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。     

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。     

安吖啶联合化疗方案治疗高白细胞急性白血病29例疗效观察

高白细胞急性白血病 ( HAL )属高危白血病 ,患者外周血白细胞计数 >10 0× 10 9/ L ,早期病死率高 ,临床缓解率低。自19 95年以来 ,我们应用安吖啶联合化疗方案治疗 HAL 2 9例 ,取得良好疗效 ,现将结果报告如下。一般资料 :选择我院收治的 HAL 患者 51例 ,其中男 2 7例 ,女 2 4例 ,年龄 17～ 59岁 ,平均 3 6岁。急性淋巴细胞白血病 ( AL L ) 11例 ,急性非淋巴细胞白血病 ( ANL L )中 M2 6例 ,M5 2 8例 ,慢粒急粒变 6例 ,均经临床、血象、骨髓象检查确诊。随机分成两组。观察组 2 9例 ,对照组 2 2例 ,两组的突出表现为高粘滞血症。观…     

高白细胞急性白血病50例分析

目的　研究高白细胞急性白血病 (HAL )的临床特点。方法　对 5 0例 HAL进行临床回顾性分析 ,同时选择 5 0例非高白细胞急性白血病 (HAL )作对照组。结果　 HAL起病急骤、病程<1月 ,脏器出血、髓外浸润的发生率、白细胞瘀滞综合征及化疗后肿瘤溶解综合征、早期死亡率较对照组高。结论　对 HAL降低血液粘滞度、化疗前、化疗中硷化尿液及水化治疗 ,以降低早期死亡率     

原发高白细胞型急性早幼粒细胞白血病66例临床特征及治疗研究

目的探讨原发高白细胞型急性早幼粒细胞白血病(APL)的临床特点及有效的治疗方法。方法回顾性分析1993年10月至2006年8月苏州大学附属第一医院收治的66例原发高白细胞型APL患者和152例非高白细胞型APL患者的临床资料,并对高白细胞型患者按治疗方案的不同进行了分组比较。结果高白细胞组APL患者早期病死率、弥散性血管内凝血(DIC)和维甲酸综合征(RAS)发生率分别为30.3%,57.6%和31.8%,均高于非高白细胞组(7.2%,38.1%和21.1%)(P<0.05),而完全缓解(CR)率较低(63.6%对88.2%)(P<0.05)。高白细胞组患者中61例接受了诱导治疗,其中31例单用维甲酸治疗,21例维甲酸联合亚砷酸治疗,9例单用亚砷酸治疗,各组早期病死率分别为27.3%,14.3%和55.6%,CR率分别为67.7%,81.0%和44.4%。61例患者中41例在接受诱导分化治疗的同时加用化疗,其CR率为80.5%,总病死率为19.5%;而未加用化疗的20例患者其CR率为45.0%,总病死率为55.0%,两组比较差异有显著性意义(P<0.05)。结论原发高白细胞型APL较非高白细胞型APLCR率低,早期病死率高,DIC、RAS发生率高。维甲酸加亚砷酸双诱导并联合小剂量化疗是治疗高白细胞型APL的最有效的方案,可明显减少早期病死率,提高CR率。     

白血病细胞清除术加用联合化疗治疗高白细胞急性白血病

白血病细胞清除术加用联合化疗治疗高白细胞急性白血病蔡大利高峰肖卫国翟明高白细胞急性白血病（ＨＬＡＬ）病情凶险，早期病死率高，易合并脑出血及成人呼吸窘迫综合征（ＡＲＤＳ），化疗缓解率极低［１，２］。采用血细胞分离机进行白细胞清除术加用联合化疗已有少数报...     

成人急性早幼粒细胞白血病治疗方案与疗效分析

目的:研究难治或复发性急性早幼粒细胞白血病(APL)不同诱导缓解方案的疗效,诱导缓解后不同巩固维持治疗方案对预后和生存率的影响。方法:APL57例(包括初次诱导未缓解与第1次复发的APL),按照不同的诱导缓解治疗方案分组(含砷剂组:单用亚砷酸组及亚砷酸加全反式维甲酸(ATRA)联合治疗组;不含砷剂组:单用化疗组)比较各组的完全缓解率(CR)和达到CR的时间;按照不同的缓解后治疗方案分组(亚砷酸/全反式维甲酸/化疗序贯治疗组;化疗组)比较各组复发率、总生存率(OS)、无病生存率(DFS)。采用SPSS10.0软件进行统计学分析(χ2检验、t检验、MannWhitney检验、Kaplan-Meier生存曲线、Log-Rank检验)。结果:含砷剂(亚砷酸)组诱导CR率可达80,明显高于不含亚砷酸组CR率(61.4±9.04)(P<0.05);含砷剂组达到CR时间(36.36±9.56)d,较不含亚砷酸组(47.26±22.21)d显著缩短(P<0.01)。诱导缓解后的治疗对生存影响显著,全反式维甲酸、亚砷酸、蒽环类化疗序贯治疗组复发率9.0,低于化疗组38.9(P<0.05)。序贯治疗组1年、3年生存率是(74.56±4.57)、(60.09±4.64),而化疗组1年、3年生存率仅为(57.84±8.01)、(49.13±13.14)(P<0.05)。序贯治疗组的3年DFS(71.48±1.94),显著高于化疗组的DFS(51.32±13.72)(P<0.05)。结论:含有亚砷酸诱导缓解方案诱导缓解率高,达CR时间短。全反式维甲酸、亚砷酸、蒽环类化疗序贯治疗复发率低,长期生存率高。监测PML/RARa融合基因对提示复发和调整治疗有重要意义。     

榄香烯乳联合化疗治疗急性难治性白血病120例疗效观察

目的评价榄香烯乳加联合化疗治疗难治性急性非淋巴细胞白血病的疗效。方法随机将241例白血病患者分为治疗组和对照组:治疗组120例,用榄香烯乳300mg/m2/d加入5%GS 500ml中静脉滴注,持续用药14天,同时加联合化疗HAA方案:高三尖杉酯碱4mg/m2/d静滴,持续7天,阿克拉霉素20mg/m2/d静滴、qd×7天,阿糖胞苷100~200mg/m2/d,第1~7天;对照组121例,单用HAA化疗,方案用量用法同治疗组。结果治疗组120例中有85例CR,有12例PR,NR23例,CR率70.8%(85/120),总有效率80.8%(97/16)。对照组121例中CR53例,PR11例,NR57例,CR率为43.8%(53/121),总有效率52.9%(64/121)。差异有显著性(P<0.05)。结论榄香烯乳对难治性急性非淋巴细胞白血病(ANLL)有肯定疗效,比单用联合化疗效果好,且不良反应少,无血象和骨髓抑制。     

白细胞清除术联合化疗24例高白细胞急性白血病的疗效观察

目的观察白细胞清除术联合化疗对高白细胞急性白血病的治疗效果。方法白细胞清除术联合化疗治疗24例高白细胞急性白血病患者。结果 24例高白细胞急性白血病患者经白细胞清除术后化疗,缓解率达63．3％,早期死亡率4．5％。结论白细胞清除术联合化疗治疗高白细胞急性白血病是目前较先进的一种方法。     

白细胞单采术在高白细胞急性白血病诱导治疗中的作用

目的 探讨白细胞单采术联合化疗在高白细胞白血病（HLAL）治疗中的作用及注意事项。方法 使用CS-3000血细胞分离机对37例高白细胞急性白血病患者进行白细胞单采,术后进行化疗,观察疗效,并与同期HLAL单纯化疗的疗效相比较。结果 白细胞单采术后患者外周血白细胞数显著下降,在进行化疗后比单用化疗疗效好。结论 白细胞单采能迅速降低白细胞数,提高化疗缓解,是治疗高白细胞白血病的重要辅助方法。     

55例老年人急性白血病治疗观察

目的针对老年人急性白血病治疗方法及化疗剂量选择的意见不一，探讨支持治疗、小剂量单药化疗及联合化疗的疗效及影响预后的因素。方法回顾性分析５５例老年急性白血病患者的治疗情况，统计其完全缓解（ＣＲ）率、生存期及影响因素。结果ＣＲ率：支持治疗组１２例，为０；小剂量单药组１７例，为１７．６％；联合化疗组２６例，为３８．５％。生存期：支持治疗组平均１３天，小剂量单药及联合化疗组分别平均５．９及６．２个月。结论仅用支持治疗疗效差，联合化疗的ＣＲ率高于小剂量单药化疗者，药物毒性无增加，但未能延长患者生存期。初诊时外周血幼稚细胞过高、血小板过低者ＣＲ率低。早期病死率高、放弃治疗者多，亦是影响ＣＲ率的因素。     

急性髓细胞白血病联合应用G—CSF和IL—2的临床意义

在联合化疗方案基础上加用重组人粒细胞集落刺激因子（G－CSF）和重组白细胞介素－2（IL－2）治疗AML22例，并以单用联合化疗方案的18例为对照组，进行疗效随访观察。结果：治疗组完全缓解率81．8％，对照组72．2％（P＞0．05）。到1996年10月，治疗组缓解或4～48个月，中数缓解期19．6个月，生存期6～51个月，中数生存期23个月；对照组中数缓解期13．5个月（4～32个月），中数生存期14．6个月（5～36个月）。治疗组缓解期和生存期优于对照组（P＜0．05）。     

高强度聚焦超声联合化疗治疗进展期消化系统恶性肿瘤临床观察

背景：我围消化系统恶性肿瘤发病率高，晚期患者预后较差。目的：评估高强度聚焦超声（HIFU）联合化疗治疗进展期消化系统恶性肿瘤的疗效和安全性。方法：予164例进展期消化系统恶性肿瘤患者行HIFU联合全身静脉化疗，另160例患者行单纯全身静脉化疗作为对照，观察两组临床疗效和不良反应。结果：单纯化疗组近期有效率为43．1％，其中完全缓解（CR）6．2％，部分缓解（PR）36．9％；HIFU联合化疗组近期有效率为55．5％，其中CR8．5％．PR47．0％，组间差异无显著性（P〉0.05）。单纯化疗组中位生存时间为9．7个月，HIFU联合化疗组为13．2个月，组间差异有显著性（P〈0．05）。主要不良反应有恶心、呕吐、骨髓抑制和神经毒性，单纯化疗组严重不良反应发生率为15．6％．HIFU联合化疗组为18．3％，组间差异无显著性（P〉0．05）。结论：HIFU联合化疗治疗进展期消化系统恶性肿瘤临床疗效较好，不增加化疗的毒副作用，患者可耐受，值得在临床上推广应用。     

Efficacy of rituximab in gastric diffuse large B cell lymphoma patients

AIM:To evaluate retrospectively the efficacy of rituximab plus chemotherapy in gastric diffuse large B cell lymphoma(DLBCL).METHODS:Sixty patients(median age:58 years)with histologically confirmed gastric DLBCL treated at four Italian institutions between 2000 and 2007,were included in this analysis.Patients were selected by stage (Ⅰ-Ⅳ,Lugano staging system),European Cooperative Oncology Group performance status(0-2)and treatment strategies.Treatment strategies were chemotherapy alone(group A,n=30)[schedule...     

Intensive salvage chemotherapy for primary refractory or first relapsed adult acute lymphoblastic leukemia: results of a prospective trial.

BACKGROUND AND OBJECTIVE: Adults with primary refractory or relapsed acute lymphoblastic leukemia (ALL) have a very poor prognosis with current salvage chemotherapies. Complete remissions (CR) can be obtained with intensive regimens in 40-60% of cases, but they are short-lived. In an effort to obtain high CR rates and prolong their duration and achieve long-term survival in a substantial number of patients, we designed an intensive combination salvage regimen (RELAL-88). In this protocol, chemotherapy was to be followed by an allogeneic or autologous stem cell transplant (SCT) within three months from CR. DESIGN AND METHODS: Forty-five patients with primary refractory (n=17) or first relapsed ALL (n=28) were treated with the RELAL-88 five-day induction regimen comprising vindesine, mitoxantrone, cyclophosphamide, intermediate-dose Ara-C, prednisolone and methotrexate. Twenty-eight patients received granulocyte colony-stimulating factor (G-CSF), 16 patients from day 6 (early G-CSF group) and 12 from day 14 of therapy (delayed G-CSF group). RESULTS: Thirty-four patients (74%) achieved CR (95% CI 60-87), two died in aplasia due to infection and nine were non-responders. No pretreatment variable analyzed was predictive of the chance of obtaining CR. Recovery of neutrophils occurred at a median of 29 days from the start of chemotherapy without G-CSF and 20 days with G-CSF (p = 0.005), without differences between the early and late G-CSF groups. Non-hematologic side effects were usually well tolerated and consisted mainly of infections and mucositis. Twenty-three of 34 patients (68%) who achieved CR reached the planned SCT (nine autologous and 14 allogeneic). The median overall survival was 5.7 months, and the median disease-free survival for those achieving CR was 4.6 months. Of the variables analyzed for their influence on overall survival among the 34 patients who achieved CR, only the availability of an HLA-compatible sibling was associated with a prolonged survival (p = 0.03). INTERPRETATION AND CONCLUSIONS: The RELAL-88 intensive salvage regimen produces a very high rate of CR in poor-risk adult ALL. Non-hematologic toxicities were tolerable, and most eligible patients could undergo the planned SCT. G-CSF significantly shortened the period of neutropenia by about eight days, irrespective of whether it was started early or late after chemotherapy. However, as with other currently available salvage therapies, remissions were short-lived, and more effective post-remission treatment strategies are needed. In our experience, only allogeneic SCT offered the chance of long-term survival.     

Mitoxantrone alone or in combination chemotherapy (VeMP) as second-line treatment in relapsed or refractory poor-prognosis non-Hodgkin's lymphoma. A report of the Non-Hodgkin's Lymphoma Co-operative Study Group (NHLCSG).

BACKGROUND AND METHODS. From October, 1986 to July 1989, 35 consecutive patients with high- and intermediate-grade non-Hodgkin's lymphoma, relapsed or refractory to first-line-anthracycline-containing regimens, were treated with mitoxantrone alone or in combination chemotherapy (VeMP: Ve = VP-16, M = Mitoxantrone, P = Prednisolone). RESULTS. In the first 15 patients, treated with Mitoxantrone alone, complete response (CR) and partial response (PR) each occurred in 4 patients, for a total response rate of 54%. In the following 20 patients, treated with the VeMP regimen, CR occurred in 10 patients (50%), PR in 1. The overall three-year survival was 27% in the first group and 40% in the second. Acute toxicity was generally mild. No patient developed cardiac symptoms or other toxicities requiring discontinuation of therapy. Myelosuppression was the most important side effect, being more remarkable for patients treated with VeMP regimen. CONCLUSION. Mitoxantrone, alone or in combination chemotherapy, appears to be a drug with significant activity in aggressive non-Hodgkin's lymphomas.     

Intensification of chemotherapy using block therapies as consolidation and reinduction therapies for acute lymphoblastic leukemia during childhood

Between April 1994 and March 1997, 143 children (age range, 1-15 years) with newly diagnosed acute lymphoblastic leukemia (ALL), except for those patients with t(9;22), were treated according to protocol-94 of the Osaka Childhood Leukemia Study Group. In this trial, the intensity of chemotherapy was enforced in the consolidation and reinduction phases by introducing AML-type block therapies consisting of concentrated administration of 4 to 6 drugs during 5 or 6 days. For patients in the higher risk groups, rotational combination chemotherapy was introduced following the early phase. A total of 124 children with B-cell precursor ALL (B-pre ALL) were classified into 3 groups, the ultrahigh-risk group (UHRG) (15 patients), the high-risk group (HRG) (61 patients), or the standard-risk group (SRG) (48 patients), based on age. leukocyte count, immunophenotype, central nervous system leukemia, response to treatment, and selected chromosomal abnormalities. The complete remission rate was 93%, and the 6-year event-free survival (EFS) rate was 79%+/-4%. EFS rates for the UHRG, HRG, and SRG groups were 67%+/-12%, 80%+/-6%, and 81%+/-6%, respectively. Nineteen patients with T-cell ALL were treated with the protocol for the UHRG. Thirteen patients (68%) attained complete remission, and the 6-year EFS rate was 55%+/-12%. Thus, intensification of chemotherapy improved the EFS rate and AML-type block therapies appeared to be effective as the consolidation and reinduction therapies for B-pre ALL.