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Objective:To investigate the clinical characteristics and prognosis of secondary hemophagocytic syndrome (HPS) in adults.Methods:The clinical data of 43 adult patients with primary secondary HPS in Mianyang Central Hospital of Sichuan Province from January 2014 to June 2020 were retrospectively analyzed. The patient's clinical manifestations and biochemical indicators were summarized. The clinical characteristics of patients between high-level ferritin (≥5 000 μg/L) group and low-level ferritin (<5 000 μg/L) group, lymphoma-related HPS group and infection-related HPS group were compared. Logistic regression model was used for multivariate survival analysis.Results:All patients had fever as the main complaint, and infections were manifested at the onset or during treatment. In all patients, 88.4% (38/43) had hemophagocytosis in the bone marrow; 88.4% (38/43) had varying degrees of cytopenia; 36.6% (15/41) had reduced fibrinogen [median value 0.93 g/L (0.50-1.35 g/L)]; 76.7% (33/43) had elevated aminotransferase. Compared with the low-level ferritin group (19 cases), the high-level group (21 cases) had a lower proportion of monocytes (0.081±0.040 vs. 0.163±0.076, P = 0.016), the incidence of fibrinogen reduction and the incidence of aminotransferase elevation were high [60.0% (12/20) vs. 11.1% (2/18), P = 0.002; 95.2% (20/21) vs. 52.6% (10/19), P = 0.006]. Compared with infection-related HPS patients, lymphoma-related HPS patients had a higher incidence of lymphadenopathy [72.7% (16/22) vs. 27.8% (5/18), χ2 = 8.021, P = 0.005] and a lower incidence of aminotransferase elevation [59.1% (13/22) vs. 94.4% (17/18), χ2 = 4.848, P = 0.028]. Multivariate analysis showed that the high proportion of neutrophils ( OR = 0.886, 95% CI 0.786-0.998, P = 0.046) and high-level albumin ( OR = 0.376, 95% CI 0.156-0.907, P = 0.030) after treatment were protective factors for survival of patients. Conclusions:Among adult patients with primary secondary HPS, the proportion of monocytes in patients with ferritin ≥5 000 μg/L is low, and liver damage and fibrinogen reduction are more likely to occur. Lymphoma-related HPS patients are more likely to have lymphadenopathy, and infection-related HPS patients are more likely to have liver damage. After treatment, a low proportion of neutrophils and hypoproteinemia indicate a poor prognosis in adult patients with secondary HPS.
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Objectives@#To explore the effects of 13-cis-retinoic acid (13cRA) alone or combined with interferonα-2b (IFNα-2b) for the inhibition of cell growth and apoptosis induction of mantle cell lymphoma cell lines Jeko-1 cells.@*Methods@#Jeko-1 cells were treated by different concentrations of 13cRA alone or combined with IFN-α2b. CCK-8 was used to measure the inhibition effects by different treatments. Cell cycles were analyzed by flow cytometry. Effects on apoptosis were assessed by staining of Annexin Ⅴ/PI. And the levels of Cyclin D1, caspase-9 and Rb proteins were measured by Western blot method.@*Results@#13cRA alone at different doses and its combination with IFNα-2b inhibited Jeko-1 cells growth and induced apoptosis, but the combination had higher inhibition potential and significant apoptosis rate (P<0.05) . The growth inhibition and apoptosis induction in Jeko-1 cells increased significantly with the elevation of drugs concentration and treating duration (P<0.05) . As well as the percentage of Jeko-1 cells at G1/G2 phases increased (P<0.05) and cells at S phase decreased (P<0.05) , the levels of Cyclin D1 and Rb decreased with elimination caspase-9.@*Conclusion@#13cRA, IFN-α2b and their combined administration inhibited cells growth and induced apoptosis, decreased the cell populations at S phase and blocked the cells at G1/G2 phase. Combination of the drugs may have a cooperated action. The therapeutic synergistic effects of 13cRA and IFN-α2b were assumed to lower the expression of Cyclin D1 and Rb proteins, and induce apoptosis by activating caspase-9 pathway.
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<p><b>OBJECTIVE</b>To Explore the poor prognostic factors of diffuse large B-cell lymphoma (DLBCL).</p><p><b>METHODS</b>The clinical data of 409 newly diagnosed patients with DLBCL from January 2000 to December 2010 were collected, and the prognostic factors by univariate and multivariate stratification were analyzed .</p><p><b>RESULTS</b>Of the 409 DLBCL patients, 244 were males and 165 females, the median age was 56(16-89) years old, the median follow-up time was 23(2-108) months. In univariate analysis, age, clinical stage, B symptoms, ECOG scores, the international prognostic index (IPI) scores, bone marrow involvement, low absolute lymphocyte count (ALC), high LDH, β2-MG>2 times of normal, regimen and therapeutic effect had significant influence on OS and PFS (P<0.05). Multivariate analysis showed that stage III-IV and high LDH were the poor prognostic factors of OS and PFS (P<0.05). When IPI scores were included, low ALC and IPI 3-5 scores were the poor predictors of OS and PFS in CHOP-like group (232 cases), revised IPI (R-IPI) was an independent poor predictors of OS and PFS in RCHOP-like group (177 cases).</p><p><b>CONCLUSION</b>Stage III-IV and high LDH have negative influence on OS and PFS in patients with DLBCL, low ALC and IPI 3-5 scores affect OS and PFS in CHOP-like group, R-IPI affects OS and PFS in RCHOP-like group.</p>