含地西他滨方案治疗老年急性髓系白血病26例疗效分析

目的:探讨地西他滨单药及联合CAG化疗方案治疗老年急性髓系白血病(AML)患者的临床疗效及不良反应等。方法:回顾性分析接受含地西他滨方案治疗的26例老年AML患者的临床特点,评估临床疗效及不良反应。结果:26例老年AML患者首程治疗后17例达完全缓解,3个疗程后18例达完全缓解,1例达部分缓解,总有效率73.1%。不良反应主要为骨髓抑制,其中17例出现肺部感染,2例出现败血症,3例出现粒细胞缺乏伴感染。结论:地西他滨单药及联合CAG方案治疗老年AML患者具有较高的缓解率和较低的不良反应,值得进一步探究及临床推广应用。     

地西他滨/阿扎胞苷联合HAAG方案治疗老年急性髓系白血病患者的临床疗效

目的:回顾性对比观察及分析地西他滨/阿扎胞苷分别联合HAAG(高三尖杉酯碱HTT、阿糖胞苷Ara-C、阿克拉霉素Acla及重组人粒细胞集落刺激因子G-CSF)治疗无法接受强化疗的老年急性髓系白血病患者的有效性和安全性.方法:回顾性分析我院2018年1月-2020年4月收治的33例老年急性髓系白血病患者,分为地西他滨组1...     

地西他滨联合FLAG方案治疗复发难治型急性髓系白血病疗效观察

目的:探讨地西他滨联合FLAG方案对复发难治型急性髓系白血病患者疗效及远期生存率的影响。方法:选取复发难治型急性髓系白血病患者136例,采用随机数字表法将患者分为2组,每组68例,对照组采用FLAG方案(氟达拉滨、阿糖胞苷与粒细胞刺激因子)治疗,观察组采用地西他滨联合FLAG方案治疗,比较2组临床疗效。结果:观察组完全缓解率与总体缓解率明显高于对照组,疾病进展率明显低于对照组(P0.05或P0.01)。观察组口腔溃疡、药物性肝损害、消化道反应、感染与骨髓抑制等药物不良反应发生率明显低于对照组,总生存时间与无复发时间明显长于对照组(P0.05或P0.01)。结论:地西他滨联合FLAG方案治疗复发难治型急性髓系白血病患者的疗效显著,远期生存率明显提高。     

地西他滨联合小剂量CAG治疗老年急性髓系白血病疗效研究

目的对比地西他滨联合小剂量CAG方案(阿克拉霉素+阿糖胞苷+粒细胞集落刺激因子)与CAG方案治疗老年急性髓系白血病的疗效及安全性。方法收集2012年1月至2013年12月在中国医科大学附属第一医院诊治的老年急性髓系白血病29例,其中17例作为观察组给予地西他滨+小剂量CAG方案,12例作为对照组给予标准剂量CAG方案,对比两组患者的疗效及不良反应。结果观察组的总缓解率(82.4%)明显高于对照组(41.7%),差异有统计学意义(P=0.046)。两组不良反应的表现及发生率相似,差异无统计学意义(P0.05)。结论地西他滨+小剂量CAG方案的总缓解率优于CAG方案,且不增加化疗相关风险,可作为老年急性髓系白血病的一线治疗方案。     

地西他滨治疗复发难治性急性白血病临床应用进展

常规诱导化疗无法达到缓解或缓解后复发是急性白血病患者治疗面临的重要问题之一。DNA 甲基化转移酶 抑制剂地西他滨可抑制DNA 甲基化, 在肿瘤细胞中具有双重性作用, 包括激活沉默基因以及低剂量促分化、高剂 量产生细胞毒性。近年来, 地西他滨无论是联合化疗药物, 还是联合其他靶向药物或造血干细胞移植, 正越来越多 地应用于复发难治急性白血病, 特别是急性髓细胞白血病的治疗中。     

地西他滨加改良CAG方案联合人白细胞抗原半相合淋巴细胞输注治疗老年急性髓系白血病缓解1例

骨髓增生异常综合征（MDS）是一组造血干细胞异常的恶性克隆性疾病,可转化为急性髓系白血病（AML）。MDS转化为AML时,化疗常常不能有效杀灭或抑制肿瘤细胞,且骨髓抑制相当严重,化疗后骨髓抑制期的出血、感染常成为患者临床死亡主要原因。因此,继发于MDS的AML患者预后差,治疗困难。近期笔者应用地西他滨加阿糖胞苷、阿克拉霉素和粒细胞集落刺激因子（CAG）联合半相合淋巴细胞回输,成功诱导缓解1例继发于MDS的AML,并显著缩短化疗后的骨髓抑制期,获得良好疗效。     

老年急性白血病病人化疗后骨髓抑制期感染的临床分析

目的分析老年急性白血病(AL)病人化疗后骨髓抑制期感染的临床特点,探讨其防治措施。方法回顾性分析2013年1月至2015年12月102例老年AL病人(老年组)及100例中青年AL病人(对照组)化疗后进入骨髓抑制期时感染的发生率,并对其感染率、粒细胞缺乏持续时间、致病菌情况及治疗情况进行比较分析。结果老年组的感染发生率高于对照组(P0.05),2组内亚组分析显示,与单纯AL比较,白血病合并支气管炎、糖尿病、风湿病等病人的感染发生率相对较高(P0.01);中性粒细胞计数越低、持续时间越长,感染发生率越高(P0.05);使用集落刺激因子(G-CSF)合并抗感染治疗组粒细胞缺乏持续的时间较单用抗感染组明显缩短,差异有统计学意义(P0.01),且在对照组中效果优于老年组(P0.05)。细菌培养结果显示,2组致病菌均以革兰阴性杆菌为主,如铜绿假单胞菌、大肠埃希菌,其次为革兰阳性球菌,如葡萄球菌属,而真菌最少,如白色念珠菌。结论老年AL病人骨髓抑制期易发生感染,有效的抗生素和粒细胞集落刺激因子的合理应用,可减少老年AL病人化疗后骨髓抑制期感染的发生率并改善预后。     

诱导缓解化疗方案治疗老年急性髓系白血病的疗效及预后

急性髓系白血病是造血系统的髓系原始细胞克隆性恶性增殖性疾病,是一个具有高度异质性的疾病群,可以由正常髓系细胞分化发育过程中不同阶段的造血祖细胞恶性变转化.近年来,老年人病急性髓系白血病的发生率高[1],治疗老年急性髓系白血病的方案众多[2].本研究分析阿糖胞苷和阿克拉霉素联合粒细胞集落刺激因子(CAG)诱导缓解化疗方案和氟达拉滨联合阿糖胞苷(FA)化疗方案的治疗缓解率、不良反应和复发预后情况,探讨治疗老年急性髓系白血病的最佳方案.     

多疗程地西他滨治疗骨髓增生异常综合征及急性髓系白血病患者的回顾性分析

目的:分析多疗程地西他滨治疗骨髓增生异常综合征(MDS)及急性髓系白血病(AML)患者的临床疗效与安全性。方法:对接受地西他滨治疗的30例MDS患者及27例AML患者进行回顾性分析。结果:地西他滨单药治疗MDS患者中,随着疗程数增加,完全缓解(CR)/骨髓完全缓解(mCR)率增加,差异有统计学意义(P=0.047)。对可能影响疗效的临床特征分析发现,在MDS患者中,重度贫血对CR/mCR有影响(P=0.042);在AML患者中,预后分层对CR/mCR有影响(P=0.016)。地西他滨治疗MDS患者相关并发症分析中,单药方案1个疗程粒细胞减少中位时间为10(0~25)d,2个疗程为6(0~24)d,3个疗程为4(0~10)d;联合方案中,1个疗程粒细胞减少中位时间为11(0~30)d,2个疗程为8(0~30)d,3个疗程为4(0~11)d;肺部感染发生率为30.0%,治疗相关死亡1例(为移植后复发)。地西他滨单药及联合方案治疗AML患者,1个疗程粒细胞减少中位时间为21(0~37)d,2个疗程为13(0~37)d,3个疗程为13(0~18)d;肺部感染发生率为40.7%,治疗相关死亡2例。通过多因素COX比例风险模型分析发现,IPSS评分及铁过载是影响MDS患者总生存的预后因素(P=0.031、0.042),而预后危险分层是影响AML患者总生存的预后因素(P=0.013)。结论:地西他滨治疗MDS/AML疗效确切,单药治疗MDS患者中,随着疗程数增加,缓解率增加;地西他滨不良事件具有可控性,安全性好,大部分患者可以安全度过化疗后骨髓抑制期。     

多疗程地西他滨治疗骨髓增生异常综合征及急性髓系白血病患者的回顾性分析

目的:分析多疗程地西他滨治疗骨髓增生异常综合征(MDS)及急性髓系白血病(AML)患者的临床疗效与安全性。方法:对接受地西他滨治疗的30例MDS患者及27例AML患者进行回顾性分析。结果:地西他滨单药治疗MDS患者中,随着疗程数增加,完全缓解(CR)/骨髓完全缓解(mCR)率增加,差异有统计学意义(P=0.047)。对可能影响疗效的临床特征分析发现,在MDS患者中,重度贫血对CR/mCR有影响(P=0.042);在AML患者中,预后分层对CR/mCR有影响(P=0.016)。地西他滨治疗MDS患者相关并发症分析中,单药方案1个疗程粒细胞减少中位时间为10(0~25)d,2个疗程为6(0~24)d,3个疗程为4(0~10)d;联合方案中,1个疗程粒细胞减少中位时间为11(0~30)d,2个疗程为8(0~30)d,3个疗程为4(0~11)d;肺部感染发生率为30.0%,治疗相关死亡1例(为移植后复发)。地西他滨单药及联合方案治疗AML患者,1个疗程粒细胞减少中位时间为21(0~37)d,2个疗程为13(0~37)d,3个疗程为13(0~18)d;肺部感染发生率为40.7%,治疗相关死亡2例。通过多因素COX比例风险模型分析发现,IPSS评分及铁过载是影响MDS患者总生存的预后因素(P=0.031、0.042),而预后危险分层是影响AML患者总生存的预后因素(P=0.013)。结论:地西他滨治疗MDS/AML疗效确切,单药治疗MDS患者中,随着疗程数增加,缓解率增加;地西他滨不良事件具有可控性,安全性好,大部分患者可以安全度过化疗后骨髓抑制期。     

Combination chemotherapy with low-dose cytarabine, homoharringtonine, and granulocyte colony-stimulating factor priming in patients with relapsed or refractory acute myeloid leukemia

As sensitization of leukemic cells with granulocyte colony-stimulating factor (G-csf) can enhance the cytotoxicity of chemotherapy in acute myeloid leukemia (AML), a pilot study was conducted in order to evaluate the effect of G-csf priming combined with low-dose chemotherapy in patients with relapsed and refractory AML. The regimen, G-HA, consisted of cytarabine 7.5 mg/m2/12 hr by subcutaneous injection, days 1-14, homoharringtonine 1.5 mg/m2/day by intravenous continuous infusion, days 1-14, and G-csf 150 microg/m2/day by subcutaneous injection, days 0-14. Thirty-six AML patients were enrolled, 23 refractory and 13 relapsed. Eighteen patients (50%, 95% confidence interval: 33-67%) achieved complete remission (CR) with a median CR duration of 7.2 months, and two elderly patients continued a regimen of maintenance therapy and remained in remission for 26.3 and 14.1 months, respectively, as of last follow-up. Eight patients (22%) experienced neutropenia (median duration: 6 days; range: 2-22 days). Thirteen of the 36 (36%) developed severe infections. Grade 1-2 nonhematologic toxicities were documented, including nausea and vomiting (20%), liver function abnormality (6%), and heart function abnormality (6%). No central nervous system and kidney toxicity was observed. The G-HA regimen is effective in remission induction for refractory and relapsed AML patients and well tolerated in maintenance therapy in some subgroups of elderly patients. Further studies are necessary to elucidate optimum dose and schedule for this regimen to enhance the treatment efficacy of relapsed or refractory AML patients.     

脑卒中患者发生院内感染的临床情况及血免疫指标影响研究

目的探讨脑卒中患者发生院内感染的临床情况以及免疫功能影响,为临床诊疗提供参考依据。方法回顾性分析2016年1月—2018年1月在我院就诊的360例脑卒中患者的临床资料。统计医院感染的发生率,并根据患者是否发生院内感染分为感染组(n=55)和未感染组(n=305)。统计分析患者感染部位、病原菌分布及影响因素,分析免疫功能免疫球蛋白A(immunoglobulin A,IgA)、IgG、补体3(complement 3,C3)、C4对患者的影响。结果360例脑卒中患者中男190例,女170例,年龄45~75岁,平均(60.12±4.89)岁。感染组以肺部感染为主,占比58.18%。55例感染患者共分离出病原菌76株,以革兰阴性菌为主,占比55.26%(42/76),其次为革兰阳性菌,占比31.58%(24/76),最后为真菌,占比13.16%(10/76)。年龄,性别,意识障碍,侵入性操作,住院天数,机械通气,吞咽困难,糖尿病,IgA、IgG、C3及C4水平下降与脑卒中患者发生院内感染有关(P均<0.05);多因素Logistic回归分析结果显示,意识障碍,性别,侵入性操作,机械通气,吞咽困难,糖尿病,IgA、IgG、C3及C4水平下降等是脑卒中患者发生院内感染的独立危险因素(P均<0.05)。结论脑卒中患者院内感染发生率较高,意识障碍,性别,侵入性操作,机械通气,吞咽困难,糖尿病,IgA、IgG、C3及C4水平下降等是脑卒中患者发生院内感染的独立危险因素,免疫功能降低与脑卒中患者发生院内感染密切相关,临床应注重对患者免疫功能监测,适当增强患者自身免疫功能。     

Aclarubicin and Low-Dose Cytosine Arabinoside in Combination with Granulocyte Colony-Stimulating Factor in Treating Acute Myeloid Leukemia Patients with Relapsed or Refractory Disease and Myelodysplastic Syndrome: A Multicenter Study of 112 Chinese Patients

One hundred twelve patients with geriatric acute myeloid leukemia (AML), refractory or relapsed AML, or myelodysplastic syndrome and refractory anemia with excess of blasts in transformation (MDS-RAEBt) were entered into this study to receive CAG (aclarubicin and low-dose cytosine arabinoside [Ara-C]in combination with granulocyte colony-stimulating factor [G-CSF]) with the objective of evaluating the efficacy and tolerance of this regimen. Low-dose Ara-C was given subcutaneously at a dosage of 10 mg/m2 every 12 hours on days 1 to 14. Aclarubicin was administered intravenously at a dosage of 14 mg/m2 per day on days 1 to 4 (CAG regimen A) or 7 mg/m2 on days 1 to 8 (CAG regimen B). Recombinant G-CSF was given subcutaneously at a dosage of 200 3g/m2 per day on days 1 to 14. We demonstrated comparable overall complete remission rates for the 4 groups of patients: 30.8% (8/26) in the elderly patients, 48.4% (30/62) in the refractory AML patients, 44.4% (8/18) in the relapsed AML patients, and 38.5% (5/13) in the MDS-RAEBt patients. Of the 52 patients followed up, the 12-month progression-free survival (PFS) and overall survival (OS) rates estimated by the Kaplan-Meier method were 40.73% 3 8.15% and 42.85% 3 8.23%, respectively. The median PFS and OS times were 9.0 3 2.2 months and 11.0 3 1.6 months, respectively. Toxic effects were very rare and mainly consisted of neutropenia and thrombocytopenia due to myelosuppression; approximately 70% to 80% of patients had neutropenia or thrombocytopenia that exceeded National Cancer Institute grade II. Nonhematologic toxicities were not observed in this study.The CAG regimen seems promising, with acceptable toxicity, for the treatment of various categories of poor-prognosis AML and MDS-RAEBt.     

综合重症监护病房老年患者医院感染现状及危险因素分析

目的 了解综合重症监护病房(intensive care unit,ICU)老年患者医院感染现状,探讨老年患者发生医院感染的危险因素.方法 回顾性调查2015年1月-2019年6月期间在上海市某三甲医院综合ICU内年龄≥65岁的老年住院患者发生医院感染的情况,分析主要感染类型和检出病原菌种类,采用病例对照研究方法,比较...     

Incidence of febrile neutropenia and neutropenic infections in elderly patients receiving anthracycline-based chemotherapy for breast cancer without primary prophylaxis with colony-stimulating factors

There is concern about the potential increase of hematological toxicity in elderly patients treated with chemotherapy. Recently, primary prophylaxis with colony-stimulating factors (CSFs) was proposed for elderly patients receiving moderately toxic chemotherapy. However, evidence for the benefits of this primary prophylaxis for elderly breast cancer patients is currently lacking. We retrospectively analyzed the incidence of febrile neutropenia (FN) and neutropenic infections in elderly breast cancer patients receiving anthracycline-based chemotherapy without primary prophylaxis with colony-stimulating factors. In addition, we assessed the direct costs of hospitalization for these complications. Febrile neutropenia or neutropenic infection occurred in 13% of the 46 patients. Further studies are needed to adequately evaluate the risk of neutropenic complications (NC) in elderly patients receiving standard-dose chemotherapy for breast cancer and the potential benefits of primary prophylaxis with colony-stimulating factors.     

Treatment of an Elderly Patient with Acute Myeloid Leukemia and Invasive Pulmonary Aspergillosis Infection with Combined Allogeneic Hematopoietic Stem Cells Microtransplantation and Voriconazole

Invasive aspergillosis infection (IF) in patients with hematologic malignancies is common. Prognosis of IF in patients with acute myeloid leukemia (AML) not responsive to chemotherapy is very poor, especially when neutropenia is duration. Fractional HLA haplo-identical mobilized neutropenia peripheral blood stem cell (PBSC) transfusion, which was defined as micro-transplantation, was recently adopted in treatment of elder patients with AML and shown to be effective in fasting hemopoiesis recovery. Here we report the outcome of an elderly patient with AML accompanying IF treated with microtransplantation and voriconazole. The patient (female, age 62) was diagnosed relapsed AML accompaning suspected invasive fungal infection. She refused to accept further chemotherapy. PBSC from her daughter were collected and transfused fractionally. Voriconazole was used for anti- aspergillosis treatment. After stem cell infusions, the patient’s neutrophil count increased, and platelet transfusion interval extended from 3–4 to 10–14 days. Lung CT indicated that the lesions were significantly absorbed. The patient survived for 257 days. We concluded that for elderly patients with AML and accompanying IF who are not eligible for chemotherapy, microtransplant may be beneficial for improving the efficacy of anti-fungal treatment.     

Prevention and therapy of neutropenia in elderly patients

Standard chemotherapy in elderly patients is still nowadays a difficult issue, due to the fact that marrow reserve decrease with age and the results might lead to higher toxicity of otherwise well tolerated regimen and schedule. In the literature, very few data exist of myelosuppression in patients with solid tumors, while more data have been published on non-Hodgkin's lymphoma. The burden of toxicity increase with age, leading to the fact that some patients with curable or sensitive disease do not receive appropriate treatment. One of the ways to try to circumvent neutropenia is the prophylactic use of haematopoietic growth factors with the double aim of maintaining dose-intensity and reducing toxicity. This paper will describe the patterns of marrow toxicity in treating elderly patients with cancer and the role of haematopoietic growth factors.     

Clinical outcome of treatment with a combined regimen of decitabine and aclacinomycin/cytarabine for patients with refractory acute myeloid leukemia

We conducted a clinical trial of low-dose decitabine plus aclacinomycin/cytarabine (AA) treatment (DAA) for 20 patients with refractory/relapsed de novo acute myeloid leukemia (AML) or AML transformed from myelodysplastic syndrome (MDS/AML) in order to examine its efficacy and tolerability. Additionally, P15^ink4b methylation status was analyzed (for 15 patients) pre- and post-DAA treatment, and in vitro drug sensitivity tests were performed for seven patients (AA or AA?+?decitabine) to explore the role of decitabine in this combination treatment regimen. A total of 11 patients (55.0?%) achieved complete remission (CR) after DAA treatment, including 7 of whom reached CR after only one treatment course. The other two patients achieved partial remission. The median overall survival (OS) was 10?months for all 20 patients. The median OS for those who achieved CR was significantly longer than that of patients with no response (NR; P?=?0.01). The treatment regimen was well tolerated, and there was no treatment-related mortality. The mean levels of P15^ink4b methylation decreased significantly in six patients who achieved CR, whereas very few changes in P15 ^ink4b methylation were detected for the five patients with NR following DAA treatment. The data from the methyl thiazolyl tetrazolium assays showed that the inhibition rates of AA and DAA for tumor cells were identical. We conclude that induction therapy with DAA for refractory/relapsed de novo AML or MDS/AML achieved high levels of CR and improved OS and demonstrated adequate tolerance. Moreover, the decitabine component of DAA may function through a demethylation effect.     

肺癌患者医院感染调查分析

目的对肺癌患者发生医院感染的状况进行调查分析。方法对126例肺癌患者发生医院感染的状况进行分析。结果 126例肺癌患者中分离出病原菌148株,病原菌以革兰氏阴性杆菌为主(62.84%),革兰氏阳性杆菌(29.73%),真菌(7.43%);细菌的耐药性普遍较高;感染的相关因素有:年龄、住院时间、肺癌临床分期、侵袭性操作、放疗/化疗、抗生素的使用、免疫抑制剂或激素、伴有基础疾病。结论肺癌患者医院感染病原菌以革兰氏阴性杆菌为主,病原菌常为多药耐药。合理控制院内感染的相关因素,对指导临床合理用药具有重要意义。