Objective To apply the evidence-based treatment method to direct the clinical therapy of refractory chronic lymphocytic leukemia (CLL). Methods Such evidence-based medicine databases as The Cochrane Library (Issue 10, 2010), OVID database, PubMed (January 1992 to October 2010) and http://www.nccn.org/ were searched to find the clinical evidence with high quality and the optimum treatment was designed based on the patient’s preferences. Results Two RCTs and five CCTs were included. The available clinical evidence displayed that rituximab could improve the therapeutic effect of combined chemotherapy on the refractory CLL, the COP/CHOP regimens were effective for the fludarabine-resistant CLL, and hematopoietic stem cell transplantation could be an effective salvage therapy for the relapsed/refractory CLL, but not the first-line recommendation drug. This patient was treated by CHOP regimen combined with rituximab, the condition of disease was improved two months after stopping chemotherapy, and the follow-up was conducted. Conclusion Current evidence reveals that rituximab combined with CHOP regimen produces good tolerance with a better clinical outcome than that of CHOP regimen. Clinical practice results display that the combination of rituximab and CHOP regimen can bring good prognosis to the patient, but still needs high-quality evidence to prove．
Objective?To assess the clinical effectiveness and safety of granulocyte colony stimulating factor (G-CSF) for patients with acute lymphoblastic leukemia (ALL). Methods?We searched the Cochrane Library, PubMed, EMbase, CNKI, and VIP databases from January 2000 to October 2009. Randomized controlled trials (RCTs) about G-CSF for patients with ALL were retrieved. The methodological quality of the included studies was assessed and the data was extracted according the Cochrane Reviewer’s Handbook. Meta-analyses for overall survival, complete remission, quality of life, infections, relapse rate, and adverse events were performed using RevMan 5.0 software. Results?Six RCTs involving 620 patients with ALL were included. The results of meta-analyses showed that the G-CFS group was superior to the control group in the overall survival of adult ALL patients (RR=2.24, 95%CI 1.28 to 3.90, P=0.004). Conclusion?G-CSF can improve the overall survival of adult ALL patients. However, it is not demonstrated that G-CSF could improve complete remission rate and quality of life, and reduce infections and relapse rate. More high-quality and large scale RCTs are required.
Objective We intended to get good understanding of the current role of imatinib （or glivec） in the treatment of a patient with chronic-phase chronic myeloid leukemia. Methods We attempted to find the current best evidence of imatinib for treating chronic myeloid leukemia in chronic phase by searching ACP Journal Club （1991 -Jun, 2005 ）, The Cochrane Library（Issue 2, 2005 ）and MEDLINE（1990 -Jun, 2005 ） and further critically appraised the available evidence. Results Imatinib appeared to be more effective than current standard drag treatments in terms of hematologic and cytogenetic response with better quality of life and fewer side effects. However, there was uncertainty concerning long term outcomes. Given the current evidence together with our clinical experience and considering the patient and his family members＇ values and preference, imatinib （400 mg qd） was administered to him. No obvious adverse effects occurred with 3 months follow-up. Conclusions Imatinib is effective and well tolerated in the treatment of chronic myeloid leukemia in chronic phase. Further researches on long-term follow-up data from imatinib trials are definitely needed.
【摘要】 目的 分析交叉抗原表達的急性白血病的臨床特征及緩解率。 方法 對2009年10月-2010年11月血液內科的210例交叉表達髓系和淋巴細胞系相關抗原的初治急性白血病患者的標本，采用流式細胞術檢測白血病細胞的免疫表型，根據免疫標記和FAB（French、American、Britain）分型進行分組，分析其異質性的生物學特征和影響緩解率的相關因素。 結果 210例急性白血病的FAB分型以AML-M1/M2（82例）和ALL（78例）為主；免疫分型以B淋巴細胞系和髓系混合表達多見（116例），其中CD34表達率高達91.4%（192例）， CD7表達率為50.5%（106例），且與CD34相關（P=0.04）；出現CD34、CD7、CD19三者共表達的患者緩解率較低（9.09%）。 結論 交叉抗原表達的急性白血病的診斷有賴于免疫分型的判斷，其分化抗原的表達類型是影響其緩解率的重要因素。【Abstract】 Objective To observe the clinical characters of acute leukemia with cross-lineage antigen expression and analyze the remission rate. Methods Between October 2009 and November 2010, 210 patients were diagnosed and classified by morphology. Cytochemistry and immunology were used to analyze the immunophenotype. According to the immunostaining relative factors and FAB (French, American, and Britain) phenotype standard, the samples were divided into several groups. The conical characters and relative factors of remission rate were analyzed. Results In 210 patients with cross-lineage antigen expression, AL, AML-M1/M2 (82 cases) and ALL (78 cases) were common in FAB phenotype,and cross-lineage of B lineage and myelolineage were common in immunotype (116 cases). CD34 got the highest expression frequency of all (192 cases),and had the most important effect on patients′ prognosis. CD7 was also positive commonly (106 cases) and related with CD34 (P=0.04). So it′s significant for the outcome. The patients who got co-expression of CD34, CD7 and CD19 had worse prognoses. Conclusions Acute leukemia with cross-lineage antigen expression is a special type and is confirmed by immunotype. Furthermore, expression types of differentiation antigen are critical for the prognosis.
Objective To systematically review the health economic evaluation studies of medicines for the treatment of acute myeloid leukemia (AML). MethodsThe PubMed, EMbase, Cochrane Library, CBM, CNKI, and WanFang Data, as well as the CRD database specifically for health economics were electronically searched from inception to June 2022, and related journals in the field of health economics and the websites of HTA institutions in various countries were manually searched. The quality of the studies was assessed using the CHEERS checklist. The basic characteristics of health economics evaluation publications were summarized, the quality of model structures and methodologies was assessed and economic evaluation results were compared among different treatments. Results A total of 17 studies were included, and cost-effectiveness analyses were conducted from the perspectives of the health system, patients, the whole society, and medical insurance payers. The economic evaluation models were relatively unified, but there were differences in methods and results reporting, and the quality needed to be improved. The research objects were mainly the comparison of hypomethylating agents, targeted medicine and traditional chemotherapy regimens, as well as the comparison of different chemotherapy combinations and different drug dosages. Conclusion Real-world studies are mainly focused on traditional chemotherapy regimens, and model-based health economic evaluations, such as Markov models, are more frequently applied to newly developed targeted drugs and demethylation drugs. Among all treatments, the chemotherapy regimens including cytarabine, midostaurin, and decitabine are found to be more cost-effective.
【摘要】 目的 探討小兒白血病合并回盲腸綜合征的臨床特點、診斷及治療。方法 對2005年2月—2009年10月間4例小兒白血病合并回盲腸綜合征的臨床癥狀、體征及輔助檢查進行回顧性分析。結果 在小兒白血病的治療過程中,可出現回盲腸綜合征。臨床表現為腹痛、腹脹及腹瀉等;查體可見腹肌緊張,右下腹壓痛,或有反跳痛等;血常規中白細胞減少,尤其中性粒白細胞顯著下降;給予抗感染,靜脈營養,丙種球蛋白增強機體抵抗力,輸濃縮紅細胞及血小板支持治療,可以收到較好的治療效果。若保守治療癥狀得不到緩解,或病情加重,可行手術治療。結論 回盲腸綜合征是小兒白血病治療過程的合并癥,其臨床表現復雜,體征缺乏特異性,根據不同的病情采用相應的治療方法可收到良好的臨床效果。
【摘要】 目的 探討儀器法和鏡檢法計數白血病幼稚粒細胞百分比的相關性和一致性。 方法 2009年6-9月對71例慢性粒細胞性白血病（慢粒）、亞急性粒細胞性白血病（M2）、急性早幼粒細胞性白血病（M3）及急性粒單核細胞性白血病（M4）白血病患者進行儀器法和鏡檢法計數周圍靜脈血幼稚粒細胞的百分比的檢測，并進行比較分析。 結果 兩種方法計數的慢粒、M2、M3及M4型共71例白血病患者的幼稚粒細胞的百分比比較，有統計學意義（t=6.404，Plt;0.01）；但具有相關性（r=0.771，Plt;0.001）。且四種類型白血病中的每一種類型的白血病的兩種方法的幼粒值也都具有相關性和不一致性（Plt;0.05）。 結論 SYSMEX XE-2100全自動血細胞分析儀對慢粒、M2、M3及M4的周圍靜脈血幼稚粒細胞識別能力欠佳，仍需采用鏡檢法進行檢測。【Abstract】 Objective To investigate the correlation and consistency of the percentage of immature granulocytes of peripheral venous blood in patients with leucocythemia between the instrument method and microscope test method. Methods From June to September 2009, instrument method and microscope test method were used to measure the percentage of immature granulocytes of peripheral venous blood in patients with leucocythemia [chronic granulocytic leukemia (CGL), subacute granulocytic leukemia (M2), acute promyelocyte leukemia (M3), and acute myelomonocytic leukemia (M4)]. Results The difference in the percentage of immature granulocytes of the 71 samples between the 2 methods was significant (t=6.404,Plt;0.01), but still with correlation (r=0.771,Plt;0.001). Besides, there were also correlation and consistency of the percentage of immature granulocytes of the four types of leukemia between the two methods (Plt;0.05). Conclusion The identification ability of SYSMEX XE-2100 type automatic blood cell analyzer for measuring the percentage of immature granulocytes of peripheral venous blood in patients with CGL, M2, M3 and M4 is still weak. Currently, microscope test method still needs to be applied in the measurement.
Objective To systematically evaluate the effectiveness of dasatinib in doses of 140 mg once daily and 70 mg twice daily for chronic myeloid leukemia (CML). Methods The randomized controlled trials (RCTs) were retrieved from Embase (1974 to November 2011), Pubmed (1966 to November 2011), The Cochrane Library (Issue 11, 2011), CBM (1979 to November 2011), VIP (1989 to November 2011), CNKI (1994 to November 2011), Wanfang Data (1997 to November 2011) and references listed in all articles. RCTs meeting inclusive criteria were included, the data were extracted, the quality was evaluated and cross-checked by two reviewers independently according to Cochrane Handbook for Systematic Reviews of Interventions, and then meta-analyses were conducted using RevMan 5.1 software. Results A total of four studies involving two RCTs and 862 patients were included. Results of meta-analyses showed that when dasatinib was used in the long-term treatment of CML, no significant difference was found between 140 mg once daily and 70 mg twice daily in the complete hematologic response (RR=0.97, 95%CI 0.88 to 1.07, P=0.58), complete cytogenetic response (RR=0.94, 95%CI 0.80 to 1.11, P=0.47) and major cytogenetic response (RR=0.99, 95%CI 0.86 to 1.13, P=0.86). In the short-term treatment of CML, there were no significant differences in the complete hematologic response (RR=0.99, 95%CI 0.90 to 1.07, P=0.73), complete cytogenetic response (RR=0.99, 95%CI 0.78 to 1.26, P=0.95) and major cytogenetic response (RR=1.01, 95%CI 0.83 to 1.22, P=0.95). The subgroup analyses on the long-term treatment of CML in both chronic phase and advanced phase showed that there were no significant differences in the complete hematologic response, major cytogenetic response and complete cytogenetic response. Conclusion In the effectiveness of dasatinib for CML, the dose of 140 mg once daily is similar to the dose of 70 mg twice daily. Considering possible moderate selection bias existing in the methodological quality of the included studies which may affect the authenticity of outcomes, this conclusion should be further proved by conducting more high-quality, large-scale and double- blinded RCTs.