去甲氧柔红霉素联合阿糖胞苷治疗急性髓系白血病的临床疗效

目的：探讨急性髓系白血病患者采用去甲氧柔红霉素联合阿糖胞苷治疗的临床疗效。方法70例急性髓系白血病患者按照随机数字表法分为对照组与治疗组,各35例。对照组采用柔红霉素治疗。治疗组采用去甲氧柔红霉素治疗。比较2组临床疗效、生存质量、毒副作用。结果治疗后治疗组治疗有效率为45．71％（16／35）与对照组[40．00％（14／35）]比较P＞0．05;治疗组治疗获益率为57．14％（20／35）,明显高于对照组[45．71％（16／35）]（P＜0．05）;2组患者KPS改善率比较（P＜0．05）。治疗组治疗期间不良反应发生率为48．57％（17／35）明显低于对照组[77．14％（27／35）]（P＜0．05）。结论去甲氧柔红霉素联合阿糖胞苷治疗急性髓系白血病患者的临床总体疗效较好,且显著改善患者生存质量,减少不良反应,值得推广应用。     

去甲氧柔红霉素联合阿糖胞苷治疗急性髓系白血病的疗效观察

目的:评价去甲氧柔红霉素(IDA)联合阿糖胞苷(Ara-C)(IA方案)治疗急性髓系白血病(AML)的疗效及不良反应。方法:50例AML患者,年龄10-61岁(中位年龄38岁),男27例,女23例。诱导化疗方案为IDA 10mg.m-2.d-1,d1-3;Ara-C 100mg.m-2.d-1,d1-7。结果:完全缓解率达86%,诱导化疗期间未发生早期死亡。不良反应主要为粒细胞缺乏所致的感染及血小板减少所致的出血。结论:IDA-A方案作为AML的诱导缓解化疗,安全、有效,具有较高的CR率。     

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。     

去甲氧柔红霉素或柔红霉素联合阿糖胞苷诱导治疗急性髓系白血病的疗效比较

 目的　探讨去甲氧柔红霉素（IDA）+阿糖胞苷（Ara-C）（IA方案）及柔红霉素（DRA）+ Ara-C（DA方案）诱导治疗急性髓系白血病（AML）的疗效的比较。方法　回顾性分析确诊并行IA方案（IDA每天8～12 mg／m2静脉滴注,第1天至第3天;Ara-C每天100～150 mg／m2,每12 h静脉滴注1次,第1天至第7天）或DA方案（DNR每天40～50 mg／m2静脉滴注,第1天至第3天;Ara-C用法同IA方案）诱导治疗的93例AML患者的临床资料,用SPSS13.0软件包对上述两个组的完全缓解（CR）率、有效率进行分析。结果　IA组和DA组的CR率为72.5 %、47.2 %（χ2＝5.011,P＜0.05）,有效率为82.5 %、77.4 %（χ2＝0.122,P＞0.05）。结论　对于急性髓系白血病的诱导治疗,IA方案较DA方案具有更高的诱导CR率。所需要的天数分别为16.62±3.07vs18.88±4.63、16.56±4.18vs15.50±5.06、23.69±9.61vs21.76±8.68、20.87±2.45vs21.75±5.17及24.18±2.68vs24.29±6.87,粒细胞缺乏持续的天数为10.36±4.72vs12.44±7.21,上述各组P均大于0.05。结论：对于急性髓系白血病的诱导治疗,IA较DA方案有更高的CR率,而未增加骨髓的毒副作用。     

柔红霉素治疗急性白血病的临床观察

柔红霉素 (ＤＮＲ)是一种蒽环类抗肿瘤药物。我院自 1998年 11月～ 2 0 0 1年 5月 ,用ＤＮＲ与其它药物联合 ,治疗 15例初治急性白血病 (ＡＬ)患者 ,取得较明显疗效 ,现报告如下。1　材料和方法1.1　病例资料ＡＬ 15例均为本院住院患者 ,男性 7例 ,女性 8例 ,中位年龄 31(14岁～ 5 9岁 )岁。所有病例均经临床、外周血象、骨髓象及组化检查确诊 ,符合 1987年全国白血病化学治疗讨论会制订的标准[1] 。 15例均为初治病例 ,ＦＡＢ分型为急性淋巴细胞白血病(ＡＬＬ) 6例 (Ｌ1型 3例 ,Ｌ2 型 2例 ,Ｌ3 型 1例 ) ,急性非淋巴细胞白血病 (ＡＮＬＬ)…     

柔红霉素治疗急性白血病的临床观察

柔红霉素(DNR)是一种蒽环类抗肿瘤药物。我院自1998年11月～2001年5月，用DNR与其它药物联合，治疗15例初治急性白血病(AL)患者，取得较明显疗效，现报告如下。……     

国产柔红霉素(DNR)治疗急性白血病疗效观察

柔红霉素（ＤＮＲ）自１９６３年发明以来,长期用于治疗急性白血病,尤其是急性非淋巴细胞性白血病,疗效明确、显著,迄今仍是治疗急性白血病的主要基本药物之一。１９９６年２月～９月我们采用深圳万乐药业有限公司生产的柔红霉素治疗１６例急性白血病,获得较满意的疗...     

去甲氧柔红霉素治疗急性白血病的临床疗效观察

目的 观察和比较去甲氧柔红霉素治疗急性的初治、复发以及难治性白血病的临床疗效.方法34例急性白血病应用去甲氧柔红霉素辅以其它药物的联合化疗,分为初治组、复发组和难治组三组进行疗效观察比较.结果总有效率达70.6%,初治组与复发组疗效比较有显著性差异(P<0.05),初治组与难治组比较疗效有显著性差异(P<0.01).结论 去甲氧柔红霉素是一种新型、有效的治疗急性白血病的药物.     

Dose intensification of daunorubicin and cytarabine during treatment of adult acute lymphoblastic leukemia

BACKGROUND:

Cancer and Leukemia Group B (CALGB) Study 19802, a phase 2 study, evaluated whether dose intensification of daunorubicin and cytarabine could improve disease‐free survival (DFS) in adults with acute lymphoblastic leukemia (ALL) and whether high‐dose systemic and intrathecal methotrexate could replace cranial radiotherapy for central nervous system (CNS) prophylaxis.

METHODS:

One hundred sixty‐one eligible, previously untreated patients ages 16 to 82 years (median age, 40 years) were enrolled, and 33 (20%) were aged ≥60 years.

RESULTS:

One hundred twenty‐eight patients (80%) achieved complete remission (CR). Dose intensification of daunorubicin and cytarabine was feasible. At a median follow‐up of 10.4 years for surviving patients, the 5‐year DFS rate was 25% (95% confidence interval, 18%‐33%), and the overall survival (OS) rate was 30% (95% confidence interval, 23%‐37%). Patients aged <60 years who received the 80 mg/m² dose of daunorubicin had a DFS of 33% (95% confidence interval, 22%‐44%) and an OS of 39% (95% confidence interval, 29%‐49%) at 5 years. Eighty‐four patients (52%) relapsed, including 9 patients (6%) who had isolated CNS relapses. The omission of cranial irradiation did not result in higher than historic CNS relapse rates.

CONCLUSIONS:

Intensive systemic, oral, and intrathecal methotrexate dosing permitted the omission of CNS irradiation in adult patients with ALL. This intensive approach using higher doses of daunorubicin and cytarabine failed to result in an overall improvement in DFS or OS compared with historic CALGB studies. Future therapeutic strategies for adults with ALL should be tailored to specific age and molecular genetic subsets. Cancer 2013. © 2012 American Cancer Society.     

The use of liposomal daunorubicin (DaunoXome) in acute myeloid leukemia

Altered pharmacokinetics of liposomal formulations of drugs can diminish toxicity and allow the administration of the encapsulated drug at high doses. The liposomal formulation of daunorubicin (DaunoXome, L-DNR) has been reported to produce high mean area under the plasma curve (AUC) levels due to a slow distribution of the liposomal moiety into the body and also to reduce the conversion of daunorubicin to the toxic, but inactive, daunorubicinol. Animal and in vitro studies have shown increased intratumor and intracellular levels of the drug, resulting in enhanced cytotoxicity, even in multidrug-resistant cell lines, while normal tissue toxicity, including cardiotoxicity, may be reduced. L-DNR has been tested as a single agent or in combination with arabinosyl cytosine in the treatment of patients with acute myeloid leukemia (AML) in relapse or in patients with newly diagnosed AML or with disease failing initial remission-induction therapy. The results have indicated that L-DNR can be used at high doses, up to 150 mg/m² for 3 days, safely with acceptable toxicity. The anti-leukemia activity has been reported to be at least equal or superior to that of free daunorubicin. Mucositis appeared more frequently than cardiotoxicity and high complete remission rates have been reported in patients with AML in first relapse. However, the superiority of L-DNR with regard to efficacy and toxicity will only be shown by prospective clinical studies comparing L-DNR with free daunorubicin or other regimens. Two comparative trials are currently active in AML patients, one in children and another in the elderly, run by the international BFM and GIMEMA groups, respectively.     

FA方案用于急性髓系白血病不同治疗阶段疗效分析

Objective  To evaluate the therapeutic effect of the fludarabine and cytarabine (FA) regimen on acute myeloid leukemia (AML) at different phases during treatment. Methods  A total of 185 patients with AML were divided into 4 groups based on the outcome of previous treatments. Patients in Group 1 had no remission after the first course of induction chemotherapy (n = 55). Patients in Group 2 had no remission after no less than two courses of induction chemotherapy (n = 41). Patients in Group 3 had early relapse (n = 40). Patients in Group 4 had late relapse (n = 49). Patients in groups 2, 3 and 4 had refractory AML or AML with relapse. We assessed the efficacy and toxicity of FA combination chemotherapy in each of these 4 groups. Results  The complete remission (CR) rates of Groups 1, 2, 3 and 4 were 74.5% (41/55), 45.9% (19/41), 17.5% (7/40) and 38.8% (19/49), respectively. The CR rate was higher in Group 1 than in the other 3 groups (34.6%, 45/130) (P = 0.000). A significant correlation was found between CR rate and the number of chemotherapeutic courses (P = 0.023). The main adverse reactions included bone marrow suppression and secondary infection. Conclusion  FA regimen is a good choice for patients with AML, especially those who have failed to achieve CR after the first course of induction chemotherapy. Supported by a grant from the Planned Science and Technology Project of Guangzhou (No. 2006Z3-E0401).     

Arsenic trioxide and low-dose cytarabine in older patients with untreated acute myeloid leukemia, excluding acute promyelocytic leukemia

BACKGROUND: Acute myeloid leukemia (AML) carries a dismal prognosis in older patients. In this study, the authors evaluated the safety and efficacy of arsenic trioxide combined with low-dose cytarabine in untreated patients aged >or=60 years with AML. METHODS: In a phase 1/2 design, arsenic trioxide was administered intravenously at a dose of 0.25 mg/kg on Days 1 through 5 and on Days 8 through 12, and low-dose cytarabine was given subcutaneously twice daily on Days 1 through 14 in escalating doses to a target of 10 mg/m(2) per dose. Of 64 patients who had pathologically confirmed AML, excluding patients with acute promyelocytic leukemia and using World Health Organization criteria, the median age was 71 years, 10 patients (16%) had treatment-related AML, 40 patients (63%) had an antecedent myelodysplastic syndrome or myeloproliferative disorder, and 35 patients (55%) had unfavorable cytogenetics. Thirty-four patients (53%) had an Eastern Cooperative Oncology Group performance status of 2 or 3. RESULTS: Complete remission was achieved in 21 of 61 patients (34%), including 15 of 50 patients (30%) who had secondary or treatment-related AML, 10 of 33 patients (30%) who had unfavorable cytogenetics, and 6 of 34 patients (18%) who had a poor baseline performance status. The mortality rate within the first 4 weeks was 8%. Neutropenic fever was observed in >80% of patients, and 41% of patients had bacteremia. Nonhematologic toxicity generally was mild and reversible and included fatigue, nausea, diarrhea, rash, peripheral edema, and elevated transaminases. There were no clinically significant cardiac arrhythmias. CONCLUSIONS: The addition of arsenic trioxide to low-dose cytarabine appeared to improve responses in elderly patients who had AML compared with either agent alone, and a randomized trial of the combination versus single-agent low-dose cytarabine is ongoing.     

儿童急性白血病并发急性阑尾炎的临床特点和诊治分析

目的:分析儿童急性白血病(acute leukemia, AL)并发急性阑尾炎的临床特点和诊治策略,为临床优化诊疗方案提供参考。方法:对2015年1月至2022年6月我中心血液肿瘤科住院的急性白血病治疗过程中并发急性阑尾炎的6例患儿临床资料进行回顾性分析。该6例患儿均采用中国儿童肿瘤协作组CCCG-ALL-2015方案联合化疗。通过分析总结患儿的临床表现、发生急性阑尾炎时所处的治疗阶段、超声特点及治疗手段,对比患儿的治疗效果及其转归。结果:收集的6例患儿,根据出现急性阑尾炎的时间依次编号为例1-6,均为男性,年龄范围2～12岁,中位年龄6岁;急性B淋巴细胞白血病5例(B-ALL),急性混合表型白血病(T淋系+髓系表型)1例,急性阑尾炎可出现在化疗的不同阶段,初始联合化疗开始45天内发病的4例,化疗间期1例,再诱导阶段1例。6例患儿主要表现为发热、右下腹痛、腹胀、呕吐,腹部超声诊断急性阑尾炎。1例接受单纯内科治疗,2例诊断后立即行腹腔镜手术治疗,3例内科保守治疗无效后行腹腔镜治疗。6例患儿阑尾炎均得以治愈,其中5例推迟化疗进程。结论:儿童AL并发急性阑尾炎多发生在ALL,并在早期联合化疗...     

外周血铁调素25 mRNA及蛋白表达水平在白血病患儿中的临床价值

目的：观察急性淋巴细胞白血病（ALL）患儿外周血铁调素25（Hepc-25）mRNA和蛋白表达情况,并探讨其与ALL化疗疗效的关系。方法选取接受MR方案治疗的白血病患儿93例作为观察组,另选取同期20例健康体检儿童作为对照组。采用实时定量聚合酶链反应（RT-PCR）和酶联免疫吸附法（ELISA）测定两组外周血中Hepc-25 mRNA和蛋白表达水平。分析Hepc-25与ALL疗效的关系。结果白血病患儿外周血Hepc-25 mRNA及蛋白表达水平均高于对照组,差异具有统计学意义（P﹤0.05）;经治疗好转组患儿外周血Hepc-25 mRNA及蛋白表达水平较治疗前均下降（P﹤0.05）;而治疗无效组患儿Hepc-25 mRNA及蛋白表达水平较治疗前比较,差异无统计学意义（P﹥0.05）。结论 ALL患儿外周血Hepc-25过表达对疾病复发有一定的预测价值,与白血病患儿的化疗疗效有密切关系。     

High-dose cytarabine induction is well tolerated and active in patients with de novo acute myeloid leukemia older than 60 years

BACKGROUND:

High‐dose cytarabine (HiDAC) is safe and very effective in younger patients with acute myeloid leukemia (AML), but it generally is not well tolerated in the elderly.

METHODS:

The authors explored the safety and tolerability of a modified HiDAC induction regimen consisting of 6 daily doses of cytarabine at 2 g/m² in combination with 3 daily doses of daunorubicin at 45 mg/m² in 59 consecutive patients aged >60 years who had de novo AML diagnosed between July 1996 and February 2005.

RESULTS:

The median patient age was 68 years (range, 60‐86 years). The regimen was well tolerated. Infections were common and occurred in 39% of patients, but cerebellar toxicities occurred in only 7% of patients and were reversible. The day‐30 induction‐related mortality rate was 10%. Overall, 69% of patients achieved complete remissions (CR), and 80% received up to 3 consolidations with HiDAC. The median follow‐up for surviving patients was 53 months (range, 17‐114 months). The median overall survival was 15.3 months (range, 1‐114 months), and the relapse‐free survival was 13.8 months (range, 1‐113 months). Survival for patients who achieved CR was 27 months (range, 2‐114 months).

CONCLUSIONS:

The modified HiDAC regimen was well tolerated in patients aged >60 years with AML and was associated with low induction mortality and high rates of CR. Nevertheless, these high remissions still were associated with poor overall outcomes. Cancer 2011;. © 2011 American Cancer Society.     

Improved outcome of patients with low- and intermediate-risk cytogenetics acute myeloid leukemia (AML) in first relapse with gemtuzumab and cytarabine versus cytarabine: results of a retrospective comparative study

BACKGROUND:

Acute myeloid leukemia (AML) in first relapse is associated with a poor outcome even when treated with intermediate‐ to high‐dose cytarabine (IHDAraC). Gemtuzumab ozogamycin (GO) used as a single agent has clinical activity in relapsed and refractory AML. Various combination regimens of GO have been developed, but few data are available regarding their efficacy compared with IHDAraC‐based regimens.

METHODS:

The authors performed a retrospective analysis of response and survival in 90 AML patients in first relapse treated with either IHDAraC (n = 56) or IHDAraC + GO (n = 34). Patient characteristics of the two groups were comparable.

RESULTS:

Median follow‐up was 37 months. Compared with IHDAraC, IHDAraC + GO induction was associated with a better response rate (68% vs 45%, P = .04), a better overall survival (median, 35 months vs 6 months, P = .001), and a better event‐free survival (24 months vs 6 months, P = .002). This effect was limited to patients with low‐risk and intermediate‐risk cytogenetics. In multivariate analysis, age, cytogenetic risk, first complete remission duration, and the use of IHDAraC + GO were independently associated with better results.

CONCLUSIONS:

This study showed that the addition of GO to IHDAraC is associated with a better efficacy for patients in first relapse of AML with low‐ or intermediate‐risk cytogenetics. Prospective controlled studies of GO in this population are warranted. Patients with high‐risk cytogenetics should be offered investigational new drugs. Cancer 2011. © 2010 American Cancer Society.     

Clofarabine plus low-dose cytarabine followed by clofarabine plus low-dose cytarabine alternating with decitabine in acute myeloid leukemia frontline therapy for older patients

BACKGROUND:

Standard therapy for older patients with acute myeloid leukemia (AML) has a poor outcome. The authors have designed a combination of clofarabine plus low‐dose cytarabine followed by a prolonged consolidation alternating with decitabine.

METHODS:

Sixty patients with a median age of 70 years (range, 60‐81 years) with newly diagnosed AML were included. They received clofarabine 20 mg/m² intravenously daily for 5 days plus cytarabine 20 mg subcutaneously twice daily for 10 days. Responding patients continued for up to 17 courses of consolidation therapy including decitabine.

RESULTS:

Forty of 59 evaluable patients responded (66%). Complete remission rate was 58%. Median relapse‐free survival (RFS) was 14.1 (95% confidence interval [CI], 6.9 to not estimable), and median overall survival (OS) was 12.7 months (95% CI, 8.8 to not estimable). Median OS of responding patients (complete response [CR]/CR with platelet count <100 × 109/L) was 24.2 months (95% CI, 17 to not estimable). Compared with a historical group of patients who received clofarabine plus low‐dose cytarabine with a shorter consolidation, RFS was not statistically different. Induction mortality was low (7% at 8 weeks) and toxicities manageable.

CONCLUSIONS:

Clofarabine plus low‐dose cytarabine alternating with decitabine in consolidation is active in older patients with newly diagnosed AML. The benefits of a prolonged consolidation remain unproven. Cancer 2012. © 2012 American Cancer Society.