Effect of enteral immunonutriton on patients undergoing renal transplantation / 肠外与肠内营养

Objective:To evaluate the safety and effectiveness of early enteral immunonutrition on the patients undergoing renal transplantation.Methods:Forty-six patients undergoing renal transplantation were randomly divided into two groups,named enteral immunonutrition (EIN) group and regular enteral nutrition (EN) group (given EIN and EN respetively).The humoral immunity,cellular immunity,serum albumin,prealbumin,hemoglobin,cholesterin and the incidence of rejection were observed in order to compare the therapeutic efficacy of two kinds of nutrition therapy.Results:At the 1 st day,humoral immunity and cellular immunity were no significant differences between two groups.At the 7th day,the serum levels of IgM and IgA were significant higher in EIN group than those in EN group (P ＜ 0.05) except IgG (P ＞ 0.05).The serum level ofCD3+ was also significant higher in EIN group than in EN group at the 7th day after operation.The humoral immunity and cellular immunity were significant higher in EIN group than in EN group (P ＜ 0.05) at the 28th day after operation.The serum albumin,prealbumin,hemoglobin,cholesterin level had no significant differences between two groups before operation or at the 1 st,7th,28th day after operation (P ＞0.05),although they were higher on the 28th day than 1st day both in two groups (P ＜ 0.05).But cholesterin level had no significant differences between two groups at the 28th day and 1st day (P ＞ 0.05).The incidence of rejection was similar in two groups within 30 days after operation.Conclusion:The EIN can improve the humoral immunity and cellular immunity with a better effect than EN.The early postoperative EIN can improve the clinical outcomes of the patients undergoing renal transplantation.

Abnormally lower expression of cmtm5 gene in bone marrow cells from patients with multiple myeloma / 中国实验血液学杂志

This study was aimed to detect the expression level of cmtm 5 (CKLF-like MARVEL transmembrane domain containing member 5) gene in the bone marrow cells from patients with multiple myeloma (MM), and to investigate the correlation between the expression level of cmtm5 and various clinical characteristics. Real-time quantitative reverse transcription polymerase chain reaction (RQ-RT-PCR) was used to measure the expression levels of cmtm5 gene in the bone marrow cells collected from MM patients, and the MM cell lines, namely, RPMI8226 and CZ1 cells. The normal donor marrow specimens were used as the reference. The ratio of cmtm5 copy number to abl (Abelson murine leukemia viral oncogene homolog) gene copy number was used for indicating the expression level. The results showed that the expression level of cmtm5 gene was significantly down-regulated in bone marrow cells of 51 untreated or relapsed/refractory MM patient as compared to those of normal donor marrow cells (0.047+/-0.062 for the untreated or relapsed/refractory MM patients versus 0.255+/-0.333 for the normal, p<0.01). According to the International Staging System (ISS), the cmtm5 expression level in marrow cells of patients in ISS III stage was significantly lower than that in patients in ISS I stage (0.034+/-0.034 for the ISS III stage versus 0.103+/-0.109 for ISSI stage, p<0.01). Similarly, lower expression levels of cmtm5 gene were also found in two human MM cell lines (0.014+/-0.009 for RPMI8226 cells and 0.004+/-0.006 for CZ1 cells). After the MM patients were effectively treated, their expression levels of cmtm5 gene significantly increased (0.020+/-0.005 for the untreated patients versus 0.227+/-0.038 for the effectively treated patients, p<0.01). A significant negative correlation was observed between the expression level of cmtm5 gene and the number of bone marrow plasma cells (r=-0.307, p<0.05). However, the correlation was not found between the expression level of cmtm5 gene and the clinical characteristics, such as gender, age, hemoglobin level, or M-protein level, etc. It is concluded that the expression level of cmtm5 gene is abnormally lower in the bone marrow cells from the MM patients, and are associated with ISS stages. Furthermore, the expression level of cmtm5 gene is negatively correlated with the number of bone marrow abnormal plasma cells in MM patients, which suggests that the abnormally lower expression of cmtm5 may be involved in the pathogenesis of the MM patients.

Characteristics and prognostic factors of acute myeloid leukemia with t (8; 21) (q22; q22) / 中国实验血液学杂志

The translocation t (8; 21) (q22; q22) frequently associated with additional chromosomal aberrations is one of the most recurrent chromosomal abnormalities in AML. Clinically, this type of AML usually shows some specific characteristics and has a good response to chemotherapy with a high remission rate and a relatively long median survival. On the other hand, some reports also showed poor prognosis in AML patients with t (8; 21), and the associated bad-prognosis factors have not been strongly established to date. To investigate this issue and to further identify the related characteristics of t (8; 21) AML in China, 75 Chinese AML patients with t (8; 21) were retrospectively analyzed. They comprised 68 cases of M(2), five of M(4) and two of M(5) according to FAB classification. The results indicated that Auer rods were observed in 39 patients (52%) and marrow eosinophilia was detected in only 5 patients (6.7%). These patients showed high level of HLA-DR and CD34 expression, while CD19 was detected in only 13 patients (20.9%). Cytogenetically, 62.5% cases had additional chromosomal abnormalities, and the main associated recurrent additional abnormalities were loss of a sex chromosome (LOS), trisomy 4, del (9q) and trisomy 8. After conventional induction therapy, 62 patients attained complete remission (CR) resulting in the CR rate 82.7%. With a follow-up of 1 to 96 months, 19 cases relapsed at a median time of 10.5 months (range 3 to 42 months). The median overall survival was 20 months, and the estimated 5-year overall survival (OS) rate was 32.3%. In multivariate analyses of prognostic factors, karyotype, extramedullary leukemia, age and post-remission therapy were of prognostic value for OS. Patients with additional chromosomal anomalies had shorter survival compared to those with t (8; 21) only (P = 0.019), no matter which kind of additional karyotype it was. Extramedullary leukemia was an adverse prognostic factor (P = 0.012). Patients aged 15 years or less had a longer survival than those aged more than 15 years (P = 0.045). Patients accepted HSCT in post-remission therapy had better outcome compared to those with chemotherapy only. It is concluded that Chinese AML patients with t (8; 21) had some different characteristics as compared with patients from other countries, a relatively poor outcome was observed in our patients, especially in those with extramedullary leukemia or additional chromosomal abnormalities. HSCT should be recommended to t (8; 21) AML in China, especially to those with adverse prognostic factors.

Bone marrow morphologic features in patients treated with imatinib for Philadelphia chromosome positive chronic myeloid leukemia / 中华血液学杂志

<p><b>OBJECTIVES</b>To assess bone marrow morphologic changes in Philadelphia-chromosome positive chronic myeloid leukemia (Ph(+)-CML) patients treated with Imatinib, and to evaluate the correlation of the morphologic changes with hematological or cytogenetic responses.</p><p><b>METHODS</b>One hundred and seventeen patients with Ph(+) CML: 54 in chronic phase but failed to interferon-alpha treatment, 41 in accelerated phase, 22 in blastic phase received oral administration of Imatinib 400 or 600 mg once daily for more than 18 months.</p><p><b>RESULTS</b>All of the patients responded to the treatment, including complete hematological response, bone marrow response and return to chronic phase, bone marrow cellularity and myeloblast count reduced significantly to non-CML picture. Myeloid/erythroid ratio and megkaryocyte count were decreased significantly in most patients in chronic and accelerated phases (P < 0.05). Bone marrow hypoplasia or aplasia was associated with lower cytogenetic response rates in patients in chronic phase (58.8% vs 86.5%, P = 0.035), lower complete hematological response in patients in accelerated phase (26.3% vs 75.0%, P = 0.004), and 6-month overall survival in patients in blastic phase (77.8% vs 16.7%, P = 0.009). Patients in advanced stage obtained non-CML marrow picture in 1 month of treatment had better prognosis. 18-month disease progression rates were lower (25% vs 75%, P = 0.028) and overall survival rates higher (75.0% vs 11.8%, P = 0.004) in patients obtained non-CML picture marrows than in those with CML marrows picture in accelerated phase. Hematological response rate and overall survival of more than 6 months were higher in patients with non-CML marrows picture than those with CML marrows picture (100.0% vs 40.0%, P = 0.017 and 83.3% vs 26.7%, P = 0.046 respectively) in blastic phase.</p><p><b>CONCLUSIONS</b>Normal marrow appearance can be sustained under continuous treatment of Imatinib in CML patients who achieved hematological responses.</p>

Two Ph chromosome positive chronic myelogenous leukemia patients with rare bcr/abl fusion gene / 中华血液学杂志

<p><b>OBJECTIVE</b>To investigate the unusual bcr/abl fusion gene structures of two Ph chromosome positive chronic myelogenous leukemia (CML) patients in chronic phase (CP).</p><p><b>METHODS</b>By using general M- and micro -bcr/abl specific primers respectively, bcr/abl fusion transcripts were detected by reverse transcription-polymerase chain reaction (RT-PCR). The RT-PCR products sequencing was performed, the DNA sequences were analyzed in Genebank and the bcr and abl sequences at the fusion site were identified. DNA was amplified by PCR using a set of primers designed according to the sequencing result of RT-PCR products.</p><p><b>RESULTS</b>Two patients showed typical manifestations of CML-CP. Their RT-PCR products were different from usual M- or micro -type; one was longer than M-bcr/abl but shorter than micro -bcr/abl, the other one was shorter than M-bcr/abl. The RT-PCR products sequencing showed that both products contained bcr and abl gene sequences. The first patient's bcr gene was broken within exon 18, and fused to abl gene exon 2(a2), and a 40 bp of partial abl intron 1b fragment was inserted between them, resulting in a novel in-frame bcr/abl fusion transcript-e18-int-a2 which has not been reported in the literature so far. In the second patient, deletion of abl exon2(a2) led to exon 13(b2) of bcr gene fusing with abl exon 3(a3).</p><p><b>CONCLUSION</b>Uncommon bcr/abl fusion gene may occur in typical Ph(+) CML patient.</p>

A serial study of in cytogenetic change and morphology on the tetra-arsenic tetra-sulfide treatment in untreated or recurrent acute promyelocytic leukemia / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To study the morphologic and cytogenetic change in acute promyelocytic leukemia (APL) patients during the tetra-arsenic tetra-sulfide (TATS) treatment and the mechanism of TATS.</p><p><b>METHODS</b>The bone marrow cells of 13 newly diagnosed and 7 recurrent APL patients were studied through FISH and morphology during the TATS treatment by special and repeated marrow culture.</p><p><b>RESULTS</b>Cytomorphological study of 8 cases (6 untreated and 2 recurrent) showed that TATS could differentiate APL cells forward to mature granulocytes. There was obvious correlation between the reduced t (15; 17) positive cells and the reduced APL cells (r range 0.7298 - 0.9989). Except one patient with t (11; 17), 19 (13 untreated and 7 recurrent) with translocation t (15; 17) achieved clinical CR including 16 who achieved cytogenetic CR.</p><p><b>CONCLUSION</b>TATS has a differentiation-inducing effect on untreated and recurrent APL, with haematological CR and cytogenetic CR achieved. Measurement of t (15; 17) positive cells by FISH technique can reflect the change of APL cells objectively.</p>