吡喃阿霉素联合用药治疗初治急性非淋巴细胞白血病临床观察

吡喃阿霉素(THP)是新一代蒽环类抗肿瘤药物,以THP为主的化疗方案主要用于治疗难治和复发性急性白血病.我院从1997年8月-2002年12月以THP为主治疗31例初治急性非淋巴细胞白血病,取得较好疗效,现报道如下.     

榄香烯乳加联合化疗治疗急性非淋巴细胞白血病疗效观察

报道榄香烯乳加联合化疗治疗急性非淋巴细胞白血病的疗效。方法：将４３例急性非淋巴细胞白血病患者随机分为治疗组,用榄香烯乳２００～４００ｍｇ加生理盐水或５％葡萄糖５００ｍｌ,静脉滴注,持续１２～１５天,同时用ＨＡ方案：三尖杉酯碱４～６ｍｇ／ｄ１－７,阿糖胞苷１００－２００ｍｇ／ｄ１～７;对照组：单用ＨＡ方案,用量用法同治疗组。结果：治疗组ＣＲ率８０％,对照组ＣＲ率６０．９％;治疗组有效率９５％,对照组有效率７３．９％。结论：榄香烯乳对急性非淋巴细胞白血病有肯定的疗效,此药不良反应轻,无骨髓抑制,在化疗后的骨髓抑制期仍能继续使用榄香烯乳治疗,故榄香烯乳可成为急性非淋巴细胞白血病的有效药物之一。     

大剂量甲氨蝶呤治疗成人急性淋巴细胞白血病的临床观察

探讨使用大剂量甲氨蝶呤(HD -MTX)在成人急性淋巴细胞白血病(acute lymphoblastic leukemia,ALL)维持强化治疗过程中的疗效和毒副反应,采用甲氨蝶呤(MTX)1~3 g/m2,24 h持续静脉滴入,用来成人ALL的强化治疗,并用四氢叶酸钙(CF)解救。结果呈缓解状态86 .0%(49/57),骨髓复发7 0%(4/57),中枢神经系统白血病(CNS L)1 .8%(1/57),死亡5. 2%(3/57)。初步研究结果提示,HD- MTX治疗成人ALL疗效肯定,相对骨髓抑制较轻,黏膜皮肤损害较突出,毒副反应可以耐受。     

MxA方案治疗难治性急性非淋巴细胞白血病疗效观察

选择我院 1996年 3月～ 2 0 0 0年 7月难治性急性非淋巴细胞白血病患者 34例 ,应用MxA方案进行治疗 ,同时加强支持治疗 ,观察其疗效并对其分析 ,结果总有效率 70 .6 % ,并无明显的毒副作用。初步研究结果提示 ,MxA治疗难治性急性非淋巴细胞白血病是一种值得临床推广的首选方法。     

老年人急性非淋巴细胞白血病化疗疗效观察

报道了五年间收治的老年急性非淋巴细胞白血病（ＡＮＬＬ）２１例，采用ＤＡ（ＶＰ１６）与ＨＡ（ＶＰ１６）联合化疗，依据不同剂量，将其分为二组，二组总有效率为６６．６％，其中中等剂量组１４例，８例ＣＲ，平均生存时间为２６７天，２例（１８％），ＰＲ，小剂量组７例，２例（２８．５％），ＣＲ，２例（２８．５％）ＰＲ，结果提示：对老年白血病患者治疗应个体化，一般情况好者应在强有力支持治疗情况下采用中等剂量的化疗     

大剂量甲氨蝶呤治疗成人急性淋巴细胞白血病的临床观察

探讨使用大剂量甲氨蝶呤(HD-MTX)在成人急性淋巴细胞白血病(acute lymphoblastic bukemia．ALL)维持强化治疗过程中的疗效和毒副反应，采用甲氨蝶呤(MTX)1～3g/m^2．24h持续静脉滴入，用来成人ALL的强化治疗，并用四氢叶酸钙(CF)解救。结果呈缓解状态86．0％(49／57)．骨髓复发7．0％(4/57)．中枢神经系统白血病(CNS-L)1．8％(1／57)，死亡5．2％(3／57)。初步研究结果提示，HD-MTX治疗成人ALL疗效肯定．相对骨髓抑制较轻．黏膜皮肤损害较突出。毒副反应可以耐受。     

HAE方案治疗难治性急性非淋巴细胞白血病

蒽环类药物联合阿糖胞苷治疗急性非淋巴细胞白血病 (急非淋 ,ANLL )可使将近 70 %的患者获得完全缓解 ,但仍有 30 %左右的患者未能达到缓解 ,这部分病例的治疗成为提高急非淋疗效的关键。大剂量阿糖胞苷对部分耐药病例有效 ,但其毒副作用较大 ,应用受到限制。高三尖杉酯碱与蒽环类药物无论结构或作用机理均有不同 ,为探讨高三尖杉酯碱对难治病例的疗效 ,我们自 1 992年 5月至 1 998年5月间对住院病人采用 HAE方案治疗难治性急非淋 2 6例 ,报告如下。1　资料与方法1 .1　病例选择1 .1 .1　一般资料　所有病例均符合 FAB急非淋诊断标准 ,…     

门冬酰胺酶诱导缓解治疗急性非淋巴细胞白血病16例

目的探讨门冬酰胺酶(Aase)对急非淋巴细胞白血病(ANLL)诱导缓解的影响.方法用Aase联合常规HA(三尖杉酯碱、阿糖胞苷)、DA(柔红霉素、阿糖胞苷)、维甲酸和砷剂等方案治疗了16例ANLL患者.结果16例中有14例CR,总CR率87.5%.结论①Aase对无论是初治、复发还是耐药ANLL都有着明显的疗效;②Aase对CNSL具有防治作用.     

Maintenance chemotherapy prolongs remission duration in adult acute nonlymphocytic leukemia

The value of maintenance therapy after the achievement of complete remission in adult acute nonlymphocytic leukemia (ANLL) has never been clearly established. A randomized Eastern Cooperative Oncology Group (ECOG) study of postremission therapy compared outcomes in patients who received no further therapy to those administered long-term maintenance chemotherapy. Adverse results in the group administered no further therapy led to early termination of this trial after only 51 patients were randomized. Patients receiving no postremission therapy experienced significantly inferior remission durations (P = .002) compared with patients receiving maintenance therapy. All 26 patients in the group administered no postremission therapy have relapsed, with a median duration of remission of 4.1 months. In contrast, four of 25 patients (16%) who received maintenance therapy remain disease free, with a median duration of remission of 8.1 months.     

Prognostic factors affecting remission, remission duration, and survival in adult acute nonlymphocytic leukemia.

The medical records of 94 consecutive patients with acute nonlymphocytic leukemia (ANLL) were reviewed to identify significant prognostic factors. The data were analyzed using 1) Cox's linear hazard and linear logistic models, 2) chi-square comparison of the groups living longer than 2 years and those living less than 2 years, and 3) the Gehan-Breslow test of equal survival curves. The only statistically significant finding was that the presence of promyelocytic cell type and complete remission correlated with increased survival (p less than .05), but this was negated by the small number of patients with this cell type. There was a suggestive association between higher initial hemoglobin and survival (p = .09). The Gehan-Breslow test revealed a possible difference in survival between those patients more than 51 years of age and those less than 51 (p = .10). Thus none of the commonly accepted prognostic factors in acute nonlymphocytic leukemia was definitely shown to be useful. The findings of this study support an aggressive approach toward all patients with this disease.     

Hyperleukocytosis in adult acute nonlymphocytic leukemia: impact on remission rate and duration, and survival

The clinical courses of 353 patients with acute nonlymphocytic leukemia (ANLL) treated between 1971 and 1982 at the Baltimore Cancer Research Program (BCRP) of the National Cancer Institute were reviewed and examined for the impact of presenting WBC count on the initial course and overall outcome of these patients. Group A (WBC greater than 100,000/microL) had significantly more deaths during the first week of therapy than did group C (WBC less than 50,000/microL) (P = .0003). CNS hemorrhage was responsible for a significantly greater number of deaths in group A compared with group C (P less than .004). The group B (WBC 50,000 to 100,000/microL) death rate was intermediate. These findings are consistent with other reports of complications of leukostasis. Rapid intervention with antileukemic therapy and cranial irradiation may have decreased the risk of CNS hemorrhage in group A. If early deaths are removed from analysis, the complete remission rate among patient groups is not significantly different (group A, 59%; group B, 68%; group C, 65%). However, further analyses of patients achieving remission demonstrate significant differences among patient groups based on presenting WBC count. The median complete remission duration of patients in group A (4.2 months) is shorter than that of patients in group B (8.0 months) or C (8.0 months), P = .07. In addition, remission duration has improved with modern aggressive antileukemic therapy in groups B (median before 1977, 7.0 months; after 1977, 22.0 + months) and C (before 1977, 6.0 months; after 1977, 16.0 + months). No such improvement has occurred in group A, in which the median duration of remission was 4.2 months before and after 1977. The same findings are demonstrated in an analysis of survival, with improvement occurring only in groups B (median before 1977, 16.5 months; after 1977, 26.0 + months) and C (before 1977, 13.5 months; after 1977, 24.0 + months). Long-term follow-up (minimum of 4 years) of these patients has allowed an analysis of the effect of presenting WBC count on the overall outcome of adult patients with ANLL.     

Spontaneous remission in adult acute leukemia

A spontaneous complete remission of 34 months' duration was observed in an adult patient with acute myeloblastic leukemia. The remission occurred after a severe febrile pneumonia, which was treated with leukocyte transfusions. At relapse, chromosomal abnormalities reappeared slowly. Such spontaneous complete remissions, almost always associated with bacterial infections and blood transfusions, are extremely rare, and are usually of short duration. Previous cases are summarized, and the role of etiologic factors, including those related to the leukemic proliferation, are discussed.     

Differential count of 5,000 leukocytes for acute nonlymphocytic leukemia patients during remission

In order to find the level of leukemic cells during remission a differential count of 5,000 leukocytes was made in 91 acute nonlymphocytic leukemia cases during their first complete remission. Patients were divided into three groups according to the level of leukemic cells, i.e., 0-1/5,000, 2-4/5,000 and 5-/5,000. A close correlation was observed between the survival of patients and the level of leukemic cells and their tendency to decrease or increase during remission. All patients in whom leukemic cells rose from 0-1/5,000 to a level higher than 8/5,000 suffered a documented relapse after 4-8 weeks. This method appears to be a good supportive examination for acute leukemia patients during remission.