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Objective To investigate the correlation between hemoglobin level and health status of the elderly living in communities in Beijing.Methods A random cluster sampling method was used to select residents living in communities of Beijing city,and a cross-sectional study was carried out by questionnaires,scene testing and blood sample collection.WHO-formulated criteria were applied for diagnosing anemia.The health indicators in questionnaires included visual impairment,physical disability,decreased health,self-care,fatigue,anorexia,independent walking distance,exercise frequency,intelligence status and computing power.Results Complete information was obtained in a total of 1 948 elderly people,including 790 cases of male and 1 158 cases of female,with an average age of(73.9±6.1)years and a median age of 74 years(65-100).The mean level of hemoglobin in the 1 948 people was(135.65 ± 14.48) g/L,with (142.56 ± 15.56) g/L in male and (130.95 ± 11.53) g/L in female.Hemoglobin level was significantly lower in female than in men (t =54.739,P＜ 0.01).Hemoglobin level was decreased with aging,and negatively associated with appetite,physical strength,walk assistance,visual acuity and physical ability(r=-0.055,-0.067,-0.071,-0.114,-0.095;P =0.022,0.005,0.004,0.000,0.000),while positively associated with health status,activities in daily life,athletic ability,exercise frequency and intelligence (r =0.073,0.126,0.122,0.066,0.124;P =0.002,0.000,0.000,0.006,0.000).Conclusions The hemoglobin level of the elderly decreases with aging and is associated with health status and quality of life in the elderly,which should be taken care seriously.
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Objective:To evaluate the clinical efficiency and prognostic factors of autologous peripheral blood stem cell trans-plantation (APBSCT) in 30 cases of multiple myeloma (MM). Methods:Two of the 30 patients received the second treatment of APB-SCT because of relapse after the first treatment. Thus, a total of 32 case-times of APBSCT were studied. Combination chemotherapy was inducted regularly before APBSCT (11 patients used bortezomib as an induction drug), and chemotherapy combined with the G-CSF regimen was used to mobilize peripheral blood stem cells. Preconditioning was based on melphalan. Results:Mononuclear cells in harvest were 6.41 × 108/kg, and CD34+cells in harvest were 4.75 × 106/kg. The median times of neutrophil and platelet engraftment were 9.5 and 11 d, respectively. The complete remission (CR) and very good partial remission (VGPR) rates were 37.5%and 34.4%af-ter APBSCT, respectively. The median overall survival (OS) was 67.27 months in all patients, and the median progression-free survival (PFS) was 29.77 months. The median PFS rates were 29 and 20 months in the patients who achieved CR and PR, respectively, and the median PFS was not observed in the patients who achieved VGPR. Statistical differences in PFS were detected between the CR+VGPR and PR groups (P=0.025). The CR rates were 63.6%and 23.8%in the bortezomib (bortezomib-based chemotherapy) and non-bortezo-mib groups (P=0.034), respectively. The median OS and PFS were not obtained in the bortezomib group, whereas the median PFS was 22 months in the non-bortezomib group (P=0.045). Conclusion: MM patients treated with bortezomib-based chemotherapy followed by APBSCT had prolonged PFS. APBSCT can improve the response and survival of MM patients.
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<p><b>OBJECTIVE</b>To explore the clinical characteristics and prognostic value of monosomal karyotype (MK) patients in adult acute myeloid leukemia (AML).</p><p><b>METHODS</b>We retrospectively studied 45 patients of MK⁺ in newly-diagnosed adult AML in our center from Oct 2000 to Dec 2012. Clinical characteristics, cytogenetic data and prognostic features were analyzed in the cohort of MK⁺ patients.</p><p><b>RESULTS</b>MK was found in 45 patients (19.0%) of 237 newly-diagnosed adult AML with cytogenetic data available at diagnoses. Among these 45 cases, there were 28 male (62.2%) and 17 female (37.8%). Median age of MK⁺ patients at diagnose was 58(18-91) years old. The presence of -5(31.1%) and -7(17.8%) were the most common chromatid among MK⁺ AML patients. MK was much more prevalent among elderly patients. Among AML patients, the proportions of MK⁺ patients younger than 30, 30 to 59 and older than 60 years old groups were 11.5%, 17.7% and 22.4%, respectively. There was no difference between MK⁺ and MK⁻ patients in gender distribution (P=0.545). There was also no difference between MK⁺ and MK⁻ patients in the distribution of FAB castigation (P=0.239). Median survival of MK⁺ AML patients was 6.5 months. Cumulative 5-year overall survival (OS) of was 5.2%. Forty-three MK⁺ patients (43/45, 95.6%) also had a complex karyotype (CK). Two cases that did not meet the CK had not achieved complete remission (CR), and died within 6 months. There were 12 patients who were CK⁺ in 192 MK⁻ patients. The differences of OS and CR rates between MK⁺CK⁺ patients and MK⁻CK⁺ were statistically significant (P<0.05).</p><p><b>CONCLUSION</b>The increased detection rate of MK with age was associated with lower CR and OS in AML patients.</p>
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Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Chromosome Aberrations , Karyotyping , Leukemia, Myeloid, Acute , Diagnosis , Genetics , Monosomy , Prognosis , Remission Induction , Retrospective StudiesABSTRACT
Objective To evaluate the effect of a modified culture method on the karyotype anomalies detection rate in elderly patients with multiple myeloma (MM),and to explore the relationship between clinical characteristics and chromosome anomalies in multiple myeloma.Methods Two culture methods were applied on the bone marrow samples which obtained from 28 MM patients.One method was used to culture cells for 24 hours with interleukin 6 (IL-6) 10 μg/L and granulocyte-macrophage colony-stimulating factor (GM-CSF) 40 μg/L,and the other for 6 days.Karyotype was analyzed by G-banding technique.Results In the 24-hour culture group,no metaphases cell was found in 4 cases (14.3 ％),karyotype anomalies were found in 6 cases in the other 24 cases,and the detection rate was 25.0％ (6/24).In the 6-day culture group,no metaphases cell was found in 1 patient (3.6％),karyotype anomalies were found in 15 cases in the other 27 patients,and the detection rate was 55.6％ (15/27).There was a significant difference in the detection rate of karyotype anomalies between the two groups (x2 =4.89,P ＜ 0.05).In 27 cases with enough metaphases in the 6-day culture group,20 cases were newly diagnosed or in progression,among whom karyotype anomalies were found in 14 cases (70.0％,14/20),and 7 cases were in stable phase,among whom karyotype anomalies were found in 1 case (14.3％,1/7).The detection rate of abnormal karyotype was higher in newly diagnosed or in progressive patients than in stable patients (P ＜0.05).Conclusions 6-day culture method can improve the detection rate of karyotype anomalies in elderly patients with multiple myeloma,which is better than 24-hour culture method.The detection rate of karyotype anomalies is higher in newly diagnosed or in progressive patients than in stable patients.
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Objective To explore the cytogenetic characteristics of acute myeloid leukemia(AML) patients.Methods The karyotype analysis was performed in 178 AML using the short-term culture of bone marrow cell and G-banding technique.Results Among the 178 patients,171 had enough metaphases for analysis and 128(74.9%)had clonal karyotypic abnormalities.Twenty-seven patients were secondary to myelodysplastic syndrome (MDS-AML),with 25 (92.6%) patients carrying clonal karyotypic abnormalities.Among the remaining 144 patients of de novo AML,103(71.5%)had clonal karyotypic abnormalities.The rate of abnormal clonal karyotype was higher in MDS-AML than that of de novo AML (P=0.021).Among the 171 patients,41(24.0%)were in favorable risk group,80(46.8%)in intermediate risk group and 50(29.2%)in adverse risk group.t(15;17)was the most common chromosomal aberration.The maiority intermediate risk chromosomal aberration was;normal karyotype.The most common cytogenetic abnormality among adverse group was a complex karyotype.Adverse cytogenetic aberrations,such as -5/5q-,-7/7q-,frequently occurred in conjunction with one another as part of a complex karyotype.Totally 75 patients were 60 years or older,among them,16.0%were in favorable risk group,48.0%in intermediate risk group and 36.0%in adverse risk group.Among 96 younger patients,30.2%were in favorable risk group.45.8%in intermediate risk group and 24.0%in adverse risk group.The rate of favorable risk chromosomal aberration was lower in elder patients than in younger(P=0.03 1).The rate of adverse risk chromosomal aberration and the rate of monosomal karyotype were higher in MDSAML than in de novo AML patients(P<0.001).Conclusions The most common favorable,intermediate and adverse chromosomal aberrations were t(15;17),normal karyotype and complex karyotype respectively.The karyotype was poor in MDS-AML and elder AML patients.
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Objective To explore the karyotype distribution in elderly patients with acute leukemia (AL) and compare the prognostic characteristics of karyotype by age grouping.Methods Chromosomal karyotypes were analyzed in 215 cases with AL using the short-term culture of bone marrow cells and G-banding technique.Results There were 202 cases with enough mitosis for analysis and 149 cases(73.8％)with abnormal clone in 215 patients with AL.The rates of abnormal clone were 73.0％ (27/37),74.4％(64/86) and 73.4％ (58/79) in patients aged ≤30,31-59 and ≥60 years,respectively,and no difference were found among age groups (P=0.982).Among 171 patients with acute myeloid leukemia (AML) with detected mitosis,there were 41 better-risk cases (24.0 ％) with most frequent aberration of t(15;17) accounting for 65.9 ％,80 intermediate-risk cases (46.8 ％ ) with principal of normal karyotype accounting for 53.8 ％,and 50 poor-risk cases (29.2 ％)with complex karyotype occupied by 84.0％.The karyotype percentage of better-risk,intermediaterisk and poor-risk were 50.0％,36.4％ and 13.6％ in patients aged ≤30 years,24.3％,48.7％ and 27.0％ in aged 31-59 years,and 16.0％,48.0％ and 36.0％ in aged ≥ 60 years,respectively.The rate of better-risk karyotype was higher in patients aged ≤30 years than the other two groups (P=0.021and P=0.001) and the ratio of poor-risk karyotype higher in patients aged ≥ 60 years than in patients aged ≤30 years (P=0.046).Among 29 patients with acute lymphoblastic leukemia (ALL),10 cases had poor-risk and 19 cases had intermediate-risk karyotype.Conclusions Karyotype analysis provides an important basis for risk assessment and the rate of poor-risk karyotype may increase with the ageing in patients with AML.
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Objective To explore the clinical and biological characteristics and treatment effect of acute myeloid leukemia (AML) in elderly patients. Methods The clinical data of 62 patients over 60 years old with AML were retrospectively analyzed, and they were compared with those of 60 younger adult patients (18-59 years old) at the same period. Results In elderly patients, the complete remission (CR) rate was 27. 7% and the overall effective rate was 44.7%, which were lower than those of younger adult patients (74.1% and 87.9 %, 1-espectively, P＜0.01). The early death rate was 19.0% and the mortality rate during the first two induction chemotherapy was 29. 3% in the elderly, which were higher than those of younger adult patients (3. 3% and 6.7%, 1-espectively,P＜0.01). The 27.4% of elderly patients were diagnosed as myelodysplastic syndrome (MDS)-transformed AML, which were more than that of younger adult patients (10.0%, P＜0.05), and they had lower CR rate than those without MDS (P＜0. 05). The 28.2% of elderly patients had lymphoid antigen positive AML and 71.8% of patients showed CD34+ which were higher than those of younger adult patients (8. 1% and 48.6%, respectively, P＜0. 05), and they had lower CR rate than those of lymphoid antigen negative and those of CD34- AML (P＜0. 05). Elderly patients had less favorable and more unfavorable karyotypes than younger adult patients (45.7 % and 15.4 %, P＜0. 05). Conclusions The elderly patients with AML have more unfavorable prognostic factors than younger adult patients. They have lower CR rate and higher mortality rate. There are many specialties in elderly patients and the treatment strategy should be made more individually.
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Objective To explore the outcome of monoclonal gammopathy of undetermined significance (MGUS). Methods The data from 14 MGUS patients in our hospital including clinical features, outcome and change of M protein concentration were analyzed retrospectively. Results The MGUS didn't have the clinical manifestations of multiple myeloma (MM), the time of outcome from MGUS to MM was about 4-20 years (mean time, 10 years). The most types of MM were IgA and IgG, 6 cases were IgA type, 6 cases were IgG type and 2 cases were light chain type. The concentration of immune globulin in general showed an upward trend year by year. A few showed fold lines ascend. Conclusions The elevated monoclonal immunoglobulin may develop into MM after many years. We must follow up frequently to avoid error diagnosis and missed diagnosis.
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Objective To investigate the prevalence by age,response to different therapies and outcome in newly diagnosed idiopathic thrombocytopenic purpura(ITP). Methods ITP patients who were hospitalized from July 1992 to December 2006 and followed uD with telephone were retrospectively analyzed.Results 103 patients with ITP were investigated. The time of follow-up was between 2 months to 15years.to adrenocorticosteroid and 4 patients under going splenectomy achieved a normal platelet count. In those immunosuppressive agents:including vincristine,cyclophosphamide,azathioprine and cyclosporin A(CsA)used in the present series. CsA was shown to be more effective. It could increase the platelet count when given together with prednisolone,the effective rate was 81.3%(26/32). Severe side effects like kiney function failure were not found in CsA treated patients so the use of geug in ITP would be recommended.There were 2,1 and 1 ITP patients progressing respectively to Sjogren's syndrome,systemic lupus erythematosus and lymphoma. 7 patients died,1 patient died of cerebral bleeding,2 brain infarction,3 malignant neoplasm and 1 nephrosis The refractory rate of ITP is 17.2%(10/58). Conclusions The morbidity in older people is high. The mortal bleeding in ITP is low. Treatment should be tailored to the individual patient.
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Objective To explore the clinical characteristics,therapy reactions and prognosis of the elderly patients with idiopathic thrombocytopenic purpura(ITP). Methods A total of 43elderly ITP patients(age≥60 years old)including 16 men and 27 women were reviewed and further followed up for 1 month to 15 years. Results Until June 2007,35 elderly ITP patients survived,platelet counts were sustained(30-50)×109/L in 7 cases,but no significant bleeding was found.Thirty-six patients had adrenocorticosteroid therapy first, 25 patients were sensitive to adrenocorticosteroid therapy,4 patients underwent splenectomy,and 3 patients achieved a normal platelet count. Immunosuppressive agents(vinscristine,cyclophosphamide, azathioprine and Cyclosporin A)treatments were held in 5 6 case-times,Cyclosporin A and azathioprine were more effective than vinscristine and cyclophosphamide.The refractory rate was 13.9%.One patient progressed to monoclonal gammopathy of unknown significance and 1 to lymphoma.Eight patients died.1 patient died of brain bleeding after trauma,3 patients died of malignant neoplasm,4 patients died of heart failure induced by infection. Conclusions The clinical features of elderly ITP patients are atypical.the mortal bleeding in them was rare,treatment strategy should be individualized tO each elderly patient.
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OBJECTIVE To investigate the incidence and pathogens of infection in 1659 consecutive cases in single center hematological unit.METHODS The incidence,pathogen,and outcome of infection in 1659 hospitalized patients with hematological disorders from 1999 to 2006 were retrospectively analyzed.RESULTS The overall incidence of infection was 24.4% according to the person-times of hospitalization,which included 22.1% of nosocomial infection and 2.3% of community acquired infection.Most of the pathogenic bacteria of the nosocomial infection were Gram-negative.The most common bacteria in the sputum samples included Enterobacter cloacae(19.3%) and Pseudomonas aeruginosa(14.8%).The most common bacteria in the blood samples were coagulase negative Staphylococcus(CNS,39.3%),the next was Pseudomonas aeruginosa and Escherichia coli.There were 4.21% bacteria resistant to most of antibiotics in nosocomial infection.There were 114 fungi isolated.Candida albicans was accounted for 35.1%.The mortality due to nosocomial infection was 7.4%.CONCLUSIONS The patients in hematology ward are susceptible to infection.The pathogens of nosocomial infection are most likely G-bacteria.Some bacteria are resistant to almost all antibiotics.The incidence of fungal infection is increasing in the near 8 years.
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Objective To investigate platelet function with special regard to the role of platelet membrane glycoproteins (GPIIb/IIIa?GPIb) and endothelial cell disturbance in the older non valve cardiac patients with atrial fibrillation and their clinical implications. Methods 22 older patients with non valve cardiac atrial fibrillation were studied. There were two age and sex matched control groups, one with 18 patients in sinus rhythm with cardiovascular disease, called the normal sinus rhythm group; the other with 16 health subjects named the health control group. The expression of activated GPIIb/IIIa and GPIb on platelet was analyzed with flow cytometry. Mean platelet volume (MPV) was measured by automatic hematologic analyzer, the plasma vWF was assayed using ELISA. Results The non valve atrial fibrillation group had markedly activated platelet, indicated by increased expression of activated GPIIb/IIIa ( P