6-MP联合伊马替尼治疗高龄Ph + 急性淋巴细胞白血病1例

患者,女,74岁,因乏力、体重下降6个月先就诊于我院消化内科,诊断为"十二指肠球部溃疡",予抑酸、护胃、抗炎等治疗效果不佳,多次复查血常规白细胞进行性升高,血红蛋白及血小板降低,后行骨穿检查诊断为急性淋巴细胞白血病,为进一步治疗来我科,于2009年3月8日收住院.     

复合性淋巴瘤1例

患者,男,22岁,因咳嗽、咳痰1个月,加重伴左胸痛、气促4 d于2008年2月20日入院.体格检查:颈软,气管居中,左颈部稍肿胀,可及一绿豆大小肿物,质硬,活动度可,无压痛.前胸部及左侧颈部、前臂血管较右侧明显.胸部CT检查:左胸部前纵隔偏左处见巨大软组织影,大小约13.0 em x9.4 em×17.0cm,向上累及上前纵隔,左颈总动脉、左锁骨下动脉及上腔静脉受压部分包绕,左侧主动脉弓、肺动脉及左心缘受压移位,左主支气管受压后移,左肺组织受压;两侧胸腔少量积液,纵隔及大血管旁未见明显肿大淋巴结.     

变异型Ph易位

变异型Ph易位包括单纯变异型,复杂变异型和隐匿型,其发生率约为Ph阳性CML的4～8%。变异型Ph易位具有与标准Ph易位相同的分子标志,即bcr-abl基因重组。变异型Ph染色体通过逐步易位或同步易位形成。变异型Ph易位CML患者的预后和血液学特征与标准型Ph易位CML患者无显著差异。一些Ph阴性CML在细胞遗传学未见Ph易位,但具有bcr-abl基因重组的分子遗传学证据。     

Cytomegalovirus interstitial pneumonitis following allogeneic peripheral blood stem cell transplantation

Objective： To explore the risk factors and prophylaxis and treatment of cytomegalovirus interstitial pneumonitis （CMV-IP） after allogeneic peripheral blood stem cell transplantation （allo-PBSCT）. Methods： 43 patients who received allo-PBSCT were allocated to either a Gancyclovir（GCV）-prophylaxis group （n=19） or a non-GCV prophylaxis group （n=24）. A comparison was made of the incidence of CMV-IP in patients given or not given prophylactic gancyclovir. Results： 9 patients in non-GCV prophylaxis group developed late CMV-IP （P〈0.05）. Graft-versus-host-disease （GVHD） may be associated with a high risk of CMV-IP. 5 cases of CMV-IP were successfully treated with GCV, but 3 cases died of CMV-IP. The most common adverse event of GCV was neutropenia, but was reversible. Conclusion： CMV infection was a major cause of interstitial pneumonitis after allo-PBSCT, which correlated strongly with the severity of GVHD. Gancyclovir was shown to be effective in both prophylaxis and treatment of CMV-IP.     

急性白血病患者辨证分型与血象、骨髓象及血、尿环核苷酸关系的临床观察

把59例急性白血病患者分为温毒瘀血、痰热症瘕、气阴两虚三型,观察其盘象、骨髓象和血、尿环核苷酸变化,发现各型与正常人比较均有显著差异,但程度并不一致。对32例患者治疗前后观察,气阴两虚型的缓解率较高,而温毒瘀血型较差。实验认为急白中医分型具有分子病理学基础。     

A higher incidence of relapse for acute lymphocytic leukemia treated with allogeneic hematopoietic stem cell transplantation conditioned with BU-CY<Subscript>2</Subscript> regimen

Objective: To analyze long-term outcome in sixty leukemia patients received allogeneic hematopoietic stem cell transplantation (allo-HSCT) following busulfan and cyclophosphamide (BU-CY2) between 1994 and 2000.Methods: BU-CY2 was used as the conditioning regimen and allo-HSCT was performed for all patients. All the patients were followed-up until August 2001 or death. The leukemia-free survival, relapse and transplant-related mortality were discussed. Results: All 60 patients had sustained engraftment. Acute GVHD occurred in 22 out of 60 patients (36.7%), and the incidence of acute GVHD was 48% in the patients with CML, 30% in AML and 26.7% in ALL. 38 patients are still alive in continuous remission with a median follow-up of 30 months (range 12-84) and 22 patients have died. The main causes of death were acute GVHD in 3 patients, CMV-IP in 7 patients and relapse in 11 patients,the remaining one died of pulmonary infection. Among 11 patients who died of relapse, 8 patients with ALL relapsed in the early stage post transplant (8115, 53.3%), relapse was observed in the remaining 3 patients with AML, and however, no relapse was observed in CML. The probability of disease-free survival at 3 years for CML. AML and ALL patients was 80%, 70% and 26.7%, respectively.Conclusion: This results suggests that BU-CY2 is an effective conditioning regimen in patients with AML and CML, resulting in a low relapse rate and high long-term survival rate, but not as effective in patients with ALL, with a higher incidence of relapse and therefore, not recommended for ALL patients.     

非血缘关系非清髓骨髓移植治疗难治性原发性巨球蛋白血症一例

患者,女,48岁,1998年因头昏、乏力在外院确诊为原发性巨球蛋白血症(WM),予以瘤可宁治疗,并间断进行血浆置换,病情缓解.2003年9月出现低热,血红蛋白进行性降低,在外院行CT检查,发现腹腔淋巴结肿大,予以氟达拉滨和利妥昔单抗(商品名美罗华)治疗,临床症状缓解,腹腔淋巴结缩小.     

异基因外周血干细胞移植治疗骨髓移植失败后地中海贫血一例

我们在中国大陆首次用ＨＬＡ不合的同胞外周血干细胞移植 (ＰＢＳＣＴ)治疗 1例骨髓移植 (ＢＭＴ)失败的重型 β地中海贫血 (珠蛋白生成障碍性贫血 ,地贫 )患儿 ,报告如下。患儿 ,女 ,2 .5岁。体重 12ｋｇ ,体表面积 0 .5 2ｍ2 ,2 0 0 1年7月入院。患儿出生后 6个月时诊断为 β地贫 (重型 ) ,基因型 4 1 4 2 /41 4 2 (纯合子 )。父亲基因型 4 1 4 2 /Ｎ ,母亲 4 1 4 2 /Ｎ ,胞兄 4 1 4 2 /Ｎ(3人均为轻型杂合子 )。 1999年 12月 ,患儿11个月时 ,于外院行ａｌｌｏ ＢＭＴ。供者为其胞兄 (12岁 )。供、受者ＨＬＡ Ａ 1个主要位点不合 ,血型均…     

造血干细胞移植术后应用膦甲酸钠诱发癫痫发作2例

例1,女,28岁。因确诊慢性粒细胞白血病8年、急单变3个月拟行异基因造血干细胞移植收住我院血液科。于2003年12月26日行异基因外周血干细胞移植,供者为胞姐,HLA配型是1个主要位点不相合,预处理方案为:马利兰(16 mg／kg)加