CAG预激方案联合左旋门冬酰胺酶和泼尼松诱导治疗复发难治性前体淋巴细胞白血病/淋巴瘤

 目的　寻找复发难治性前体淋巴细胞白血病／淋巴瘤诱导缓解的有效方法。方法　以CAG预激方案联合左旋门冬酰胺酶（L-Asp）和泼尼松（PDN）诱导治疗6例复发难治性前体淋巴细胞白血病／淋巴瘤和1例急性杂合细胞白血病。结果　6例患者完全缓解（CR）,1例部分缓解（PR）,总有效率100 %（7／7）,CR率85.7 %（6／7）。患者不良反应轻,均可耐受。结论　CAG联合L-Asp和PDN是复发难治性前体淋巴细胞白血病／淋巴瘤值得尝试的诱导化疗方案。     

成人早期前体T急性淋巴细胞白血病（ETP-ALL）与非ETP-ALL的临床特点对比

目的:对比分析成人早期前体T急性淋巴细胞白血病（ETP-ALL）与非早期前体T急性淋巴细胞白血病（non-ETP-ALL）的临床特点。方法:回顾性分析于我科系统诊治的成人T细胞急性淋巴细胞白血病（T-ALL）患者19例，其中ETP-ALL 6例，non-ETP-ALL 13例，对比两组患者临床基本状况、血液及骨髓检测结果、免疫分型结果及诱导治疗后缓解情况。结果:ETP-ALL组患者白细胞水平显著低于non-ETP-ALL组患者，血小板水平显著高于non-ETP-AL组患者，主要见于pro-T-ALL，首次诱导治疗后完全缓解或接近完全缓解（CR/CRi）率显著低于后者。结论:ETP-ALL患者具有较独特的临床特点，对常规诱导治疗反应差，有必要积极探索新的治疗方法和药物。     

环孢素治疗皮下脂膜炎样T细胞淋巴瘤一例并文献复习

目的 探讨环孢素对初发、复发难治皮下脂膜炎样T细胞淋巴瘤(SPTCL)的治疗效果.方法 回顾性分析中日友好医院收治的1例经环孢素治疗后长期生存SPTCL患者的病例资料,并进行文献复习.结果 该SPTCL患者初始经环孢素治疗迅速获治疗反应并完全缓解(CR).后淋巴瘤间断复发,使用环孢素均可迅速缓解,停用后CR持续1～6年.再次复发后使用环孢素疗效欠佳,予CHOP样方案化疗获得部分缓解,再用环孢素获得CR,至截稿时生存22年.结论 环孢素对初发、复发难治SPTCL均具良好疗效.     

IA联合CAG方案序贯诱导缓解治疗原发性初治急性髓系白血病

 目的 观察IA[去甲氧柔红霉素（IDA）+阿糖胞苷（Ara-C）]联合CAG方案[粒细胞集落刺激因子（G-CSF）+Ara-C+阿克拉霉素（ACLA）]序贯诱导缓解治疗原发初治急性髓系白血病（AML）的疗效和安全性。方法 患者选用IA联合CAG方案序贯诱导缓解治疗。治疗过程中,随访患者临床表现、血常规、血生化和骨髓细胞学检查指标。结果 14例患者接受本方案治疗,其中男性9例,女性5例,中位年龄37岁（15 ~ 64岁）。CR 10例,PR 2例,NR 2例。CR率71.4 %,总反应率（CR+PR）85.7 %。达到CR中位时间为距CAG方案治疗结束第15（14 ~ 29）天。最常见的毒副反应为骨髓抑制,其次为感染,以肺部感染最常见（发生率42.8 %）。结论 IA联合CAG方案序贯诱导缓解治疗原发性初治AML有效且安全。     

CAG方案治疗老年急性髓细胞白血病的临床观察

 目的 观察CAG方案对老年急性髓细胞白血病（AML）的疗效。方法 老年初治AML患者25例,以CAG方案进行诱导缓解化疗,观察有效率和副作用。结果 CR率48 %,PR率12 %,总有效率60 %;结论 CAG方案可作为初治老年AML的有效方案。     

6例皮下脂膜炎样T细胞淋巴瘤临床病理特征及治疗分析

观察皮下脂膜炎样T细胞淋巴瘤（SPTCL）的临床特点、病理及免疫表型,探讨其有效的治疗方法及预后因素。方法:回顾性分析6例SPTCL患者临床、病理特征及治疗疗效。结果:6例患者均表现为不同部位皮下结节和（或）硬结性红斑,伴或不伴淋巴结肿大。其中2例侵犯骨髓,2例EBV阳性,5例伴有发热。所有患者均有典型的病理学和免疫表型改变,肿瘤细胞浸润皮下小叶及脂肪组织,镜下淋巴瘤细胞花环状围绕单个脂肪细胞排列,中等或大细胞,染色质浓染。细胞表达T细胞标记物CD3及CD45RO,不表达B细胞标志物CD20及CD79a,1例CD56阳性,3例TIA-1阳性,4例GranzymeB阳性,3例初始治疗应用CHOP均效果差未达到持续缓解,应用含吉西他滨方案治疗初治和复发患者4例,3例完全缓解（CR）,1例部分缓解（PR）,均未出现严重血液学毒性。1例合并噬血细胞综合征（HPS）和EBV感染者死亡。结论:含吉西他滨的联合化疗方案是一种对初治及复发SPTCL均有效的治疗方法。伴HPS、合并EBV感染是其不良预后因素。      

自体外周血造血干细胞移植治疗T细胞淋巴瘤疗效分析

 【摘要】 目的 评价自体外周血造血干细胞移植（APBSCT）治疗T细胞淋巴瘤的临床疗效。方法 回顾性分析2006年9月至2011年12月于上海瑞金医院行APBSCT的T细胞淋巴瘤患者22例,包括T淋巴母细胞淋巴瘤6例,外周T细胞淋巴瘤（PTCL）16例（间变大细胞淋巴瘤8例,非特异性PTCL4例,皮下脂膜炎样T细胞淋巴瘤1例,鼻型NK／T细胞淋巴瘤2例,皮肤T细胞淋巴瘤1例）。所有病例均按WHO 2001年和WHO 2008年分类进行病理分型。预处理方案包括BEAM方案13例,ICE方案4例,CBV方案5例。采用1998年国际工作小组制定的非霍奇金淋巴瘤疗效评价标准评价疗效,根据患者移植前疾病状态和对化疗敏感性分为完全缓解（CR1）组和未达CR1组、敏感组和耐药组,并对临床治疗疗效以及移植前疾病状态与预后关系进行分析。结果 22例患者移植后中位随访13.1个月（1～60个月）,2年预期的无进展生存率为（67.6±11.0） %,总生存率为（71.1±11.1） %。移植后共6例出现疾病进展或复发,其中5例死亡。CR1和化疗敏感组无进展生存率分别为100 %和91.7 %,高于未达CR1组（42.6 %）和耐药组（19.0 %）,而且两组病例总生存也显著优于未达CR1组和耐药组。结论 T细胞淋巴瘤患者移植时疾病缓解状态和对化疗敏感性对移植疗效有显著影响,提示在化疗敏感阶段和（或）获得CR1后应早期行APBSCT治疗。     

CAG方案治疗老年急性髓细胞白血病临床观察

目的观察CAG方案治疗老年急性髓细胞白血病（AML）的临床疗效及安全性。方法16例老年AML患者均接受CAG方案治疗1～2疗程,CAG方案：阿柔比星（阿克拉霉素）每天6mg／m^2,静脉滴注,第1～8天;阿糖胞苷10mg／m^2,皮下注射,1次／12h,第1～14天;G—CSF每天200μg／m^2,皮下注射,第1～14天。结果16例患者中完全缓解（CR）9例．部分缓解（PR）2例,总有效率69％。除血象及骨髓象受抑制外,无严重感染及脏器损伤。结论CAG方案对老年AML治疗有确切疗效,且耐受良好.     

三种挽救化疗方案对初始诱导失败/复发AML患者的疗效及安全性分析

摘 要：［目的］探讨FLAG、CAG及MAC方案对初始诱导失败/复发AML患者疾病缓解率、生存时间及毒副作用的影响。［方法］ 150例诱导失败/复发AML患者,根据治疗方案不同分为FLAG组（50例）、CAG组（50例）及MAC组（50例）,比较三组患者疾病缓解率、中位无进展生存时间、中位总生存时间及毒副作用发生率。［结果］ MAC组患者完全缓解率高于FLAG、CAG组（P<0.05）;三组患者部分缓解率比较差异无统计学意义（P>0.05）;MAC组患者总体反应率显著高于FLAG组（P<0.05）。三组患者中位无进展生存时间比较差异无统计学意义（P>0.05）;MAC组患者中位总生存时间长于FLAG、CAG组（P<0.05）。三组患者肝功能损伤、肾功能损伤、腹泻及恶心呕吐发生率比较差异均无统计学意义（P>0.05）;CAG、MAC组患者Ⅰ～Ⅱ度继发感染发生率均显著高于FLAG组（P<0.05）;但三组患者Ⅲ～Ⅳ度继发感染发生率比较差异无统计学意义（P>0.05）。［结论］ 相较于FLAG和CAG方案,MAC方案治疗初始诱导失败/复发AML可有效提高疾病缓解率,延长总生存时间,且未增加严重毒副作用发生风险。     

TAE方案治疗难治性白血病18例

 目的　观察TAE方案治疗难治性白血病的疗效。方法　依托泊苷（VP16）联合阿糖胞苷（Ara-C）和吡柔比星（THP）治疗难治性白血病18例,其中2例用标准诱导方案2个疗程不缓解,10例第1次完全缓解（CR）后6个月内复发,3例第1次CR后6个月以上复发（晚期复发）,原诱导方案无效,3例为2次以上复发,所有患者均经过柔红霉素（DNR）或高三尖杉酯碱（HH）治疗。用药方法：VP16 100 mg静脉滴注连用3～5 d,Ara-C 100～200 mg静脉滴注连用5～7 d,THP 20～30 mg静脉滴注连用3 d,2个疗程后评价疗效。结果　第1个疗程后CR 4例,第2个疗程后CR 4例,总CR 8例（44.4 %）,部分缓解（PR）4例（22.2 %）,总有效率66.6 %。结论　TAE方案治疗难治性白血病疗效显著,值得临床推广应用。     

Low‐dose cytarabine and aclarubicin combined with granulocyte colony‐stimulating factor for the treatment of relapsed or primary refractory acute lymphocytic leukemia: a retrospective study of 25 Chinese patients

Despite improvements in treatment, the prognosis of relapsed or primary refractory acute lymphocytic leukemia (ALL) remains poor, and outcomes are worse in older adults with the short first complete remission (CR). Attainment of the second CR by salvage therapy would improve the survival of these patients and may enable them to undergo curative treatment with allogeneic hematopoietic stem cell transplantation. The fact that there are diverse salvage protocols for these adult patients but without a striking CR‐induction efficacy indicates that efforts are still needed to indentify new effective reinduction regimens. In this study, the CAG regimen (cytarabine, 10 mg/m² subcutaneously every 12 h on days 1–14; aclarubicin, 5–7 mg/m² intravenously daily on days 1–8; and concurrent granulocyte colony‐stimulating factor, 200 µg/m²/day subcutaneously) was administered to 25 patients with relapsed or refractory ALL, including 11 T‐cell ALL (T‐ALL) and 14 B‐cell (B‐ALL) patients (age range, 11–61 years; median age, 26 years), to assess its efficacy as a salvage therapy. One course of the CAG regimen resulted in an overall response [CR or partial remission (PR)] rate of 64%, a CR rate of 56% and generally mild adverse effects. An overall response was observed in all 11 T‐ALL patients (10 CR and 1 PR) and 35.7% of B‐ALL patients (p = 0.0009). The significant treatment potential of CAG regimen for relapsed or primary refractory ALL, especially for T‐ALL patients, described in this report would prepare them for a second CR to pursue longer survival. Copyright © 2013 John Wiley & Sons, Ltd.     

FLAG方案与CAG方案治疗复发、难治性急性髓系白血病的疗效比较

目的：评价并比较FLAG方案与CAG方案治疗复发、难治性急性髓系白血病（acute myeloid leukemi-a,AML）的疗效及安全性。方法：将2004年1月至2011年3月于我院接受化疗的复发、难治性AML患者74例,按治疗方案分成FLAG组和CAG组,对2组的疗效及不良反应进行分析比较。结果：FLAG组完全缓解率（CR）为61.5%,总有效率为76.9%;CAG组CR为35.4%,总有效率为50%,组间比较差异有显著性意义（P〈0.05）。原发难治AML、复发性AML、M1型、M2型、M5型及由骨髓增生异常综合征（myelody splastic syn-drome,MDS）转化而来的复发、难治性AML的CR率和总有效率,FLAG组均高于CAG组,组间比较差异有显著性意义（P均〈0.05）。2组的血液学不良反应主要是骨髓抑制,非血液学不良反应较少。结论：CAG方案和FLAG方案均为复发、难治性AML的有效治疗方案,但FLAG方案CR率和总有效率高,不良反应可耐受,可进一步扩大临床应用。     

地西他滨联合半量CAG方案治疗复发难治急性髓系白血病效果观察

目的 观察地西他滨联合半量CAG方案治疗复发难治急性髓系白血病(AML)的临床效果.方法 收集2015年1月至2017年1月大同市第三人民医院8例接受地西他滨联合半量CAG方案治疗的复发难治AML患者的临床资料,分析其疗效及不良反应.结果 1个疗程地西他滨联合半量CAG方案治疗后,完全缓解3例,部分缓解2例.主要不良反应为骨髓抑制及感染,8例患者均出现Ⅲ～Ⅳ级血液学不良反应,5例出现感染,2例出现Ⅰ级药物性肝损害,无治疗相关死亡发生.结论 地西他滨联合半量CAG方案治疗复发难治AML具有良好疗效,值得进一步研究.     

Treatment of Refractory and Relapsed Adult Acute Leukemia Using a Uniform Chemotherapy Protocol

Twenty-nine adult patients with relapsed (21) or refractory (8) de novo acute leukemia (12 ALL and 17 ANLL) were treated with a remission-induction salvage chemotherapeutic protocol including vindesine, mitoxantrone, cyclophosphamide, intermediate-dose cytosine arabinoside, prednisolone and methotrexate. Ten of seventeen (59%) ANLL and 8/12 ALL (67%) achieved complete remission (CR). Seven of eight (86%) cases refractory to first-line remission-induction therapy (3/4 ANLL and 4/4 ALL) entered complete remission. The most frequent non-hematologic side effects were gastrointestinal. All patients experienced severe pancytopenia, with median times to recovery of granulocyte and platelet counts of 28 and 29 days, respectively. Nine of twenty-nine (31%) patients suffered febrile episodes of unknown origin and 13/29 (45%) suffered documented infections. Five patients (17%) died while aplastic, four from infection and one from cardiotoxicity. Four patients who entered CR were submitted to a bone marrow transplantation (BMT), two autologous and two allogeneic BMT. Sixteen of the 18 patients who entered CR relapsed, with a median remission duration of 3.5 ± 2.9 months. Two patients remain in remission at 5+ and 17+ months. These results suggest that this protocol is an effective remission-induction salvage therapy for adult acute leukemias.     

异基因造血干细胞移植治疗急性T 淋巴细胞白血病和淋巴瘤：附50例临床报告

目的 探讨异基因造血干细胞移植（allogeneic hematopoietic stem cell transplantation,allo-HSCT）治疗急性T淋巴细胞白血病（T cell acute lymphoblastic leukemia,T-ALL）和急性T淋巴母细胞淋巴瘤（T cell acute lymphoblastic lymphoma, T-LBL）的疗效及预后。方法 回顾性分析2014—2019年于航天中心医院接受allo-HSCT的50例T-ALL/LBL患者的临床资料,分析其临床疗效、并发症及预后。结果 50例患者中男性41例,女性9例,中位年龄20.5岁（范围：9.0~63.0岁）;单倍体移植44例,脐血移植 2例,同胞全合移植 4例;T-ALL 40例,T-LBL 10例;移植前处于完全缓解（CR）状态16例,处于未完全缓解（非CR）状态34例。移植后,中位随访20个月（范围：1~84个月）,存活23例,死亡27例;移植后24个月的总生存率和无复发生存率分别为50.0%和44.0%,36个月的总生存率和无复发生存率分别为45.5%和40.0%。随访期间,共有20例患者复发,复发率为40.0%（20/50）。移植前获CR、无髓外病变、无中枢神经系统受累的患者预后较好,而移植前有无基因突变、不同预处理方案、有无急性/慢性GVHD患者的总生存期及无复发生存期组间比较差异无统计学意义（均P>0.05）。结论 在这项小样本、无对照的临床研究中,T-ALL/LBL患者在缓解期行allo-HSCT可能较挽救性移植的生存预后有所改善,其中复发为移植失败的主要原因。     

Treatment of adult acute lymphoblastic leukaemia using an intensive chemotherapy protocol

Summary A total of 25 evaluable adult patients with acute lymphoblastic leukaemia (ALL) were treated with an intensive chemotherapy regime modified from the L17/L17M protocol of the Sloan-Kettering Hospital. There were 18 men and 7 women; their median age was 36 years (range, 13–78). Seven cases had L1 morphology and 18, L2. The immunophenotype was common-ALL in 10, null-ALL in 9, T-ALL in 4 and B-ALL in 1. Of the 25 patients, 14 (56%) achieved a complete remission (CR). The causes of induction failure were partial remission (PR) only in 7 (28%) and hypoplastic death in 4 (16%). Of the 14 CR patients, 11 (78.6%) relapsed. Five patients developed CNS disease. The median disease-free survival and overall survival were only 9 and 13 months, respectively. As the follow-up periods of the surviving patients were short, late relapses may still occur and the overall treatment result is likely to be worse on longer follow-up. The possible causes of this disappointing result are discussed.     

阿扎胞苷联合CAG方案再诱导治疗儿童复发难治急性髓系白血病临床观察

目的:探讨阿扎胞苷联合CAG（阿糖胞苷+阿柔比星+粒细胞集落刺激因子）方案再诱导儿童复发难治急性髓系白血病（AML）的疗效和安全性。方法:回顾性分析2018年11月至2019年8月福建医科大学附属协和医院收治的3例接受阿扎胞苷联合CAG方案再诱导治疗的复发难治AML患儿的临床资料,分析疗效、预后及不良反应发生情况。结果:3例患儿中,2例为复发AML（分别距开始治疗18个月和8个月后复发）,1例为难治AML（2个疗程标准化疗不能达完全缓解）。在2个疗程阿扎胞苷联合CAG方案再诱导后,2例达完全缓解,1例达部分缓解,之后均桥接造血干细胞移植（HSCT）。随访16~21个月（距首次阿扎胞苷联合CAG方案再诱导的时间）,患儿均为无白血病生存。除了血液学不良反应及感染外,阿扎胞苷未增加其他不良反应。结论:阿扎胞苷联合CAG方案诱导儿童复发难治AML有较高的再缓解率和安全性,及时桥接HSCT可取得较好的预后。     

High-dose cyclophosphamide, BCNU, and etoposide followed by autologous bone marrow rescue as treatment for adult acute leukemia in relapse

High-dose cyclophosphamide, 1,3-bis-(2 chloroethyl)-1-nitrosourea (BCNU), and VP-16-213 followed by autologous bone marrow rescue was administered to 29 adult patients with acute leukemia in relapse who had failed to respond to prior salvage treatment, with the following results: 14 patients (48%) achieved complete remission (CR), two patients died early of infection and hemorrhage during hypoplasia, and 13 patients had relapsed with leukemia after an initial hypo-plastic phase. Median remission duration was 3 1/2 months (range, 1-8 months). Maintenance treatment with cyclophosphamide and VP-16, which was given to six patients, did not prolong remission duration. Subsequent salvage treatment was well tolerated by both responders and patients who failed to reach CR. This regimen, which is active in both acute lymphocytic leukemia and acute myelogenous leukemia, had a mild toxicity.     

Treatment of primary refractory or relapsed acute lymphoblastic leukemia (ALL) in children.

Thirty-one intensively pretreated children with ALL in first bone marrow relapse or refractory to initial therapy were treated with a combination of intermediate-dose Ara-C and idarubicin (IDA). Twenty-four patients (77%) achieved complete remission (CR), 8 patients relapsed early and 2 were removed from the study. Fourteen (45% of the original 31 patients) underwent bone marrow transplant (BMT) and 7 of them (22%) are still in continuous CR (CCR) with a median follow-up of 18 months. These results confirm that it is possible to achieve CR even in ALL children who failed on an initial intensive regimen. Newer modalities of post-remission therapy, especially for children lacking an HLA donor, should be considered.     

Salvage chemotherapy with low-dose cytarabine and aclarubicin in combination with granulocyte colony-stimulating factor priming in patients with refractory or relapsed acute myeloid leukemia with translocation (8;21)

High expression levels of granulocyte colony stimulating factor (G-CSF) receptor were found in the leukemic cells of acute myeloid leukemia (AML) patients with t(8;21). Therapeutic significance of G-CSF receptor on chemotherapy remains to be defined. We evaluate the efficacy and tolerability of CAG regimen, consisting of concurrent use of G-CSF with low-dose cytarabine and aclarubicin, in 36 refractory/relapsed AML patients with t(8;21). The overall complete remission (CR) rate was 75% and median CR duration was 12 months. No significant treatment-related adverse events were observed. These data demonstrate that CAG regimen might be an alternative option in the treatment of AML with t(8;21), especially in older patients or patients with co-morbidities.