/ c 雌性小鼠60只,随机分为6组,每组10只。实验组(Group20、Group35、Group50 Group75、Group90)分别于第1~4天给予BU 20、35、50、75、90mg/(kg·d),第5~6天给予 CY 50mg/(kg·d),空白对照组(normal)给予同等体积的药物溶媒。以各组小鼠的血细胞计数、骨髓病理、生存情况等为主要指标综合评价各组的造血情况及其变化规律。结果:经 BUCY 方案处理后,各组小鼠均出现不同程度的体重、食欲降低。各实验组动物均于给药的第3天开始出现外周血白细胞降低,且白细胞最低值均出现在给药第11天。其中 Group20组小鼠能产生轻度骨髓抑制并全部存活,Group35和 Group50组均可产生理想的非清髓效果,但 Group50组的生存率明显低于 Group35组(P <0.05)。Group75和 Group90组均为致死的清髓性剂量。结论:Group35组的用药方案可作为理想的小鼠非清髓性预处理方案,用于造血干细胞移植的基础研究。  相似文献   

8.
中国女性乳腺癌危险因素的Meta分析   总被引:2,自引:1,他引:1  
[目的]评价中国女性乳腺癌部分危险因素的作用,探讨乳腺癌的病因。[方法]运用Meta分析方法对我国1996~2006年间公开发表的有关乳腺癌危险因素病例对照研究的12篇文献资料进行定量综合分析。[结果]各因素合并OR值分别为:初潮年龄OR=1.5401(95%CI:1.3437~1.7654);哺乳OR=0.6837(95%CI:0.4779—0.9782);口服避孕药OR=1.3278(95%CI:1.0627—1.6589);良性乳腺疾病史OR=2.6180(95%CI:2.0275—3.3804);吸烟OR=1.8576(95%CI:1.5394—2.2415);饮酒OR=0.8137(95%CI:0.6196~1.0686);饮茶OR=0.8625(95%CI:0.7646~0.9728)。[结论]初潮年龄、口服避孕药、良性乳腺疾病史及吸烟是乳腺癌发生的危险因素,哺乳及饮茶则是乳腺癌的保护因素。  相似文献   

9.
江岷  曹履先 《山西白血病》1992,1(4):222-222
在自体骨髓移植(ABMT)治疗急性白血病(AL)中,环磷酰胺(CY)合用全身照射(TBI)是常用的经典预处理方案,其主要问题是移植后的白血病复发,而多数来源于残留白血病细胞。因在TBI中应用肺屏蔽技术来预防间质性肺炎(IP)肋骨中的残留白血病细胞就多了。在CY加TBI的基础上,我们在16例AL病人ABMT中应用肋骨照射(RR)作为预处理的一部分,以便能杀灭更多的残留白血病。男:女=5:1t,其年龄14岁~46岁,13/16为急性非淋巴细胞白血病,3/16为急性淋巴细胞白血病,14例病人移植前处于首次完全缓解期(CR1),另2例为CR2或CR3。  相似文献   

10.
目的运用Meta分析软件评价胆囊癌根治手术及单纯胆囊切除治疗Ⅱ期胆囊癌的远期疗效。方法通过Pubmed、WOS、万方、维普、中国生物文摘书库检索自1990年1月至2011年12月相关文献,Jadad质量评分评估文献所涉及研究的质量,治疗组为胆囊癌根治术后患者生存人数,对照组为单纯胆囊癌切除术后患者的生存人数,运用Meta分析评估两组患者1、3、5年的生存差异。结果10篇文献入选病例数共279例,其中根治组146例,单纯切除组133例。Meta分析结果显示:1年生存[OR=3.900,CI=(1.160,13.140),P=0.030],3年生存[OR=2.780,CI=(1.060,7.310),P=0.040],5年生存[OR=3.160,CI:(1.130,8.870),P=0.030],两组差异均有统计学意义。结论同单纯胆囊切除术相比,根治性切除术可提高Ⅱ期胆囊癌术后的1、3、5年生存率。  相似文献   

11.
Studies were carried out to determine if a priming dose of total body irradiation (TBI) given before the first drug exposure in chemo-radiation protocols similar to those used in marrow transplantation would reduce the survival of hematopoietic stem cells. The cytotoxic drugs employed were cyclophosphamide (CY) and piperazinedione (PIP), both of which are currently used in the clinic for ablation of the host marrow prior to transplantation therapy for leukemia. The effects were evaluated in a normal and a leukemic mouse model using the endogenous colony-former technique. Splitting the TBI to give part of the total dose before the first dose of drug was found to enhance stem cell kill in some instances, but not in others. The optimum proportion of TBI given as the first dose did not appear to exceed 100 rads. When a higher proportion of the total TBI was given as the initial dose there was an indication of a protective effect on the stem cells with the PIP-TBI protocols, but similar protection was not observed with the CY-TBI protocols. When CY and PIP were combined together in the same protocol it was found that a simple inversion of the order of these two drugs could result in a six-fold difference in the extent of stem cell ablation achieved, indicating that with multiple drug protocols the drug sequencing itself could be equally important as the manner in which the radiation is given.  相似文献   

12.
PURPOSE: Preparative regimens involving total-body irradiation (TBI) produce significant late toxicities in some children who receive bone marrow transplants, including impaired growth and intellectual development. Busulfan is often used as an alternative to TBI, but there are few data regarding its relative efficacy. PATIENTS AND METHODS: We compared outcomes of HLA-identical sibling transplants for acute lymphoblastic leukemia (ALL) in children (< 20 years of age) who received cyclophosphamide plus TBI (CY/TBI) (n = 451) versus those who received busulfan plus cyclophosphamide (Bu/CY) (n = 176) for pretransplant conditioning. Patients received transplants between 1988 and 1995 and their results were reported to the International Bone Marrow Transplant Registry by 144 participating institutions. The CY/TBI and Bu/CY groups did not differ in gender, immune phenotype, leukocyte count at the time of diagnosis, chromosome abnormalities, remission status, or length of initial remission. T-cell depletion was used more frequently in the CY/TBI group; the Bu/CY group included a higher proportion of children who were less than 5 years of age. The median follow-up period was 37 months. RESULTS: The 3-year probabilities of survival were 55% (95% confidence interval [CI], 50% to 60%) with TBI/CY and 40% (95% CI, 32% to 48%) with Bu/CY (univariate P =.003). The 3-year probabilities of leukemia-free survival were 50% (95% CI, 45% to 55%) and 35% (95% CI, 28% to 43%), respectively (univariate P =.005). In a multivariate analysis, the risks of relapse were similar in the two groups (relative risk [RR], 1.30 for Bu/CY v CY/TBI; P =.1). Treatment-related mortality was higher in the Bu/CY group (RR, 1.68; P =.012). Death and treatment failure (relapse or death, inverse of leukemia-free survival) were more frequent in the Bu/CY group (RR, 1. 39; P =.017 for death; RR, 1.42; P =.006 for treatment failure). CONCLUSION: These data indicate superior survival with CY/TBI conditioning, compared with Bu/CY conditioning, for HLA-identical sibling bone marrow transplants in children with ALL.  相似文献   

13.
The ability of WR-2721 [S-2(3-aminopropylamino)ethyl-phosporothioic acid] to selectively protect the host against the toxic effects of multiple doses of cis-dichlorodiammineplatinum [cis-Pt] or cyclophosphamide [CY] has been studied in mice and rats bearing 3 different tumours. Selective protection against cis-Pt induced nephrotoxicity has been demonstrated under all conditions studied, with the extent of protection being inversely related to the size of the cis-Pt dose. For example, pre-treatment with 200 mg/kg of WR-2721 30 min before each weekly dose of 2 mg/kg of cis-Pt allows the administration of this cytotoxic agent for 3 times longer before nephrotoxic injury. In none of these studies was there tumour protection. The same pattern was observed with CY, but quantitation of the extent of marrow protection was not possible for the multiple treatment studies, due to the longer latent period between induced and observed death with this drug. We conclude, therefore, that for both of these drugs, selective protection of the kidney and marrow is not only maintained under conditions of multiple treatment, but actually enhanced due to the need for smaller doses of cytotoxic agents in these protocols.  相似文献   

14.
Clinical and pharmacokinetic studies were performed regarding the toxicity of methyl 6-[3-(2-chloroethyl)-3-nitrosoureido]-6-deoxy-alpha-D-glucopyranoside (MCNU) with other drugs, in conjunction with a peripheral blood stem cell autograft (PBSCT), for treating 26 children with acute leukemia or lymphoma associated with high-risk features. In the early phase of the study, MCNU (300 to 500 mg/m2) was administered with cytosine arabinoside (Ara-C) (1.6 to 16 g/m2), etoposide (VP-16) (0.8 to 1.6 g/m2), cyclophosphamide (CY) (100 to 200 mg/kg), or busulfan (16 mg/kg). No acute toxicity was noticed after this high-dose therapy. The dose-limiting factor of the regimens was significant but reversible interstitial pneumonitis (IP). In a subsequent trial with an MCNU/VP-16/Ara-C/CY (MCVAC) regimen in which the dose of MCNU was reduced, the risk of IP diminished. This study is still in progress, but the clinical response has so far been encouraging. Fifteen of 26 children are alive and well in unmaintained complete remission (CR) with a median follow-up period of 11 months (range, 3 to 34 months) after transplantation. This MCNU-based regimen without total body irradiation (TBI) is especially important in children to avoid the serious sequelae of irradiation. Our results justify a broader clinical trial to evaluate the effects of the MCVAC regimen followed by PBSCT.  相似文献   

15.
Six antitumor platinum compounds were used in combination with cyclophosphamide plut 1 of 7 other antitumor drugs for treatment of L1210 leukemia in B6D2F [C57BL/6 X DMA/2) F] mice. Data obtained from each three-agent regimen were compared with those obtained after administration of each compound alone and each appropriate two-agent combination. No cure (greater than 60-day survival) was obtained with any compound used alone. Combination of cyclophosphamide with a platinum compound (Pt+CY) yielded a collective cure rate of 193/420, and the addition of a third cure rate to 290/420 (P less than 0.001). Certain regimens produced 100% cure rates. The most effective drugs when used in combination with PT+CY were cytosine arabinoside, 5-fluorouracil, hydroxyurea, and Yoshi-864. Adriamycin, methotrexate, and vincristine were less effective at the doses used. Toxicity, as evidenced by maximum weight loss, was slightly greater with the three-agent combinations than with the Pt+CY regimens.  相似文献   

16.
Use of total body irradiation (TBI) and/or chemotherapy as a preparation for marrow transplantation in the treatment of leukemia has been only moderately successful in the clinic. Although cyclophosphamide (CY) has shown promise as a marrow ablative agent, leukemia relapses are often found, and optimal therapeutic protocols have not been established. Our transplantation therapy studies of murine leukemia with parental recipients and hybrid donors provide an excellent model for research aimed at improved survival of human transplant patients. Utilizing a murine leukemia induced by a virus, various doses of CY in combination with sub-lethal irradiation were compared to determine the optimal pretreatment for transplantation therapy. Both normal and leukemic mice were engrafted with virus resistant, histocompatible marrow following these preparations, then monitored for survival and long term effects. Leukemic mice were also evaluated for pluripotent as well as myeloid committed stem cells as a measure of the effectiveness of the treatment in elimination of leukemic cells. Leukemic groups were also compared for the percentage and time of leukemia relapse. All CY/X-ray combinations were more effective in elimination of stem cell populations than supralethal TBI alone. However, the best survival was obtained with lethal TBI alone or low dose CY in combination with 550 R.  相似文献   

17.
Objective: Explore the feasibility of allo- hemopietic stem cell transplants in treating patients with B cell acute lymphocytic leukemia. Methods: Between september 2006 and February 2011, fifteen patients with B cell acute lymphocytic leukemia (ALL) were treated by allo-hemopietic stem cell transplants (HSCT). Stem cell sources were peripheral blood. Six patients were conditioned by busulfan (BU) and cyclophosphamide (CY) and nine patients were conditioned with TBI and cyclophosphamide (CY). Graft versus host disease (GVHD) prophylaxis regimen consisted of cyclosporine A (CSA), methotrex ate (MTX) and mycophenolatemofetil (MMF). Results: Patients received a median of 7.98×108·kg-1 (5.36-12.30×108·kg-1) mononuclear cells (MNC). The median time ofANC> 0.5×109/L was day 12 (10-15), and PLT> 20. 0×109/L was day 13 (11-16). Extensive acute GVHD occurred in 6 (40.0%) patients, and extensive chronic GVHD was recorded in 6 (40.0%) patients. Nine patients were alive after 2.5-65 months follow-up. Conclusion: Allogeneic stem cell transplant could be effective in treating patients with B cell acute lymphocytic leukemia.  相似文献   

18.
Summary C3H/He mice were inoculated withPseudomonas aeruginosa by various routes 1 day after X5563 transplantation or 4 days after cyclophosphamide (CY) administration. Administration of PSK (Krestin) i.p. or p.o. to the tumor-bearing mice or CY-treated tumor-bearing mice resulted in an increase in survival rates. ViableP. aeruginosa were inoculated i.v. on day 0 into mice inoculated with tumor cells on day -12 and vaccinated with killedP. aerouginosa on day -10, or into mice inoculated with tumor cell on day -15, treated with CY on day -14 and vaccinated on day -10. Resistance to infection, which is enhanced by vaccination, was depressed by tumor burden or treatment with CY, but such depression was prevented by PSK administration.Abbreviations used CY cyclophosphamide - i.p. intraperitoneally - s.c. subcutaneously - p.o. orally - i.v. intravenously  相似文献   

19.
The relationship between tumour volume response and cell kill in B16 melanoma following treatment in vivo with cyclophosphamide (CY) and 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea (CCNU) was investigated. Tumour volume response, expressed as growth delay, was estimated from measurements of tumour dimensions. Depression of in vitro colony-forming ability of cells from treated tumours was used as the measure of tumour cell kill. The relationship between these parameters was clearly different for the two agents studied. CY produced more growth delay (7.5 days) per decade of tumour cell kill than CCNU (2 to 3.5 days). The possibility that this was due to a technical artefact was rejected in favour of an alternative explanation that different rates of cellular repopulation in tumours treated with CY and CCNU might be responsible. Cellular repopulation was measured directly, by performing cell-survival assays at various times after treatment with doses of CY and CCNU which produced about 3 decades of cell kill. The rate of repopulation by clonogenic cells was much slower after treatment with CY than with CCNU, and this appears to account for the longer duration of the growth delay obtained with CY.  相似文献   

20.
We investigated antitumor effect of cis-diammine-dichloroplatinum (cisplatin or CDDP), cyclophosphamide (CY) and interferon-gamma (gamma-IFN) against argyrophil small cell carcinoma (ASCC) of the uterine cervix using heterotransplanted ASCC tumor (YIK-1) into nude mice, containing HPV 16 DNA in a multicopy integrated form. No tumor growth retardation was observed in the nude mice which received the single administration of CDDP 2 mg/kg, CY 10 mg/kg or gamma-IFN 1 x 10(7) U/kg. However, the combined administration of CDDP and CY, or CDDP, CY and gamma-IFN markedly inhibited the tumor growth. Moreover, with comparison about relative tumor volume between these two groups, the combination of CDDP, CY and gamma-IFN was more effective than that of CDDP and CY. These data suggest that the combination chemotherapy of CDDP, CY and/or gamma-IFN was effective for the suppression of tumor growth in argyrophil small cell carcinoma of the uterine cervix. Further study on the antitumor potentiation of various anti-cancer agent and the combination of them against ASCC is needed.  相似文献   

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