小剂量MAE方案治疗难治与复发急性白血病

目的:探讨小剂量米托蒽醌(MTZ)、阿糖胞苷 (Arc)联合依托泊甙(VP-16)治疗难治与复发急性白血病的疗效及毒副作用.方法:难治与复发急性白血病52 例,应用小剂量MAE方案化疗,完全缓解后应用中剂量阿糖胞苷或预激方案巩固.结果:22例急性非淋巴细胞白血病中,10例(45.5%)达完全缓解(CR),2例(9.1%)部分缓解(PR),总有效率为54.5%;30例急性淋巴细胞白血病中,9例(30.0%)CR,2例(6.6%)PR, 总有效率为36.6%.毒副作用主要是骨髓抑制、恶心、呕吐.结论:小剂量MAE 方案治疗难治与复发急性白血病的疗效较好,毒副作用较轻.     

门冬酰胺酶诱导缓解治疗急性非淋巴细胞白血病16例

目的探讨门冬酰胺酶(Aase)对急非淋巴细胞白血病(ANLL)诱导缓解的影响.方法用Aase联合常规HA(三尖杉酯碱、阿糖胞苷)、DA(柔红霉素、阿糖胞苷)、维甲酸和砷剂等方案治疗了16例ANLL患者.结果16例中有14例CR,总CR率87.5%.结论①Aase对无论是初治、复发还是耐药ANLL都有着明显的疗效;②Aase对CNSL具有防治作用.     

去甲氧柔红霉素为主方案治疗难治性急性白血病16例

目的 观察应用去甲氧柔红霉素(IDA)联合阿糖胞苷(Ara-C)治疗难治性急性白血病的疗效.方法 16例经血常规和骨髓象检查确诊的白血病患者,其中5例为急性淋巴细胞白血病(ALL)复发患者;11例为急性非淋巴细胞白血病(ANLL)患者,其中7例为初治患者,4例为复发患者.16例均为行DA、HA、VDP、HOAP等化疗方案而未达到完全缓解者.采用静脉滴注IDA 10 mg/m2,第1天至第3天;Ara-c 100 mg/m2,第1天至第7天,休息7～14 d,再行第2个疗程,连续应用2个疗程后评价疗效.结果 完全缓解(CR)8例(50.00%),部分缓解(PR)3例,未缓解(NR)5例,总有效率68.75%.结论 以IDA为主治疗难治性急性白血病疗效较好,不良反应较少.     

以吡柔比星为主的联合化疗对初治急性白血病疗效的临床观察

目的:观察吡柔比星(THP)组成的联合化疗对初治急性白血病的缓解率及毒副作用。方法:治疗组:以THP替代标准方案中DA或VDCP中的柔红霉素(DNR),即用TA与VTCP方案(THP20 mg/m2 ~ 30 mg/m2)对初治的20例急性非淋巴细胞白血病(ANLL)及16例急性淋巴细胞白血病(ALL)诱导缓解治疗。对照组:用DA与VDCP分别对初治25例ANLL与18例ALL患者诱导缓解治疗。分别观察其一个疗程的疗效情况及毒副作用情况。结果:两组在ANLL的总有效率(RR)分别是70 %和76 %,在ALL的RR率分别是75 %与77.8 %,其中CR率ANLL分别为60 %与64 %,ALL两组分别为62.5 %与61.1 %,两组间差异均无显著性(P>0.05),毒副作用THP组主要表现轻度的恶心、呕吐,少数有轻度脱发,仅1例发现心脏出现较度毒性,骨髓毒性较重,DNR组有3例发生了轻度的心脏毒性,其余与THP相似。结论:用THP替代标准方案中的DNR对初治的急性白血病疗效显著,无明显严重的毒副作用,与标准的DA与VDCP方案相比疗效无显著差异,毒副作用基本相当。     

去甲氧柔红霉素为主的联合化疗治疗急性白血病

 目的　分析去甲氧柔红霉素（IDA）和柔红霉素（DNR）治疗急性白血病（AL）的疗效和毒副作用。方法　59例AL患者,初治43例,复发难治16例。急性非淋巴细胞白血病（ANLL）39例,用IA方案化疗;急性淋巴细胞白血病（ALL）18例,用IDA联合长春新碱、异环磷酰胺、泼尼松方案化疗;急性混合细胞白血病（MAL）2例,用IDA联合长春新碱、环磷酰胺、阿糖胞苷方案化疗。同期48例患者采用DNR为主的方案治疗。结果　IDA为主方案的完全缓解（CR）43例,部分缓解（PR）4例,总有效率79.7 %;初治43例中,CR 34例,PR 3例,总有效率86.1 %;复发难治16例中,CR 9例,PR 1例,总有效率62.5 %;39例ANLL中,CR 28例,PR 3例,总有效率79.5 %;18例ALL中,CR 15例,PR 1例,总有效率88.9 %;DNR为主方案的总有效率为80.4 %。结论　IDA是疗效确切、安全、可靠的抗白血病药物。     

FLAG方案治疗难治性急性非淋巴细胞白血病的临床研究

 目的 评估FLAG方案对难治性急性非淋巴细胞白血病（ANLL）的疗效。方法 23例难治性ANLL患者采用FLAG方案治疗，氟达拉滨（Flud） 25 ~ 30 mg·m-2·d-1（50 mg／d），第1天至第5天，静脉滴注；阿糖胞苷（Ara-C）0.5 ~ 2 g·m-2·d-1第1天至第5天，静脉滴注；粒细胞集落刺激因子（G-CSF）300 μg／d，第0天至第5天或至中性粒细胞（ANC）计数≥0.5×109／L，皮下注射，连续治疗2个疗程以上评估疗效，并记录不良反应。疗效评价标准分为完全缓解（CR），部分缓解（PR），未缓解（NR）。结果 治疗总有效率73.91 %（17例），1个疗程CR率为52.17 %（12例），总的CR率为65.22 %（15例）。初发难治CR率85.71 %；晚期复发CR率87.5 %。结论 FLAG方案治疗难治性ANLL总体疗效较为满意，尤其对于初发难治和晚期复发患者，且毒副作用可以耐受，是治疗难治性白血病较为理想的方案。     

小剂量MAE方案治疗难治与复发急性白血病

目的：探讨小剂量米托蒽醌（MTZ）、阿糖胞苷（Arc）联合依托泊甙（VP-16）治疗难治与复发急性白血病的疗效及毒副作用。方法：难治与复发急性白血病52例，应用小剂量MAE方案化疗，完全缓解后应用中剂量阿糖胞苷或预激方案巩固。结果：22例急性非淋巴细胞白血病中，10例（45．5％）达完全缓解（CR），2例（9．1％）部分缓解（PR），总有效率为54．5％；30例急性淋巴细胞白血病中，9例（30．0％）CR，2例（6．6％）PR，总有效率为36．6％。毒副作用主要是骨髓抑制、恶心、呕吐。结论：小剂量MAE方案治疗难治与复发急性白血病的疗效较好，毒副作用较轻。     

替尼泊苷联合方案治疗交叉表达双系相关抗原急性白血病的临床研究

目的 :探讨替尼泊苷联合方案治疗交叉表达淋系和髓系抗原急性白血病的化疗疗效。方法 :应用替尼泊苷联合阿糖胞苷、环磷酰胺、长春地辛及泼尼松组成 TA或 TA+COP方案 ,治疗伴淋系抗原表达的急性髓细胞白血病 (L y+ AML) 2 4例和伴髓系抗原表达的急性淋巴细胞白血病(My+ AL L) 1 7例。结果 :完全缓解 (CR)率为 5 6 .1 % (2 3/ 4 1 ) ,总有效率为 80 .5 % (33/ 4 1 )。与常规方案 (DA、VDL P)诱导疗效相比有显著性差异 (P<0 .0 1 )。其中 L y+ AML 的 CR率为 5 8.3% ,总有效率为 79.2 % ;My+ AL L 的 CR率为 5 2 .9% ,总有效率为 82 .4 %。复治性 L y+ AML / My+ AL L 总有效率为 72 .7% (8/ 1 1 )。两种方案的骨髓抑制明显 ,毒副作用能够耐受。结论 :L y+ AML 和 My+ AL L不宜采用常规诱导缓解方案 ,TA和 TACOP方案宜作为此类患者的首选治疗方案     

环孢素A联合化疗方案治疗复发、难治性白血病

目的：探讨用环孢素A联合化疗方案治疗复发、难治性白血病的疗效。方法：18例急性非淋巴细胞白血病患者，采用CsA+DA方案治疗6例，CsA+MAE方案治疗12例。结果：CsA+DA组完全缓解率为33％。CsA+MAE组完全缓解率为50％。两组病例的有效率及完全缓解率经统计学分析没有显著差异，P值均大于0.5。结论：环孢素能够逆转难治性白血病的耐药性，在难治性白血病的治疗中有一定作用，但缓解后的治疗需要引起重视。     

环孢素A联合DA方案治疗难治性急性髓细胞白血病临床观察

目的：观察环孢素A联合DA方案治疗难治性急性髓细胞白血病的疗效。方法：用环孢素A(CsA)联合阿糖胞苷(Ara-C)、柔红霉素(DNR)治疗19例难治复发性急性髓性白血病。结果：完全缓解8例,部分缓解6例,无效3例,2例未能观察疗效。完全缓解率47．0％,总有效率82．4％。19例化疗后均有血象、骨髓象受抑制,8例化疗后发生严重感染。均无心、肺、肝、肾等严重并发症和过敏反应。CR的8例中1例失访。1例CR后4个月骨髓再次复发,治疗无效死亡,6例仍完全缓解,CR期2个月～18个月。结论：CsA联合化疗方案可以提高难治性AML的CR率。     

重组白介素11联合HAM方案治疗急性髓性白血病

[目的]研究重组白介素11(rhIL-11)联合HAM方案化疗对急性髓性白血病的疗效.[方法]将急性髓性白血病患者分成3组,一组行HAM(三尖杉酯碱、阿糖胞苷、米托蒽醌)方案化疗2个疗程,一组行DA(柔红霉素、阿糖胞苷)方案化疗2个疗程,一组在HAM方案化疗的基础上加用rhIL-11治疗2个疗程,观察血象三系细胞的动态变化、血象最低值及恢复时间;观察骨髓幼稚细胞的比例,判定疗效(完全缓解、部分缓解及未缓解);观察各组出血情况及所需输注血小板的患者比例.[结果]HAM化疗组疗效优于DA化疗组;重组白介素11组与另两组比较,血象恢复更快;血小板最低值更高;出血发生率更低;所需输注血小板的患者比例更少;rhIL-11组疗效与单用HAM方案化疗的疗效相仿.[结论]rhIL-11联合HAM方案化疗能有效治疗急性髓性白血病,rhIL-11的主要作用是升高血小板.     

Combined chemotherapy with m-amsacrine in high-risk patients with acute non-lymphocytic leukemia

Thirteen patients (7 male, 9 female) aged 22-71 years (means = 55 years) with acute non-lymphocytic leukemia and contraindications for anthracyclin therapy were treated with combined chemotherapy using m-amsacrine primarily or in relapse. The main reasons for avoiding cardiotoxic substances were overt cardiac insufficiency and former administration of daunorubicin with more than 540 mg/m2 body surface area. Amsacrine was combined with 6-thioguanine, VP 16-213 and cytosine arabinoside in conventional or high dosage. Eight out of 13 patients (62%) achieved complete remission after one or two courses of chemotherapy. One patient showed partial remission and could be brought into complete remission with another chemotherapy using high-dose ara-C and mitoxantrone. Three patients died in aplasia after chemotherapy and 1 other patient had to be regarded as a complete non-responder. Remission duration and survival time for the 8 successfully-treated patients so far is 1-12 months; however, medians have not yet been reached, since only one of the eight patients relapsed after 6 months of complete remission. These data indicate a high efficacy of m-amsacrine in combined chemotherapy for acute non-lymphocytic leukemia in high-risk patients with contraindications for anthracyclins.     

VP 16-213 in the treatment of acute leukemia in childhood

Effectiveness and side effects of VP 16-213, a semi-synthetic podophyllotoxin, on acute leukemia and histiocytic medullary reticulosis in childhood was tested. Four cases of refractory acute lymphocytic leukemia, five of acute non-lymphocytic leukemia-one induction failure and 4 in remission--and a case of histiocytic medullary reticulosis were treated with a combination of VP 16-213 (Days 1-5), cytosine arabinoside (Days 1-5) and adriamycin (Day 6). None of the acute lymphocytic leukemia patients yielded a complete response; however, one of them later attained a partial response with modified intermittent administration of VP 16-213 and cytosine arabinoside. A patient with acute non-lymphocytic leukemia who had failed to attain initial remission, achieved a complete response after the second course of the treatment with increased dosages. In the four acute non-lymphocytic leukemia patients in remission, complete remission was maintained more than 4 a months. A case of histiocytic medullary reticulosis demonstrated partial response. The major toxic effects produced by this regimen were marked pancytopenia and vomiting. VP 16-213 appears to be effective for myelocytic and monocytic malignancies in childhood.     

Childhood acute lymphocytic leukemia: study VIII.

This controlled study of children with ALL was designed to test the efficacy and toxicity of one-, two-, three- and four-drug therapy during remission and whether more aggressive therapy in the first eight weeks prolongs remission in patients with features associated with a particularly poor prognosis. After inducing remission with prednisone, vincristine and asparaginase, patients received cranial irradiation and IT methotrexate and were randomized to receive: 1--methotrexate alone; 2--methotrexate plus mercaptopurine; 3--same as in group 2 plus cyclophosphamide; and 4--same as in group 3 plus arabinosyl cytosine. Patients with CNS leukemia at diagnosis received IT methotrexate weekly during the induction period and a higher dose of CNS irradiation. Patients with anterior mediastinal enlargement at diagnosis received radiotherapy to the mass during the induction period. Patients who failed to attain bone marrow remission after four weeks of therapy were given daunorubicin and prednisone for 2--4 additional weeks. Of the 282 patients entering this study between January 1972 and November 1975, 268 (95%) attained complete remission and 228 (85%) were randomized to receive continuation chemotherapy with 1, 2, 3 or 4 drugs. In Group 1 (methotrexate alone), 14 of 20 patients relapsed and 9 developed leukoencephalopathy without antecedent CNS leukemia apparently due to higher doses of intravenous methotrexate; in Groups 2, 3 and 4 the results were equivalent, but without leukoencephalopathy in initial CR. The addition of cyclophosphamide and arabinosyl cytosine increased toxicity and complications without demonstrably increasing the leukemocidal effect. In the 40 patients given additional early therapy, the modalties employed in this study did not prolong remission.     

国产去甲氧柔红霉素和进口柔红霉素治疗急性白血病的疗效及安全性比较

 目的　对比国产去甲氧柔红霉素（IDA）和进口柔红霉素（DNR）在急性白血病治疗中的的疗效和安全性。方法　68例急性白血病患者随机分为IDA组35 例和DNR组33例。IDA组35 例患者中,急性髓细胞白血病用IA（国产IDA、阿糖胞苷）方案治疗,急性淋巴细胞白血病用VICLP（长春新碱、国产IDA、环磷酰胺、左旋门氡酰氨酶和泼尼松）方案治疗;同期DNR组33例患者中,急性髓细胞白血病用DA（进口DNR、阿糖胞苷）方案治疗,急性淋巴细胞白血病用VDCLP（长春新碱、进口DNR、环磷酰胺、左旋门氡酰氨酶和泼尼松）方案治疗。结果　IDA组完全缓解21例,部分缓解5例,总缓解率74.2 %（26／35）,DNR组完全缓解16例,部分缓解4例,总缓解率62.3 %（20／33）,两组总缓解率差异无统计学意义（χ2＝0.89,P＝0.50）;IDA组缓解时间超过一年者占完全缓解患者的80 %（17／21）,而DNR组为37.5 %（6／16）,两组差异有统计学意义（χ2＝5.56,P＝0.02）。结论　国产IDA治疗急性白血病缓解率及长期缓解率均优于进口DNR,是疗效确切、安全可靠的抗白血病药物。     

Clinical effect and pharmacokinetics of intermediate dose Ara-C therapy in a patient with acute non-lymphocytic leukemia with two CNS recurrences

A case of two repeated CNS recurrences of acute non-lymphocytic leukemia (M2) was treated with intermediate dose Ara-C therapy and achieved 2 complete remissions. The clinical effect and pharmacokinetics of intermediate dose Ara-C therapy in this patient were discussed. A 55-year-old male with acute non-lymphocytic leukemia (M2) achieved complete remission by combination chemotherapy of Behenoyl-ara-C, Daunorubicin, 6-Mercaptopurine and Prednisolone in July, 1985. He subsequently received consolidation and intensification therapy with periodical intrathecal injection of Methotrexate (MTX), but 13 months later he developed his first CNS recurrence which was resistant to the intrathecal administration of Ara-C and MTX. As he also relapsed systemically, Ara-C was administered in intermediate dose (1 g/m2 every 12 hrs for 5 days) and he achieved complete remission both in the CNS and systemic manifestations. Six months later he was diagnosed as having a second CNS recurrence and another systemic relapse. Intermediate dose Ara-C was administered again, and he achieved complete remission in the CNS and partial remission in systemic manifestations. Pharmacokinetic study revealed high peaks of Ara-C concentration in plasma (6.2 microM immediately after the end of the infusion) and high degree of its penetration into the CNS (5.6 microM at 3 hr after the end of the infusion) suggesting the effective and perhaps a uniform level of Ara-C is achieved throughout the CNS by this therapy. In 3 other patients without CNS involvement 0.88 +/- 0.44 microM of Ara-C, which is enough concentrations for its cytostatic effect, was detected at 3 hr after the end of infusion, suggesting the efficacy of the therapy for CNS prophylaxis. In this case the relapse occurred after repeated administration of antileukemic drugs, including Behenoyl-ara-C, an analog of Ara-C, and was resistant to the intrathecal administration of Ara-C. These findings suggest that intermediate dose Ara-C therapy was effective to overcome a resistance to antileukemic drugs, including Ara-C, and also, in some cases, more effective than intrathecal injection of antileukemic drugs for the treatment of CNS leukemia.     

含三氧化二砷方案治疗复发难治性非M3急性非淋巴细胞白血病45例疗效观察

目的:回顾性分析三氧化二砷联合LD-HA治疗难治性非M3急性非淋巴细胞白血病的疗效及不良反应。方法:应用三氧化二砷(0.15mg·kg﹣1·d﹣1,d1~5,d8~12)+ LD-HA(高三尖杉酯碱1mg/d,阿糖胞苷25mg,2次/d,d1~14治疗。ANC（中性粒细胞计数）<1.0×109／L时使用粒细胞集落刺激因子(G-CSF)5μg·kg﹣1·d﹣1,直至ANC>1.0×109／L。结果:一个疗程的总有效率达91.1％,其中CR 32例(71.1％),PR 9例(20％),NR 4例(8.9％)。不良反应轻微。结论:三氧化二砷联合LD-HA治疗难治性非M3急性非淋巴细胞白血病安全有效。     

Evaluation of 58 patients with acute leukemia]

We made a retrospective study of 44 patients with acute non-lymphocytic leukemia (ANLL) and 14 patients with acute lymphocytic leukemia (ALL) admitted to our hospital from September 1984 to May 1991. The complete remission (CR) rate of ANLL was 90.9%, against 85.7% for ALL. The 5-year survival of ANLL was 50.7%, and that of ANLL under age 60 years was 70.3%. The 2-year median survival of ALL was 35.1%. These results were obtained with response-oriented individualized therapy, and intensive chemotherapy with a view to eradication of residual leukemic cells. Eight elderly patients with ANLL were treated with cytosine arabinoside in low doses. Complete remission was achieved in 6 patients, but these cases relapsed. These treatments should be reconsidered for long CR duration. Our schedules of response-oriented individualized therapy were too flexible to apply at another institute so they should be arranged for general application.     

全反式维甲酸、化疗及白血康序贯治疗急性早幼粒细胞白血病疗效观察

目的:观察全反式维甲酸、联合化疗及白血康序贯治疗急性早幼粒细胞白血病的疗效和副作用。方法:对经诱导达完全缓解的41例急性早幼粒细胞白血病(APL)患者,停药4周后采用HA、DA或MA方案巩固治疗,间歇4周后,给予口服白血康胶囊28天;再间歇4周给予口服全反式维甲酸28天,为1个周期。间歇4周再重复以上周期。完全缓解后第1年每疗程间隔1个月,第2年每疗程间隔2个月,第3年3个月。结果:45例APL患者诱导缓解后41例达完全缓解,40例参与序贯治疗者,3年和5年DFS和OS均为96.7%,毒副作用轻。结论:应用全反式维甲酸、联合化疗及白血康序贯治疗急性早幼粒细胞白血病,3年和5年DFS和OS均明显提高,这一新的联合治疗方案有可能使APL成为通过非骨髓移植手段获得治愈的白血病。     

A pilot study of carboplatin augmentation therapy for patients with poor risk acute non-lymphocytic leukemia.

Eleven patients with acute non-lymphocytic leukemia and persistent leukemia on a bone marrow done 6 days after the start of standard induction chemotherapy with daunorubicin and cytosine arabinoside were given augmentation chemotherapy with carboplatin as a continuous intravenous infusion over 3 days. Nine of the 11 patients (82%) entered complete remission. The hematologic and non-hematologic toxicities encountered by these patients were similar to those seen after conventional therapy alone with the exception of peripheral neuropathy in one patient. Of the two induction failures, one patient died of treatment-related toxicity and one patient had resistant leukemia.