儿童复发急性淋巴细胞白血病疗效及预后因素单中心分析

目的：探讨单中心复发急性淋巴细胞白血病（ALL）患儿采用ALL-R-2003方案的疗效和预后风险因素。方法回顾性分析2004年1月至2014年12月51例诊断为复发ALL患儿的临床资料,进行统计学分析。结果51例患儿中位初诊年龄5.5岁（0.8～13.4岁）,中位复发时间为初诊后25个月（3～68个月）,中位随访时间39个月（3～116个月）。复发患儿初发时标危、中危及高危组所占比例分别为27.5%（14／51）、29.4%（15／51）和43.1%（22／51）。复发后3年总生存（OS）率和无事件生存（EFS）率分别为（18.8±5.9）%和（16.2±5.8）%。非常早期复发、早期复发及晚期复发患儿的复发后3年OS率分别为0、（11.7±7.7）%和（51.7±14.8）%（P＝0.000）。不同复发部位和不同免疫表型患儿的复发后生存时间差异无统计学意义（P＞0.05）。按复发危险度分组的S1、S2、S3、S4组3年OS率分别为（50.0±35.4）%、（39.9±1.3）%、（10.0±9.5）%和0（P＝0.000）。 bcr-abl、MLL融合基因阳性者复发后3年OS率分别为（25.0±21.7）%和0,融合基因阴性者复发后3年OS率为（24.1±12.0）%,差异无统计学意义（P＞0.05）。复发后行骨髓移植组与未行移植组患儿的复发后3年OS率分别为（40.0±15.5）%和（13.0±5.9）%（P＝0.038）。结论复发ALL患儿初发时为高危分组及复发时间早时,则预后差。bcr-abl或MLL基因阳性患儿复发后预后差,骨髓移植可延长患儿生存时间。初发分组、复发时间及移植是影响预后的因素,其中复发时间和移植是影响预后的独立因素。     

复发性大肠癌再次手术有关问题探讨——(附34例临床分析)

从1974.1.～1989. 12.在三所医院合计400例大肠癌病人中,我们对34例大肠癌术后复发的病人进行了再次手术(占8.5％),切除22例,(切除率为64.6％)。较其他报道略高〔1〕。因此,研究大肠癌术后复发的再手术,在临床上具有较大意义,现结合文献资料,对此问题进行初步分析。     

维思通、氯氮平治疗精神分裂症复发情况的对照研究

为探讨新型抗精神病药对精神分裂症复发的影响,采取随机抽样法,选取160例精神分裂症缓解期服用维思通做为维持治疗的患者进行2年的跟踪观察,并以同样的方法抽取160例精神分裂症缓解期服用氯氮平的患者做为对照组。结果,维思通总体复发率显著低于氯氮平组,两组在复发原因上也存在差异,另外,研究组比较或组间比较均有显著差异。结论:维思通对精神分裂症的长远疗效明显优于氯氮平,且依从性好,复发率低,社会功能受损小。     

复发性心肌梗塞的危险因素探讨

目的探讨复发性心肌梗塞（AMI）患者的危险因素。方法将复发AMI患者70例与同期患有AMI、出院后无再梗塞的96例患者对比，分析其临床危险因素。结果与AMI者比较，发生再梗塞时，症状多不典型（27．1％，70．0％，P〈0．01）；多支病变者显著高于无再梗塞者（71．4％，47．8％，P〈0．01）；冠状动脉病变积分亦显著高于无再梗塞者（12．75±5．61，8．96±3．48，P〈0．05）；再梗塞者的血总胆固醇水平显著高于无梗塞者（5．69±1．34，3．95±1．39，P〈0．05）；血糖水平亦高于后者（9．21±1．39，7．03±0．97，P〈0．05）。结论再梗塞患者多具有严重的冠状动脉多支病变，临床症状多不典型，其血胆固醇和血糖水平增高为主要的危险因素。     

北京地区2008-2010年肺结核病复发流行病学和机制分析

目的研究北京地区肺结核病的复发情况,确定复发病例中内源性复燃和外源性再感染的比例。方法对北京各区县随机收取的4694例肺结核病临床病例进行回顾性研究,从中筛选出治疗痊愈后,间断6个月以上再次入院确定为复发的病例。对复发病例进行背景资料分析,分析和复发有关的风险因素;并且对复发病例临床分离株应用数目可变串联重复序列基因分型方法进行分析,确定复发形式。结果从4694例肺结核病临床病例中发现265例复发病例,复发率为67%;在复发风险上30~59岁年龄段和其他年龄段人群相比差异有统计学意义(OR=1.780,95%CI:1.406~2.255,P<005);复治患者和初治患者相比差异有统计学意义(OR=1.032,95%CI:1.010~1.054,P<005)。配对的复发病例中64%(37/58)为内源性复发,36%(21/58)为外源性再感染。结论在北京地区30~59岁年龄段人群、初始入院为复治的患者更容易出现肺结核病复发;复发病例主要为内源性复燃,同时也存在一定的外源性再感染和近期传播。     

Treatment strategies in acute myeloid leukemia (AML)

Summary The strategy for treatment of relapsed or refractory acute myeloid leukemia must primarily be based on the patient's age and clinical condition as well as on the stage of the disease. Accordingly, the general decision between an intensive approach including high-dose chemotherapy or possibly immediate allogeneic bone marrow transplantation versus less-aggressive palliative treatment will precede the selection of the most appropriate salvage regimen. In patients qualifying for intensive second-line chemotherapy the duration of the first remission and the number of relapses provide the means to discriminate between refractoriness or maintained responsiveness to conventional protocols. More than 50% of patients with first relapses after 6–12 months remission duration will respond to standard therapy again and should therefore not be entered on investigational agents with unproven antileukemic activity. The latter seems deeply warranted, on the other hand, for early relapses, second recurrences and resistant first relapses with a remission rate of less than 30% after conventional regimens. These guidelines not only provide an objective rationale for selecting the most appropriate strategy at relapse in individual patients. Furthermore, they facilitate interstudy comparisons and a better judgement of different treatment protocols.     

Extramedullary Leukemic Relapses Following Hematopoietic Stem Cell Transplantation with Nonmyeloablative Conditioning

Of a group of 149 patients who underwent allogeneic stem cell transplantation using the "Mexican approach", a nonablative preparative regimen, 49 individuals developed bone marrow relapse, and 8 patients developed extramedullary relapse (EMR). All EMR cases presented in patients who received allografts for myeloid malignancies. In contrast, bone marrow relapses presented in patients with myeloid or lymphoid malignancies. EMR presented 60 to 1010 days after the allograft and appeared in 3 cases as subcutaneous nodules in different parts of the body, in the vertebrae in 3 cases, and in the kidney and the breast in 1 case each. One patient had both subcutaneous nodules and epididymis EMR. When EMR was noted, acute graft-versus-host disease (GVHD) had presented in 4 patients, and limited forms of chronic GVHD were present in 3 patients. All but 1 of the patients were full chimeras when the EMR ensued, and the EMR preceded an overt hematologic relapse in all but 1 of the patients. Patients who experienced an overt hematologic relapse died 20 to 180 days (median, 40 days) after the EMR.The only individual alive 240 days after relapse shows no evidence of a full-blown hematologic relapse.An EMR after allogeneic hematopoietic stem cell transplantation usually has a bad prognosis and presents mainly in individuals with high-risk malignancies.     

High-Dose Chemotherapy with Autologous Stem Cell Transplantation for Elderly Patients with Relapsed/Refractory Diffuse Large B Cell Lymphoma: A Nationwide Retrospective Study

The number of elderly patients with diffuse large B cell lymphoma (DLBCL) continues to increase but the data regarding autologous stem cell transplantation (ASCT) for elderly patients are limited. We analyzed 484 patients, ages 60 years or over, diagnosed with relapsed/refractory DLBCL who received ASCT from 1993 to 2010 in the Japan Society for Hematopoietic Cell Transplantation database. Median age was 64 years (range, 60 to 78). To evaluate the impact of age at ASCT, patients were classified into 3 groups: those between the ages of 60 to 64, 65 to 69, and 70 years or over. Overall nonrelapse mortality (NRM) at day 100, 1 year, and 2 years was 4.1%, 5.9% and 7.7%, respectively. NRM did not significantly differ among age groups (P = .60). Two-year progression-free survival (PFS) and overall survival (OS) were 48% and 58%, respectively. PFS and OS were significantly longer in patients 60 to 64 years old; however, the survival rate was acceptable even in those 70 or over, with a 2-year OS of 46%. ASCT is feasible in selected elderly patients and age alone should not be a contraindication for ASCT. Eligibility should be individualized and identification of a subset of elderly patients at high risk of treatment-related morbidity or mortality warrants investigation.