Research Progress of Clonal Hematopoiesis of Indeterminate Potential in Multiple Myeloma --Review / 中国实验血液学杂志

With the progress of medical technology, cloning hematopoietic was found to be widely exist in normal people. Because of its clinical significance and prognosis is unclear, it is named clonal hematopoiesis of indeterminate potential(CHIP), which has been detected in blood diseases such as myelodysplastic syndrome and lymphoma, and proven to be related to poor prognosis. Recently, CHIP has been also detected in patients with multiple myeloma (MM). In this article, the definition and influencing factors of CHIP, clinical significance, prognosis and treatment in MM were reviewed.

PX-12 Promoting Apoptosis of Multiple Myeloma Cell Line H929 Induced by Bortezomib / 中国实验血液学杂志

OBJECTIVE@#To study the effect of PX-12 on apoptosis of multiple myeloma (MM) cell line induced by bortezomib.@*METHODS@#MM cell line H929 cells were divided into PX-12 group, bortezomib group, combination group, and control group. 5.0 μmol/L PX-12, 20 nmol/L bortezomib, combination of the two drugs, and DMSO were given to the above mentioned group, respectively. After culture for 24, 48, and 72 hours, the changes of cell viability were observed, the MM cell activity was detected by MTT method, and the cell cycle distribution and apoptosis of each group was detected by flow cytometry. The intracellular ROS level was measured by H@*RESULTS@#MTT assay showed that after culture for 72 hours, the activity of H929 cells in PX-12 group (P<0.05) and bortezomib group (P<0.01) was significantly lower than that in the control group, while that in the combination group was decreased most significantly (P<0.01). After culture for 48 hours, cells in G1 phase in PX-12 group was decreased to 40%, while cells in S phase and G@*CONCLUSION@#PX-12 can increase the apoptosis of MM cell line H929 induced by bortezomib, which may be caused by increasing of ROS level.

Efficacy and Influencing Factors of Autologous Hematopoietic Stem Cell Transplantation for Multiple Myeloma: Retrospective Analysis / 中国实验血液学杂志

<p><b>OBJECTIVE</b>To analyze the clinical efficacy and possible influencing factors of autologous hematopoietic Stem cell transplantation (auto-HSCT) in the treatment of patients with multiple myeloma (MM).</p><p><b>METHODS</b>Clinical data of 40 MM patients received auto-HSCT in the Department of Hematology of Henan Cancer Hospital from September 2010 to November 2017 were retrospectively analyzed, the clinical curative efficiency was summarized and the related factors were analyzed.</p><p><b>RESULTS</b>The curative efficiency of the patients before transplantation was 9(22.5%) with complete remission(CR), 5(12.5%) with very good partial remission(VGPR), 26(65%) with partial remission(PR), respectively, one of them was PR after 3 recurrences. The curative efficiency after transplantation was 22(55%) with complete remission(CR), 12(30%) with very good partial remission(VGPR), 6(15%) with partial remission(PR), respectively. And 2 cases were CR after double transplantation. Median follow-up time was 28.4 (3.1 to 88) months,15 cases presented disease progression, 7 cases were dead, 3-year estimated progression-free survival(PFS) and overall survival(OS) rate were 45.1% and 82% respectively. Unvariate analysis showed that the OS was affected by ISS stage (P<0.05), CR and VGPR (P<0.05) after transplantation; PFS was affected by ISS stage (P<0.01), before transplantation induction therapy (27 cases with bortezomizomi or thalidomide) (P<0.05), disease risk stratification (6 cases in high risk group) (P<0.05) , CR and VGPR (P<0.05) before transplantation, CR and VGPR (P<0.01) after transplantation. Cox multivariate regression analysis showed that the independent prognostic factors for OS were ISS stage, CR and VGPR after transplantation; the independent prognostic factors for PFS were the CR, VGPR, ISS stage after transplantation and induction therapy before transplant.</p><p><b>CONCLUSION</b>Auto-HSCT can improve the clinical efficacy and survival rate of MM patients; ISS stage, CR and VGPR after transplantation are independent prognostic factors for OS and PFS, and induction therapy before transplantation is also an independent prognostic factor for PFS.</p>

AsO Up-Regulates the Proportion of CD4CD25CD127 Tregs in Peripheral Blood of Patients with Severe Aplastic Anemia / 中国实验血液学杂志

<p><b>OBJECTIVE</b>To investigate the effect of ATO on the proportion of Treg in the peripheral blood of patients with severe aplastic anemia (SAA) in vitro.</p><p><b>METHODS</b>The peripheral blood of 20 newlydiagnosed patients were collected, and the peripheral blood monomuclear cells (PBMNC) were extracted. After the PBMNC were treated with ATO of different concentrotions (0, 1, 2.5 and 5 µmol/L) for 96 hours, the proportion of CD44 CD25CD127 regulatatory T cells (Treg) were detected by flow cytometry. The expression levels of Foxp3 mRNA were detected by RT-PCR, and the levels of IFN-γ,IL-4,IL-17 and TGF-β1 were detected by ELTSA to verify the results of flow cytomery.</p><p><b>RESULTS</b>ATO significantly increased the proportion of Treg (P<0.01) at the concentration of 2.5 and 5 µmol/L, and the rising degree of Treg proportion improved with the increasing ATO concentration(r= 0.524). Treg proportion increased at a concentration of 1 µmol/L, but without statistical significance (P>0.05). At 1(P<0.05), 2.5(P<0.01) and 5 µmol/L(P<0.01), ATO significantly up-regulated the expression of Foxp3 mRNA, and the increase of Foxp3 mRNA positively and linearly correlated with the increase of Treg cell-frequency(r=0.523). ATO significantly reduced the levels of IFN-γ (at ATO 1,2.5 and 5 µmol/L, P<0.01), IL-4 (at ATO 2.5 µmol/L, P<0.01; at ATO 5 µmol/L, P<0.01) and IL-17(at ATO 2.5 µmol/L, P<0.05; at ATO 5 µmol/L, P<0.01). ATO had no significant effect on TGF-β1 at 1(P>0.05) and 2.5 µmol/L (P>0.05), but significantly reduced TGF-β1 level at 5 µmol/L (P<0.05).</p><p><b>CONCLUSION</b>ATO can mediate the immune regulation through up-regulating the proportion of Treg in peripheral blood of patients with SAA and reducing the levels of IFN-γ, IL-4 and IL-17.</p>

Rituximab and Dexamethasone Combined with Cyclophosphamide for Treatment of Relapsed and Refractory Immune Thrombocytopenia / 中国实验血液学杂志

<p><b>OBJECTIVE</b>To evaluate the efficiency and safety of rituximab and dexamethasone combined with cyclophosphamide for treating patients with relapsed and refractory immune thrombocytopenia (ITP).</p><p><b>METHODS</b>Twelve patients with relapsed and refractory immune thrombocytopenia were prospectively enrolled in this study, and received rituximab 375 mg/m(2) once a week for 4 weeks, dexamethasone 40 mg once a day for consecutive 4 days, and cyclophosphamide 500 mg/m(2) biweekly for 2 weeks. The levels of IFN-r and IL-4 in peripheral blood of patients were measured by enzyme-linked immunosorbent assay (ELISA), and the percentages of Breg, Treg and Th17 cells were detected by flow cytometry before and after treatment. Efficiency was evaluated according to platelet counts, and side effects were observed.</p><p><b>RESULTS</b>Six out of 12 patients reached to complete remission and 4 patients reached to partial remission, with the total response rate 83.33%. The platelet counts [(115.42 ± 76.60) × 10(9)/L] after treatment were significantly higher than that before treatment [(115.42 ± 76.60) × 10(9)/L] (P < 0.001). The ratio of IFN-r/ IL4 after treatment (5.89 ± 2.30) was very significantly lower than that before treatment (7.00 ± 2.73) (P = 0.002). The percentage of Breg cells after treatment [(21.27 ± 4.28)%] were much significantly higher than that before treatment [(15.48 ± 1.67)%] (P < 0.001). The ratio of Treg/Th17 after treatment (3.07 ± 1.50) was significantly higher than that before treatment (0.98 ± 0.45) (P < 0.001). Infusion reaction was observed in 1 patient, secondary hypertension and hyperglycemia were in 1 patient, and pneumonia in 2 patients.</p><p><b>CONCLUSION</b>Rituximab and dexamethasone combined with cyclophosphamide can improve the outcomes of patients with relapsed and refractory immune thrombocytopenia patients and they were well tolerated, its mechanism may be related with the balance between T cell sunsets and Treg cells.</p>

Regulatory effect of As₂O₃on imbalance between adipogenic and osteogenic differentiation of BM-MSC from patients with aplastic anemia / 中国实验血液学杂志

This study was aimed to explore the regulation of arsenic trioxide (As₂O₃) on imbalance between adipogenic and osteogenic differentiation of BM-MSC from patients with aplastic anemia(AA). The BM-MSC from AA patients were separated and purified, placed into the adipogenic and osteogenic differentiation culture system, then added the As₂O₃, CsA, As₂O₃combined with CsA were added to corresponding differentiation culture system, the concentration of As₂O₃and CsA were set at 0.001 µmol/ml and 2.5 mmol/ml respectively, the cells were divided into As₂O₃group, the CsA group, combined group and control group (no drug). The cell morphological observation, oil red 'O' staining, Von-Kossa staining, and RT-PCR were used to detect corresponding differentiation marks. The results indicated that in respect to adipogenic differentiation, cellular morphology observing and oil red 'O' staining showed that the rate of adipocyte differentiation in As₂O₃group was (18.3 ± 1.9)%, which was lower than the (91.8 ± 2.7)% in the CsA group and (92.1 ± 1.2)% in control group (P < 0.05), there was no significant difference in comparison with (8.3 ± 1.9)% in the combined group (P > 0.05), but the rate of differentiation in CsA group was higher than that in combined group (P < 0.05), and there was no significant difference in comparison wtih control group. RT-PCR showed that the LPL-mRNA expression level in As₂O₃group were significantly lower than that in the CsA group and the control group (P < 0.05), no difference was observed while compared with the combined group (P > 0.05), but the LPL-mRNA expression level in CsA group was significantly higher than that in the combined group (P < 0.05). In terms of osteogenetic differentiation, the calcium deposition in As₂O₃group and combined group was obviously observed while rarely in the CsA group and the control group when detected by the Von-Kossa staining. OST-mRNA expression level in As₂O₃group were higher than that in CsA group and the control group (P < 0.05), while compared with the combined group, there was no significant difference (P > 0.05), but the OST-mRNA expression level in the CsA group was lower than that in the combined group (P < 0.05). It is concluded that As₂O₃can significantly enhance the ability of BM-MSC from AA patients to differentiate into osteoblast, also can inhibit the adipogenic differentiation, in contrast, the CsA can not promote the osteoblast differentiation of BM-MSC from AA patients.

Hyperthermia increases the sensitivity of RPMI 8226 cells to adriamycin / 中国实验血液学杂志

This study was purposed to explore the effect of hyperthermia on sensitivity of multiple myeloma cells RPMI 8226 to adriamycin (ADM) and its mechanism. The working concentration of ADM against RPMI 8226 cells was defined by MTT assay. RPMI 8226 cells were divided into 4 groups: control group, hyperthermia (42°C) group, chemotherapy (ADM) group and combination group (42°C + ADM), the survival rate of RPMI 8226 cells in 4 groups was detected by trypan blue exclusion, the inhibitory effect of hyperthermia on proliferation of RPMI 8226 cells was detected by MTT assay, the cell cycle distribution, apoptosis rate of cells, intracellular ADM concentration and P-gp expression level were measured by flow cytometry. The 1/4 IC(50) of ADM was defined as the working concentration in the experiment. The results indicated that the hyperthermia promoted the entering the cells from in G(0)/G(1) phase into S and G(2)/M phases, the expression of P-gp protein on cells in hyperthermia and combination groups was down-regulated, the intracellular ADM concentration in combination group obviously increased. It is concluded that the hyperthermia combined with ADM obviously enhance the inhibitory effect on proliferation of RPMI 8226 cells. The hyperthermia increases the sensitivity of RPMI 8226 cells to chemotherapy through down-regulating the expression of P-gp protein on cells and increasing the intracellular ADM concentration.

The efficacy of high-dose cytarabine for patients with t(8;21) AML and with normal karyotype AML / 中华血液学杂志

<p><b>OBJECTIVE</b>To compare the efficacy of high-dose cytarabine (HD-Ara-C) based chemotherapy for post-remission treatment in patients with t(8;21) (q22;q22) AML-M2 and those with normal karyotype AML-M2.</p><p><b>METHODS</b>AML-M2 patients were grouped into with (21 cases) or without (23 cases) t(8;21) (q22;q22) karyotype groups. After achieved remission by induction therapy, all patients received four cycles of HD-Ara-C (3 mg/m2 per 12 hours by three-hour infusion day 1 to day 3) with either mitoxantrone (7 mg m(-2) d(-1)) or aclarubicin (30 mg m(-2) d(-1)) or etoposide (70 mg m(-2) d(-1)) for 3d as post-remission treatment.</p><p><b>RESULTS</b>Relapse rate in the t(8;21) and the normal karyotype groups was 29% and 57% respectively (P<0.05); 3 year disease-free survival (DFS) rate was 71% and 43% respectively (P < 0.05). and 3 year over-all survival (OS) rate was 76% and 65% respectively (P >0.05).</p><p><b>CONCLUSION</b>Four cycles of high-dose cytarabine based combination chemotherapy as post-remission treatment improves long-term disease-free survival in patients with t(8;21) (q22;q22) AML-M2.</p>

Comparative characterization of mesenchymal stem cells from human umbilical cord tissue and bone marrow / 中国实验血液学杂志

This study was purposed to compare the biological characteristics of umbilical cord-derived mesenchymal stem cells (UC-MSCs) and bone marrow-derived mesenchymal stem cells (BM-MSCs). The frequency of successful isolation, cell yield, colony-forming units-fibroblastics (CFU-F), proliferation capacity, immunophenotype and multi-differentiation potentials of UC-MSCs and BM-MSCs were determined by limiting dilution assay, flow cytometry, invert microscopy, RT-PCR and so on, the determined results were compared. The results showed that MSCs were successfully isolated from all the 36 portion of UC tissue and 8 portion of BM. Although the mean number of nucleated cells isolated from UC tissue was significantly lower than that from BMs (1 x 10(6)/cm vs 5.5 x 10(7)/ml) (p=0.0002), no significant differences of the yield of adherent cells were observed (8.6 x 10(5)/cm vs 8.4 x 10(5)/ml) (p>0.05). UC-MSCs shared the most of the characteristic of BM-MSC, including fibroblastic-like morphology, typical immunophenotype, cell cycle status, adipogenic and osteogenic differentiation potentials. However, the CFU-F frequency was higher in UC (1:1609+/-0.18) than that in BM (1:35700+/-0.01) (p<0.05). Furthermore, the proliferation capacity of UC-MSCs was higher than that of BM-MSCs; the expressions of CD106 and HLA-class I in UC-MSCs were lower than those in BM-MSCs (p<0.05). It is concluded that the cell yield and most biological characteristics of UC-MSCs are similar to BM-MSCs, but UC-MSCs possess the higher proliferation capacity, and the lower expression of HLA-class I and HLA-DR as compared with BM-MSCs, therefore the human umbilical cord tissue may be considered as a promising alternative to bone marrow as a source of MSCs.

Application of all-trans retinoic acid combining chemotherapy and As4S4 in the maintenance treatment of patients with acute promyelocytic leukemia / 中华血液学杂志

<p><b>OBJECTIVE</b>To compare the efficacy of all-trans retinoic acid (ATRA) combining chemotherapy and As4S4 with ATRA combining chemotherapy for the maintenance treatment of patients with acute promyelocytic leukemia (APL).</p><p><b>METHODS</b>Sixty patients with APL induced to complete remission by ATRA and consolidated by chemotherapy were randomly divided into two groups. Thirty patients as As4S4 group received ATRA + As4S4 + chemotherapy, and another thirty patients as non-As4S4 group were treated only with ATRA + chemotherapy as maintenance therapy. The therapeutic effects, side effects and PML-RARalpha gene expression were analyzed.</p><p><b>RESULTS</b>The three-year continuous complete remission (CCR) rate was 90.0% for As4S4 group and 61.1% for non-As4S4 group, the difference being statistically significant. Significant difference was also found in the positive rate of PML-RARalpha fusion gene between the two groups. The side effects were mild.</p><p><b>CONCLUSION</b>APL patients in maintenance therapy with ATRA + 6-MP + MTX + As4S4 can obtain a higher CCR.</p>

A preliminary study on mechanisms for resistance of CML patient BM-derived bcr/abl+ and Flk1+CD31-CD34- stem cells to STI571 in vitro / 中国实验血液学杂志

To evaluate the effect of imatinib mesylate (STI571) on primitive/committed malignant progenitor cells in chronic myelogenous leukemia (CML) and to further elucidate the mechanisms involved in CML relapse and in some CML cells resistant to STI571, bone marrow-derived malignant bcr/abl-positive, Flk1(+)CD31CD34(-) cells with hemangioblastic characteristics from CML patients were grown in Methocult GF+ media with or without STI571, and inhibitory effect of STI571 on proliferation of differentiated and differentiating, bcr/abl(+), Flk1(+)CD31CD34(-) cells with hemangioblastic characteristics was investigated in vitro. The results showed that in vitro exposure to 5 micromol/L STI571 (the concentration of STI571 usually achieved in patients is 1-2 micromol/L) for 96 hours inhibited bcr/abl(+) committed progenitors (colony-forming cells, CFCs). No evident suppression of normal primitive, bcr/abl(+), and Flk1(+)CD31(-)CD34(-) cells were observed. It is concluded that CML primitive stem cells remain viable in the presence of STI571 and that inhibition of bcr/abl tyrosine kinase by STI571 restores normal hematopoiesis by removing the proliferative advantage of CML committed progenitors but that elimination of all CML progenitors may not occur. So despite dramatic short-term responses in vivo, such in vitro resistance to STI571, may translate into disease relapse after prolonged therapy.

Study on the mechanisms of imatinib-resistance of cancer stem-like cells in K562/Vp16 cell line / 中华血液学杂志

<p><b>OBJECTIVE</b>To elucidate the mechanisms of imatinib resistance involved in some chronic myeloid leukemia (CML) cells overexpressing P-glycoprotein (P-gp).</p><p><b>METHODS</b>Generation of resistant K562 cell line K562/Vp16 overexpressing P-gp was achieved by exposure of K562 cells to stepwise increase of concentrations of Vp16. A small set of side population (SP) with the characteristics of stem cells being capable of efflux fluorescent dye Hoechst 33342 in the cell line was isolated by flow cytometry. The mechanisms involved in K562/Vp16 SP cells resistant to imatinib were studied.</p><p><b>RESULTS</b>The levels of BCR/ABL and ABL proteins in K562 cells were similar to those in K562/Vp16 non-SP and K562/Vp16 SP cells. The 170 KDa P-gp was detected in K562/Vp16 and K562/Vp16 SP cells at similar levels but not in K562 cells. Compared with K562/Vp16 non-SP cells, K562/Vp16 SP cells were more resistant to imatinib, which could hardly be reversed by many multidrug resistance inhibitors. In addition, in vivo study showed that the malignancy of K562/Vp16 cells was largely attributed to the SP cells.</p><p><b>CONCLUSIONS</b>Bcr/Abl gene amplification and multidrug-resistant gene 1 (mdr1) overexpression might not be an important clinical mechanism in the diversity of resistance to imatinib treatment, and the development of drug resistance by leukemia cells may be at least partly due to a rare SP of tumor stem-like cells which drives leukemia occurrence and maintenance. These SP cells might be targeted for effective cancer therapy.</p>

Flk1+ mesenchymal stem cells ameliorate carbon tetrachloride-induced liver fibrosis in mice / 生物工程学报

Fibrosis is the common end stage of most liver diseases. Unfortunately, there is no effective treatment available currently. This study was designed to evaluate the effect of Flk1+ mesenchymal stem cells (MSC) from murine bone marrow (Flk1 + MSC) on fibrosis formation induced by carbon tetrachloride (CCl4). In this study Flk1+ MSC were isolated from bone marrow of male BALB/c mice. A CCl4 induced hepatic fibrosis model was used. Flk1+ MSC were systemically infused immediately or one week after the female mice were challenged with CCl4. Fibrosis index and donor cell engraftment were assessed two or five weeks after CCl4 challenge. We found that Flk1+ MSC transplantation immediately, but not one week after exposure to CCl4, significantly reduced CCl4-induced liver damage and collagen deposition. In addition, levels of hepatic hydroxyproline and serum fibrosis markers (HA, P-III-P) in mice receiving immediate Flk1+ MSC transplantation after CCl4 challenge were significantly lower compared to those of control mice. More importantly, histological examination suggested that hepatic damage recovery was much better in these immediately Flk1+ MSC-treated mice. Immunofluorescence, PCR, and fluorescence in situ hybridization (FISH) analysis revealed that donor cells engrafted into host liver, had epithelium-like morphology and expressed albumin (ALB), although at low frequency. In conclusion Flk1+ MSC might initiate endogenous hepatic tissue regeneration, engraft into host liver in response to CCl4 injury, and ameliorate its fibrogenic effects.