Safety and efficacy of upfront autologous transplantation as a consolidation therapy for progressive nasal type extranodal NK/T-cell lymphoma / 中华器官移植杂志

Objective:To evaluate the efficacy and safety of upfront autologous hematopoietic stem cell transplantation(auto-HSCT)as a consolidation therapy of progressive nasal type extranodal NK/T-cell lymphoma, (ENKL).Methods:From January 2012 to June 2021, clinical data were retrospectively reviewed for 28 patients with advanced-stage ENKL on chemotherapy of asparaginase-containing regimen followed by upfront auto-HSCT as a consolidation therapy.The median age at transplantation was 34.5(14-61)years.There were 19 males and 9 females.Clinical types were nasal(n=22)and non-nasal(n=6). Clinical stages were Ann Arbor III(n=15)and IV(n=13). Clinical risks were intermediate(n=8)and high(n=20)according to the Prognostic Index for Natural-Killer cell lymphoma-Epstein-Barr virus(PINK-E).Results:Hematopoietic reconstruction was performed.Median time of neutrophil engraftment was 10(8-17)days and 13(10-22)days for platelet.Median follow-up time was 59.5 months and 5-year OS/PFS 70.0%(95% CI: 50.60%-89.40%)and 59.1%(95% CI: 39.11%-79.10%). And 5-year cumulative recurrence and non-recurrence mortality rates were 35.42%(95% CI: 19.11%-59.39%)and 4.2%(95% CI: 2.16%-29.87%). Conclusions:Asparaginase-based chemotherapy followed by auto-HSCT is both safe and efficacious for progressive ENKTL.

Clinical characteristics of gastrointestinal symptoms and liver function injury in patients with coronavirus disease 2019 / 中华消化杂志

Objective:To analyze the clinical characteristics of gastrointestinal symptoms and liver function injury in patients with coronavirus disease 2019 (COVID-19).Methods:From January 23, 2020 to February 29, 2020, the medical records of 251 patients with COVID-19 admitted to the West Campus of the Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, were collected. The proportion of the patients with gastrointestinal symptoms including anorexia, nausea and vomiting, diarrhea and abdominal pain were analyzed respectively. The patients were divided into common type (76 cases), severe type (65 cases) and critical type (110 cases). The incidence of liver function injury and the changes of liver function parameters such as total bilirubin (TBil), direct bilirubin (DBil), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), γ-glutamyl transpeptidase (GGT), lactate dehydrogenase (LDH), albumin and globulin of the patients with different clinical types and with or without gastrointestinal symptoms were analyzed. Mann-Whitney U test, Chi square test and Fisher′s exact test were used for statistical analysis. Results:The main gastrointestinal symptoms of patients with COVID-19 were anorexia (33.9%, 85/251), diarrhea (12.0%, 30/251), nausea and vomiting (7.6%, 19/251) and abdominal pain (1.2%, 3/251). 143 patients (57.0%) had liver function injury, the rate of liver function injury in critical type patients was 75.5% (83/110), which was higher than that of common type patients (40.8%, 31/76) and severe type patients (44.6%, 29/65), and the differences were statistically significant ( χ2=22.765 and 16.865, both P<0.01). There was no significant difference in the proportion of patients with liver function injury between common type and severe type patients ( P>0.05). There was no statistically significant difference in the proportion of liver function injury between patients with gastrointestinal symptoms and those without gastrointestinal symptoms (57.8%(67/116) vs. 56.3%(76/135), P>0.05). The median values of TBil, DBil, ALT, AST, ALP, GGT, LDH and globulin level of critical type patients were 13.5 μmol/L, 4.9 μmol/L, 44.5 U/L, 50.0 U/L, 64.0 U/L, 41.0 U/L, 527.0 U/L and 33.6 g/L respectively. The proportions of critical type patients with TBil level >34.2 μmol/L, DBil level>13.6 μmol/L, ALT level>80 U/L and AST level>80 U/L were 7.3% (8/110), 7.3% (8/110), 17.3% (19/110) and 17.3% (19/110), respectively. These results were all higher than those of common type patients (9.5 μmol/L, 2.9 μmol/L, 28.5 U/L, 28.5 U/L, 54.0 U/L, 25.5 U/L, 225.5 U/L, 30.1 g/L, 0, 0, 6.6% (5/76) and 2.6% (2/76) ) and severe type patients (10.4 μmol/L, 3.4 μmol/L, 30.0 U/L, 31.0 U/L, 49.0 U/L, 25.0 U/L, 284.0 U/L, 30.7 g/L, 0, 0, 6.2% (4/65) and 1.5% (1/65)), and the differences were statistically significant ( Z=-4.264, -5.507, -4.000, -6.558, -3.112, -4.333, -4.858, -3.873, Fisher′s exact test, Fisher′s exact test, χ2=4.574, 9.620; Z=-3.060, -3.850, -3.923, -5.005, -9.495, -7.651, -3.853, -2.725, Fisher′s exact test, Fisher′s exact test, χ2=4.425, 10.169; all P<0.01). The median values of pre-albumin level, albumin level and the albumin to globulin ratio of critical type patients were 85.3 g/L, 28.2 g/L and 0.8, which were all lower than those of common type patients (157.3 g/L, 32.3 g/L and 1.1, respectively) and severe type patients (133.6 g/L, 31.6 g/L and 1.1, respectively), and the differences were statistically significant ( Z=-6.631, -3.647, -4.924, -4.503, -5.283 and -3.903, all P<0.01). The median albumin level of patients with diarrhea was lower than that of patients without diarrhea (28.2 g/L vs. 30.5 g/L), the proportion of diarrhea patients whose TBil level >20.0 to 34.2 μmol/L was higher than that of patients without diarrhea (70.0%, 21/30 vs. 10.9%, 24/221), and the differences were statistically significant ( Z=-2.182, χ2 =62.788; both P<0.05). Conclusions:Anorexia is the most common digestive symptom in COVID-19 patients, and the incidences of abdominal pain is low. The incidence of liver function injury of critical type patients is high. There is no significant correlation between gastrointestinal symptoms and liver function injury, and patients with diarrhea have lower albumin levels.

Clinical features of 11 cases of primary bone lymphoma / 中华血液学杂志

Objective@#To analyze the clinical features, treatment and outcomes of primary lymphoma of bone (PLB) .@*Methods@#The clinical data of 11 PLB patients were retrospectively analyzed.@*Results@#11 patients were enrolled in our study including 7 females and 4 males. The median age of the patients was 45 years old. The main histologic type was diffuse large B cell lymphoma and anaplastic large cell lymphoma. Of the 11 PLB cases, 3 cases were at stage ⅠE, 2 at stage ⅡE, 6 at stage ⅣE respectively. 6 cases were treated with chemotherapy and radiotherapy, 2 cases with total joint arthroplasty and chemotherapy, and 3 cases chemotherapy alone respectively. 5 cases got complete remission, 4 cases partial remission and 2 cases stable disease respectively. The median progression free survival was 17 (5-58) months after a median follow up of 21 (6-58) months.@*Conclusions@#Most of PLB patients were clinically in late stage lacking of clinical and imagine features. The optimal treatment for PLB was radiotherapy combined with chemotherapy, and its prognosis was relatively good.

Primary breast diffuse large B-cell lymphoma-report of 21 cases from China with literatures review / 中华血液学杂志

<p><b>OBJECTIVE</b>To evaluateclinical features, treatment and outcomes of patients diagnosed with primary breast diffuse large B-cell lymphoma（DLBCL）.</p><p><b>METHODS</b>Clinical data were analyzed for all patients diagnosed with primary breast DLBCL（n=21）. Kaplan-Meier method was used to estimate 5- year overall survival（OS）rate, and the difference was compared by Log- rank test.</p><p><b>RESULTS</b>The 21 cases of patients with primary breast DLBCL were all female with median age at diagnosis as 48 years （range 21-64 years）. 13 patients had International Prognostic Index（IPI）of 0, 6 IPI 1, and 2 IPI 2. The 5- year OS rates of CHOP/R- CHOP and R±DICE after R±EPOCH groups were 40.0% and 72.2% , respectively（P=0.035）. The central nervous system relapse rate of CHOP/R-CHOP and R±DICE after R± EPOCH groups were 16.7% and 6.7%（P=0.500）, respectively. The 5- year OS rates of patients with primary breast DLBCL staging Ⅱ E-Ⅲ E and Ⅰ E were 21.4% and 83.3% , respectively（P=0.025）.</p><p><b>CONCLUSION</b>Primary breast DLBCL was rare. The patients of primary breast DLBCL with chemotherapy regimen of R±DICE after R±EPOCH might have a better prognosis and lower relapse rate of central nervous system; the primary breast DLBCL patients staging ⅡE-ⅢE might have a poor prognosis.</p>

Assciation between uric acid levels and paroxysmal atrial fibrillation / 中国综合临床

Objective To investigate the potential relationship between the paroxysmal Atrial Fibrillation(PAF) and serum uric acid level.Methods Consecutive patients with (patient group,n =65) and without(control group,n =41) PAF,who were hospitalized in the Second Hospital of Tianjin Medical University from September 2011 to June 2012,were included in this study.We excluded subjects with congestive heart failure,acute coronary syndrome,congenital heart disease,valvular heart disease,cardiomyopathy,thyroid dysfunction and acute infection or inflammatory conditions.Baseline clinical data,complications and laboratory examination results were collected.Left atrium diameter (LAD),left ventricular end-diastolic dimension (LVEDD) and left ventricular ejection fraction (LVEF) were determined by echocardiography.Univariate and logistic regression was conducted to detect risk factors for PAF.Results Serum uric acid level were significantly increased in patients with PAF compared with controls ((360.2 ± 103.9) μmol/L vs (296.0 ±68.1) μmol/L,P =0.001).Multivariate logistic regression analysis showed that higher level of serum uric acid (OR:1.007,95％ CI:1.000-1.015) and LAD (OR:1.142,95％ CI:1.031-1.265) were independent risk factors for the occurrence of PAF.Conclusion High serum uric acid level is an independent risk factor for the development of PAF.Future larger studies should further evaluate this potential association as well as the underlying mechanisms.