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Objective@#To investigate the efficiency and safety of domestic tyrosine kinase inhibitor (TKI) dasatinib (Yinishu) as second-line treatment for patients with chronic myeloid leukemia in chronic phase (CML-CP).@*Methods@#A retrospective analysis of clinical data of CML-CP patients who received domestic dasatinib as second-line treatment in the CML collaborative group hospitals of Hubei province from March 2016 to July 2018 was performed. The optimal response rate, the cumulative complete cytogenetic response (CCyR), the cumulative major molecular responses (MMR), progression free survival (PFS), event free survival (EFS) and adverse effects (AEs) of the patients were assessed at 3, 6 and 12 months of treatment.@*Results@#A total of 83 CML-CP patients were enrolled in this study. The median follow-up time was 23 months. The optimal response rates at 3, 6 and 12 months in 83 CML-CP patients treated with dasatinib were 77.5% (54/71), 72.6% (61/75) and 60.7% (51/69), respectively. By the end of follow-up, the cumulative CCyR and MMR rates were 65.5% (55/80) and 57.1% (48/73), respectively. The median time to achieving CCyR and MMR was 3 months. During follow-up time, the PFS rate was 94.0% (79/83) and the EFS rate was 77.4% (65/83). The most common non-hematological AEs of dasatinib were edema (32.5%), rash itching (18.1%) and fatigue (13.3%). The common hematological AEs of dasatinib were thrombocytopenia (31.3%), leukopenia (19.3%) and anemia (6.0%).@*Conclusion@#Domestic dasatinib was effective and safe as the second-line treatment of CML-CP patients and it can be used as an option for CML-CP patients.
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PURPOSE: To investigate the efficacy and safety of umbilical cord blood (UCB) infusion (UCBI) plus immunosuppressive therapy (IST) treatment in comparison to IST treatment, as well as predictive factors for clinical responses, in severe aplastic anemia (SAA) patients. MATERIALS AND METHODS: Totally, 93 patients with SAA were enrolled in this cohort study. In the IST group, rabbit antithymocyte globulin (r-ATG) combined with cyclosporine A (CsA) was administered, while in the IST+UBCI group, r-ATG, CsA, and UCB were used. RESULTS: After 6 months of treatment, UCBI+IST achieved a higher complete response (CR) rate (p=0.002) and an elevated overall response rate (ORR) (p=0.004), compared to IST. Regarding hematopoietic recovery at month 6, platelet responses in the UCBI+IST group were better than those in the IST group (p=0.002), and UCBI+IST treatment facilitated increasing trends in absolute neutrophil count (ANC) response (p=0.056). Kaplan-Meier curves illuminated UCBI+IST achieved faster ANC response (p < 0.001) and platelet response (p < 0.001), compared with IST therapy. There was no difference in overall survival (OS) between the two groups (p=0.620). Furthermore, logistic regression analysis demonstrated that UCBI+IST was an independent predicting factor for both CR (p=0.001) and ORR (p < 0.001), compared to IST; meanwhile, very severe aplastic anemia (VSAA) and ANC could predict clinical responses as well. However, Cox proportional hazard regression indicated that VSAA (p=0.003), but not UCBI+IST, affected OS. Safety profiles showed that UCBI+IST therapy did not elevate adverse events, compared with IST treatment. CONCLUSION: UCBI+IST achieved better clinical responses and hematopoietic recovery than IST, and was well tolerated in SAA patients.
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Humans , Anemia, Aplastic , Antilymphocyte Serum , Blood Platelets , Cohort Studies , Cyclosporine , Fetal Blood , Logistic Models , Neutrophils , Umbilical CordABSTRACT
Objective To analyze factors associated with long-term survival of acute leukemia(AL). Methods Clinical data is analyzed in 27 leukemia cases who had at least 5 years free survival (EFS). Combined intensive chemotherapy was administered under the principle of individualization to induce remission.Regular consolidation treatment after remission was strictly continued.Long-term follow up Was kept on,with the therapeutic regimen modified accordingly.Results Complete remission(CR) was achieved in 112 of 143(78.3%)AL patients and 27(18.9%)of them had survived more than 5 years.Conclusion The long-term survival of AL patients is related to the type of AL,leukemia cell burden,extramedullary leukemia, individual treatment,time required to achieve CR,continuous intensive chemotherapy and the regular postremission treatment.
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Objective To investigate clinical significance of transforming growth factor-beta 1 ( TGF-β1 ) in patients with chronic idiopathic thrombocytopenic purpura(CITP). Methods The serum level of TGF-β1 in 38 pa-tients with initial CITP were detected using enzyme-linked immunosorbent assay(ELISA). Results The serum level of TGF-β1 in initial patients with CITP was significantly higher than that of the controls [( 132.57±5.17) μg/L vs ( 76.81±4.42) μ/L] ( P <0.01 ). The serum level of TGF-β1 in those having good response after therapy was sig-nificantly lower than before treatment[(81.26±3.78)μg/L] (P <0.01 ). There was no difference in TGF-β1 be-tween nonremission [(123.49 ± 4.31 ) μg/L] and initial patients (P > 0.05 ). There was negative correlation between TGF-β1 and platelet count(r = -0. 342 ,P < 0.05 ) ,there was positive correlation between TGF-β1 and megakaryo-cyte count (r = 0.409, P < 0.01 ). Conclusions TGF-β1 partakes in the pathogenesis of CITP, the determination of which in patients with CITP is useful to judge the state of illness, which can be regarded as an assistant index of cur-ative effect.
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Objective To analyze on the efficacy and toxicity of MAAE (MIT ,Ara-C,AMSA,VP16)regimens on treating refractory and relapsed acute leukemia in adult patients. Methods MAAE (MIT, Ara-C,AMSA, VP16) regimen, which consisted of MIT 10mg/d (d1～3), intravenousdrop, Ara-C 200mg/d (d1～7),intravenousdrop, AMSA 75 mg/d (d1～3), intravenousdrop VP16 100 mg/d(d1～4), intravenousdrop were used to treat 25 cases of adults with refractory and relapsed acute leukemia (AL). G-CSF 5 μg/kg were used every day when WBC＜0.5×109/L. Results In the 25 cases with refractory and relapsed acute leukemia, 14 cases (56 %) reached complete remission, 5 patients(20 %) reached partial remission, the total effective rate was 76 %. Conclusion MAAE regimen was a very effective alternative treatment for CR induction in adult patients with refractory and relapsed AL and low toxicity.
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OBJECTIVE To investigate the nosocomial infection and risk factors of extended spectrum beta-lactamases (ESBLs),and the concomitant infection with other bacteria and double infection in patients of malignant hematopathy.METHODS Forty six malignant hematopathy patients with nosocomial infection by ESBLs positive bacteria were studied retrospectively.RESULTS ESBLs positive bacteria of nosocomial infection in patients of malignant hematopathy were Escherichia coli and Klebsiella.67.4% Were pulmonary infection and 30.4% with septicemia.Major risk factors were the usage of the third generation cephalosporin,the usage of chemotherapy and adrenal cortical hormone,and agranulocytosis.41.3% Cases had infection with other bacteria and 13.0% cases had double infection at the same time.All cases were sensitive to carbopenems,35.7% cases were sensitive to amikacin.CONCLUSIONS The prognosis of patients with nosocomial infection by ESBLs positive bacteria is bad.It is important to select appropriate chemotherapy,measure granulocyte amount in time,control the use of third generation cephalosporin and intensify support therapy.
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OBJECTIVE To investigate the effect of recombinant human granulocyte colony-stimulating factor(rhG-CSF) combined with antifungal drugs in the treatment of malignant hematologial diseases with fungus infection.METHODS Malignant hematologial patients with fungus infection were randomized to receive fluconazole with or without rhG-CSF.(RESULTS) The response rate in patients who received fluconazole combined with rhG-CSF was 89.1% and in(control) patients was 62.8%(P