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1.
Journal of Leukemia & Lymphoma ; (12): 38-44, 2023.
Article in Chinese | WPRIM | ID: wpr-988951

ABSTRACT

Objective:To investigate the clinical characteristics and prognostic factors of TCF3-PBX1 fusion gene-positive childhood B-cell precursor acute lymphoblastic leukemia (B-ALL).Methods:The clinical data of 1 287 newly diagnosed children with B-ALL who were admitted to five hospital in Fujian province (Fujian Medical University Union Hospital, the First Affiliated Hospital of Xiamen University, Zhangzhou Affiliated Hospital of Fujian Medical University, Quanzhou First Hospital Affiliated to Fujian Medical University, Nanping First Hospital of Fujian Province) from April 2011 to December 2020 were retrospectively analyzed. According to the results of TCF3-PBX1 fusion gene testing, all the patients were divided into TCF3-PBX1-positive group and TCF3-PBX1-negative group. The clinical characteristics, early treatment response [minimal residual disease (MRD) at middle stage and end of induction chemotherapy] and long-term efficacy [overall survival (OS) and event-free survival (EFS)] of the patients in both groups were compared. Kaplan-Meier method was used for survival analysis. The prognostic factors of TCF3-PBX1-positive B-ALL were analyzed by using Cox proportional hazards model. Among 83 children with TCF3-PBX1-positive B-ALL, the treatment regimens, risk stratification and efficacy evaluation of 62 cases were performed by using Chinese Children's Leukemia Group (CCLG)-ALL 2008 regimen and 21 cases were performed by using Chinese Children's Cancer Group (CCCG)-ALL 2015 regimen, and the efficacy and incidence of serious adverse events (SAE) between the two groups compared.Results:Among 1 287 B-ALL patients, 83 patients (6.4%) were TCF3-PBX1-positive. The proportion of patients with initial white blood cell count (WBC)≥50×10 9/L in the TCF3-PBX1-positive group was higher than that in the TCF3-PBX1-negative group, while the proportions of patients with MRD ≥1% on induction chemotherapy day 15 or day 19, and MRD ≥0.01% on induction chemotherapy day 33 or day 46 in the TCF3-PBX1-positive group were lower than those in the TCF3-PBX1-negative group (all P < 0.05). Univariate Cox regression analysis showed that MRD ≥1% on induction chemotherapy day 15 or day 19 and TCF3-PBX1 ≥0.01% on induction chemotherapy day 33 or day 46 were risk factors for OS and EFS (all P < 0.05). Multivariate analysis showed that MRD ≥1% on induction chemotherapy day 15 or day 19 was an independent risk factor for OS ( HR = 10.589, 95% CI 1.903-58.933, P = 0.007) and EFS ( HR = 10.218, 95% CI 2.429-42.980, P = 0.002). TCF3-PBX1≥0.01% on induction chemotherapy day 33 or day 46 was an independent risk factor for EFS ( HR = 6.058, 95% CI 1.463-25.087, P = 0.013) but not for OS ( HR = 3.550, 95% CI 0.736-17.121, P = 0.115). The 10-year EFS and OS rates of the TCF3-PBX1-positive group were 84.6% (95% CI 76.9%-93.1%) and 89.1% (95% CI 82.1%-96.6%), and the differences between the two groups were not statistically significant (both P > 0.05). Among 80 children who received standardized treatment, compared with children who were treated with CCLG-ALL 2008 regimen, the incidence of infection-related SAE was lower in children who were treated with CCCG-ALL 2015 regimen [0 (0/21) vs. 20.3% (12/59), χ2 = 5.22, P = 0.022], but there were no statistical differences in treatment-related mortality, relapse rate, EFS and OS between the two groups (all P > 0.05). Conclusions:Children with TCF3-PBX1-positive B-ALL have a good prognosis, and MRD≥1% at middle stage of induction chemotherapy and TCF3-PBX1≥0.01% at the end of induction chemotherapy may be influencing factors for poor prognosis. CCCG-ALL 2015 regimen can reduce infection-related SAE while achieving good efficacy.

2.
Journal of Leukemia & Lymphoma ; (12): 484-487, 2022.
Article in Chinese | WPRIM | ID: wpr-953990

ABSTRACT

Objective:To investigate the clinical characteristics and prognosis of IL3-IGH fusion gene-positive pediatric acute lymphoblastic leukemia (ALL) with hypereosinophilia as the first presentation.Methods:The clinical data of 1 pediatric IL3-IGH fusion gene-positive ALL patient with hypereosinophilia as the first presentation in January 2021 in Fujian Medical University Union Hospital was retrospectively analyzed and relevant literature was reviewed.Results:This 11-year-old male patient underwent bone marrow examination, and results showed that the proportion of eosinophils was increased; immunophenotyping disclosed that there were about 49.4% abnormal naive B lymphocytes in bone marrow; 43 leukemia fusion genes showed all negative; the whole transcriptome sequencing showed IL3-IGH fusion gene-positive. The patient was finally diagnosed as B-ALL with IL3-IGH fusion gene. According to the Chinese Children Cancer Group (CCCG)-ALL 2020 regimen, eosinophils returned to normal after induction therapy. Bone marrow examination on day 19 of induction showed that the proportion of promyelocytes was 0.005, the proportion of eosinophils was 0.05, and the minimal residual disease (MRD) was 23.02%. Bone marrow examination on day 46 of induction showed remission, and MRD was 0.18%. Consolidation chemotherapy used CAT (cyclophosphamide 1 g/m 2 once; cytarabine 50 mg/m 2, 12 h once, 7 days in total; mercaptopurine 40 mg/m 2, once per night, 7 days in total) regimen. Then the patient was added with lusotinib (75 mg 12 h once) orally and continued to receive high-dose methotrexate (5 g/m 2) regimen chemotherapy for 2 courses, the MRD was 0.20%. Chimeric antigen receptor T-cell (CAR-T) regimen was administered, followed by negative MRD. Conclusions:IL3-IGH fusion gene ALL is more frequently found in males, and more common in older children and young adults. It is prone to organ infiltration damage, and it has a high rate of induction failure and recurrence as well as poor prognosis.

3.
Journal of Leukemia & Lymphoma ; (12): 441-444, 2022.
Article in Chinese | WPRIM | ID: wpr-953983

ABSTRACT

Iron, an indispensable element for life, is involved in all kinds of vital physiological activities. Due to its potential toxicity, the body has a strict regulation mechanism of iron metabolism to maintain the "iron homeostasis". Dysregulation of iron metabolism and subsequent accumulation of excess iron are closely associated with the development and progression of leukemia. Specifically, due to the pro-oxidative nature of iron and its damaging effects on DNA, excess iron promotes the progression of leukemia; on the other hand, leukemia cells need to obtain more iron than normal cells to maintain rapid growth and proliferation, which is known as "iron addiction". Iron chelators can remove iron in leukemia cells and induce differentiation and apoptosis of leukemia cells. However, "iron addiction" makes leukemia cells more susceptible to iron overload, and is more sensitive to a new form of iron-catalyzed cell death which was named ferroptosis. According to the different needs of leukemia cells and normal cells for iron, the method of selectively killing leukemia cells through iron overload may become a new strategy for leukemia treatment. This paper reviews the strategy of targeting iron homeostasis for leukemia therapy.

4.
Journal of Leukemia & Lymphoma ; (12): 343-347, 2022.
Article in Chinese | WPRIM | ID: wpr-953969

ABSTRACT

Objective:To investigate the clinical characteristics and efficacy of children with acute lymphoblastic leukemia (ALL) and TP53 mutation, and to explore the relationship between TP53 mutation and the prognosis of children with ALL.Methods:The clinical data of 141 children with newly diagnosed ALL from November 2016 to December 2019 in Fujian Medical University Union Hospital were collected, and the whole-exome gene assay was performed in bone marrow samples of the children by using next-generation sequencing technology. The clinical characteristics of children with TP53 mutation were retrospectively analyzed, and the Kaplan-Meier method was used to compare the overall survival (OS) and event-free survival (EFS) of children with or without TP53 mutation.Results:Among the 141 children with newly diagnosed ALL, TP53 mutations were detected in 5 children (3.5%), all of which were B-precursor acute lymphoblastic leukemia (B-ALL). No TP53 mutation was detected in T-cell acute lymphoblastic leukemia (T-ALL) children, and TP53 mutation accounted for 4.0% (5/126) of B-ALL children. The types of TP53 mutation were all single nucleotide variants. Five ALL children with TP53 mutation were male, with a median age of 60 months (16- 156 months). At the time of onset, all children had anemia and elevated lactate dehydrogenase, and 4 children had subcutaneous hemorrhage and hyperuricemia. The immunophenotypes of all children were precursor B-cell type, and 4 children had myeloid antigen expression. Among 4 ALL children with TP53 mutation who received standard treatment, 2 cases relapsed, and the recurrence time was 8.9 months and 12.1 months, respectively. The expected 15-month EFS rate and OS rate of ALL children with TP53 mutation were lower than those of ALL children without TP53 mutation (37.5% vs. 97.7%, χ2 = 29.90, P < 0.001; 37.5% vs.98.3%, χ2 = 24.90, P < 0.001). Conclusions:ALL children with TP53 mutation are more commonly found in male and B-cell type, with high early recurrence rate and poor efficacy. TP53 mutation may become a necessary supplement for prognostic assessment.

5.
Journal of Leukemia & Lymphoma ; (12): 204-208, 2022.
Article in Chinese | WPRIM | ID: wpr-929760

ABSTRACT

Objective:To investigate the clinical features and prognosis of B-cell acute lymphoblastic leukemia (B-ALL) children with intrachromosomal amplification of chromosome 21 (iAMP21).Methods:The data of 233 children diagnosed with B-ALL who received chemotherapy according to Chinese Children Cancer Group (CCCG) - acute lymphoblastic leukemia -2015 (CCCG-ALL-2015) protocol in the Affiliated Union Hospital of Fujian Medical University from January 2019 to December 2020 were retrospectively analyzed. These patients were divided into iAMP21 group and non-iAMP21 group according to whether iAMP21 was positive in the bone marrow fluid of children before chemotherapy based on ETV6-RUNX1 probe fluorescence in situ hybridization. Children in iAMP21 group received CCCG-ALL-2015 intermediate-risk group regimen induction chemotherapy, while children in non-iAMP21 group received different intensities of chemotherapy according to the clinical risk classification. The clinicopathological characteristics of patients were compared in both groups, the therapeutic efficacy and prognosis of B-ALL children with iAMP21 was analyzed.Results:iAMP21 was found in 5 (2.1%) of 233 B-ALL children. The median hemoglobin concentration in iAMP21 group was higher than that in non-iAMP21 group [99 g/L (71-148 g/L) vs. 74 g/L (30-156 g/L); U = 268.50, P = 0.043]; there were 4 cases (80%) with bone pain in iAMP21 group (5 cases) and 53 cases (23.2%) with bone pain in non-iAMP21 group (228 cases),and the difference in the osteoarticular pain incidence of both groups was statistically significant ( χ2 = 8.53, P = 0.017). There were no significant differences in the proportion of patients with different gender, age, white blood cell counts, platelet counts, hepatosplenomegaly between the two groups (all P > 0.05). Among 5 children with iAMP21, 1 patient was detected with high CRLF2 expression and 1 patient with IKZF1 1-8 exon loss of heterozygosity. The above mentioned two children with iAMP21, whose minimal residual disease (MRD) were still positive after consolidation therapy, and then they received chimeric antigen receptor T-cell treatment and hematopoietic stem cell transplantation. MRD of the other 3 children with iAMP21 turned negative after induction therapy. Up to the last follow-up in October 2021, 5 patients with iAMP21 had disease-free survival. Conclusions:The incidence of B-ALL children with iAMP21 is about 2%. These patients are prone to osteoarticular pain and have relatively mild anemia. The curative effect of some children is still poor after active treatment,which needs to be further clarified with more samples.

6.
Journal of Leukemia & Lymphoma ; (12): 550-554, 2021.
Article in Chinese | WPRIM | ID: wpr-907214

ABSTRACT

Objective:To investigate the clinical features and prognosis of primary central nervous system (CNS) anaplastic lymphoma kinase (ALK)-positive anaplastic large cell lymphoma (ALCL) in children.Methods:The clinical data of a child with primary CNS ALK-positive ALCL in Fujian Medical University Union Hospital were retrospectively analyzed, and the relevant literature was reviewed.Results:The child went to other hospitals with headache and fever as the main symptoms. Head magnetic resonance imaging showed a right cerebellar mass, and there was no evidence of lymphoma infiltration outside the CNS before surgery. Later, cerebellar tumor resection was performed. After the surgery, through pathological examination, the child was diagnosed as ALK-positive ALCL, but did not receive chemotherapy in time. The child transferred to Fujian Medical University Union Hospital on the 27th day after surgery, and the tumor had spread to bone marrow, testis, vertebrae, etc., and the peripheral blood NPM-ALK fusion gene was positive. The child received 2 courses of chemotherapy and achieved complete remission, but eventually died of chemotherapy complications.Conclusions:Primary CNS ALK-positive ALCL is rare and easy to be misdiagnosed. The disease progresses quickly, and the overall prognosis is poor. Timely biopsy for diagnosis and early comprehensive treatment based on chemotherapy may improve the prognosis of patients.

7.
Journal of Leukemia & Lymphoma ; (12): 470-474, 2021.
Article in Chinese | WPRIM | ID: wpr-907201

ABSTRACT

Objective:To investigate the efficacy and safety of azacitidine combined with CAG (cytarabine + aclacinomycin + granulocyte colony-stimulating factor) regimen in reinduction treatment of pediatric relapsed/refractory acute myeloid leukemia (AML) patients.Methods:The clinical data of 3 pediatric patients with relapsed/refractory AML treated with azacitidine combined with CAG regimen reinduction in Fujian Medical University Union Hospital between November 2018 and October 2019 were retrospectively analyzed, and the efficacy, prognosis and adverse reactions were also analyzed.Results:Among 3 patients, 2 cases were relapsed AML (relapse time began 18 months and 8 months after treatment started, respectively), and 1 case was refractory AML (cannot achieve complete remission after 2 courses of standard chemotherapy). After 2 courses of azacitidine combined with CAG regimen reinduction, 2 cases achieved complete remission, and 1 case achieved partial remission. And then they all underwent hematopoietic stem cell transplantation (HSCT) and had leukemia-free survival after 16-21 months follow-up (time from the first azacitidine combined with CAG reinduction). Except for hematological adverse reactions and infection, azacitidine did not increase other adverse effects.Conclusions:Azacitidine combined with CAG regimen in reinduction treatment of pediatric relapsed/refractory AML has a higher remission rate and safety, and patients undergoing timely bridging HSCT may have a good prognosis.

8.
Journal of Leukemia & Lymphoma ; (12): 112-116, 2020.
Article in Chinese | WPRIM | ID: wpr-862799

ABSTRACT

Objective:To investigate the efficacy and safety of reduced-intensity chemotherapy in treatment of children with Down syndrome-related myeloid leukemia (ML-DS).Methods:The clinical data of 3 hospitalized children with ML-DS who were diagnosed and treated by Children Oncology Group Trial A2971 chemotherapy regimen in Fujian Medical University Union Hospital from January 2016 to June 2019 were retrospectively analyzed, and the clinical characteristics, efficacy and safety were summarized.Results:The ages of 3 children were 1 year and 6 months, 2 years and 6 months, and 1 year and 10 months. Two cases were acute monocytic leukemia, and 1 case was acute megakaryoblastic leukemia. Two cases were positive for EVI1 gene and 1 case had ASXL1 gene mutation, and all 3 cases had complex karyotype. After one course of induction chemotherapy, all 3 cases achieved complete remission, and the minimal residual disease turned negative. During the induction chemotherapy, all 3 cases had severe myelosuppression, and 2 cases of them suffered from severe pneumonia and 1 case of them suffered from intestinal infection and septic shock.Conclusion:The efficacy of reduced-intensity chemotherapy in children with ML-DS is favorable, but the severe complications such as myelosuppression and infection need to be taken seriously.

9.
Journal of Leukemia & Lymphoma ; (12): 34-38, 2019.
Article in Chinese | WPRIM | ID: wpr-732682

ABSTRACT

Objective To investigate the clinical features and prognosis of children with hematological malignancies after chemotherapy accompanied with Stenotrophomonas maltophilia blood stream infection (BSI). Methods The clinical data and antimicrobial susceptibility test of 25 hospitalized children with hematological malignancies who were diagnosed as Stenotrophomonas maltophilia BSI in the Department Pediatric Hematology of Fujian Medical University Union Hospital from January 2013 to May 2018 were analyzed retrospectively. Results A total of 25 children, including 18 males and 7 females with the median age 4 (1-11) years old were diagnosed as hematological malignancies and all received chemotherapy. The frequent risk factors of Stenotrophomonas maltophilia BSI in children with hematological malignancies included prior carbapenem antibiotic for more than 1 week (80%, 20/25), and neutropenia for more than 1 week (68%,17/25) and indwelling central venous catheter (48%, 12/25). Clinically, the main manifestations included neutropenia with fever after chemotherapy; however, anti-pseudomonas cephalosporin/carbicillin antibiotic combined with vancomycin and anti-fungal therapies were ineffective. Drug susceptibility test showed that all strains were sensitive to compound sulfamethoxazole, levofloxacin and minocycline. Before blood culture report, 3 patients died of septic shock, pulmonary hemorrhage and respiratory failure; after blood culture report, the treatment regimens were adjusted to compound sulfamethoxazole combined with cefoperazone sodium and sulbactam sodium (200-260 mg·kg-1·d-1) or levofloxacin anti-infective. Finally, 18 patient was cured, 2 patients died of the bad efficacy of underlying diseases, and 2 patients died of pulmonary hemorrhage. The overall fatality rate was 28% (7/25) and the related mortality rate caused by Stenotrophomonas maltophilia BSI was 20% (5/25). Conclusion Stenotrophomonas maltophilia BSI in children with hematological malignancies after chemotherapy has a high fatality rate, and better basic disease control and appropriate antibacterial therapy are the key to improve the prognosis.

10.
Journal of Leukemia & Lymphoma ; (12): 538-540, 2019.
Article in Chinese | WPRIM | ID: wpr-751439

ABSTRACT

Objective To investigate the clinical features and treatment of child patient with chronic myeloid leukemia (CML) and T315I mutation in the ABL1 kinase domain. Methods The clinical features, diagnosis and treatment of one child CML patient with T315I mutation in ABL1 kinase domain in Fujian Medical University Union Hospital were retrospectively analyzed, and the literature was reviewed. Results The patient was treated with imatinib and dasatinib. The BCR-ABLIS value decreased and then increased. The disease progressed to the accelerated phase. At the same time, the T315I mutation was detected in the ABL1 kinase domain, the harringtonine chemotherapy was used, and the condition of patient got better. But eventually the hematopoietic stem cell transplantation could not be performed, the CML progressed to the blast phase and the patient died half a year later. Conclusions The prognosis of children with CML and T315I mutation in ABL1 kinase domain is poor. In the absence of punatinib treatment, hematopoietic stem cell transplantation should be performed as soon as possible after chemotherapy, which may improve the prognosis.

11.
Journal of Leukemia & Lymphoma ; (12): 728-733, 2019.
Article in Chinese | WPRIM | ID: wpr-800709

ABSTRACT

Objective@#To investigate the clinical effect and safety of dasatinib combined with Chinese Children's Leukemia Group-acute lymphoblastic leukemia (CCLG-ALL) 2008 protocol in treatment of childhood Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL).@*Methods@#The clinical data of 22 patients with Ph+ ALL who were newly diagnosed at the age of less than 15 years old in Fujian Medical University Union Hospital from January 2014 to December 2018 were retrospectively analyzed. All patients were treated with dasatinib combined with CCLG-ALL2008 protocol (high-risk group). The patients were assigned to two groups according to different starting times of oral dasatinib: the dasatinib-induced group (starting from day 15 of induction chemotherapy) and the dasatinib-consolidated group (starting with early consolidated chemotherapy). The early treatment response and 5-year event-free survival (EFS) rate were compared between the two groups.@*Results@#The differences of clinical characteristics and early efficacy of chemotherapy before treatment of dasatinib between the two groups were not statistically significant (both P > 0.05). The complete remission (CR) rate on day 33 of induction chemotherapy was higher in the dasatinib-induced group than that in the dasatinib-consolidated group [100% (10/10) vs. 75% (9/12)], but the difference was not statistically significant (χ 2= 2.895, P= 0.221). The rate of minimal residual disease (MRD) turned negative (<0.01%) on day 33 of induction chemotherapy in the dasatinib-induced group was significantly higher than that in the dasatinib-consolidated group [70% (7/10) vs. 17% (2/12)], and the difference was statistically significant (χ 2= 6.418, P= 0.027). The 3-year EFS rate was higher in the dasatinib-induced group than that in the dasatinib-consolidated group (88.9% vs. 63.5%), but the difference was not statistically significant (P= 0.163). The incidence of grade 3-4 infection in the dashatinib-induced group was lower than that in the dasatinib-consolidated group, and the difference was statistically significant [60% (6/10) vs. 100% (12/12), P= 0.029]. the other grade 3-4 adverse reactions related to the chemotherapy drugs mainly included hematological toxicity, diarrhea, abnormal liver function, edema and pleural effusion, but there was no significant difference between the two groups (all P > 0.05).@*Conclusions@#Dasatinib combined with CCLG-ALL2008 protocol in the treatment of children with Ph+ ALL has good efficacy and safety. Furthermore, the early use of dasatinib on day 15 of induction chemotherapy can enable patients to achieve deeper remission earlier and improve long-term efficacy.

12.
Journal of Leukemia & Lymphoma ; (12): 538-540, 2019.
Article in Chinese | WPRIM | ID: wpr-798245

ABSTRACT

Objective@#To investigate the clinical features and treatment of child patient with chronic myeloid leukemia (CML) and T315I mutation in the ABL1 kinase domain.@*Methods@#The clinical features, diagnosis and treatment of one child CML patient with T315I mutation in ABL1 kinase domain in Fujian Medical University Union Hospital were retrospectively analyzed, and the literature was reviewed.@*Results@#The patient was treated with imatinib and dasatinib. The BCR-ABLIS value decreased and then increased. The disease progressed to the accelerated phase. At the same time, the T315I mutation was detected in the ABL1 kinase domain, the harringtonine chemotherapy was used, and the condition of patient got better. But eventually the hematopoietic stem cell transplantation could not be performed, the CML progressed to the blast phase and the patient died half a year later.@*Conclusions@#The prognosis of children with CML and T315I mutation in ABL1 kinase domain is poor. In the absence of punatinib treatment, hematopoietic stem cell transplantation should be performed as soon as possible after chemotherapy, which may improve the prognosis.

13.
Journal of Leukemia & Lymphoma ; (12): 595-599, 2018.
Article in Chinese | WPRIM | ID: wpr-691678

ABSTRACT

Objective To summarize the long-term outcomes and safety of childhood Hodgkin lymphoma (HL) with protocol ABVD. Methods The clinical data of 20 children with HL admitted to the Union Hospital of Fujian Medical University from July 2010 to June 2017 were retrospectively analyzed. Among the 20 children with HL, 15 were male and 5 were female. The median age of initial diagnosis was 6.5 years old (3-12 years old). The pathological types were as follow: 1 case was nodular lymphocyte-predominant HL (NLPHL) and 19 cases were classical HL (cHL), including 9 cases of mixed cell type, 9 cases of nodular sclerosis type and 1 case of lymphocyte rich type. Basing on Ann Arbor staging system, 1 patient was evaluated as stage Ⅰ, 4 patients were stage Ⅱ, 10 patients were stage Ⅲ, and 5 patients were stage Ⅳ. There were 3 patients in the low-risk group, 7 patients in the intermediate-risk group, and 10 patients in the high-risk group. There were 9 patients with B symptoms. All patients were treated with the ABVD regimen. Results All the 20 patients completed all chemotherapy courses. After 2 courses, the effective rate was 100%(20/20), including 12 cases of complete remission (CR) and 8 cases of partial remission (PR). After the treatment, 19 cases achieved CR, and at the end of the 6 courses, the evaluation showed that 1 case had residual lesions. Follow-up to February 2018, clinical symptoms of 18 cases achieved CR, 2 cases relapsed (all high-risk group); the median follow-up time was 42 months (10.1-87.9 months), the overall survival rate was 100 % (20/20), the estimated 5-year rate of freedom from treatment failure (FFTF) was (89.1 ±7.3) %.Conclusions According to the risk stratification, ABVD regimen has good safety and long-term efficacy for children with cHL. Even the patients in low-risk or intermediate-risk group do not achieve CR after 2 courses and do not receive radiotherapy, the prognosis of them is still good.

14.
Journal of Leukemia & Lymphoma ; (12): 536-540, 2017.
Article in Chinese | WPRIM | ID: wpr-659037

ABSTRACT

Objective To investigate the clinical features,diagnosis,treatment and prognosis of disseminated aspergillosis in children with leukemia after chemotherapy.Methods The clinical features and treatment of 3 leukemia children after chemotherapy complicated with disseminated aspergillosis were retrospectively analyzed.Results The underlying diseases of all recruited cases were leukemia,which occurred many high-risk predisposing factors for invasive fungal diseases.The major clinical features of disseminated aspergillosis in children with leukemia were prolonged and antibiotics uncontrollable fever,subcutaneous solid nodules,nodules or cavities in pulmonary CT,spread low density lesions in hepatosplenic and kidney in abdominal MR(T2 weighted)and positive serum aspergillus galactomannan(GM).The diagnosis of invasive fungal disease was proven by histopathologic examination.Amphotericin B lipid complex was selected in antifungal therapy for 2 patients and the course of treatment was more than 4 weeks.Moreover,chemotherapy was advised for the 2 patients when clinical manifestations of disseminated aspergillosis improved significantly,neutrophil counts recovered and images did not deteriorate.The patients received voriconazole treatment with follow-up from 6 months to 12 months,and then disseminated aspergillosis was cured up to the standard.1 case received complete remission and was still alive until follow-up period,1 case was died of leukemia relapse because of suspension demand from the family members,and the other 1 case was died of no response or serious adverse drug reactions,uncontrolled infection,and leukemia relapse because of long-term chemotherapy suspension.Conclusions Patients with leukemia after chemotherapy may present with the following manifestations,including fever,subcutaneous solid nodules,pulmonary nodules or cavities,spread low density lesions in hepatosplenic and kidney and serum aspergillus GM antigen positive,which may indicate disseminated aspergillosis.The improvement of prognosis depends on effective and adequate antifungal treatment and chemotherapy for leukemia at the right time.

15.
Journal of Leukemia & Lymphoma ; (12): 536-540, 2017.
Article in Chinese | WPRIM | ID: wpr-657208

ABSTRACT

Objective To investigate the clinical features,diagnosis,treatment and prognosis of disseminated aspergillosis in children with leukemia after chemotherapy.Methods The clinical features and treatment of 3 leukemia children after chemotherapy complicated with disseminated aspergillosis were retrospectively analyzed.Results The underlying diseases of all recruited cases were leukemia,which occurred many high-risk predisposing factors for invasive fungal diseases.The major clinical features of disseminated aspergillosis in children with leukemia were prolonged and antibiotics uncontrollable fever,subcutaneous solid nodules,nodules or cavities in pulmonary CT,spread low density lesions in hepatosplenic and kidney in abdominal MR(T2 weighted)and positive serum aspergillus galactomannan(GM).The diagnosis of invasive fungal disease was proven by histopathologic examination.Amphotericin B lipid complex was selected in antifungal therapy for 2 patients and the course of treatment was more than 4 weeks.Moreover,chemotherapy was advised for the 2 patients when clinical manifestations of disseminated aspergillosis improved significantly,neutrophil counts recovered and images did not deteriorate.The patients received voriconazole treatment with follow-up from 6 months to 12 months,and then disseminated aspergillosis was cured up to the standard.1 case received complete remission and was still alive until follow-up period,1 case was died of leukemia relapse because of suspension demand from the family members,and the other 1 case was died of no response or serious adverse drug reactions,uncontrolled infection,and leukemia relapse because of long-term chemotherapy suspension.Conclusions Patients with leukemia after chemotherapy may present with the following manifestations,including fever,subcutaneous solid nodules,pulmonary nodules or cavities,spread low density lesions in hepatosplenic and kidney and serum aspergillus GM antigen positive,which may indicate disseminated aspergillosis.The improvement of prognosis depends on effective and adequate antifungal treatment and chemotherapy for leukemia at the right time.

16.
Chinese Journal of Pancreatology ; (6): 332-335, 2011.
Article in Chinese | WPRIM | ID: wpr-422447

ABSTRACT

Objectives To explore the expression of the receptor for advanced glycation end products (RAGE) in pancreas and the serum concentration of RAGE in rats with acute necrotizing pancreatitis (ANP).Methods Sixty four male Spraque-Dawley rats were randomly divided into control group,ANP 6,18,24,36,48,72,96 h group with 8 rats in each group.The rat model of ANP was established by injecting 20% L-arginine intraperitoneally at the dose of 250mg/100g body weight for twice at the interval of 1 h.Rats in control group were injected intraperitoneally with the same amount of saline.The pancreas samples were histologically examined by light microscope and scored.The amount of ascites,levels of serum amylase and RAGE was determined; Real-time PCR was performed to detect the expression of RAGE mRNA in pancreatic tissue.Results Pancreatic injuries aggravated with time.The amount of ascites increased from ( 1.98 ± 0.64) ml at 6h to (8.69 ±0.62)ml at 96 h.Serum amylase level began to increase at 6h after L-arginine intraperitoneal injection and reached the peak value at 18 h[(5069.88 ± 603.25 ) U/L],and returned to normal at 36 h.The serum concentration of RAGE and RAGE mRNA expression in pancreatic tissue were ( 18.33 ± 2.99) ng/ml and 0.41 ±0.13 in the control group.The corresponding values increased at 6 h in ANP group,which were (30.31 ±5.03) ng/ml and 1.57 ±0.19,and they were significantly higher than those in the control group (P <0.05) ; they reached the peak value at 24 h[( 105.41 ±21.31 ) ng/ml and 4.23 ±0.73],which were significantly higher than those in other ANP groups ( P < 0.05 ) ; at 96 h they decreased to the lowest point [( 33.54 ± 6.96) ng/ml and 1.19 ± 0.19],which were still significantly higher than those in the control group (P < 0.05 ).Conclusions The expression levels of RAGE in pancreatic tissues and serum level of RAGE increase within 36 h of ANP onset,then decrease gradually,but they are always higher than normal values.

17.
Chinese Journal of Digestive Endoscopy ; (12): 256-259, 2011.
Article in Chinese | WPRIM | ID: wpr-420076

ABSTRACT

Objective To evaluate the feasibility and efficacy of betadine solution irrigation of gastrointestinal tract for infection prevention during the procedure of natural orifice transluminal endoscopic surgery(NOTES).Methods Twelve female porcine were divided into control group(n =4)to receive lavage with 500 ml normal saline and experimental group(n =8)to undergo lavage with 500 ml normal saline followed by 200 ml betadine solution.Fluid from gastrointestinal tract(5 ml)were collected before and after lavage,and after NOTES for culture.Endoscopy was performed 24 hours after NOTES to observe possible existence of inflammation,ulcer or bleeding.The animals were sacrificed 3 weeks after NOTES to explore intra-peritoneal adhesions,abscesses and other infections.Results One swine died of diaphragmatic injury and the other 11 animals successfully survived for 3 weeks.In trans-gastric approach,the average bacterial load of the fluid was 17.5 x 103 CFU/ml before lavage.In control group,the average bacterial load of the fluid was 2.5 × 103 CFU/ml after lavage and 5.5 × 103 CFU/ml after NOTES,while those in experimental group were 0 CFU/ml and 7.5 CFU/ml,respectively.In trans-colonic approach,the average bacterial load of the fluid before lavage was 76.2 × 103 CFU/ml.In control group,the average bacterial load of the fluid was 19.5 × 103 CFU/ml after lavage and 21 × 103 CFU/ml after NOTES,while those in experimental group were 2.25 × 103 CFU/ml and 1 × 103 CFU/ml,respectively.No inflammation,ulcer or bleeding were observed by endoscopy at 24 hours after NOTES.More adhesion and abscess were found in the control group than in the experimental group.In experimental group with trans-colonic approach,only one case of adhesion was observed.Conclusion It is effective and feasible of using betadine solution irrigation of gastrointestinal tract in infection prevention during the procedure of NOTES.However,further clinical studies assessing the effectiveness and safety are still necessary.

18.
Chinese Journal of Digestive Endoscopy ; (12): 171-174, 2009.
Article in Chinese | WPRIM | ID: wpr-380942

ABSTRACT

Objective To evaluate the feasibility of getting retroperitoneal lymph node biopsy via technique of natural orifice transluminal endoscopic surgery(NOTES)in human being with current available devices.Methods We performed trans-gastric endoscopic biopsy of retroperitoneal lymph node with the aid of laparoscopy in a 50-year-old man,who presented with abdominal pain and enlarged retroperitoneal lymph nodes and signed a written informed consent before the procedure.After routine anesthesia and abdominal skin sterilization,a pneumoperitoneum was induced with a Veress needle placed in the umbilical area,followed by the introduction of a 5-mm trocar.Gastral cavity Was sterilized with antibiotics and povidone iodine.Under laparoscopie optical control,we made a styliform incision in the anterior wall of gastric corpus with a needle knife,and enlarged the incision by a dilatation balloon and then entered the peritoneal cavity with a sterile endoscope.We got two biopsies from the enlarged lymph node with a heat forceps assisted by laparoscopy.The specimen was taken out by retrieval basket through the stomach.The gastric incision Was closed with metal clips.Results The biopsy by means of NOTES was successfully performed without intra-or postoperative complications.The diagnosis was confirmed as lymphoma pathologically.The patient received chemotherapy and was discharged on the sixth postoperative day.There was no short or long-term complication.Conclusion Transgastric access for laparoscopy-assisted biopsy of retroperitoneal lymph node is feasible and safe in human being.

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Chinese Journal of Digestive Endoscopy ; (12): 480-484, 2009.
Article in Chinese | WPRIM | ID: wpr-380581
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