本科班白血病教学课件.ppt

* 急性白血病部分分化型 * * * * * * * * 化疗是白血病治疗的重要手段。按类型选方案，尽可能采用强烈诱导化疗方案。采用联合、足量、间歇、交替、长期治疗方针白血病化疗的原则①对不同的白血病类型应选择不同的化疗方案，对ALL应选择和AML不同的药物、剂量、疗程。②对具有不同预后因素的白血病个体其治疗方案应有所侧重和不同，如对T-ALL和B-ALL除常规方案治疗外，加用CTX或MTX及Ara-C可明显改善其CR率和生存期。③病人化疗前的健康状况亦是化疗个体化要考虑的问题。对肝肾心脏功能不全者化疗药物应减量。④严密观察化疗中病人的血象骨髓像变化、区别不同情况及时增加或减少化疗剂量。白血病化疗失败的原因：化疗失败主要是化疗期内因感染和出血引起早期死亡，或白血病细胞耐药而无效果。 * * * 防治高尿酸血症肾病 ：别嘌呤醇0.1g每日3次，碳酸氢钠1g每日四次；增加液体入量 发生DIC时，除病因治疗外，予以新鲜血浆、血小板输注并用小剂量肝素。 严重粒细胞缺乏时，可予G-CSF或GM-CSF 300μg/d皮下注射；无此条件者可连续输注浓缩粒细胞。注意防止真菌、细菌感染。 营养支持 * 整体汇报 Figure 1. Kaplan–Meier Estimates of the Cumulative Best Response to Initial Imatinib Therapy. At 12 months after the initiation of imatinib, the estimated rates of having a response were as follows: complete hematologic response, 96%; major cytogenetic response, 85%; and complete cytogenetic response, 69%. At 60 months, the respective rates were 98%, 92%, and 87%. Data for pa- tients who discontinued imatinib for reasons other than progression and who did not have an adequate response were censored at the last follow-up visit. Data for patients who did not have an adequate response and who stopped imatinib because of progression were censored at maximum fol- low-up. * Panel A shows that at 60 months, of the 350 patients with a complete cyto- genetic response after 12 months of imatinib therapy, an estimated 97% had not progressed to the accelerated phase or blast crisis. The corre- sponding rates for 86 patients with a partial cytogenetic response and for 73 patients who did not have a major cytogenetic response were 93% and 81%, respectively (P0.001; P = 0.20 for the comparison between patients with a complete cytogenetic response and those with a partial response). At 12 months, 44 patients had discontinued imatinib and thus were not included in this analysis. * Figure 4. Overall Survival among Patients Treated with Imatinib Based on an Intention-to-Treat Analysis. The estimated overall survival rate at 60 months was 89%. After the cen- sori