Breast Cancer Pattern and Chemotherapy Response - anInstitutional Study in Pakistan

Background: This study was planned to audit female breast cancers and their chemotherapy in a busypublic sector institution. As a case-study, Pakistan provides an opportunity to explore the issue in a low-GDP,low-literacy, populous developing country. Method: Retrospective analysis of the records at Karachi Instituteof Radiotherapy and Nuclear Medicine. Results: A total of 3,431 female breast cancer patients presented during2001-2008, half being <45 years, mostly suffering from infiltrating ductal carcinoma of breast. Further analyzinga subgroup of 183 consecutive patients over six months revealed that only 1.6% were at stage-I, whereas 75%had node-positive disease, including 19.1% with distant metastases. Some 41.6% were either high grade orpoorly differentiated. The low grade tumors showed a two-fold likelihood of ER and PR positivity as comparedto high grade lesions. 5-Flourouracil, doxorubicin and cyclophosphamide (FAC) constituted the most commonchemotherapy. Earlier diagnosis was associated with complete remission. Overall, 33% developed myelotoxicity,more often if age ≥45 years (p=0.012), out of which 60% needed active correction. All those patients who did notexperience a drop in total leukocyte count (TLC) below 4×109/L did not show complete remission. Conclusions:Infiltrating ductal carcinoma of the breast is the most common type. FAC is the most common chemotherapy.Tendency for late diagnosis, metastatic disease, treatment failure as well as leukopenia especially in ≥45 yearsis present. Failure to show leukopenia is suggestive of poor therapeutic outcome.     

二仙升白汤联合黄芪鳝鱼汤治疗化疗后白细胞减少症及对免疫功能的调节作用

目的:观察二仙升白汤联合黄芪鳝鱼汤治疗化疗后白细胞减少症(脾肾气虚证)的临床疗效及对免疫功能和细胞因子的调节作用。方法:将150例患者按随机数字表法分为对照组和观察组各75例。对照组口服鲨肝醇片,60 mg/次,3次/d,连续服用6周;Ⅲ度,Ⅳ度者,加用重组人粒细胞集落刺激因子注射液(rhG-CSF),2～5μg·kg~(-1)·d~(-1),皮下注射,至中性粒细胞恢复至5. 0×10~9个/L(白细胞计数10. 0×10~9个/L)停药。对照组口服升白康颗粒,1袋/次,3次/d;观察组服用二仙升白汤和黄芪鳝鱼汤,1剂/d;连续服用6周。记录外周血白细胞(WBC)和中性粒细胞(NEUT)数量和恢复正常时间;记录感染次数和抗生素的使用时间;记录rhG-CSF使用量和时间;记录红细胞计数(RBC),血红蛋白(Hb),血小板计数(PLT)和完成化疗率;进行治疗前后中医证候评分和生活质量(KPS)评分,检测治疗前后T淋巴细胞亚群(CD3~+,CD4~+,CD8~+,CD4~+/CD8~+)和自然杀伤细胞(NK)水平;检测治疗前后白细胞介素-2(IL-2),IL-6,肿瘤坏死因子-α(TNF-α)。结果:经秩和检验分析,两组患者白细胞减少症的疗效,观察组疗效好于对照组(Z=2. 057,P0. 05);观察组WBC,NEUT,RBC,Hb和PLT水平均高于对照组(P0. 01);观察组WBC和NEUT恢复正常时间均短于对照组(P0. 01);观察组感染次数少于对照组,抗生素使用时间短于对照组(P0. 01),rhG-CSF使用量少于对照组和使用时间短于对照组(P0. 01);治疗后观察组WBC,NEUT复常率和完成化疗率分别为76. 12%(51/67),73. 13%(49/67)和92. 54%(62/67),分别高于对照组的57. 35%(39/68),52. 94%(36/68)和79. 41%(54/68)(P0. 05);观察组NK,CD3~+,CD4~+和CD4~+/CD8~+水平均高于对照组,CD8+低于对照组(P0. 05);观察组患者IL-2水平高于对照组,IL-6和TNF-α水平均低于对照组。结论:二仙升白汤联合黄芪鳝鱼汤治疗化疗后白细胞减少症(脾肾气虚证)患者,可促进WBC,NEUT复常,还能稳定患者免疫功能,调节细胞因子,改善骨髓造血微环境,提高化疗完成率,减少感染次数和rhG-CSF用量,减轻临床症状,稳定生活质量。     

化疗后白细胞减少症的六经辨证思路

化疗相关性白细胞减少的发生与进展是一个动态演变的过程,初期以机体功能异常为主,病主在太阳,病机多属营卫失和.中后期以形质缺失为要,中期疾病进一步发展至太阴,脾阳不足,运化失常,生化乏源,临床多有乏力、纳差、腹泻等表现;后期病主在少阴,乏力症状进一步加重,出现精神萎靡不振.枢机不利,阳气郁遏贯穿病程的始终,临床治疗中可参...     

rHuGM—CSF治疗化疗后白细胞和血小板减少的临床观察

观察了用重组人粒细胞—巨噬细胞集落刺激因子（ｒＨｕＧＭ—ＣＳＦ）治疗儿童急淋化疗后白细胞和血小板减少的临床效果。选择住院化疗患儿，用ｒＨｕＧＭ—ＣＳＦ皮下注射，每次１５０μｇ，每日１次，连续２～３次。用药后取静脉血计数白细胞和血小板。结果：６例急淋患儿，用药后白细胞均增加，增幅＞０５×１０９／Ｌ４例，＞０１×１０９／Ｌ２例，６例中有５例血小板增幅＞２０×１０９／Ｌ。提示用ｒＨｕＧＭ—ＣＳＤ治疗小儿急淋化疗后白细胞和血小板减少有效，值得深入探讨     

Immune Reconstitution Inflammatory Syndrome Associated with Pneumocystis jirovecii Pneumonia and Cytomegalovirus Colitis in a Patient with Rheumatoid Arthritis

A 68-year-old woman presenting with rheumatoid arthritis was admitted due to pancytopenia caused by methotrexate. Pneumocystis jirovecii pneumonia was diagnosed based on the abnormal shadows observed on chest computed tomography, the presence of serum β-D-glucan, and positive P. jirovecii-DNA results in a sputum analysis. Subsequently, after treatment with leucovorin and trimethoprim-sulfamethoxazole, lung consolidation was found to be aggravated, along with a rapidly increasing leukocyte count. In addition, cytomegalovirus colitis was diagnosed. Both conditions were associated with immune reconstitution inflammatory syndrome caused by recovery from leukopenia. The patient was successfully treated with intravenous methylprednisolone pulse therapy and ganciclovir.     

基因重组人粒细胞集落刺激因子防治肺癌化疗反应

目的 :探讨国产基因重组人粒细胞集落刺激因子 (rHuG CSF)对肺癌病人化疗所致白细胞减少的防治作用及不良反应。方法 :采用随机分组、自身交叉对比的方法 ,将 6 0例肺癌VIP方案化疗病人分成A ,B两组 (各 30例 ) ,A组第 1周期化疗结束 4 8h开始皮下注射rHuG CSF 3μg·kg- 1,qd ,7～14d ,第 2周期单用化疗 ;B组第 1周期单用化疗 ,第 2周期化疗结束 4 8h开始皮下注射rHuG CSF 3μg·kg- 1,qd ,7～ 14d。自化疗开始隔日查血常规 1次 ,观察白细胞及中性粒细胞的变化。结果 :治疗周期白细胞总数及中性粒细胞最低值均高于对照周期 ,最低值的持续时间和化疗开始至细胞恢复到正常值以上的时间均少于对照周期。骨痛、肌痛和乏力发生率分别为 10 %和 7% ,偶有发热。结论 :rHuG CSF对化疗引起的白细胞减少具有预防和治疗作用 ,不良反应轻微 ,安全可靠。     

双黄升白颗粒剂对小鼠白细胞减少症的影响

目的:观察双黄升白颗粒剂对环磷酰胺(CTX)及Se-137放射源照射所致小鼠白细胞减少症的影响。方法:CTX腹腔注射或Se-137放射源照射造成小鼠白细胞(WBC)减少症模型,用双黄升白颗粒剂进行治疗,对模型小鼠外周血象,胸腺脾脏指数,骨髓有核细胞数(BMNC),脾结节数(CFU-s)进行检测,并进行骨髓细胞分类计数和骨髓病理观察。结果:双黄升白颗粒剂可明显升高模型小鼠的WBC,BMNC,CFU-S,使骨髓细胞粒红比值恢复正常,并有保护骨髓造血微环境作用。结论:双黄升白颗粒剂具有明显升高白细胞作用。     

地黄苷A对环磷酰胺致小鼠白细胞减少症的影响

日的 观察地黄苷A对环磷酰胺致小鼠白细胞减少症的影响。方法 利用环磷酰胺ip造成小鼠白细胞减少症模型,地黄苷A进行治疗,对模型小鼠体重、外周血象、网织红细胞数、脾脏指数、骨髓有核细胞数和DNA含量进行检测。结果 地黄苷A可明显升高模型小鼠的白细胞数、红细胞数、血小板数,网织红细胞数、骨髓有核细胞数和DNA含量及体重,结论 地黄苷A具有明显升白作用。     

针刺为主治疗苯引起白细胞减少症临床观察

[目的]观察针刺和西药对苯引起白细胞减少症的影响。[方法]将152例病人随机分为针刺组54例、针药组58例和对照组(西药组)40例，并对3组治疗前后临床症状、白细胞数的变化进行检测。[结果]治疗后3组临床症状均有改善或消失。针刺组和针药组优于对照组。3组白细胞数都有增加，针药组最明显，针刺组次之。[结论]提示针刺治疗本病具有良好的疗效，针刺加西药则疗效更好。     

阿莫西林-克拉维酸钾治疗恶性血液病化疗后白细胞减少期并发感染

目的：观察阿莫西林＿克拉维酸钾对恶性血液病化疗后白细胞减少期并发细菌感染的疗效。方法：恶性血液病化疗后白细胞减少期病人６０例（男性３６例,女性２４例,年龄４２ａ±ｓ１５ａ）,随机分为２组（每组３０例）。治疗组用阿莫西林＿克拉维酸钾０．６２５ｇ,ｐｏ,ｂｉｄ,对照组用阿莫西林０．５ｇ,ｐｏ,ｑｉｄ,疗程均为５～７ｄ。结果：治疗组和对照组的临床有效率分别为９３％和６０％,细菌清除率分别为８６％和５２％。结论：阿莫西林＿克拉维酸钾是一种有效的治疗细菌感染的药物,无明显的不良反应。