TAD方案治疗急性非淋巴细胞白血病疗效的评价

采用 TAD 方案治疗急性非淋巴细胞性白血病(ANLL)12例,年龄17～47岁。总有效率为66.7%,完全缓解率(CR)为41.7%。5例获 CR 的时间是26～66天,平均53天,较国内其它方案为快。CR 时间为2～9月,平均6.2月,较其它方案又较短。TAD 方案对心脏的毒性作用轻微。TAD 方案对5例获 CR 者,于诱导治疗第一疗程后,除1例外,骨髓中白血病细胞百分比下降均不明显;但于第二疗程后,白血病细胞全部减少到骨髓有核细胞总数的20%/以下,这种现象似可作为本方案预后的观察指标。     

MR Findings of Intrathecal Chemotherapy-Related Myelopathy in Two Cases: Mimicker of Subacute Combined Degeneration

We report the findings of spinal magnetic resonance imaging (MRI) in 2 patients who had undergone intrathecal chemotherapy and presented with the subacute onset of ascending numbness and weakness. MRI revealed a symmetric hyperintensity at the posterior columns of the spinal cord from the lower cervical region down to the conus medullaris level on T2-weighted images, and no abnormal enhancement. The imaging findings are similar to those seen in subacute combined degeneration (SCD), but the serum vitamin B(12) levels were normal in these 2 cases.     

HA方案治疗急非淋白血病的疗效观察

目的：为提高急性非淋巴细胞性白血病(急非淋)的疗效。方法：以HA方案治疗急非淋46例。结果：完全缓解率69．56％,其中2疗程内的完全缓解率52．17％。结论：本方案是一个奏效快、缓解率高的高效方案。     

氟达拉滨的药代动力学及其与阿糖胞苷协同作用的研究进展

氟达拉滨(F-ara-A)作为一种治疗白血病的药物。通过从分子生物学角度研究其作用机制和药代动力学,证明了该药除具有抗肿瘤作用外,还对阿糖胞苷(Ara-C)有增敏作用。在以F-ara-A和Ara-C为基础的临床治疗中,最常见的是FLAG方案,主要用于高危骨髓增生异常综合征及白血病患者。文章综述F-ara-A联合Ara-C在白血病治疗上的研究进展。     

阿克拉霉素联合阿糖胞苷对survivin基因表达的原代急性白血病细胞增殖的影响

目的:探讨survivin 基因表达的原代急性白血病(AL)细胞对阿克拉霉素(Acla)联合阿糖胞苷(AraC)的敏感性.方法:采用 RT-PCR方法检测28例AL患者的原代AL细胞survivin mRNA的表达;用MTT法检测体外Acla 4 mg/L, AraC 20 mg/L及2者联用(AA)对AL细胞的生长抑制率.结果:28例中, survivin mRNA阳性表达22例.AA应用对survivin mRNA阳性者AL细胞的生长抑制率达(37.24±18.36)%,高于对survivin mRNA阴性者的(24.32±9.33%(t=2.340,P=0.032).结论:survivin 基因阳性表达的原代AL细胞对AA较敏感.     

DCK基因多态性与阿糖胞苷治疗急性髓系白血病疗效的关系

目的研究脱氧胞苷激酶（DCK）的单核苷酸多态性（SNP）及其对阿糖胞苷（Ara-C）治疗急性髓系白血病（AML）疗效的影响。方法采用高温连接酶检测反应技术,检测126例接受Ara-C治疗的AML患者（AML组）和100名健康人（正常对照组）DCK基因7个SNP位点（SNP1~7）的基因型和等位基因分布频率,比较DCK不同基因型分布AML组患者的Ara-C治疗效果。结果 DCK基因SNP1（rs2306744）等位基因和SNP2（rs12648166）基因型分布频率,在正常对照组与AML组和Ara-C治疗无效组（n=35）之间比较,差异均有统计学意义（P〈0.05）。在AML组,SNP1的CC型基因型和SNP2的多态性基因型（AG＋GG型）以及SNP3（rs4694362）的野生型基因型,对Ara-C治疗表现出较好的临床反应。结论 DCK基因的SNP能作为潜在的Ara-C治疗AML患者预后的分子标志之一。     

Induction treatment of acute myeloid leukemia in an elderly patient with intramarrow injection/administration of cytarabine: first report of a case

We have used intramarrow injection/administration of cytarabine (Ara‐C) instead of conventional intravenous approach to induce remission in an elderly patient with acute myelogenous leukemia. We show for the first time that the intramarrow injection of chemotherapeutic agents such as Ara‐C can be used safely and effectively.     

D-index dose not predict the development of pulmonary infection in acute myeloid leukemia patients undergoing consolidation chemotherapy with high-dose cytarabine

The D-index is calculated as the area over the neutrophil curve during neutropenia. We investigated the impact of the D-index on pulmonary infection in 33 acute myeloid leukemia patients undergoing consolidation chemotherapy with high-dose cytarabine. There was no difference in the D-index between chemotherapies with and without pulmonary infection. The cumulative D-index (c-D-index) until the development of infection exceeded 4000 in four of five patients with pulmonary infection. Although there was no difference in the total D-index throughout the overall consolidation chemotherapy, the total D-index from induction to consolidation and the D-index at induction chemotherapy were higher in patients with pulmonary infection during consolidation than in those without it (P = 0.014 and 0.019, respectively). Our results showed that the cumulative effect of neutropenia might determine the risk of pulmonary infection in consolidation chemotherapy. We are planning a clinical trial of c-D-index-guided preemptive antifungal therapy.     

Pre-pubertal exposure of cytarabine-induced testicular atrophy,impaired spermatogenesis and germ cell DNA damage in SD rats

Context: Cytarabine (Ara-C) is an effective chemotherapeutic drug for the treatment of acute leukaemias. It inhibits the DNA synthesis and repair, thereby causes cytotoxicity in the proliferating cells.

Objective: This study was aimed to investigate the effects of pre-pubertal exposure of Ara-C on testesticular development in juvenile SD rats and their function at puberty.

Materials and methods: Ara-C was injected at the doses of 50, 100 and 200?mg/kg/day from postnatal day (PND) 29–42 (14 days) by intraperitoneal (i.p.) route. Half of the animals were sacrificed on PND 43 and remaining on PND 70. End points of the evaluation included gross pathological examination, histomorphometric analysis, sperm count and sperm head morphology, cell proliferation and DNA damage as well as apoptosis analysis.

Results: Ara-C treatment significantly decreased food and water intake, weight gain, testes and epididymis weight and increased histological alterations in the seminiferous tubule. Furthermore, Ara-C treatment significantly decreased the PCNA-positive cells and sperm count in a dose-dependent manner. Ara-C treatment also increased the DNA damage and apoptosis in testes and sperm as evident from the comet and TUNEL assays results.

Discussion: The present study results clearly indicated that Ara-C treatment impaired spermatogenesis and adversely affects the testicular development and its function in rats by reducing the germ cell proliferation and the inducing DNA damage and apoptosis.