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Objective:To evaluate the clinical efficacy and safety of Blinatumomab on the treatment of refractory or relapsed precursor B-cell acute lymphoblastic leukemia (R/R BCP-ALL) in children.Methods:Clinical data of children with R/R BCP-ALL treated with Blinatumomab in the Department of Hematology, Children′s Hospital of Soochow University, from August 2021 to June 2022 were retrospectively analyzed.Children were divided into<45 kg group and ≥45 kg group according to their weight at admission.They were treated with different dosages of Blinatumomab, and bone marrow remission was assessed at about 15 days.Clinical indicators and adverse events during the treatment period were recorded.The rank sum test of two independent samples were used to compare the differences between groups.The Fisher′ s test was used for comparing categorical variables. Results:Among the 16 children with R/R BCP-ALL, 12 cases (75%) achieved complete response (CR) and minimal residual lesion (MRD) turned negative at about 14 days.Among them, 5 out of 9 children with bone marrow primitive naive cell ratio≥0.5 achieved CR, and 7/7 children with bone marrow primitive naive cell ratio<0.5 achieved CR.The peak value of interleukin-6 (IL-6) in children with CR was significantly higher than those without CR ( Z=2.50, P=0.012). Twelve cases achieved CR on bone marrow assessment around day 15, and 3 cases who did not achieve CR remained in remission on day 28, with an efficacy prediction accuracy of 93.8%(15/16). Adverse events included fever, neutropenia, hypokalemia, abnormal liver function, hypocalcemia, edema, rash, hypertension, myocardial damage, abdominal pain, hypotension, and cytokine release syndrome, which were all grade 1.Neurotoxicity and death were not reported. Conclusions:The remission rate of R/R BCP-ALL in children treated with Blinatumomab was high, especially in patients with a low tumor load.The toxicity and adverse events of Blinatumomab treatment are minor and controllable.Day 15 is the optimal time point to evaluate the efficacy of Blinatumomab on children with R/R BCP-ALL, and a higher IL-6 peak can be served as a predictor of its efficacy.
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Invitation of patients and their families as advisors in medical activities is conducive to enhancing patient safety and medical quality, as an innovative way for hospital reform and development. By analysis of such practice of overseas hospitals, the authors recommended on introducing this practice into China. The specific recommendations included creating a social support atmosphere for patient and family as advisors, promoting patient and family engagement by hospitals, establishing a management evaluation system for the patient and family engagement, improving the comprehensive literacy level of patient and family advisors, and building an internet platform for patient and family engagement.
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Objective To explore the effect of parvovirus B19 (VB19) infection on pediatric leukemia patients. Methods The pediatric leukemia patients were enrolled in the study in the Children's Hospital of Soochow University. Expression levels of VB19-DNA-PCR were detected using the polymerase chain reaction. Positive patients would be monitored and treated by conventional treatment as well until VB19 gene became negative. The data was compared according to the VB19 clearance time, clinical symptoms and blood counts to evaluate the effect. Results In the 3009 samples from 824 pediatric leukemia patients, there were 36 samples (1.2%) from 12 cases (1.5%) of pediatric leukemia paients with positive VB19 infection. Among the positive patients, 11 cases (1.9%) were from 582 with acute lymphoblastic leukemia (ALL) patients and 1 (0.45%) was from 212 with acute myeloid leukemia (AML). According to the treatment stage, 3 cases were in initially diagnosed period, 2 cases in early stage of consolidation chemotherapy, 4 cases in delayed enhanced chemotherapy period, and 3 cases in maintenance chemotherapy period. According to the treatment response, 4 cases were in continuous treatment, 2 cases were sensitive to treatment, and 3 cases were drug resistant. In the drug resistance group, 2 cases developed into the pure red cell aplastic anemia (PRCA). After treatment, one was recovered from PRCA with VB19 cleared, the other one remained PRCA with continuously positive VB19. Conclusions More VB19 virus infection in pediatric ALL happened in delayed enhanced chemotherapy period. The persistent presence of VB19 infection on pediatric leukemia patients is closely related with PRCA.
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The leaves and fruits of Ginkgo biloba L.are embodied in Pharmacopoeia of People's Republic of China,mainly contain ginkgo flavonoids,terpene lactones,phenolic acids,isopentenyl alcohol,steroids and other chemical compositions.The extract and active ingredients can be made into tablets,capsules,granules,oral liquid,injection,dripping pills,syrup,tincture and other formulations,clinically used for cardiovascular and cerebrovascular disease treatment.The adverse reactions are allergies,diarrhea,bleeding,liver and kidney toxicity.This review contains the chemical composition,dosage form and clinical adverse reactions of Ginkgo biloba in recent years,for providing a reference of further development and rational utilization of this plant resource.
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Objective To investigate the clinic pathologic features of young patients with renal malignant tumour by comparing with older patients. Methods The clinical data of 83 younger adults(age,≤40 years) with renal cell carcinoma and 703 cases of older renal cell carcinoma (age＞40 years)was analyzed and compared retrospectively. All of the patients were surgically treated between 1986and 2007. Results Among patients with symptoms, younger female patients were more likely to have abdominal pain(12/27, 44.4% vs. 154/703, 21.9%)and mass (2/27, 7.4% vs. 154/703,1.3%)than older (P＜0.05). The older groups were more likely to have dear cell carcinoma than in the younger(501/703, 71.3% vs. 47/83, 56.6%)(P＜0.05). The rate of PRCC has the trends to be higher in young patients than that in older patients (21/83, 25.3% vs. 118/703, 16.8%) (P=0.054),especially in male patients (17/56, 30.4 %) (P=0.011). The rate of MFH and leiomyosarcoma was significantly higher in young patients than that in older patients (6/83, 7.2% vs. 12/703,1.7%) (P＜ 0.05), especially in female patients (4/27,14.8%). Younger male patients were more likely to have a higher incidence of small tumors (T≤4 cm)(24/56,42.9 % vs. 173/703,24.6 % )(P＜0.05)and a lower incidence of big RCC(T＞7 cm) than older patients(12/56,21.4% vs. 295/703,42.0%) (P＜0.05). Conclusion Younger female renal cell carcinoma patients tends to have worseprognosis than older patients, while younger male patients have better prognosis due to different pathology.
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Objective To study the clinical and pathologic features of chromphobe renal cell carcinoma (ChRCC) and to evaluate the conventional pathologic prognostic parameters in prognosis.Methods Seventy-five cases (42 males and 33 females) with pathological confirmed ChRCC (36 on the left and 39 on the right kidney) after nephrectomy during 1998 to 2009 were retrospectively analyzed. Patient's age ranged from 25 to 74 years, with a mean age of 56 years. Evaluation of conventional prognostic parameters was carried out. Kaplan-Meier survival curve was used to study the survival relationship. Results The mean tumor diameter was 7.3 cm. The majority of tumor macroscopic surface color was gray and yellow or gray and red. The majority of tumor cells were big polygon chromphobe cell or small round eosinophils. The TNM stages of these ChRCC were as follows: 30 cases in T1N0M0, 1 in T1N0M1, 26 in T2N0M0, 1 in T2N0M1, 11 in T3N0M0, 3 in T3N0M1, 1 in T3 N1 M0, 1 in T4 N0 M1 and 1 in T4 N1 M1. The pathologic grade of ChRCC was G1 in 3 cases, G2 in 24cases, G3 in 46 cases and G4 in 2 cases. All the 75 cases were followed up for 9 to 93 months (mean 44months), 7 patients died and others were alive without recurrence and metastasis. 3-year and 5-year survival rates were 93.3% and 90. 7%, respectively. The univariable analysis showed that tumor size (P=0. 028), TNM stage (P＜0. 001) were associated with tumor progression. The multivariable Cox regression model revealed that TNM stage was an independent predictor of aggressive ChRCC. Conclusions The ChRCC tumors are generally larger than other types of RCC and with a favorable prognosis. Fuhrman nuclear grade is not suitable for ChRCC. TNM stage is an independent predictor of aggressive ChRCC.
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Objective To investigate the expression of c-kit and analyze its relationship with proliferating cell nuclear antigen (PCNA) in RCC subtypes and its clinical progression. Methods Expression of c-kit protein was retrospectively studied with immunohistochemistry in paraffin sections from 137 cases of clear renal cell carcinoma (CCRCC), 82 papillary renal cell carcinoma (PRCC), 51 chromophobe renal cell carcinoma (ChRCC). Results The positive rate of c-kit in ChRCC was 94.1%(48/51), it was statistically higher than that in CCRCC (16. 1%, 22/137) and PRCC (28.1 %, 23/82)(P=0. 001 ). In ChRCC, the positive expression of c-kit was related with TNM stages. The positive expression of PCNA was related with the grade in CCRCC and PRCC. But there was no relationship between PCNA expression and grade of ChRCC. It also had the relationship with the metastasis in CCRCC. Conclusions The expression of c-kit in ChRCC is higher than in other subtype of RCC, and associated with tumor local progression. That makes c-kit as a helpful marker to discriminate different subtypes of kidney cancer.
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Objective To detect the relationship between the pathological type and lymph node metastasis and prognosis in papillary thyroid carcinoma patients. Method Clinicopathological data were retrospectively analyzed on 578 cases of papillary thyroid carcinoma patients undergoing surgery between 1954—1988. Result There were 265 cases with lymph node metastasis among 380 unenvelop cases of papillary thyroid carcinoma, and 138 cases with lymph node metastasis among 198 envelop cases. Lymph node metastasis in diffuse sclerosis type was higher than that in the microminiature(P0.05). The mortality rate in dropsy papillary type was lower than branch papillary and follicle subtype(all P
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Objective To establish HPLC fingerprint for Fructus Aurantii Immaturus.Methods The HPLC method was used with Diamonsil-C18 column (250 mm?4.6 mm,5 ?m),and a mixture liquid of acetonitrile-0.01% NaH2PO4 as mobile phase in a gradient elution.The HPLC fingerprint for 36 batches of Fructus Aurantii Immaturus was studied on their similarity,cluster,and principal components analyses.The common HPLC fingerprint of Fructus Aurantii Immaturus was established,which was studied with principal components analyses.Results Under the selected spectrum condition,the 36 batches of Fructus Aurantii Immaturus were classified into two groups based on the result of similarity,cluster,and principal components analyses.Conclusion This method is reasonable and reliable to the quality control of Fructus Aurantii Immaturus.