ABSTRACT
BACKGROUND: Acute myeloid leukemia (AML) patients with non-remission (NR) after the first cycle of standard induction chemotherapy remain a challenge owing to poor response and tolerance to re-induction regimen. We retrospectively evaluated the efficacy and safety of three regimens in AML patients refractory to the first course of standard induction regimen. MATERIALS AND METHODS: The three regimens consisted of (1) High-dose cytarabine, aclarubicin and granulocyte colony-stimulating factor (HD-CAG) regimen (n = 44); (2) intermediate/high-dose cytarabine (I/HDAC) regimen (n = 30); and (3) standard-dose cytarabine (SDAC) combination regimen that was identical to the first course of standard induction regimen (n = 27). RESULTS: Results indicated that after the second course, the overall response (OR), i.e., complete remission [CR]+partial remission [PR]) rates in HD-CAG was higher than in the I/HDAC group (84.1% vs. 56.7%, P = 0.009), whereas the CR rates among 3 groups were not statistically different (P = 0.541). Meanwhile, the proportion of subjects reporting certain adverse effects in the HD-CAG group was lower than the I/HDAC or SDAC groups. There were no significant differences in overall survival (OS) and disease-free survival (DFS) rates among the 3 groups (P = 0.881 and P = 0.872, respectively). CONCLUSION: Our preliminary results indicate that HD-CAG regimen may represent a better alternative option for AML patients with NR after the first course of standard induction chemotherapy.
ABSTRACT
BACKGROUND: Effective mobilization and collection of hemopoietic stem cells are initial factors for peripheral stem cell transplantation, while they make sure a permanent reconstruction of hemopoiesis. Mobilization and collection have been developed; however, the collection is more, and the yield of hemopoietic stem cells is various. OBJECTIVE: To investigate the best time of mobilization and collection of peripheral blood stem cells from healthy donors. METHODS: A total of 16 donors who were selected from Haikou People's Hospital between January 2003 and December 2008 were randomly divided mobilization group (A, n=6) and mobilization + collection group (B, n=10). A group was subcutaneously injected with 5.0-10.0 μg/(kg·d) recombinant human granulocyte colony-stimulating factor (rhG-CSF) (Filgrastim), and B group was treated with rhG-CSF and intravenously injected with 10 mg dexamethasone. Peripheral stem cells were collected twice in each group. The two groups were collected at the fourth and 5~(th) day of mobilization after the second or 4th hour subcutaneous injection of rhG-CSF. The collection was 4.0-5.0 mL, the manhandled volume was 3.0-5.0 mL, and the total blood volume was 6.7-10.1 L. RESULTS AND CONCLUSION: Number of mononuclear cells was (4.0-8.0)×10~8 kg~(-1) in the two groups. The cell concentration of fourth hour was higher than the second hour after rhG-CSF treatment (P < 0.05). The mononuclear cell concentration of fourth hour was higher than the second hour after the fourth and 5~(th) day of rhG-CSF treatment. Our research showed that we could collect sufficient amount of cells (to a high concentration) by one time, which had reasonable collection time - value-effectiveness relationship, when the cycle blood volume was 1.8-2.2 times of circulating blood volume.
ABSTRACT
BACKGROUND:In allogene hematopoietic stem cell transplantation,the choice of preconditioning scheme is an important link of the success of hematopoietic stem cell transplantation,and a major research direction of stem cell transplantation.The myeloablative pretreatment scheme has great toxicity,and pretreatment related death rate is high.Thus,it is necessary to explore an ideal pretreatment scheme to expect a decrease in side effects and relapse.OBJECTIVE:To observe the effect of modified Bu/CY pretreatment regimen for treating hematologic malignancies.METHODS:The 8 patients were selected at the Department of Hematology,Haikou Municipal People's Hospital Affiliated to Xiangya School of Medicine,Central South University from November 2003 to March 2008,and received modified Bu/CY pretreatment:cytarabine 2.0-3.0 g/(m2·d)×2 d,intravenous drip,for 24 consecutive hours;myleran 4 mg/(kg·d)×3 d;cyclophosphamide 50 mg/(kg·d)×2 d;methyl-cyclohexyl nitrosourea 25 mg/(m2·d)×1 d;antithymocyte globulin 25 mg/(kg·d)×4 d. We have increased the arabinosylcytosin dose twice,and changed to a 24-hour infusion via intravenous drip,so that pretreatment strength was increased and promote lasting implantation of hematopoietic stem cells,based on the modified program.Graft-versus-host disease(GVHD)prevention:cyclosporin A and mycophenolate mofetil would be used advanced to minus 7 days (one day before stem cell transfusion is minus 1)based on the classic methotrexate regimen.The ABO blood group changes and DNA were tested in patients before and after ransplantation.RESULTS AND CONCLUSION:①The detection of hematopoietic reconstitution after transplantation:All patients have received hematopoietic reconstitution,with no pretreatment-related death.The white blood cells reduced to 0 after-3- +7 days of hematopoietic stem cell transplantation,and continues to(3-22)days,+10- +21 days white blood cells ＞ 1.0×109/L,+11- +51 days,platelets ＞ 20x109/L.②Incidence of GVHD:of 8 patients,there were GVHD Ⅳ grade(intestinal)in 1 case,acute graft-versus-host disease grade Ⅰ-Ⅱ in 3 cases.Above-mentioned results indicated that the further modification of BU/CTX2 regimen may be an effective pretreatment program,with a few side effects,which is better than the classic total-body irradiation/CY regimen.What's more,it is simple accurate,reliable rote of anti-leukemia and will be a safe and effective method for treating hematologic malignancies.