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Objective:To analyze the clinical characteristics of primary acute myeloid leukemia (AML) (non-M3 type) in children suffering from different levels of platelet count(PLT).Methods:In the Tumor Hospital of Zhengzhou University from January 2014 to December 2018, laboratory and clinical data of 247 de novo primary AML pediatric patients were retrospectively reviewed.According to the PLT before treatment, patients were divided into very low platelet group (VLG), low platelet group (LG) and non-lowing platelet group (NLG), with<50×10 9/L, ≥50×10 9/L but <125×10 9/L and ≥125×10 9/L as the boundaries.All patients were followed up until June 30, 2019.Meanwhile, the follow-up data was obtained by consulting medical records or by telephone.SPSS 17.0 software was applied for data analysis. Results:In general clinical features, a different group of hemoglobin (Hb) content, fusion gene AML- ETO and clinical risk stratification were statistically significant in different PLT groups ( χ2=11.270, 12.115 and 12.848, respectively, all P<0.05). However, the differences of other indicators in different groups of PLT were not statistically significant (all P>0.05). There were no statistically significant differences in terms of 3-year disease-free survival(DFS) rate (59.3%, 36.3%, 50.4%) among the 3 groups (all P>0.05). The median total survival(OS)time(40.5 months)and 3-year OS rate(41.0%) of NLG patients were significantly higher than those of VLG(23.1 months, 30.1%)and LG(14.1 months, 18.2%)patients, with statistically significant differences( χ2=7.798 and 6.553, respectively, all P<0.05). The univariate analysis of gender, white blood cell(WBC), Hb, PLT, lactic dehydrogenase(LDH), FLT3-ITD, NPM1, DNMT3A, CEPBA, C-KIT, AML-ETO, molecular genetic prognosis, complete remission(CR), and hemopoietic stem cell transplantation(HSCT) displayed that DNMT3A mutation was an adverse factor that affects patients′ OS ( χ2 =5.834, P<0.05), and the positive factors that influences OS were non-reducing PLT before treatment, and obtaining CR and subsequent HSCT ( χ2=7.798, 79.168, and 31.337, respectively, all P<0.05). Multi-factor analysis revealed that the independent protective factors that affect patients′ OS were the non-reducing PLT before treatment, and obtaining CR and subsequent HSCT( Wald=42.760, 15.918, and 10.183, respectively, all P<0.05). Conclusions:Before treatment, non-reducing PLT is a protective factor for primary childhood AML patients, and the prognosis is satisfying.
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Objective Combined with the medical records of two patients with megaloblastic anemia (MA) after allogeneic hematopoietic stem cell transplantation (AHSCT),the relevant literature was reviewed.Methods The medical records of two patients with MA after AHSCT were analyzed retrospectively.The primary disease was diagnosed by analyzing the blood cells,bone marrow cell morphology,cell chemical dyeing,bone marrow biopsy and immune classification.After AHSCT,MA was diagnosed through bone marrow cell morphology,folic acid and vitamin B12 detection.Results AT 32nd day after transplantation,bone marrow cells morphological examination of case 1 showed:nucleated cells proliferation activity,granulocytes proliferation activity,giant rod nucleus granulocytes visible;different stages of the red blood cells proliferation activity,higher proportion of immature red blood cells,most of whose nucleus developed later than the cytoplasm;megakaryocytes and platelets scattered distribution.Blood contents of folic acid and VB12 were far below the reference range.After administration of folic acid and VB12 for 2 weeks,routine blood test showed the volume of red blood cells returned to normal.Reexamination of bone marrow cell morphology showed megaloblastic cells disappeared.Three months after transplantation,bone marrow cells morphological examination in case 2 showed:nucleated cells proliferation activity,low granulocytes proliferation,giant rod nucleus granulocytes visible;different stages of the red blood cells proliferation activity,higher proportion of orthochrmatic normoblasts,most of whose nucleus developed later than the cytoplasm;scattered distribution of megakaryocytes and platelets.Blood contents of folic acid were far below the reference range,but the content of VB12 was normal.After administration of folic acid and VB12 for 2 weeks,the routine blood test showed the volume of red blood cells returned to normal.The reexamination of bone marrow cell morphology showed megaloblastic cells disappeared.Conclusion After AHSCT,attention should be paid to the detection of folic acid and VB12 in vivo.Folic acid and VB12 are timely supplemented when necessary to avoid the occurrence of MA in patients with AHSCT.
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Objective To analyze the clinical characteristics of de novo primary AML patients with higher blast cell ratio in peripheral blood than bone marrow and its relationship with CR1. Methods The clinical data on de novo primary AML patients in Henan Provincial Tumor Hospital from January 2015 to December 2016 were ret-rospectively reviewed. Based on the proportion of blast cells in the peripheral blood and bone marrow ,the patients were divided into BHG and NBHG. All the data was analyzed respectively by Schisquare test ,rank sum test or Spearman correlation analysis according to the types of clinical data. Results As compared with NBHG patients , BHG patients had a higher rate of bleeding,palpitation,M2 subtype,FLT3-ITD mutation,and average level of LDH andα-HBDH in serum before treatment,and the difference was statistically significant(P<0.05);however, the rate of CR1,M3 and M5 subtype in BHG patients was lower than that in NBHG patients,and the difference was statistically significant(P < 0.05). The proportion of peripheral blood blast cells in patients with AML has a positive correlation with serum levels of LDH and α-HBDH(R:0.331 and 0.352,P < 0.05). Conclusions De novo primary AML patients with higher blast cell ratio in peripheral blood than bone marrow are mostly M2 subtype,easily associated with FLT3-ITD mutation,bleeding and palpitation symptoms,and they have a lower CR1rate. The proportion of blast cells in peripheral blood is positively correlated with levels of serum LDH and α-HBDH.
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Objective To investigate the difference of clinical features between FLT3-ITDmt and FLT3-IT-Dwt de novo primary acute myeloid leukemia(AML). Methods Clinical data of 31 FLT3-ITDmt and 113 FLT3-ITDwt de novo primary AML patients from January 2015 to December 2016 were retrospectively reviewed and ana-lyzed by Student′s test,chi-square test or rank sum test according to the types of clinical data. Results There were statistically significant differences in WBC,RBC,HGB of peripheral blood and the mutation of DNMT3A gene(statistical values:705.000;-2.535;-2.290 and 5.715 respectively,all P < 0.05)in 2 types of AML. Conclusion When compared with FLT3-ITDwt de novo primary AML patients,FLT3-ITDmt ones have the fea-tures of higher WBC,lower RBC and HGB of peripheral blood,and are more likely to be associated with mutation in the DNMT3A gene.
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Objective:To investigate the change of thymus in different period of EAE mice. Methods: The thymic index and thymocyte number at 0,10,15,20 days after EAE induced were recorded. The percent of thymic apoptosis and CD4+CD44+T cells in spleen was acquired by Flow Cytometry. The content of p53 and Bcl-2 gene was detected by PCR and electrophoretic technique. Results:The thymic index and thymocyte number correspondingly reduced at 0,10,15 days after EAE induced. Apoptotic rate of thymocyte increased at 10,15 days after EAE induced,highest at 10 days. The percent of CD4+CD44+T cells also increased at 10,15 days after EAE induced, highest at 10 days. The content of p53 increased, while Bcl-2 reduced at 10 days after EAE induced. Conclusion:The atrophy of thymus is most serious at 15 days after induction;while the apoptotic percent is highest at 10 days after induction,which have a relationship with regulation of p53 and Bcl-2. The change of thymus in EAE mice closely related with EAE attack,and the recovery of thymus precede EAE.
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OBJECTIVE To study the incidence of ?-lactamases,mainly the extended-spectrum beta-lactamases(ESBLs) and metallo-beta-lactamases(MBLs) of Chryseobacterium indologenes and Ch.gleum.METHODS Agar dilution method was applied to detect minimal inhibitory concentrations(MIC) to 12 different antibiotics used frequently.Three-dimensional test was used to detect ESBLs and metallo-?-lactamases.The genes of ?-lactamases were amplified with 3 pairs of primers special for Ch.indologenes and Ch.gleum.RESULTS Among the 25 strains of Ch.indologenes and 10 strains of Ch.gleum,68%(17/25) isolates of Ch.indologenes and 90%(9/10)isolates of Ch.gleum were considered as MBLs positive strains,but no isolates were detected for the production of ESBLs.CONCLUSIONS MBLs are the important mechanism of multi-drug resistance for Ch.indologenes and Ch.gleum.