老年白血病个体化治疗探讨

59例老年白血病治疗中，联合化疗组48例中，CR占29．2％．PR占25％，总有效率54．2％；小剂量诱导组11例,PR占18．2％．总有效率18．2％。两组差异显著（P＜0．05）。提示对老年患者宜采用个体化选择不同方案治疗。     

一例急性早幼粒细胞白血病同时伴有ins(15;17),t(2;17;20)和三体8异常

目的 对1例伴有ins(15;17),t(2;17;20),+8复杂异常的急性早幼粒细胞白血病(acute promyelocytie leukemia,APE)病例进行细胞和分子遗传学研究.方法 按常规制备染色体,以R显带技术进行核型分析,并先后作多色荧光原位杂交(multiplex fluoresence in situ hybridization,M-FISH)、染色体涂染和PML-RARa双色FISH检测.结果 R显带核型分析为47,XY,2q-,+8,17q+,20p+;M-FISH检测为:47,XY,t(2;17;20)(q24;q21;p13),+8;染色体涂染证实了2qZ4以下片段易位到17q21上和17q21以下片段易位到20p13上;双色FISH示17号染色体上RARa(retinoic acid receptora,RARe)基因部分片段插入到15号染色体形成PNL-RARa融合基因,即ins(15;17)(q22;q21.1q21.3).结论 FISH技术是明确隐匿/插入易位的可靠手段,凡形态学拟诊为APL而常规核型分析未发现t(15;17)者均应进行FISH检测.     

CAG预激方案治疗难治和复发伴t(8;21)的急性髓细胞白血病

体外研究发现白血病细胞受粒细胞集落刺激因子(G-CSF)刺激后可被诱导进入细胞增殖周期的S期,提高阿糖胞苷(Ara-C)等细胞周期特异性细胞毒药物的杀伤敏感性.1995年日本学者Saito等根据上述研究提出一种新的治疗方案,由低剂量的Ara-C、阿克拉霉素(ACR)、G-CSF组成,称为预激(CAG)方案.     

不同类型造血干细胞移植后巨细胞病毒感染的监测

目的观察在不同类型造血干细胞移植中巨细胞病毒感染状况。方法应用半巢式PCR技术定期检测了2001-03~2003-07苏州大学附属第一医院住院病人55例移植病人外周血标本,比较不同类型移植CMV-DNA阳性率的差别。结果在检测的462份标本中,有285份为阳性,33/55(60%)患者CMV-DNA阳性,非清髓性造血干细胞移植(NST)的阳性检出率为15/17(88·2%),亲缘间外周血造血干细胞移植(PBSCT)的阳性检出率为3/7(42·9%),非亲缘性骨髓移植(UR-BMT)的阳性检出率为7/11(63·6%),亲缘性骨髓移植(R-BMT)的阳性检出率为8/20(40·0%)。NST与PBSCT、R-BMT的巨细胞病毒感染率差别显著(χ~2=5·44,P<0·05;χ~2=9·14,P<0·05),NST与UR-BMT(χ~2=2·39,P>0·05)间的差别无统计学意义。结论巨细胞病毒感染在不同的造血干细胞移植方式可能存在差异。     

维奈克拉联合多药化疗治疗复发难治早期前体T淋巴细胞白血病15例疗效及安全性分析

目的探讨维奈克拉(Venetoclax, Ven)联合多药化疗治疗复发难治早期前体T淋巴细胞白血病(R/R ETP-ALL)患者的疗效及安全性。方法回顾性分析2018年12月至2022年2月在苏州大学附属第一医院住院治疗的15例R/R ETP-ALL患者的临床资料。再诱导治疗以Ven为基础联合多药化疗, 其中8例联合去甲基化药物, 4例同时联合去甲基化药物和HAAG方案, 2例同时联合去甲基化药物和CAG预激方案, 1例联合克拉屈滨。Ven用法为100 mg第1天, 200 mg第2天, 400 mg第3～28天, 口服;联合唑类抗真菌药物时减量至100 mg/d。结果 15例R/R ETP-ALL患者中, 男10例, 女5例, 中位年龄35(12～42)岁。难治4例, 复发11例。用药第21天疗效:完全缓解(CR)率为60.0%(9/15), CR伴血液学不完全恢复(CRi)率为6.7%(1/15), 总有效率(ORR)为66.7%。所有患者12个月总生存(OS)率为60.0%, 中位OS时间为17.7个月;全部CR患者12个月无病生存(DFS)率为60.0%, 中位DFS时间未达到...     

母供子非去T细胞性单倍体异基因造血干细胞移植治疗恶性血液病

目的:对18例恶性血液病进行母供子非去T细胞性单倍体异基因造血干细胞移植(Allo-HSCT)治疗,探讨其疗效及毒性反应。方法:6例急性髓系白血病(AML-M23例,AML-M41例,AML-M5b2例),3例慢性粒细胞白血病(伴骨髓纤维化1例),8例急性淋巴细胞白血病(ALL),非霍奇金淋巴瘤(Ⅳ期B组)1例,以母亲为供者进行非去T细胞性单倍体Allo-HSCT。供者动员方案:G-CSF300μg/12h×5d后采集造血干细胞。输注D34 细胞(3.58~8.90)×106/kg。预处理方案为:MeCCNC250mg·m-2·d-1×1d,Ara-C4g·m-2·d-1×2d,Bu4mg·kg-1·d-1×3d,CTX1.8g·m-2·d-1×2d。ALL患者以全身放疗(TBI)代替Bu。以CsA、MMF、MTX和ALG预防移植物抗宿主病(GVHD)。结果:所有患者均顺利完成预处理。移植后发生急性GVHD16例、慢性GVHD10例,出血性膀胱炎1例。全部患者在移植后10~20d获造血重建。18例患者中12例存活。结论:非去T细胞性单倍体Allo-HSCT是治疗恶性血液病的一种安全、有效的方法;同时提示在以后的单倍体异基因造血干细胞移植中优先选择母亲供体,对降低GVHD的严重程度、提高移植成功率是有帮助的。     

异基因造血干细胞移植相关性膜性肾病2例

慢性移植物抗宿主病(cGVHD)是异基因造血干细胞移植的主要远期并发症,多表现为皮肤、黏膜、肝脏和呼吸系统的异常,并发膜性肾病极为少见,现将我科诊治的2例患者报道如下.     

一株新的急性髓系白血病细胞系SH-2的建立及其鉴定

Objective To establish and characterize a novel human myeloid leukemia cell line SH-2. Methods Bone marrow mononuclear cells(BMMNC) isolated from a AML-M2 patient, who failed to ob-tain complete remission after chemotherapy and allogenic bone marrow transplantation were passed in a long term IMDM culture medium supplemented with 20% fetal calf serum. Stromal cells were retained and rh-IL-3was added in the culture system. A new human myeloid leukemia cell line SH-2 was successfully established with a cytogeuetic characteristics of a loss of Y chromosome(- Y), a derivative chromosome 16 resulting from unbalanced translocation between chromosome 16 and 17, monosome 17, trisomy 19 and p53 alteration. Vari-ous methods were employed to characterize SH-2 cell line. Results SH-2 cells has been maintained without cytokine and stromal cells for more than 3 years without EB virus and mycoplasma contamination. SH-2 cells had the basically same morphological, immunophenotypic and cytogenetic features as the patient' s leukemia cells did, such as myeloid morphology, an immunophenotype of CD13+ , CD33+ , CD56+ , CD16/56+ and a hypodiploid karyotype of 45, X, - Y, der(16) t(16;17) (q24;q12) , - 17, + 19, which were gradually de-creased and replaced by the near-tetraploid cells with a karyotype of 73 - 102 (80), XX, - Y, - Y, del (lq31) ×2, der(16)t(16;17) (q24;q12) ×2, - 17, - 17, + 19, + 19. FISH and multiple FISH delineated all the abnormalities and revealed a loss of one p53 allele due to monosomy 17. DNA direct sequencing detec-ted a point mutation of CAG to CAT at codon 576 of exon 5 in another p53 allele. RT-PCR showed that SH-2 cells expressed apoptosis-related genes (bcl-2, Fas, GST- π and p21) rather than MDR-related genes. Short tandem repeat PCR provided powerful evidence for the derivation of SH-2 cell line from the patient' s leukemia cells. SH-2 cells had certain colony formation and tumorigenic capacities in nude and SCID mice. Conclu-sion SH-2 is a new myeloid leukemia cell line with a unique biology background, and will provide a useful tool for leukemia research.     

一株新的急性髓系白血病细胞系SH-2的建立及其鉴定

Objective To establish and characterize a novel human myeloid leukemia cell line SH-2. Methods Bone marrow mononuclear cells(BMMNC) isolated from a AML-M2 patient, who failed to ob-tain complete remission after chemotherapy and allogenic bone marrow transplantation were passed in a long term IMDM culture medium supplemented with 20% fetal calf serum. Stromal cells were retained and rh-IL-3was added in the culture system. A new human myeloid leukemia cell line SH-2 was successfully established with a cytogeuetic characteristics of a loss of Y chromosome(- Y), a derivative chromosome 16 resulting from unbalanced translocation between chromosome 16 and 17, monosome 17, trisomy 19 and p53 alteration. Vari-ous methods were employed to characterize SH-2 cell line. Results SH-2 cells has been maintained without cytokine and stromal cells for more than 3 years without EB virus and mycoplasma contamination. SH-2 cells had the basically same morphological, immunophenotypic and cytogenetic features as the patient' s leukemia cells did, such as myeloid morphology, an immunophenotype of CD13+ , CD33+ , CD56+ , CD16/56+ and a hypodiploid karyotype of 45, X, - Y, der(16) t(16;17) (q24;q12) , - 17, + 19, which were gradually de-creased and replaced by the near-tetraploid cells with a karyotype of 73 - 102 (80), XX, - Y, - Y, del (lq31) ×2, der(16)t(16;17) (q24;q12) ×2, - 17, - 17, + 19, + 19. FISH and multiple FISH delineated all the abnormalities and revealed a loss of one p53 allele due to monosomy 17. DNA direct sequencing detec-ted a point mutation of CAG to CAT at codon 576 of exon 5 in another p53 allele. RT-PCR showed that SH-2 cells expressed apoptosis-related genes (bcl-2, Fas, GST- π and p21) rather than MDR-related genes. Short tandem repeat PCR provided powerful evidence for the derivation of SH-2 cell line from the patient' s leukemia cells. SH-2 cells had certain colony formation and tumorigenic capacities in nude and SCID mice. Conclu-sion SH-2 is a new myeloid leukemia cell line with a unique biology background, and will provide a useful tool for leukemia research.     

综合治疗无血缘异基因骨髓移植术后重度急性移植物抗宿主病二例

我院于 2 0 0 1～ 2 0 0 2年治疗 2例无血缘异基因骨髓移植(URD BMT)并发急性移植物抗宿主病 (aGVHD)患者 ,取得满意疗效 ,现报道如下。例 1 ,女 ,9岁。于 2 0 0 1年 2月发病 ,诊断为慢性粒细胞白血病 ,经羟基脲联合INF α治疗达完全缓解 (CR) ,于发病后 7个月 ,停用IFN α 1个月后到我院行URD BMT。例 2 ,女 ,2 8岁。于 2 0 0 1年 8月发病 ,确诊为无t(8;2 1 )急性髓系白血病 (AML M2a) ,经MA方案 [米托蒽醌 (M)、阿糖胞苷 (Ara C) ]化疗达CR ,后又予IDA +Ara C方案 [去甲氧柔红霉素 (IDA)、Ara C]、EA方案 [足叶乙甙 (…