急性非淋巴细胞白血病缓解后应用大剂量阿糖胞苷巩固强化治疗的观察

对24例急性非淋巴细胞白血病缓解后采用 HD—Ara—C强化治疗,结果中数缓解期为15个月,中数生存期20个月,有14例(58.3%)仍处于 CR。其中20%的患者无病生存期超过40个月。     

小剂量阿糖胞苷治疗急性非淋巴细胞白血病的临床观察

本资料对经过周围血象及骨髓象检查确诊,且伴有明显出血、感染、多系统严重并发症而不能耐受强烈联合化疗的急性非淋巴细胞白血病病人,试用小剂量阿糖胞苷(Ara-c)治疗。(Afa-c,15mg,肌肉注射,每天一次),21天为一疗程,未缓解者,休息7~14天后重复应用,其间定期复查血象。结果:13例中完全缓解(CR)3例,占23.08%,部分缓解(PR)6例,占46.16%,有效率为69.24%。本资料提示该治疗方法对急性原始粒细胞白血病(M_1、M_2型)疗效较佳,P<0.01;对于经过联合化疗后未缓解的病人仍然有效,并对其作用机理做了讨论。     

急性非淋巴细胞白血病治疗相关因素分析

目的 :初治成人急性非淋巴细胞白血病 (AL L )治疗缓解率相关因素分析。方法 :用 t检验和卡方检验对各种因素进行统计学处理。结果 :初诊时外周血白细胞 (WBC) <2 0× 10 9/ L组和 WBC 2 0× 10 9/ L～ 5 0× 10 9/ L组分别与 WBC >5 0× 10 9/ L组比较 ,缓解率均有显著性差异 (P<0 .0 1和 P<0 .0 5 ) ;根据初诊时血清中乳酸脱氢酶 (L DH )值 ,将 CR组与 PR组、CR组与 NR组两两比较 ,均有显著性差异 (P<0 .0 1)。低年龄组 (16岁～ 5 5岁 )治疗缓解率 (6 7.1% )大于高年龄组 (>5 5岁 )缓解率 (6 0 .4% ) ;初诊时外周血及骨髓 (BM)中原始 +(早 )幼稚细胞比例数低者治疗缓解率高于比例数高者治疗缓解率 ,但均无显著性差异 (P>0 .0 5 )。结论 :患者年龄、初诊时 WBC、L DH、外周血及 BM中原始 +(早 )幼稚细胞比例数均为 ANL L治疗缓解率的相关因素。     

HDA方案治疗急性非淋巴细胞白血病临床研究

１９８５年～１９９３年收治急性非淋巴细胞白血病（ＡＮＬＬ）２１８例，用ＨＤＡ方案治疗７２例，ＣＲ率为７６．３８％、ＨＡ方案治疗７８例，ＣＲ率４４．８７％、ＤＡ方案治疗６８例，ＣＲ率４８．８５％，ＨＤＡ组与ＨＡ、ＤＡ组疗效差异显著（Ｐ＜０．００５），ＣＲ后必须坚持长期多疗程的强化治疗才能延长生存期、提高治愈率。     

HAE方案治疗难治性急性非淋巴细胞白血病

蒽环类药物联合阿糖胞苷治疗急性非淋巴细胞白血病 (急非淋 ,ANLL )可使将近 70 %的患者获得完全缓解 ,但仍有 30 %左右的患者未能达到缓解 ,这部分病例的治疗成为提高急非淋疗效的关键。大剂量阿糖胞苷对部分耐药病例有效 ,但其毒副作用较大 ,应用受到限制。高三尖杉酯碱与蒽环类药物无论结构或作用机理均有不同 ,为探讨高三尖杉酯碱对难治病例的疗效 ,我们自 1 992年 5月至 1 998年5月间对住院病人采用 HAE方案治疗难治性急非淋 2 6例 ,报告如下。1　资料与方法1 .1　病例选择1 .1 .1　一般资料　所有病例均符合 FAB急非淋诊断标准 ,…     

较大剂量DA加细胞诱导剂维甲酸治疗急性非淋巴细胞白血病的体会

用较大剂量柔红霉素和阿糖胞苷(DA)加细胞诱导剂全反式维甲酸(RA)联合治疗急性非淋巴细胞白血病14例,经过两个疗程完全缓解13例,死亡1例,所需时间30±8天,既或是高白细胞白血病也能缓解存活,缓解时间尚在观察之中。对较大剂量DA加RA治疗过程中造血系统的变化及药物毒性反应、并发症做了说明。     

MA方案治疗成人急性非淋巴细胞白血病的疗效分析

[目的]评价米托蒽醌、阿糖胞苷(MA)方案作诱导治疗成人急性非淋巴细胞白血病(ANLL)初治患者的疗效。[方法]对诊断明确者分为M1、M2型及M4、M5型，各型内部随机分为MA组和柔红霉素、阿糖胞苷(DA)组，1、2个疗程后，分别评价疗效。[结果]M1、M2型中，MA、DA组1个疗程后CR分别为70．0％、63.6％，2个疗程总CR分别为75．0％、68．2％，总有效率分别为85.0％、81．8％，两组间均无显著性差异。M4、M5型中，MA、DA组1个疗程CR分别为68．8％、33．3％，两者有显著差异，而2个疗程总CR分别为68．8％、46。7％，总有效率分别为81．3％、60．0%，两组问无显著性差异。MA组骨髓抑制作用强于传统DA组。[结论]MA方案可作为成人ANLL（M4、M5)首选诱导治疗方案。     

原发性骨髓纤维化转化为急性淋巴细胞白血病1例

1病例介绍 患者,男,41岁.于1999年3月发现脾脏进行性肿大,诊断为原发性骨髓纤维化,未进行治疗.     

急性淋巴细胞白血病患儿在诱导缓解期的营养不良状况调查

  目的  了解儿童急性淋巴细胞白血病（acute lymphoblastic leukemia,ALL）诱导缓解期的营养不良状况;分析ALL诱导缓解期间疾病本身、治疗、并发症对患儿营养不良状况的影响。  方法  分析2016年12月至2017年12月贵州医科大学附属医院儿童血液肿瘤科行诱导缓解方案的ALL患儿病历资料,选取40例患儿作为研究对象,收集患儿基本信息,分别于诱导缓解治疗的第1天、第15天、第33天监测患儿的身高、体质量、计算体质指数（boby mass index,BMI）,并同时检测血清白蛋白、血清前白蛋白等实验室检查结果,采用SPSS 23.0软件进行数据分析。  结果  40例ALL患儿中,诱导缓解治疗第1天存在营养不良16例（40.0%）,治疗第15天14例（37.0%）,第33天14例（37.0%）;在营养不良的患儿中,诱导缓解治疗第1天发生中重度营养不良4例（25.0%）,第15天9例（64.3%）,第33天12例（85.7%）;第1天和第33天比较差异具有统计学意义（P＜0.017）。在诱导缓解期监测BMI,第1天BMI为15.98±2.17、第15天为15.65±2.20、第33天为15.66±1.92,三者间比较差异无统计学意义（P=0.730）。对患儿营养状况相关因素的单因素进行分析,感染、消化系统受累、血清白蛋白水平与营养不良的发生有关,同时对这3个因素进行多因素分析,感染和血清白蛋白水平与营养不良的发生间差异具有统计学意义（P＜0.05）。  结论  在诱导缓解期间部分ALL患儿营养不良程度加重,感染是ALL患儿发生营养不良的高危因素,血清白蛋白水平下降可提示营养不良的发生,对患儿进行动态的营养状况监测十分必要。      

MHA方案治疗急性非淋巴细胞白血病疗效观察

我院1998年1月-2000年11月，用国产米托蒽醌（MTZ）、三尖杉醌咸、阿糖胞苷组成的联合化疗方案，治疗成人急性非淋巴细胞白血病（ANLL）30例，取得较满意疗效，现报告如下。     

急性非淋巴细胞性白血病骨髓白血病细胞B7分子和HLA-DR的检测

目的:检测急性非淋巴细胞性白血病患者骨髓白血病细胞表面MHC-Ⅱ分子和B7共刺激分子的表达情况。方法:采集分离34例初诊或复发的急性非淋巴细胞性白血病患者骨髓细胞,其骨髓中原始细胞比例>70%。应用结合有荧光PE或FITC的单克隆抗体标记骨髓细胞,用流式细胞仪进行HLA-DR、CD80(B7-1)和CD86(B7-2)免疫标记检测。结果:34例患者除M3型外,HLA-DR抗原的表达均较高,其中M2型最高,为(80.14±9.07)%;CD80阳性率均很低,最高为M1型,为(6.34±1.12)%,其余均在1%～4%之间;CD86的表达高于CD80,最高为M5型,为(32.60±4.18)%,最低为M6型,为(12.34±2.36)%。结论:急性非淋巴细胞性白血病细胞表面共刺激分子表达以CD80减低或缺乏为主。     

格列卫联合HA方案治疗20例Ph染色体阳性急性白血病

背景与目的:格列卫是2001年5月美国FDA批准用于临床挽救性治疗慢性粒细胞白血病(chronicmyelocyticleukemia,CML)的基因靶向药物,单药治疗由CML转变来的Ph染色体阳性急性白血病的疗效较低。体外实验显示,格列卫与多种化疗药物具有协同作用,但有关其临床联合应用的报道极少。本研究目的在于探讨应用格列卫联合HA方案治疗Ph染色体阳性急性白血病(Ph+-AL)的疗效及其不良反应。方法:20例(男性16例,女性4例,中位年龄43岁)Ph+-AL患者的外周血或骨髓中原始细胞均>30%,Ph染色体或荧光原位杂交(FISH)双标双融合bcr/abl异位探针检查的阳性率均≥90%,其中由CML转变的Ph+急性非淋巴细胞白血病(Ph+-ANLL)17例、Ph+-ALL1例,原发性Ph+-ALL2例。表现复杂核型15例,t(9;22)5例。确诊至本治疗前的中位时间为4个月,其中18例曾用多种化疗方案2～4疗程治疗无效。本次治疗,20例均口服格列卫0.3～0.6g/d,疗程中位数2.5(1～6.5)月;Ph+-ANLL患者联合HA(HHT1～2mg/d,持续静脉滴注6～24h,Ara-C30～50mg/d,10～14天/月);Ph+-ALL患者联合HAOP或DVP方案(HA剂量同前;DNR40mg/d,1～3天,持续静脉滴注;VCR每周2mg,静脉推注,强的松60～80mg/d,1～14天),疗程中位数2个。发生骨髓抑制者减量或停用格列卫,同时加用G-CSF;格列卫的骨髓细胞学和遗     

Allogeneic and autologous bone marrow transplantation for acute nonlymphocytic leukemia

Current results show that 50% of young patients with ANLL who undergo allogeneic BMT experience prolonged DFS and may be cured. Encouraging results with high-dose chemo/radiotherapy and autologous BMT are likewise being reported. In addition, some studies using intensive postremission treatment without BMT have shown results comparable to many transplant series. As better ways of preventing GVHD are found, the morbidity and mortality of allogeneic BMT should be reduced and the benefits of transplantation for curing patients with ANLL should be increased. However, the applicability of allogeneic BMT will remain limited due to the availability of compatible donors whether related or unrelated. Further studies are needed in the use of postremission intensive therapy with and without autologous bone marrow support. However, results to date should engender the same degree of enthusiastic optimism that followed the early reports of improved outcome with allogeneic BMT when applied to first remission patients.     

自体骨髓混合HLA半相合异基因骨髓移植治疗急性白血病

 目的 观察自体骨髓混合HLA半相合异基因骨髓移植治疗急性白血病的疗效及移植相关并发症。方法 对7例急性白血病患者先实施经液体培养（与IL-2共孵育,1 000 U／ml骨髓血）和微波照射法体外净化的自体骨髓移植,2 ~ 5 d后输注一定量HLA半相合同胞兄妹的异基因骨髓。结果 中性粒细胞和血小板恢复的平均时间为+27 d和+29 d,3例发生Ⅲ~ Ⅳ度急性移植物抗宿主病（aGVHD）并死亡,其中1例并发肝静脉闭塞症。另外4例发生Ⅱ度aGVHD,HLA基因检测和（或）性染色体分析均呈混合嵌合现象并持续半年左右,这4例长期无病存活时间分别117,106,101,85个月,5年无病生存4例。结论 混合骨髓移植具有疗效好、复发率低、患者可获长期生存及相对安全可行等特点,但仍有必要进一步优化同／异基因骨髓细胞的比例及植入时机,并采取一定程度的移植物抗宿主病（GVHD）预防措施。     

Total body irradiation as preparation for bone marrow transplantation in treatment of acute leukemia and aplastic anemia

In an attempt to improve survival while minimizing toxicity, many bone marrow transplant centers are now studying the use of cytoreduction regimens with an increased amount of radiation in single-dose or fractionated-exposure schedules for patients with leukemia and aplastic anemia. In order to review the current results, the literature prior to September, 1982 was surveyed and data were tabulated for each transplant center regarding the number of patients receiving transplants, diagnoses, cytoreduction regimen, clinical status, remission duration, relapse rate, causes of death and incidence of interstitial pneumonia. The incidence and severity of cataracts, growth failure, hypothyroidism and second malignant neoplasms were noted, and the data obtained from the literature search were updated and expanded by telephone questionnaire when possible. Marked variation in the technique of transplantation was found among the participating institutions, making it difficult to determine the contribution of the various TBI doses, dose rates and fractionation schedules to the efficacy and toxicity of the combined regimen. In order to define the risk-benefit ratio of the various TBI regimens more clearly, prospective controlled, randomized studies will be required.     

Osteosarcoma after bone marrow transplantation for acute lymphoblastic leukemia

A male patient initially diagnosed with acute lymphoblastic leukemia at age 9 years received chemotherapy (total body irradiation, 12 Gy) followed by allogeneic bone marrow transplantation. Since then, he had been in complete remission. Three years after the bone marrow transplantation, he complained of increasing pain in the right knee. Radiological and histological examinations led to a diagnosis of conventional osteosarcoma. We performed intensive chemotherapy and wide local excision of the osteosarcoma. Intensive chemotherapy was accomplished as planned, although recovery from myelosuppression was delayed during some cycles. Polymerase chain reaction-single-strand conformation polymorphism analysis revealed a p53 gene mutation in exon 7 in the tumor cells, but not in skin or blood cells. This is an extremely rare case of osteosarcoma after bone marrow transplantation.     

Specific chromosomal changes in patients with acute nonlymphocytic leukemia from India

We analysed forty consecutive patients with acute nonlymphocytic leukemia (ANLL) using methotrexate cell synchronization and 24 h-unstimulated cultures of bone marrow cells to determine the incidence of chromosomal aberrations and the association of specific anomalies with FAB morphological subtypes, in an Indian population. All patients demonstrated an abnormal karyotypic pattern. The specific chromosomal changes viz., t(9;22), t(8;21), t(15;17), t/del(11q), 12p- were found in M 1(3/5), M2(8/15), M3(8/8), M4(1/1) M5(2/4) and M2Ba(1/1) (M2 with Basophilia) patients. Abnormalities of 11q were also noted in two M2 patients showing monocytic involvement. A translocation involving chromosomes 6 and 9 was seen in one patient with M1 and two patients with M2. An inv(16) was observed in M1 (one case), M2 (two cases) and M6 (one case). A del(16) was noted in an M4 case. Although t(9;22) is frequently associated with M1 patients, it was also detected in M2 (two patients) and M4 (one patient). Among all the FAB specific anomalies described above, t(8;21) and t(15;17) were observed only in M2 and M3 patients, respectively. Interestingly, one M2 patient had two independent clones, one with t(8;21) and t(9;11). Deletion or translocation involving 11q was found in a Ph positive M4 patient. New structural rearrangements such as t(1;7) (q32;q36) in association with t(8;21), and t(14;22) (q32;q11) in association with del(11)(q23) were detected in a M2 and a M5 patient, respectively. In conclusion, our studies have revealed that the incidence of FAB specific abnormalities viz., t(8;21); t(15;17), t(9;22), t/del(11q) and also other recurrent anomalies viz., -7/7q-, +8 is much higher in our patients, as compared with other countries. This difference may be attributed to the influence of differential environmental exposure to unknown carcinogenic agents.     

Etoposide and teniposide in the treatment of acute leukemia

Etoposide and teniposide are semi-synthetic glucoside derivatives of podophyilotoxin with a documented antitumour activity in various types of malignant diseases. It was an early observation that these epiphodophyllotoxins were efficacious in hematological malignancies such as lymphomas and leukernias. In this report the clinical evidence supporting the activity of etoposide and teniposide in acute lymphoblastic (ALL) and nonlymphoblastic leukemia (ANLL) is reviewed. Unlike podophyilotoxin, etoposide and teniposide do not appear to affect microtubular function nor arrest cells in mitosis. These epiphodophyllotoxins, like other DNA intercalating agents, have topoisomerase II as their target. Most studies with etoposide have been performed in ANLL and with teniposide in ALL. This choice seems to be rather arbitrary and is better explained by traditional reasons than actual study results. The data in acute leukemias are partly flawed by the absence of certain prospective comparative trials. However, the current information on etoposide clearly shows that this agent has substantial activity in ANLL and may well be incorporated into front-line regimens and the same is true for teniposide in the treatment of ALL. Nevertheless, based on available literature, there are no convincing data to the author’s mind to support that one of these agents is superior to the other in the treatment of acute leukemias.     

Phase I study of alvocidib plus cytarabine/mitoxantrone or cytarabine/daunorubicin for acute myeloid leukemia in Japan

Therapeutic improvements are needed for patients with acute myeloid leukemia (AML), particularly those who have relapsed or who have treatment‐refractory (R/R) AML or newly diagnosed patients with poor prognostic factors. Alvocidib (DSP‐2033), a potent cyclin‐dependent kinase 9 inhibitor, has previously demonstrated promising clinical activity for the treatment of AML. In this multicenter, open‐label, uncontrolled, 3 + 3 phase I study, we investigated the safety and tolerability of alvocidib administered in combination with either cytarabine and mitoxantrone (ACM) for R/R AML or cytarabine/daunorubicin (A + 7 + 3) for newly diagnosed AML. Alvocidib was administered to all patients as a 30‐min intravenous (i.v.) bolus (30 mg/m²/d), followed by a continuous i.v. infusion over 4 h on days 1–3 (60 mg/m²/d). A total of 10 patients were enrolled: six received ACM (at two dose levels of cytarabine and mitoxantrone) and four received A + 7 + 3. Alvocidib was tolerated and no dose‐limiting toxicities were observed. All patients experienced adverse events, of which diarrhea was the most frequent (100%); hematologic events were also common. Alvocidib concentration peaked at the end of dosing (4.5 h after start of administration), plasma accumulation after repeated dosing was minimal and urinary excretion was negligible. The rate of complete remission/complete remission with incomplete hematologic recovery was 66.7% with the ACM regimen in R/R AML, including four complete remission (median duration 13.6 months), and 75% (three complete remission) with the A + 7 + 3 regimen. Further development of alvocidib in hematologic malignancies is warranted. The trial is registered with Clinicaltrials.gov, {"type":"clinical-trial","attrs":{"text":"NCT03563560","term_id":"NCT03563560"}}NCT03563560.     

A critical comparison of allogeneic bone marrow transplantation and conventional chemotherapy as treatment for acute nonlymphocytic leukemia

Published data from two centers conducting bone marrow transplantation on patients with acute nonlymphocytic leukemia in first remission were pooled and compared with results from an Eastern Cooperative Oncology Group (ECOG) study in which patients were treated with conventional chemotherapy. A series of adjustments were made to the ECOG sample to account for selection factors that restrict access of patients to transplantation. The transplant sample exhibits considerably higher disease-free survival when compared to the adjusted ECOG series (53% versus 21% at three years). The transplant series is somewhat younger than the ECOG series (median, 24 years versus 28 years). The impact of age on the disease-free survival results is difficult to assess because of the relatively small samples in the different age groups. However, by defining a suitable control group, methodology for making a critical comparison between the two modalities is presented which, if applied to larger samples of patients, should help to resolve the issue. In the absence of data from a large, prospective randomized study, a critical retrospective comparison of available data is essential in the assessment of treatment options.