TEAA方案治疗难治性及复发性急性白血病疗效观察

目的:探讨治疗难治性复发性急性白血病(AL)的有效方案。方法:27例难治性复发性AL用吡柔比星(THP)、足叶乙甙(VP16)、安吖啶(AMSA)、阿糖胞苷(Ara-C)组成的TEAA方案治疗。用法:THP10mg/d,静脉滴注,第1~3天;VP16 100mg/d,静脉滴注,第1~4天,AMSA75mg/d,第1~3天,静脉滴注;Ara-C200mg/d,第1~7天,静脉滴注。结果:在1~3个疗程(平均1.4疗程,32.5d后)完全缓解16例(59.3%),部分缓解(PR)5例(18.5%),总有效率为77.8%。结论:TEAA方案是治疗难治性复发性AL较有效的方案。     

早期吡柔比星膀胱内灌注预防膀胱癌术后复发

目的:探讨膀胱肿瘤电切术(TURBt)后早期应用吡柔比星灌注化疗预防肿瘤复发的疗效。方法:对112例病理证实的膀胱移行细胞癌患者,59例行早期灌注(Ⅰ组),53例行常规灌注(Ⅱ组)。Ⅰ组于术后6小时内将30mg吡柔比星溶于40ml蒸馏水膀胱内灌注,保留2小时后排出,术后7天开始规律膀胱灌注;Ⅱ组于术后7天开始吡柔比星规律膀胱灌注,比较两组患者膀胱肿瘤复发率。结果:随访7~54个月,平均35个月,Ⅰ组6例膀胱肿瘤复发,Ⅱ组13例复发,差异有统计学意义;不良反应包括尿路刺激征、肉眼血尿等,两组比较差异无统计学意义。结论:TURBt后早期开始吡柔比星膀胱灌注化疗,可以显著降低膀胱肿瘤复发率。     

The effect of pirarubicin chemotherapeutic regimen on osteosarcoma associated with lung metastasis and myocardial function assessment北大核心

Objective: To evaluate the clinical effect of pirarubicin (THP) chemotherapeutic regimen on osteosarcoma with lung metastasis, detect the heart function, and evaluate the adverse reactions induced by THP. Methods: For the 32 patients THP 50 mg/m2 was given on day 1 and cisplatin (DDP) was given for 2-3 d with total dosage of 80 mg/m2 or ifosfamide (IFO) was given for 4 d with total dosage of 8 g/m2. A color Doppler ultrasound echocardiography was used to measure the ejection ratio of left ventricle and the heart function parameters such as E/A value. Results: The survival time was (31.00 ±7.98) months and the disease free time was (13.00 ± 2.46) months. The objective remission rate was 46. 88% and the partial remission rate was 40.63 % in osteosarcoma patients with lung metastasis after combined THP chemotherapy. The side effects induced by THP treatment mainly involved gastrointestinal reaction and bone marrow depression. The left ventricular ejection fraction showed no significant difference between the groups who received various THP cumulative dosages. The E/A value was significantly decreased in high THP cumulative dosage group after chemotherapy (P < 0.05). Conclusion: The THP chemotherapeutic regimen is effective and safe in the treatment of osteosarcoma with lung metastasis, which could be served as a salvage chemotherapeutic regimen. Two dimensional and color Doppler echocardiography may be valuable to assess the early cardiotoxicity induced by anthracyclines.     

Stability and compatibility of four anthracyclines: doxorubicin, epirubicin, daunorubicin and pirarubicin with PVC infusion bags

A rapid isocratic technique was developed for the analysis of four anthracyclines (doxorubicin, epirubicin, daunorubicin and pirarubicin) in parenteral solutions using high pressure liquid chromatography (HPLC) with fluorescence detection and a C18 Hypersil ODS column. The availability and compatibility of these drugs from solutions infused via PVC infusion bags through PVC administration sets have been examined. No significant drug loss was observed during simulated infusions (n=4) for 24 h using PVC infusion bags and administration sets. No significant difference was found between infusion solutions (5% glucose or 0.9% NaCl), except for pirarubicin. The reconstitution of pirarubicin in 0.9% NaCl was impossible, because we observed a precipitation of the compound in solution. The stability of the drugs was also studied in solution, in PVC bags after storage at 4°C with protection from light. The results show the stability of doxorubicin, epirubicin and daunorubicin during 7 days of storage to be satisfactory, irrespective of the infusion solution (5% glucose or 0.9% NaCl). In the case of pirarubicin, the stability of the drug was satisfactory during 5 days of storage in 5% glucose, but beyond, we observed a degradation of the compound with formation of doxorubicin in the infusion solution.     

吡柔比星诱导膀胱癌细胞凋亡的实验研究及预防膀胱癌术后复发的效果

目的　探讨吡柔比星诱导膀胱癌细胞凋亡的机制和膀胱内灌注预防术后复发的效果。　方法　采用MTT法、流式细胞术和透射电子显微镜技术 ,研究不同浓度的吡柔比星对人膀胱癌细胞株T2 4的抑制作用。对 6 0例经尿道电切术的膀胱移行细胞癌患者 ,术后以 30～ 40mg吡柔比星膀胱内灌注 ,观察预防复发的效果。　结果　吡柔比星浓度为 10mg/L和 10 0mg/L时 ,对T2 4细胞生长的抑制率分别为 80 %和 94% ,G1期前出现明显的凋亡峰 ,可见胞浆内空泡形成、核染色质凝聚等典型细胞凋亡特征。当浓度为 10 0 0mg/L时 ,细胞出现坏死特征。共 5 8例完成 1个以上疗程 ,平均随访 18.8个月 ,复发 5例 (8.6 % )。　结论　抑制癌细胞生长和诱导细胞凋亡甚至死亡是吡柔比星抗肿瘤的机制之一。用吡柔比星进行膀胱内灌注预防膀胱癌术后复发安全、有效     

经尿道钬激光联合吡柔比星灌注治疗腺性膀胱炎

目的探讨经尿道钬激光联合吡柔比星灌注治疗腺性膀胱炎的方法及疗效。方法经膀胱镜检及活组织检查确诊38例腺性膀胱炎患者，均行经尿道钬激光切除，术后给予吡柔比星膀胱灌注治疗。结果38例获得8～40个月随访。27例治愈，8例好转，其中有3例6～12个月复发，无癌变。结论经尿道钬激光切除术后应用吡柔比星膀胱内灌注能减少腺性膀胱炎术后复发，且副反应少，安全性较高。     

THP用于可手术乳腺癌术前化疗的近期疗效观察

目的比较以THP为主及ADM为主的两种化疗方案在乳腺癌术前化疗中的疗效及毒副反应。方法42例临床ⅡB~ⅢA期乳腺癌中22例术前应用CTF方案(CTX THP 5-Fu)化疗2个疗程,20例用CAF方案(CTX ADM 5-Fu)化疗2个疗程,观察这两种方案的疗效及毒副反应,化疗后1周内手术。结果THP组完全缓解1例,部分缓解8例,轻微缓解6例,无临床进展病例,总有效率为68.2%;ADM组完全缓解1例,部分缓解7例,轻微缓解5例,无临床进展病例,总有效率为65.0%。结论THP是乳腺癌新辅助化疗的理想药物,其毒性反应较轻,尤其是白细胞减少、心电图异常、脱发的毒副反应较轻。     

早期乳腺癌患者AX方案辅助化疗的不良反应及生活质量观察

目的:观察早期乳腺癌患者行吡柔比星联合卡培他滨(AX)辅助化疗方案的不良反应及生活质量。方法:对60例实施AX方案和60例实施吡柔比星联合环磷酰胺(AC)方案的乳腺癌患者进行不良反应登记,并通过乳腺癌生活质量量表进行生活质量调查,比较两者的反应情况。结果:AX方案呕吐、严重呕吐(III/IV级)发生率明显低于AC方案(53.3%vs.75.0%,P=0.013;10.0%vs.25.0%,P=0.031);AX方案手足综合征发生率明显高于AC方案(45.0%vs.11.7%,P=0.001),但严重手足综合征发生率两者差异无统计学意义(3.3%vs.0,P=0.154);骨髓抑制、恶心、腹泻、脱发以及心脏不适及严重不良反应(III/IV级)发生率两组差异无统计学意义。生活质量功能领域调查显示,AX方案在个人角色、社会功能领域得分明显高于AC方案(78.40 vs.70.92,P=0.042;81.00 vs.75.33,P=0.035),躯体、情绪、认知功能得分两组无统计学差异(均P0.05)。结论:AX方案与传统AC方案比较,前者给药简便,呕吐及严重呕吐发生率低,患者整体生活质量更高。     

吡柔比星与柔红霉素分别联合阿糖胞苷治疗急性早幼粒细胞白血病的疗效对比研究

目的 比较吡柔比星联合阿糖胞苷与柔红霉素联合阿耱胞苷治疗急性早幼粒细胞白血病疗效及不良反应.方法 选择医院收治的急性早幼粒细胞白血病患者92例,随机分为观察组与对照组,每组各46例.对照组给予柔红霉素联合阿糖胞苷进行治疗,观察组给予吡柔比星联合阿糖胞苷进行治疗.对两组患者治疗后的临床疗效、G-CSF次数、红细胞平均输注量、血小板平均输注量、血液指标及不良反应发生率进行比较.结果 ①观察组患者的总有效率与对照组相比较,差异无统计学意义(P＞0.05).②观察组患者的G-CSF使用次数明显高于对照组(P＜0.05);观察组患者的红细胞平均输注量及血小板平均输注量明显高于对照组(P＜0.05).③观察组患者治疗后的血液指标与对照组相比较,差异无统计学意义(P＞0.05).④观察组患者治疗后不良反应发生率与对照组相比较,差异无统计学意义(P＞0.05).结论 吡柔比星联合阿糖胞苷与柔红霉素联合阿糖胞苷治疗急性早幼粒细胞白血病的临床疗效与不良反应相当,但吡柔比星联合阿糖胞苷的心脏毒性较小,可作为急性早幼粒细胞白血病的一线治疗方法.     

吡柔比星术后即刻膀胱灌注+短程维持膀胱灌注化疗预防浅表性膀胱癌术后复发临床研究

目的 探讨吡柔比星(THP)术后即刻膀胱灌注+短程维持膀胱灌注化疗预防浅表性膀胱癌术后复发的安全性和疗效.方法 107例浅表性膀胱癌患者按随机数字表法分为术后即刻膀胱灌注+短程维持膀胱灌注化疗组(A组,50例)和常规膀胱灌注化疗组(B组,57例).A组术后24h内完成THP膀胱灌注,维持膀胱灌注每周1次,共8次.B组术后1～2周开始进行THP膀胱灌注,每周1次,共8次,再改为每个月1次,共10次.总疗程12个月.定期膀胱镜检查进行随访.结果 术后随访13～84个月,A组膀胱局部不良反应发生率26.00％( 13/50),全身症状发生率4.00％(2/50),膀胱肿瘤复发率16.00％(8/50).B组膀胱局部不良反应发生率22.81％( 13/57),全身症状发生率1.75％( 1/57),膀胱肿瘤复发率19.30％( 11/57),两组比较差异无统计学意义(P＞0.05).结论 THP术后即刻膀胱灌注是安全有效的,但是对膀胱穿孔明显、经尿道膀胱肿瘤切除术后膀胱黏膜创面广泛的患者,术后不宜即刻膀胱灌注化疗药物.THP术后即刻膀胱灌注+短程维持膀胱灌注化疗预防浅表性膀胱癌术后复发的效果明确,患者耐受性好.