Autologous Unpurged Bone Marrow Transplantation for Acute Non Lymphoblastic Leukemia in First Remission

Forty consecutive adult patients under the age of 50 with acute non-lymphoblastic leukemia (ANLL) in first complete remission, underwent autologous bone marrow transplantation (ABMT) between March 1984 and April 1990. The conditioning regimen employed included cyclophosphamide and total body irradiation, followed by the administration of unpurged ABMT. The median time from diagnosis to transplant was 7 months (3-15 months), and the median time from complete remission to ABMT was 4 months (range 3-9 months). Twenty-two (51%) patients remain in complete remission 6-81 months (median 24 months) after ABMT.

The causes of death were, recurrent leukemia (11 patients), parenchymal toxicities such as acute respiratory distress syndrome and veno-occlusive disease (3 patients), hemorrhage (2 patients) and infection (2 patients). Eleven patients relapsed after 3-12 months (median 5 months). This study has produced survival data comparable to those of other institutions employing TBI for either allo or autotransplants.     

急性非淋巴细胞白血病三种诱导化疗方案疗效分析：附96例报告

本文报导三种化疗方案:HCVZP—L、HCD(HAD)、AD(AA)治疗急非淋白血病(M_3、M_6除外)96例。其中 HCVZP—L 方案治疗49例,CR 率73.5％;HCD(HAD)方案治疗36例,CR 率75％;AD(AA)方案治疗11例,CR 率81.8％。     

HDA方案治疗急性非淋巴细胞白血病临床研究

１９８５年～１９９３年收治急性非淋巴细胞白血病（ＡＮＬＬ）２１８例，用ＨＤＡ方案治疗７２例，ＣＲ率为７６．３８％、ＨＡ方案治疗７８例，ＣＲ率４４．８７％、ＤＡ方案治疗６８例，ＣＲ率４８．８５％，ＨＤＡ组与ＨＡ、ＤＡ组疗效差异显著（Ｐ＜０．００５），ＣＲ后必须坚持长期多疗程的强化治疗才能延长生存期、提高治愈率。     

A case of mixed lineage acute non-lymphocytic leukemia with t(5;12)(p13;p13)

A two-year-old boy had mixed lineage acute non-lymphocytic leukemia (ANLL) with a 46,XY, t(5;12)(p13;p13) karyotype. He was admitted to the hospital with fever and petechiae. Morphological and cytochemical characteristics showed the blasts to meet the standard French-American-British criteria for M1, but surface marker analysis showed the blasts to express both myeloid (CD33: 91.3%) and T-cell (CD2: 82.3%, CD7: 97.9%) antigens. The boy was treated with an ANLL protocol, and successfully brought to a remission which has continued for more than 30 months.     

同源核糖核酸在急性非淋巴细胞白血病联合化疗中的意义

在急性非淋巴细胞白血病（ＡＮＬＬ）联合化疗的基础上加用了同源核糖核酸（ＲＮＡ），其结果显示：在联合化疗的基础上加用同源ＲＮＡ虽不能提高ＡＮＬＬ联合化疗的完全缓解率，但能减少复发率，并能改善患者的免疫功能，可作为ＡＮＬＬ联合化疗的辅助药物。     

Idarubicin plus Cytarabine versus Doxorubicin plus Cytarabine in Induction Therapy for Acute Non- Lymphoid Leukaemia: A Randomized Trial

A randomized trial comparing idarubicin plus cytarabine (IDA/Ara-C) with doxorubicin plus cytarabine (ADM/Ara-C) in induction therapy for ANL,L was carried out. The IDA/Ara-C regimen consisted of idarubicin 20 mg/m² p.o. given on days 1, 2 and 3 plus cytarabine 25 mg/m² as a loading dose followed by 100 mg/m² by continuous infusion daily × 7 days. The ADM/Ara-C regimen consisted of adriamycin 30 mg/m² on days 1, 2 and 3 and the same dose of cytarabine.

Patients who responded to the first cycle with at least 502, reduction of marrow blasts received a second treatment cycle followed by a consolidation cycle of the same treatment for those in CR at the end of 2 cycles. 35/52 (6770 receiving ADM/Ara-C achieved CR, with 25 (48%) patients in CR after a single treatment cycle. 28/48 (58%) receiving ADM/Ara-C achieved CR of whom 11 (23%) went into remission after the first treatment cycle. IDA/Ara-C caused less nausea and vomiting, less stomatitis, a shorter duration of neutropenia and less need for platelet support than ADM/Ara-C. The median duration of CR is 62 weeks for IDA/Ara-C and 48 weeks for ADM/Ara.-C. These differences are not statistically significant. Clinical cardiotoxicity occurred in 4/48 patients treated with ADM/Ara-C. No clinical cardiac toxicity was observed in those receiving IDA/Ara-C. The mean post-treatment ejection fraction was, in addition, lower for ADM/Ara-C than for IDA/Ara-C. It is concluded that IDA/Ara-C is an effective and safe induction therapy for ANLL.     

Comparison of acute myeloid leukemia occurring de novo or preceded by a myelodysplastic stage: Differences in cellular DNA content

The DNA content of bone marrow cells in patients with acute leukemia preceded by a myelodysplastic stage (MDS-AML) was compared to that in patients with de novo AML. We studied granulocytes, lymphocytes, monocytes, and blasts/promyelocytes from Feul-gen-stained bone marrow smears of 11 patients with de novo AML, ten patients with MDS-AML, and 13 apparently healthy controls. The mean amount of DNA per cell (DNA index; Dl) in each cell population was determined using a digital video-based imageanalyzing system (CAS-100). Analysis of variance (F test) showed a significant difference in the DNA content between de novo AML on one hand and MDS-AML and controls on the other as regards to blasts/promyelocytes (P < 0.01), lymphocytes (P < 0.05), and monocytes (P < 0.01), respectively. In three of 11 (27%) patients with de novo AML, a lower than normal limit Dl was found both in immature and mature bone marrow cells. Patients with MDS-AML had those of Dl values similar to normal controls. In consequence, a significantly reduced mean Dl was found in patients with de novo AML in blasts/promyelocytes (P < 0.01), and monocytes (P < 0.05) compared to both normal controls and MDS-AML. Together with data published separately, suggesting differences in granulocyte morphology, clonality, and HLA-DR expression, these data suggest biological differences between the two diseases. © 1993 Wiley-Liss, Inc.     

Toxicity trials of amsacrine (AMSA) and etoposide +/− azacitidine (AZ) in childhood acute non-lymphocytic leukemia (ANLL): a pilot study

Recurrent or induction therapy-resistant ANLL carries a grave prognosis. The combination of AMSA at 100 mg/M² daily for 5 days and etoposide at 200 mg/M² daily for the first 3 days of therapy was given to 40 patients with refractory ANLL. An additional 17 patients received those two agents plus azacitidine at a dosage of 250 mg/M² on days 4 and 5. All three drugs were given as one-hour infusions. All patients had normal electrolyte determinations daily and were on cardiac monitors during the period of drug administration. No arrhythmias were detected in 522 doses of AMSA. Toxicities observed were primarily related to myelosuppression. Forty-nine of the 57 patients required hospitalization for suspected or proven infection. Nausea/vomiting and mucositis were the next most commonly occurring toxicities. Responses were seen in 22 patients.     

Progress in the treatment of childhood acute leukemia: A review

The dramatic improvements in the survival experience for children diagnosed with acute leukemia are analyzed using data collected through hospitals participating in the National Cancer Institute's End Results Group Program between 1950 and 1973. Children under 15 years of age who were diagnosed with both acute lymphocytic leukemia (ALL) and acute nonlymphocytic leukemia (ANLL) showed moderate improvements in the 1950s, but beginning in the 1960s those with ALL did far better. Statistically significant differences at the 0.05 level were noted between their three-year survival rates for all cohorts analyzed between 1960 and 1973. For the 1970-1973 cohort, three-year survival rates were 49% and 20% for ALL and ANLL, respectively, and five-year survival rates were 34% and 12%. Between 1950 and 1976 the age-adjusted incidence rate for all childhood leukemias remained relatively stable in a sample of five geographic areas, changing from 4.6 per 100,000 children under 15 years of age to 4.3 per 100,000. In contrast, the corresponding age-adjusted mortality rate fell approximately 45% over the same period, from 4.4 per 100,000 to 2.4 per 100,000.     

18例中枢神经白血病的临床诊治

目的 探讨中枢神经系统白血病(CNSL)的临床特征及诊治.方法 回顾性分析18例CNSL患者的临床资料.结果 本组18例CNSL患者经鞘内注射治疗后,生存8例(44.44%),死亡10例(55.56%).结论 CNSL早期诊断,及时治疗,尽量避免长期鞘内注药及放疗引起的中枢神经系统损伤.