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血液惡性疾病之體外化學葯物敏感試驗
In Vitro Chemosensitivity Test for Hematologic Malignancy
摘要
本實驗將各類血液惡性疾病之惡性細胞，用短時間體外液體培養基中培養（In vitro short term liquid medium culture）方法，並以染料排除法（Dye exclusion assay, DEA）計算化學葯物之敏感度（Chemosensitivity），及不同濃度之葯物作用下，惡性細胞毒殺作用之變化。本實驗共有18位各類血液惡性疾病，其中兩側死於敗血症；而在可評估的16例中則包括急性白血病（Acute leukemia）13例，慢髓芽球性白血病合併愈性芽細胞危象（CML with acute blastic crisis）1例，惡性淋巴摺合併骨髓侵犯（malignant lymphoma with bone marrow involvement）1例及多發性骨髓瘤（multiple myeloma）1例，而體外測試之化學前物包括cytosine arabinoside（cytosar）、Adriamycin、Epirubicin、Daunomycin及Vincristir，結果發現在16例病患中，體外測得對葯物敏感而隨床治療能得到完全緩解（Complete Remission）者10例中有8例，預測正確率為百分之八十。另體外測得對葯物具抗葯性（Resistance）者有6例，而臨床治療則全部都無法得到完全緩解，預測之正確率為百分之百。本實驗發現以短時間體外液體培養方法並利用染料排除法測出之葯物敏感度之結果與臨床之治療效果十分吻合，且本實驗方便、快速，對臨床上葯物治療之選擇實用性高，並可進一步做臨床療效（Effectiveness）及抗葯性之評估。
並列摘要
To determine if an in vitro assay could help in predicting clinical response, we studied 18 patients with hematologic malignancy. Tumor cells obtained by marrow aspiration were tested for chemosensitivity using a short term liquid medium culture and dye exclusion assay. Results were compared to subsequent response to treatment. Chemotherapeutic drugs were chosen without knowing the assay results. Two patients were excluded because of early death. The 16 patients studied included acute myelogenous leukemia (13), chronic myelogenous leukemia (1), malignant lymphoma with bone marrow involvement (1) and multiple myeloma (1). Chemotherpeutic agents evaluated included cytosar, adriamycin, epirubicin, daunorubicin and vincristine. Cyclophosphamide was not studied since the active metabolite, 4- hydroperoxyclophosphamide, was not available.Our results show that in vitro sensitivity to at least one of the drugs received predicted the response of complete remission in 8 out of 10 patients (80%). Alternatively, in vitro resistance to all drugs received corresponded to lack of complete remission in 6 out of 6 patients (100%). Thus, we concluded that this short term liquid medium culture method and dye exclusion assay correlated well with in vivo clinical response. This test is simple and rapid and can be applied widely to help in the choice of chemotherapeutic drugs in treating hematologic malignancy.
延伸閱讀
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