ABSTRACT
【Objective】 To evaluate the clinical efficacy and prognostic factors in multiple myeloma (MM) patients treated with autologous hematopoietic stem cell transplantation (auto-HSCT). 【Methods】 The clinical data of 155 MM patients newly diagnosed and suitable for transplantation in our hospital from 2014 to 2021 were retrospectively analyzed. They were divided into auto-HSCT group and non-auto-HSCT group according to the treatment mode. The clinical efficacy, overall survival (OS) and progression-free survival (PFS) of the two groups were compared. Furthermore, the prognostic factors of auto-HSCT group were analyzed. 【Results】 ① There were 51 patients in auto-HSCT group and 104 patients in non-auto-HSCT group. There was no statistical difference in baseline characteristics except age between the two groups. ② Hematopoietic reconstruction was achieved in all patients in auto-HSCT group, and no transplantation-related mortality was found. ③ The clinical efficacy of pre-and post-transplantation was compared in auto-HSCT group. sCR/CR rate was significantly increased after transplantation (P=0.041). The effective remission rate (≥VGPR) was also higher (P=0.05). As for the best efficacy, sCR/CR rate and effective remission rate were both significantly higher in auto-HSCT group than in non-auto-HSCT group (P=0.001). ④ In auto-HSCT group, by the end of follow-up, the median OS was not reached, the median PFS was 30.5 months, and 3-year OS and PFS was 87% and 40.3%, respectively. In non-auto-HSCT group, the median OS was 61 months, the median PFS was 21 months, and 3-year OS and PFS was 65.3% and 33.1%, respectively. It indicated that OS was significantly prolonged in auto-HSCT group (P=0.004). PFS was also prolonged but without significant difference (P=0.065). ⑤ Analysis of prognostic factors in auto-HSCT group showed that decreased PLT (P=0.038) and increased serum-adjusted calcium (P=0.017) were independent risk factors for OS, decreased PLT (P=0.005), female (P=0.018) and disease status of PR or worse before transplantation (P=0.012) were independent risk factors for PFS. 【Conclusion】 Auto-HSCT can improve the remission rate, prolong OS in MM patients, and possibly prolong PFS. Increased serum-corrected calcium and decreased PLT are independent prognostic factors for OS in patients treated with auto-HSCT. Decreased PLT, female, and disease status of PR or worse before transplantation are independent prognostic factors for PFS.
ABSTRACT
Chimeric antigen receptor T (CAR-T) cell therapy is a novel cellular immunotherapy that is widely used to treat hematological malignancies, including acute leukemia, lymphoma, and multiple myeloma. Despite its remarkable clinical effects, this therapy has side effects that cannot be underestimated. Cytokine release syndrome (CRS) is one of the most clinically important and potentially life-threatening toxicities. This syndrome is a systemic immune storm that involves the mass cytokines releasing by activated immune cells. This phenomenon causes multisystem damages and sometimes even death. In this study, we reported the management of a patient with recurrent and refractory multiple myeloma and three patients with acute lymphocytic leukemia who suffered CRS during CAR-T treatment. The early application of tocilizumab, an anti-IL-6 receptor antibody, according to toxicity grading and clinical manifestation is recommended especially for patients who suffer continuous hyperpyrexia, hypotensive shock, acute respiratory failure, and whose CRS toxicities deteriorated rapidly. Moreover, low doses of dexamethasone (5-10 mg/day) were used for refractory CRS not responding to tocilizumab. The effective management of the toxicities associated with CRS will bring additional survival opportunities and improve the quality of life for patients with cancer.
ABSTRACT
Objective To explore the development and optimization of scientific research performance evaluation system (SRPES) in affiliated hospitals of university.Methods Take Xi'an Jiaotong University Second Affiliated Hospital as an example,summarize and conduct statistical analysis of SRPES data in past ten years.Results Along with the development and optimization of SRPES,the hospital makes a breakthrough in personnel training,the development of discipline construction is remarkable,the scientific research output also presents a better development trend.Conclusions Continuing navigation and improvement of SRPES and incentive policies play an important role in guiding the development of scientific research with stated objectives.
ABSTRACT
Objective To investigate the expression level and clinical significance of WT1 gene in acute luekemia (AL) patients.Methods WT1 gene level was detected by real time quantitative-polymerase chain reaction in acute myelogenous leukemia (AML) and in acute lymphocytic leukemia (ALL) patients.Then the expression levels of WT1 gene in different subtypes of AML were compared,and the correlation between gene expression and disease courses and prognosis were observed.Moreover,the relationship between disease courses and WT1 expression in patiens after receiving haemopoietic stem cell transplantation were analyzed.Results Among 66 cases,WT1 expression positive rate was 87.5 ％ (14/16) in AML and 76.0 ％ (38/50) in ALL.In AML,the expression level in M3 showed the lowest than that in any other subtypes (compared with M1,M2,M4,M5,P value was 0.040,0.007,0.006 and 0.01,respectively).The expression level of WT1 was closely correlated with leukemia disease courses.The expression level in complete remission (CR) group showed a significant lower expression level than that in non-remission group (P =0.018) and relapse group (P =0.003),and the re-increase of WT1 expression level could predict relapse as early as 1.5 months.Moreover,WT1 expression also showed an close relationship with prognosis of patients receiving haemopoietic stem cell transplantation.Patients whose WT1 was undetectable had a better prognosis than those with persistent expression,and increase again after becoming undetectable.Conclusion WT1 has a high expression level in AL,which can represent minimal residual disease.The expression level in M3 was lowest than that in different AML subtypes,and its expression level has a close correlation with clinical disease course and prognosis of AL.
ABSTRACT
[Objective]To discuss the clinical effect of fludarabine and busulfan (Bu+Flu) as a low toxicity myeloablative conditioning regimen for allogeneic peripheral blood stem cell transplantation (allo-HSCT)in leukemia patients.[Methods]Clinical data of 13 patients with hematological malignancies receiving conditioning regimen with Bu+Flu for allo-HSCT were analyzed retrospectively.Conditioning regimen was Bu+Flu,compalriot mismatched and unrelated transplantation combined with rabbit anti-human thymocytes immune globulin (ATG).CsA+short course of methotrexate or CsA + mycophenolate mofetil were used to prevent graft-versus-host disease (GVHD).DNA sequencing of short tandem repeat (STR)polymorphism analysis method was performed for identification of donor stem cells implantation.[Results]13 patients all tolerated with this conditioning regimen well,no serious complications occurred.Neutrophil engraftment was at 9-15 days (median 11 days),platelet engraftment at 8-25 days (median 13 days).10 patients achieved hematopoiesis reconstitution with their full donor chimerisms confirmed by STR-DNA analysis.Acute GVHD occurred in 5 cases,accounting for 38.5％.Chronic GVHD occurred in 4 cases of 10 patients could be assessed,accounting for 40.0％.Severe GVHD more than Ⅱ degree did not happen.1-39 months (median time 11 months)of follow-up revealed the overall survival rate of 76.9％(10/13),disease-free survival of 61.5％ (8/13).The causes for death were relapse in all.[Conclusion]The conditioning regimen with Bu+Flu has low toxicity,well tolerance and better effect.
ABSTRACT
Objective To observe the efficacy of HAG regimen in remission inductive treatment for elderly patients with acute myeloid leukemia (AML) and myelodysplastic syndrome-refractory anemia with excess blasts (MDS-RAEB). Methods The clinical features of 21 cases with AML and 9 cases with MDSRAEB (≥60 year old) treated with HA-G regimen in remission induction were retrospectively analyzed,including the complete remission (CR) rate, efficiency rate as well as their toxicities. Results In 21 elderly patients with AML treated with HAG regimen, the efficiency rate was 66.7 % (14/21), CR rate 47.6 % (10/21).In 9 elderly patients with MDS-RAEB, the CR rate was 55.6 % (5/9). The main toxicity of HA-G regimen was infections secondary to hematopoiesis suppression after chemotherapy. All patients were well tolerated to adjusted regimen. Conclusion The HA-G regimen is much effective in remission induction for elderly patients with AML and MDS-RAEB.
ABSTRACT
Objective To study the clinic effect and safety of MEAD chemotherapy regimen for adult patients with relapsed or refractory acute lymphocyte leukemia. Methods Between July 2006 and July 2009,twenty-two adult patients with relapsed or refractory acute lymphocyte leukemia received MEAD regimen (mitoxantrone 6 mg/d dl-3 iv drip,cytarabine 100 mg/d dl-5 iv drip,etoposide 100 mg/d dl-5 iv drip,dexmethasone 10 mg/d dl-8 iv drip). Results The complete remission (CR) rate of adult patients with relapsed or refractory acute lymphocyte leukemia was 31.8 %,the partial remission(PR) rate was 22.7 % and the overall response (OR) rate 54.5 %. The cumulitive CR rate was 50.0 %,and the PR rate 40.9 % after two times MEAD chemotherapy regimen. The main adverse effect was different level of myelosuppression,and other toxicity of vital organ was mild. Conclusion MEAD regimen is effective and can be tolerated for adult patients with relapsed or refractory acute lymphocyte leukemia,and its side effect is mild.
ABSTRACT
Objective To study the curative effects and adverse effects of the thalidomide combined with COMP chemotherapy in treating multiple myeloma(MM).Methods 42 patients were initially diagnosed as MM and 27 patients were refractory and relapsed MM.The small dose of thalidomide combined with COMP management and COMP management alone were used.The effective rate and adverse effects were analyzed.Changes of M-protein in serum,percentage of plasma cells in bone marrow and the level of hemoglobin were also analyzed in both pre-treatment and post-treatment periods.Results In 42 patients who were initially diagnosed as MM,the effective rate was 40.9% for 22 patients treated by chemotherapy alone and 70.0% for 20 patients treated by the thalidomide combined with chemotherapy.Statistic difference was observed between those two group.As to the 27 patients who were refractory and relapsed MM,the effective rate was 42.9% for 13 patients treated by chemotherapy alone and 84.6% for 14 patients treated by the thalidomide combined with chemotherapy.Statistic significance was present between them.Adverse effects were less and tolerated.Conclusion Treatment of small dose of thalidomide combined with COMP chemotherapy could significantly improve the effective rate with less adverse effects.
ABSTRACT
In recent years,the quality of study of medical students in their internship has declined because of the interruption of graduation record examination and obtaining employment after graduation.We made many managments every year in administration to enhance rules;On one hand we changed teaching pattern,methods and take a series of stimulating measures to encourage and promote teacher's teaching consciousness,on the other hand we ensured the quality of internship study and cultured excellent qualified medical students by adjusting time of internship,keeping a strict hand over examination and so on.
ABSTRACT
Objective:To evaluate the cytotoxicity of macrophage of C57BL/6 mice treated with the prepared leukemia vaccine.Methods:Established the leukemia burden mice and prepared three types of leukemia vaccine,which were administered on the mice respectively.The MTT colormetric method was adopted 2 and 4 weeks later to measure the cytotxicity of M? derived from the mice accept immunotherapy or prevention,and compared with control group.Results:(1)With the growth of leukemia cells in the mice,the cytotoxicity of M? was seriously depressed;(2)The administration of tumor vaccine prepared from inactivated tumor cells,IFA and cytokines,such as rGM CSF,rIL 2 and rIL 6,promote the cellular immunity of tumor burden mice,more effciently than tumor vaccine made from either inactivated tumor cells and IFA or inactive tumor cells themselves along.Conclusion:The tumor vaccine simply prepared with inactive tumor cells,IFA and cytokines can active the non specific cellular immunity that represented as M?,for example non specific cytotoxicity,antigen present,immune surveillance and so on,these can build a base for active the T lymphocyte the next.The tumor vaccine provides a promising future in the therapy against hematopietic tumor.
ABSTRACT
Objective:To observe the general status, the effect of resisting to the aggression of FBL-3 cells and protective immunity of the mice by using leukemia vaccine during the immune reconstitution.Methods:The immune deficiency C57BL/6 mice induced by total body irradiation were reconstituted immunity with homologous splenic lympocytes.The mice were immunized by injecting FBL-3 cells subcutaneously,and then attacked by using FBL-3 cells 7days thereafter.The activities of mice,the percentage of carcinoma formation and the growth status of tumor were observed.The amount of IFN-? in peripheral blood was determined by ELISA to evaluate the magnitude of cell immunity.The condition of cell infiltration in tumor central region and its periphery region was explored by patologic-section.Results:Immune reconstitution could obviously elevate protective immunity on the basis of using vaccine,and the amount of IFN-? was obviously higher.The FBL-3 tumors inoculated thereafter grwe slowly,and significant infiltration of mononuclear cells peri-tumor as well as necrosis of tumor cells were observed.Also,the life time of the mice was prolonged.Conclusion:Immune reconstitution and vaccine can significantly elevate protective immunity
ABSTRACT
Objective To observe the general status and the immunity of DBA/2 mice injected with leukemia vaccine during the immune reconstitution, and to observe the survival rate of these injected mice that were then challenged by L1210 cells. Methods Normal mice and reconstituted lymphopenic mice (RLM; DBA/2 mice rendered lymphopenic with sublethal irradiation and reconstituted with naive splenocytes) were used in the vaccination and challenge experiments with L1210 cells. Results Following vaccination, a significant increase of the IFN-? was detected in the blood of vaccinated RLM compared with that of vaccinated normal mice, as assessed by ELISA. Significantly, greater protection was induced in vaccinated RLM, which led to a stronger protection from death. Conclusion The vaccination of reconstituted lymphopenic hosts could elicit superior anti-tumor immunity compared with normal hosts, highlighting the potential clinical benefit of performing tumor vaccination during immune reconstitution.