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发布于:2018-5-18 02:06:41  访问:4 次 回复:0 篇
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Why PD98059 Could Influence Many Of Us
Of course, CR is an arbitrarily defined state of reduced disease burden based on morphological assessment of the bone marrow and peripheral blood and is by no means sufficient for achieving cure, as shown by studies demonstrating the need for post-remission therapy in both younger and older patients with AML (Stone, 2010). However, achieving CR and perhaps other definitions of lesser response, such as CR with incomplete platelet recovery (commonly denoted as CRp), serve to identify patients that are sensitive to the standard cytotoxic chemotherapeutic agents, particularly cytarabine and the anthracyclines. It is clear, both in leukaemia and in cancer therapy, that morphological CR is not equivalent to complete eradication of all neoplastic cells and new and more sensitive techniques of identifying minimal Tolmetin residual disease (MRD) have demonstrated the persistence of cells responsible DAPT secretase clinical trial for relapse in most patients achieving CR (Grimwade et?al, 2010). So, it is likely that, with the development of new and effective targeted strategies with the potential for eradicating MRD, our concepts and definitions of CR, may evolve further in the future (Hokland & Ommen, 2011). At the present time, however, achievement of morphological CR will remain the gold standard for assessing the sensitivity of an individual patient��s leukaemic cells to cytotoxic chemotherapy while other indicators, such as lesser responses and the degree of clearance of leukaemic cells from the bone marrow on day 14 or 21, may also be useful to assess and grade chemosensitivity. The original definitions of response as devised in a report by a group of international investigators interested in conducting clinical trials in patients with AML, was revised in 2003 to include updated endpoints of clinical relevance (Cheson et?al, 1990, 2003). The definition of morphological CR requires a morphological leukaemia-free state with <5% blasts Proteasome inhibitor in the bone marrow aspirate sample (including marrow spicules and at least 200 nucleated cells), together with an absolute neutrophil count ��1��0?��?109/l and platelet count ��100?��?109/l in the absence of any evidence of extramedullary disease (Cheson et?al, 2003). Frequently, 1�C5% circulating blasts may be identified at the time of CR and at least one study has suggested that these low numbers of persistent peripheral blasts at CR have no effect on the subsequent outcome (Estey et?al, 2003). However, in general, and particularly in clinical research, circulating blasts are considered to be evidence of resistant disease unless they disappear on subsequent evaluations. Another issue is the time of defining CR in relation to the induction treatment.
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