MCS单采去除白细胞治疗高白细胞白血病的护理体会

高白细胞白血病(HLL)是在少数急性或慢性粒细胞白血病急变时,外周血白细胞大于100×109/L.异常增高的外周血白细胞导致血液黏滞度增加,血流缓慢,加重组织缺氧,白血病细胞比正常细胞大且僵硬,变形性差,易在小血管形成微血栓或凝块,造成微循环障碍.白细胞单采去除术可迅速去除患者体内白细胞,减轻患者病征,为下一步药物化疗打下基础.笔者2005年1月～2006年6月对15例HLL患者采用MCS血细胞分离机单采去除患者白血病细胞治疗,取得了满意的治疗效果.现将单采治疗过程中护理体会报告如下.     

高白细胞数白血病—血液流变学、临床特征及治疗

血白细胞数超过10万/mm~3的白血病,称为高白细胞数白血病(HLL)①②,约11%急淋,15%急粒或急粒单、急单,60～90%慢粒为 HLL③④,Hug(1983)报告400例急粒中有46例(11.5%)周围血白细胞数超过10万/mm~3①,也有学者报告发生率达20.5%④。Berg 等(1979)报告87例急性非淋巴细胞白血病中,其中13例(14.94%)血     

白细胞单采在高白细胞性白血病中的治疗作用

治疗性白细胞单采术是指去除患者循环血液中异常增多的白细胞,以减少其对机体的致病作用,是一种见效迅速、安全的辅助治疗手段。1997年8月~2005年5月,我们应用白细胞单采联合化疗治疗高白细胞性白血病(hyperleukocytic leukemia,HLL)40例,效果较好,现报道如下。资料与方法一般资料40例均系我院住院患者,按标准[1]诊断白血病,就诊时WBC均>100×109/L。高白细胞急性白血病(hyperleukocytic acute leukemia,HAL)25例(男14、女11),中位年龄35(17~65)岁,其中急性淋巴细胞性白血病(acute lymphoblastic leukemia,ALL)6例,急性非淋巴细胞性白…     

20例高白细胞性白血病白细胞单采后观察

高白细胞性白血病是指外周血白细胞 >1 0 0×1 0 9/L患者 ,属高危型白血病 ,易发生颅内出血、脑栓塞等严重并发症 ,病死率高 (早期死亡率高 )。笔者对 2 0例高白细胞性白血病行白细胞单采治疗进行了观察 ,现报道如下。1　材料与方法1 .1 　 主要材料与设备美国 Baxter公司产 Cs30 0 0血细胞分离机、Cs30 0 0专用一次性全封闭管道 ( Kit4R2 2 30 )、CIS- F82 0血细胞计数仪 (日本株式会社产品 )、1 0 %的葡萄糖酸钙 (扬州中保制药有限公司 )、1次性 50 ml大空针 (威海医用高分子厂 )。1 .2 　 临床资料行白细胞单采患者 2 0例 ,男 1 3例 …     

高白细胞急性髓系白血病的临床分析

目的:探讨高白细胞急性髓系白血病(HAML)患者的临床特征、预后并与同期非高白细胞急性髓系白血病(NHAML)患者进行比较。方法:观察随访66例HAML(WBC≥100×109/L)病例(非M3型),分析并发症、早期死亡(early death,ED)、治疗反应、远期预后等,并与同期随机选择的202例NHAML(WBC<100×109/L)病例(非M3型)进行比较。结果:①HAML病例发生低钾血症、出凝血异常、感染、肺白细胞淤滞、脾脏肿大、淋巴结肿大等并发症的概率高于NHAML病例(P<0.05)。HAML病例FAB分型以M4/M5型为主。②HAML病例ED 4例(6.1%),ED与出凝血异常(P<0.01)、肺白细胞淤滞(P<0.01)、CNS白细胞淤滞症状(P<0.01)相关。③HAML病例CR率66.7%,且M4/M5型CR率低。HAML病例3年DFS率为45.7%,3年OS率为32.5%。完全缓解(CR)率与年龄、是否为M4/M5型相关(P<0.05)。3年无病生存率(DFS)与是否>50岁及染色体分组相关(P<0.01)。3年总生存率(OS)与是否CR相关(P<0.05)。NHAML病例CR率为90...     

白细胞去除术联合化疗治疗54例高白细胞急性白血病

目的:研究白细胞去除术联合化疗治疗高白细胞急性白血病(HLAL)。方法:对54 例HLAL患者进行白细胞去除术后,进行诱导缓解化疗,同时对30 例HLAL患者行单纯化疗作对照。结果:采用白细胞去除术后,54例患者白细胞中位数由术前的178.0(102.8~395.2)×109/L降到42.2(23.0~80.0)×109/L,临床症状明显改善。联合化疗后完全缓解(CR)率为63%。明显高于对照组CR率17%(P<0.01);早期病死率为13%,低于对照组的36.5%(P<0.05);总有效率为72%,高于对照组的27%(P<0.05)。结论:白细胞去除术联合化疗治疗HLAL疗效优于单纯化疗,可提高CR率、总有效率,降低早期病死率,是治疗HLAL较先进的方法。     

输尿管镜下钬激光与气压弹道碎石术对老年输尿管上段结石患者应激反应及碎石效果的比较

目的探讨输尿管镜下钬激光碎石术(HLL)与气压弹道碎石术(PL)对老年输尿管上段结石(UUC)患者应激反应及碎石效果的影响。方法入选2016年6月至2018年6月宝鸡市人民医院泌尿外科老年UUC患者100例,随机数表法分为HLL组和PL组,每组50例,比较2组患者手术情况、碎石效果、术后皮质醇(Cor)和促肾上腺皮质激素(ACTH)水平以及并发症差异。采用SPSS 22.0统计软件对数据进行分析。组间比较采用t检验或χ~2检验。结果 HLL组相比PL组患者术中出血量[(60.97±7.02) vs (83.25±9.24) ml]、手术时间[(66.43±6.81) vs (85.43±8.72) min]、碎石时间[(31.88±3.55) vs (40.45±4.22) min]和住院时间[(6.42±1.07) vs (7.65±1.11) d]降低,术后Cor[(387.11±40.12) vs (437.13±45.43) ng/ml]和ACTH[(14.02±1.54) vs (15.71±1.68) pmol/L]水平降低,差异均具有统计学意义(P0.001)。HLL组相比PL组患者一次碎石成功率[100%(50/50) vs 88%(44/50),P=0.012]和结石取净率[96%(48/50) vs 84%(42/50),P=0.046]高,并发症发生率低[6%(3/50) vs 20%(10/50),P=0.037]。结论输尿管镜下HLL可有效减少老年UUC患者手术创伤、并发症和应激反应的发生,且具有良好的碎石效果,值得临床推广。     

老年泌尿系统结石患者输尿管镜下钬激光碎石术的疗效

目的探讨输尿管镜下钬激光碎石术和气道弹压碎石术对老年输尿管及膀胱结石患者的疗效及并发症。方法老年输尿管及膀胱结石患者150例根据治疗方案随机分成钬激光碎石术(HLL)组和气道弹压碎石术(URSL)组。比较两组一般资料、手术效果、并发症情况等。结果HLL组单次碎石总有效率高于URSL组(P<0.01)。HLL组与URSL组2个月后输尿管上段结石清除率无统计学差异(P>0.05);输尿管中下段结石清除率差异显著(P<0.05);膀胱结石无统计学差异(P>0.05);HLL组总的清除率高于URSL组(P<0.05)。HLL组手术时间低于URSL组(P<0.01);两组术后疼痛VAS评分差异显著(P<0.01)。两组手术并发症差异不显著(P>0.05)。结论对于老年输尿管及膀胱结石患者,相对于URSL,HLL方案在不增加并发症的前提下,碎石及清除效果更肯定。     

45例初治高白细胞性急性白血病的治疗效果与预后分析

目的:探讨初治高白细胞急性白血病(HAL)的临床特征、治疗效果及预后分析。方法:对45例初治HAL进行临床回顾性分析,同时以371例非高白细胞急性白血病(NHAL)作对照组。结果:HAL构成比为10.8%。HAL组的髓外浸润、DIC、白细胞淤滞综合征及早期死亡率较对照组高。HAL组完全缓解(CR)率为28.9%,低于NHAL的57.1%,早期病死率是17.8%。早期死亡的主要原因是颅内出血和呼吸窘迫综合征。HAL的缓解率和早期死亡率与FAB分型有关。结论:HAL完全缓解率低,早期死亡率高,预后差,特别是HAL-M3的早期死亡率高,要重视其早期处理。HAL的早期积极治疗可降低早期死亡率。     

血液病患者单采血小板输注无效的原因及对策

目的探讨血液病患者单采血小板输注无效（PTR）发生率及其影响因素,为临床正确应用血小板制剂提供指导。方法回顾性分析单采血小板输注的70例患者318例次输注资料,通过计算血小板计数增加指数和血小板恢复百分率结合患者出血状况有无改善,判断血小板输注有效性,并讨论其影响因素及处理措施。结果急性白血病、再生障碍性贫血、骨髓异常综合征和特发性血小板减少性紫癜患者PTR发生率分别为22.1%、25.5%、38.3%和51.2%,四种类型的血液病患者血小板PTR发生率差别有统计学意义（P均〈0.05）;同种疾病无并发症患者PTR发生率低于有并发症者（P〈0.05）;无并发症患者PTR发生率随着输注次数的增加而上升（P〈0.05）。未过滤白细胞与过滤白细胞患者PTR发生率比较差异有统计学意义（P〈0.05）。结论疾病类型、有无并发症等因素影响血液病患者血小板输注的治疗效果,减少并发症、过滤白细胞可提高血小板的输注效果。     

New monoclonal antibodies SN3, SN3a, and SN3b directed to sialic acid of glycoprotein on human non-T leukemia cells

We have generated and characterized three new monoclonal antibodies (mAbs), termed SN3, SN3a, and SN3b, which are directed to sialic acid of a glycoprotein(s) on human non-T leukemia cells. These mAbs were generated by immunizing mice with an antigen preparation isolated from cell-membrane glycoconjugates of NALM-1, a pre-B leukemia cell line. The initial characterization of the mAbs consisted of a sensitive cellular radioimmunoassay against various cultured human leukemia-lymphoma (HLL) and nonmalignant cell lines. They strongly reacted with all four (all three in the case of SN3a) non-T/non-B HLL cell lines tested and both pre-B HLL cell lines tested. However, they reacted with only one of three B HLL cell lines tested. In addition, these mAbs did not react with other cell lines, which include T- and myelomonocytic HLL cell lines and nonmalignant B-cell lines. Normal peripheral blood cells were also tested; the mAbs reacted with B cells and granulocytes but not with T cells, monocytes, erythrocytes, or platelets. In a test using SN3 and SN3b with uncultured cell specimens derived from various cancer patients, the mAbs primarily reacted with non-T/non-B and B HLL specimens, as well as with chronic myelocytic leukemia specimens. The biochemical nature of antigenic determinants defined by the three mAbs was studied by treating the non-T leukemia cells with sialidase and proteases. The results show that the antigenic determinants defined by these mAbs all contain a sialic acid residue(s) that is attached to the cells via a protein backbone(s). Competitive binding experiments show that binding of SN3 to the leukemia cells was blocked almost completely by SN3a and SN3b, as well as by BA-1. Both SN3 and SN3a are IgG1 antibodies, whereas SN3b is an IgM antibody; SN3b showed a strong complement-mediated cytotoxic activity against non-T leukemia cells.     

Impact of body-mass index on the outcome of adult patients with acute myeloid leukemia

Background Obesity increases the risk of treatment-related complications and reduces survival in children with acute myeloid leukemia. Little is known about the impact of obesity on the outcome of adult patients with acute myeloid leukemia. DESIGN AND METHODS: We compared the baseline characteristics and effect on treatment and survival in 1,974 previously untreated adult patients with acute myeloid leukemia undergoing treatment, according to international classification of body-mass index. RESULTS: The median body-mass index was 26.7 (15.5-61) and 63% of patients were overweight/obese. After adjustment for other confounders, such as age, gender, performance status, karyotype, white blood cell, platelet and peripheral blast counts, obese patients had better complete remission rates (P=0.0046), lower rates of resistant disease (P=0.038) but similar rates of survival and severe adverse events. Conclusions In the treatment of acute myeloid leukemia in adults, obesity was associated with increased response rates and no apparent increase in toxicity. Obesity should not, therefore, be a criterion for excluding patients from aggressive therapy.     

异基因造血干细胞移植治疗白血病76例临床观察

目的观察不同来源的异基因造血干细胞移植治疗白血病的疗效并探讨主要并发症的处理方案。方法对2001年9月至2007年3月第四军医大学西京医院血液科76例白血病患者行异基因造血干细胞移植治疗,其中慢性粒细胞白血病34例,急性髓性白血病24例,急性淋巴细胞白血病15例,T细胞淋巴瘤/白血病3例。人类白细胞抗原(HLA)全相合的同胞供者57例,1个HLA位点不合同胞供者3例,HLA单倍型半相合同胞供者7例,非血缘供者9例。预处理方案采用改良的马利兰联合环磷酰胺(BUCY)或改良的环磷酰胺联合全身放疗及阿糖胞苷或鬼臼乙叉甙(CyTBI Ara-c/VP-16)方案。采用标准的环孢素A(CsA)联合短期甲氨蝶呤(MTX)方案预防移植物抗宿主病(GVHD);无关供者移植加用抗人胸腺细胞球蛋白,单倍型半相合移植同时加用CD25单克隆抗体。结果96.1%(73/76)获得植入。24.7%(18/73)出现急性GVHD,32.9%(24/73)出现慢性GVHD;合并重症肝静脉闭塞病2例;并发纯红细胞性再生障碍性贫血5例。随访3~72个月,现存活56.6%(43/76),43.4%(33/76)在移植后1~36个月时死亡,19例死于白血病复发,14例死于移植相关并发症。结论多种来源的异基因造血干细胞移植是治疗白血病的有效方法,于慢性粒细胞白血病慢性期、急性白血病缓解期移植效果较好,移植前处于高危难治状态的病例复发率仍较高。     

上海地区急性白血病患者五年生存率及预后因素分析

目的 总结上海市近１０年来急性白血病的长期生存率及影响预后的因素。方法 对上海市近１０年的急性白血病患者胸用回顾性队列研究和生存分析方法。结果 急性白血病患者共１０２８例,其中达到５年长期生存１５０例患者,发现总的５年长期生存率为１８．６％,急性髓细胞白血病（ＡＭＬ）为１３．３％,急性淋巴细胞白血病（ＡＬＬ）为２８．１％,Ｍ３和Ｌ１的长期生存率较高。儿童、ＷＢＣ较你、血小板较高、外周血原＋（早）幼     

Progressive multifocal leukoencephalitis (PML) in three patients treated with standard-dose fludarabine (FAMP)

Since 1990 we have treated 60 patients with standard-dose fludarabine for chronic lymphocytic leukemia (B-CLL), on a compassionate basis. Three patients developed grade IV neurologic complications after treatment, with demyelination of white matter on magnetic resonance imaging (MRI) in patient # 1, diffuse demyelination, abnormal oligodendroglia and enlarged astrocytes at brain biopsy in patient n°2, and progressive multifocal leukoencephalitis (PML) with JC virus on brain biopsy in patient # 3. The neurotoxicity of fludarabine was often observed after administration of high doses (90-120 mg/m²). At standard doses (18-25 mg/m²) neurologic complications were observed in very few cases (0.2%). PML was observed in only 0.52% of patients with chronic lymphocytic leukemia (CLL), particularly those with advanced CLL. Our findings are consistent with the results of published studies and show an increase in neurologic complications in patients with advanced CLL treated with fludarabine. This increased vulnerability is probably multifactorial, but may be secondary to the immunodeficiency.     

Hyperleukocytosis, leukostasis and leukapheresis: practice management

Hyperleukocytosis, arbitrarily defined in acute leukemia as a white blood cell count greater than 100,000/mL, often is associated with increased morbidity and mortality in patients with leukemic processes. It can induce leukostasis, tumor lysis syndrome and disseminated intravascular coagulopathy and has significant prognostic implications with or without one of these clinical complications. The main sites that tend to be injured from the obstructions are the central nerve system and lungs. Despite characteristic clinical presentations, the diagnosis of leukostasis is rarely made with high confidence. The main goal of the management of hyperleukocytosis and/or leukostasis is to reduce the white blood cell count before starting induction chemotherapy. The cytoreduction can be achieved by either leukapheresis and/or hyroxyurea. The technical aspects, complications and efficacy of leukapheresis are discussed in the current article.     

Development of hairy cell leukemia in a patient with antiphospholipid syndrome

We present a young woman who was diagnosed as primary antiphospholipid syndrome (deep vein thrombosis and pulmonary embolism in 1999; moderate thrombocytopenia with high-positive anticardiolipin ELISA tests in 2002, and cerebral thrombosis in 2003), and then developed hairy cell leukemia (massive splenomegaly, neutropenia, hairy cells in blood smear and bone marrow trephine biopsy in 2004). A partial remission was achieved with interferon-alpha 2a therapy. After the initiation of 2-chloro-deoxyadenosine therapy, splenomegaly disappeared, the percentage of hairy cells on the bone marrow reduced below 1%, platelet count returned to normal levels. After complete remission was achieved for hairy cell leukemia proved by bone marrow trephine biopsy, antiphospholipid antibodies were found to be negative, and no further thromboembolic complications and thrombocytopenia were seen. In our literature search, we found only six cases that had both antiphospholipid antibodies and hairy cell leukemia. Our case is the first case of antiphospholipid syndrome before the development of hairy cell leukemia. Both hairy cell leukemia and antiphospholipid syndrome responded to lymphocytotoxic treatment with 2-chloro-deoxyadenosine.     

Association of monocytic leukemia in patients with extreme leukocytosis

Fifteen of 73 newly diagnosed patients with acute myeloid leukemia (AML), admitted to Mount Sinai Hospital between July 1977 and October 1979, presented with leukocyte counts greater than 100,000/μl. Eleven of these 15 patients with hyperleukocytosis had myelomonocytic (AMML-M4) or monocytic (AMOL-M5) leukemia compared to 14 of 58 patients with lower white cell counts (p < 0.001). Identification of type of leukemia, using the FAB classification, was based on morphology and special stains, including myeloperoxidase, Sudan black B, periodic acid-Schiff and nonspecific esterase with and without inhibition by fluoride. The proportion of patients with splenomegaly is higher in those with hyperleukocytosis (73 percent) than in those with lower white blood cell counts (p < 0.001) regardless of cell type. Leukemic infiltration of the skin, gums and central nervous system was seen exclusively in patients with AMML and AMOL. The serum lysozyme levels were significantly higher for all patients with AMML and AMOL regardless of the white blood cell count. The mean serum lysozyme for M-4, M-5 patients was 59.7 μg/ml compared to 18.9 μg/ml in patients with other cell types (p < 0.0001). Patients with a white blood cell count ≤100,000/μl had a complete remission rate of 69 percent compared to 47 percent for patients with higher white blood cell counts.     

Renal complications in chronic lymphocytic leukemia and monoclonal B-cell lymphocytosis: the Mayo Clinic experience

While the renal complications of plasma cell dyscrasia have been well-described, most information in patients with chronic lymphocytic leukemia and monoclonal B-cell lymphocytosis is derived from case reports. This is a retrospective analysis of patients with chronic lymphocytic leukemia or monoclonal B-cell lymphocytosis who underwent kidney biopsy for renal insufficiency and/or nephrotic syndrome. Between January 1995 and June 2014, 49 of 4,024 (1.2%) patients with chronic lymphocytic leukemia (n=44) or monoclonal B-cell lymphocytosis (n=5) had a renal biopsy: 34 (69%) for renal insufficiency and 15 (31%) for nephrotic syndrome. The most common findings on biopsy were: membranoproliferative glomerulonephritis (n=10, 20%), chronic lymphocytic leukemia interstitial infiltration as primary etiology (n=6, 12%), thrombotic microangiopathy (n=6, 12%), and minimal change disease (n=5, 10%). All five membranoproliferative glomerulonephritis patients treated with rituximab, cyclophosphamide and prednisone-based regimens had recovery of renal function compared to 0/3 patients treated with rituximab with or without steroids. Chronic lymphocytic leukemia infiltration as the primary cause of renal abnormalities was typically observed in relapsed/refractory patients (4/6). Thrombotic microangiopathy primarily occurred as a treatment-related toxicity of pentostatin (4/6 cases), and resolved with drug discontinuation. All cases of minimal change disease resolved with immunosuppressive agents only. Renal biopsy plays an important role in the management of patients with chronic lymphocytic leukemia or monoclonal B-cell lymphocytosis who develop renal failure and/or nephrotic syndrome.     

A prospective study of the natural history of transient leukemia (TL) in neonates with Down syndrome (DS): Children's Oncology Group (COG) study POG-9481

A unique transient leukemia (TL) has been described in newborns with Down syndrome (DS; or trisomy 21 mosaics). This leukemia has a high incidence of spontaneous remission; however, early death and subsequent development of acute megakaryoblastic leukemia (AMKL) have been reported. We prospectively evaluated 48 infants with DS and TL to determine the natural history and biologic characteristics of this disease, identify the clinical characteristics associated with early death or subsequent leukemia, and assess the incidence of subsequent leukemia. Blast cells associated with TL in DS infants exhibited FAB M(7) morphology and phenotype. Most infants (74%) had trisomy 21 (or mosaicism) as the only cytogenetic abnormality in the blast cells. Most children were able to spontaneously clear peripheral blasts (89%), normalize blood counts (74%), and maintain a complete remission (64%). Early death occurred in 17% of infants and was significantly correlated with higher white blood cell count at diagnosis (P < .001), increased bilirubin and liver enzymes (P < .005), and a failure to normalize the blood count (P = .001). Recurrence of leukemia occurred in 19% of infants at a mean of 20 months. Development of leukemia was significantly correlated with karyotypic abnormalities in addition to trisomy 21 (P = .037). Ongoing collaborative clinical studies are needed to determine the optimal role of chemotherapy for infants at risk for increased mortality or disease recurrence and to further the knowledge of the unique biologic features of this TL.