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BACKGROUND@#To compare the efficacy and safety of dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin plus rituximab (DA-EPOCH-R) with standard rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) in Waldeyer's ring diffuse large B-cell lymphoma (WR-DLBCL) at a single institution.@*METHODS@#This retrospective study included 115 newly diagnosed patients with WR-DLBCL, of whom 68 patients received R-CHOP, and 47 patients received DA-EPOCH-R as their first-line treatment. The baseline features of the two groups were well balanced using a 1:1 propensity score matching method, and a total of 84 cases were obtained, including respective 42 cases in the R-CHOP and DA-EPOCH-R groups, for further survival and prognosis analysis. The primary objectives included progression-free survival (PFS) and overall survival (OS).@*RESULTS@#During a median follow-up of 45 months, there were nine (21.4%) deaths in the R-CHOP group and two (4.8%) in the DA-EPOCH-R group. Kaplan-Meier analysis showed statistically significant improvements in PFS and OS in patients with DA-EPOCH-R compared with those treated with R-CHOP (log-rank test, P = 0.025 and P = 0.035, respectively). The 2-year PFS and OS rates in the DA-EPOCH-R group were 90.1% (95% confidence interval [CI]: 81.4-99.8%) and 95.2% (95% CI: 89.0-100.0%), respectively, and 80.5% (95% CI: 69.3-93.6%) and 90.5% (95% CI: 52.8-99.8%) in the R-CHOP group. Patients without B symptoms and elevated lactate dehydrogenase levels had a higher PFS in the DA-EPOCH-R group, with P values of 0.038 (hazard ratio [HR]: 0.11; 95% CI: 0.01-0.88) and 0.042 (HR: 0.19; 95% CI: 0.04-0.94), respectively. There were no statistically significant differences in clinical responses and treatment-related toxicities between the two groups.@*CONCLUSION@#Compared with patients received R-CHOP, those treated by DA-EPOCH-R had superior PFS, OS, and controlled toxicity in patients with WR-DLBCL.
Subject(s)
Humans , Rituximab/therapeutic use , Vincristine/therapeutic use , Retrospective Studies , Prednisone/therapeutic use , Etoposide/therapeutic use , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Lymphoma, Large B-Cell, Diffuse/drug therapy , Cyclophosphamide/therapeutic use , Doxorubicin/therapeutic useABSTRACT
Objective@#To investigate the turnaround time (TAT) of clinical laboratory specimens in Shaanxi Province, and provide evidence for improving quality of laboratories. @*Methods@#The 90th percentiles of pre-analytical TAT and intra-laboratory TAT of emergency and inpatient specimens from four majors, such as biochemistry, immunology, blood-urine-faces routines and blood coagulation, were filled in by laboratories on-line, and the returned data were analyzed by Excel 2007 and SPSS 17.0 software. The comparison of the data between two groups was performed with Mann-Whitney U test, and that from multiple groups by Kruskal-Wallis H test. @*Results@#A total of 267 questionnaires were issued, and 91.0% of laboratories finished the fill-in. Among them, 138 laboratories filled in the specimens′ TAT completely. There was no statistical difference in pre-analytical TAT of emergency specimens from four majors (P＞0.05), and the pre-analytical TAT was within 45 minutes in more than 85% of laboratories. There was significant difference in pre-analytical TAT of inpatient specimens from four majors (P＜0.05), and the pre-analytical TAT was within 120 minutes in 80% of laboratories. The specimens′ TAT of blood-urine-faces routines was slightly shorter than that of immunology. No matter emergency or inpatient specimens, the pre-analytical TAT of four majors in the laboratories of the second-level hospitals was less than that in the third-level hospitals (P＜0.05). Whether emergency or inpatient specimens, there were significant differences in the intra-laboratory TAT of four majors (P＜0.05). The intra-laboratory TAT of blood-urine-faces routines was the shortest, followed by that of blood coagulation and biochemistry, and that of immunology was the longest. The intra-laboratory TATs of emergency specimens for biochemistry, immunology, blood-urine-faces routines and blood coagulation were 30-120 minutes, 30-180 minutes, within 60 minutes and 15-120 minutes respectively, in 80% of laboratories. The intra-laboratory TATs of inpatient specimens for blood-urine-faces routines and blood coagulation were within 120 minutes and within 180 minutes respectively, in 80% of laboratories, while those for biochemistry and immunology were equal or greater than 240 minutes and 300 minutes respectively, in 20% of laboratories. No matter emergency or inpatient specimens, there was no significant difference in intra-laboratory TAT between the second-level hospitals and the third-level hospitals (P＞0.05). @*Conclusion@#The TAT of clinical laboratory specimens in Shaanxi Province is quite different. Some laboratories need to optimize the specimens′ turnaround process and shorten the TAT of specimens.
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Objective@#To summarize the adverse effects of pegaspargase in the treatment of lymphoid malignancies and management experience.@*Methods@#Clinical data of patients who received chemotherapy including pegaspargase in the Department of Hematology of Beijing Tongren hospital during August 2011 to December 2015 were retrospective analyzed, and the adverse effects of pegaspargase and the management experience was summarized.@*Results@#A total of 129 patients with 443 times of pegaspargase used during this period. The common adverse reactions included allergic reactions in 2 cases (1.6%), acute pancreatitis in 19 (14.7%) including 6 acute symptomatic pancreatitis and 13 chemical pancreatitis with elevated pancreatin, hypertriglyceridemia in 15 cases(11.6%), hyperglycemia in 85 (65.9%), hypoglycemia in 7 (5.4%), elevated aminotransferase in 25 (19.4%), hyperbilirubinemia in 21 (15.5%), hypoalbuminemia in 62 (48.1%), prolonged APTT in 61 (47.3%), prolonged PT in 22 (17.1%), prolonged TT in 15 (11.6%), hypofibrinogen in 75 (58.1%), thrombus in 11 (8.5%) and bleeding in 3 (2.3%). The above adverse reactions were improved by symptomatic treatment of anti allergy, inhibition of secretion of pancreatic juice, lipid lowering, hypoglycemic, liver preservation, supplementation of plasma and hemostasis, respectively. Some serious adverse reactions affected the application of pegaspargase, even lead to discontinuation of the aspartate.@*Conclusion@#Though adverse effects associated with pegaspargase are extensive, most patients can successfully complete the chemotherapy containing the pegaspargase with close monitoring and timely treatment.
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Objective To provide theoretical guidance for further research on the role of miR-1 99a-3p in formation and development of bladder cancer.Methods Mature sequence of miR-1 99a-3p was analyzed;target genes and transcription factors of miRNA-1 99a-3p were predicted,and the target genes were analyzed for gene ontology (GO)enrichment and Kyoto Encyclopedia of Genes and Genome (KEGG)pathway.Then TF-miRNA-mRNA network diagram was constructed.Results Sequences of miR-1 99a-3p were highly conserved in various species.In GO analysis,the target genes of miR-1 99a-3p were enriched in many biological processes,such as regulation of cellular process,regulation of macromolecule metabolic process,and regulation of biological process (P <0.01 ).In KEGG pathway,the target genes were mainly located in bacterial invasion pathway of epithelial cells,ECM-receptor interaction pathway,PI3K-Akt signaling pathway,MAPK signaling pathway,small cell lung cancer pathway,and proteoglycans pathway in the cancer (P <0.05).According to the TF-miRNA-mRNA network diagram,the important genes that might be regulated by miR-1 99a-3p were MYC,SP1,mTOR,NFκB,and NFκB1.Conclusion miR-1 99a-3p may directly target mTOR and participate in the formation and development of bladder cancer through regulating PI3K-Akt-mTOR signaling pathway.
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Objective To explore the role of miRNA-148a in bladder tumorous development and progression.Methods Ex-pression of miRNA-148a was assessed in 35 bladder carcinoma tissues and 16 non-carcinoma tissues by fluorescence quanti-tative real time PCR,and correlation with clinical features was evaluated.Target genes and transcription factors of miRNA-148a were predicted using bioinformatic analysis,then TF-miRNA-148a-target genes network diagram was built and the tar-get genes was analyzed of gene ontology enrichment and KEGG pathway.Results Expression of miRNA-148a was lower in bladder carcinoma tissues than in non-carcinoma tissues(0.000 8±0.000 2 vs 0.002 1±0.000 5)(t=2.46,P 0.05).268 target genes of miRNA-148a were predicted by three softwares at the same time,60 transcription factors were predicted and the binding sites with combination scroes above 80 was 657.The target genes of miRNA-148a was enriched in many biological processes,such as neuron differentiation,generation of neurons,neuron projec-tion development,cytoplasmic mRNA processing body,cytoplasm(P <0.001).They also participated in p53 signaling path-way,proteoglycans in cancer-homo sapiens,pathways in cancer,prostate cancer,protein processing in endoplasmic reticulum, focal adhesion and so on(P <0.05).According to TF-miRNA-148a-target genes network diagram,miRNA-148a was regula-ted by SP1,ESR1,AP1,MYC and BRCA1,genes of IGF1,P27kip1 ,NCOA1,PTEN,SERPINE1 might be regulated by miR-NA-148a.Conclusion miRNA-148a which was significantly down-regulation in bladder carcinoma tissues may be participate in bladder tumorous development and progression,bioinformatics analysis provides some ideas for further research.
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Objective To analyse the problems presented in external quality assessment (EQA)for blood cytomorphology and propose measures for improvement.Methods Statistical analysis was performed on EQA results for blood cytomorphology from 2011 to 2013 in Shaanxi Province,including general information of participant laboratories,coincident rate,and reported incorrect results.EQA for blood cytomorphology was held two times every year in Shaanxi province,with ten pictures inclu-ding bone marrow and peripheral blood smear each time.The compact disc including twenty pictures was given to partici-pants by EMS.Participants reported two EQA results in April and September each year.The center statisticed the EQA re-sults and provided the EQA reports to every participants in June and November.Results Participating laboratories increased from 76 in 2011 to 163 in 2013.The ratio of laboratories with the coincidence rate≥80% was 80%,47%,44%,55%,77%and 96% respectively.The number for single cell with the coincidence rate≥80% was 38.The coincidence rate of peripheral blood cells was higher than that of the bone marrow on the whole.Causes of incorrect results included cell lines’misclassifi-cation,growth stage’s misclassification,insufficient identification of abnormal cytomorphology,and so on.Conclusion The identification of blood cytomorphology was unbalanced in different leveled hospitals in Shaanxi Province.To develop EQA of blood cytomorphology definitely has a positive role in improving the experimenters’skill of identifying cytomorphology.
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Extranodal NK/T cell lymphoma,nasal type is a common subtype of non-Hodgkin's lymphomas in China.Many difficulties remain in its diagnosis and treatment.Correct diagnosis can be established according to the typical histology findings and immunology phenotypes with CD33（E）,EBER and/or CD56 positive.Prognostic factors should be assessed in the initiation of diagnosis.Ann Arbor staging classification has still being widely used and PET-CT scan is strongly recommended.Chemotherapy followed by radiotherapy should been considered for early-stage patients and combined chemotherapy is the best choice for advanced stage patients.The regimens containing L-asparaginase should be considered firstly due to the evidences from many clinical trials.Stem cell transplantation is recommended to almost all patients except for IE stage patients without any unfavorable prognostic factor.New regimens should be investigated and assessed in the perspective randomized clinical trials.
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Objective To study clinical features, treatment and prognosis of nasal NK/T cell lymphoma associated Hemophagocytic Syndrome (HPS).Methods Retrospectively analysis method was used to analyze the clinical data of 3 patients with nasal NK/T cell lymphoma associated HPS. Results 3 patients with nasal NK/T cell lymphoma fulfilled the criteria of HPS. All patients had adverse prognostic factors of lymphoma.1 patient developed HPS as the main primary manifestations of underlying lymphoma,the other 2 patients developed HPS during lymphoma progression. In three cases, bone marrow was infiltrated with lymphoma cells.When HPS occurred,the disease progressed rapidly.The most obvious clinical features were fever,pancytopenia,hypofibrinogenemia,hyperferritinemia,and hemophagocytosis in bone marrow. After being treated according to the HLH-2004 combined with chemotherapy, all patients showed a clinical response,but with the progression of lymphoma,HPS quickly relapsed,and all patients died of severe hepatic dysfunction,coagulopathy,or DIC.Conclusion Nasal NK/T lymphoma associated HPS is an invariably fatal disease with poor prognosis,typically occurring at advanced stage or the terminal phase of the disease.HLH-2004 based protocol in combination with chemotherapy is helpful for nasal NK/T cell lymphoma associated HPS,which may delay disease progression and provid opportunities for the treatment of primary disease.
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Objective To evaluate the clinical features,therapies and prognosis in patients with mucosa-assoeiated lymphoid tissue (MALT) lymphoma in ocular adnexal marginal zone (OAML).Methods A retrospective analysis was made upon clinical data from 21 patients with OAML admitted into Beijing Tongren Hospital from June,2008 to December,2011.Results There were 12 (57.1 ％) men and 9(42.9％) women,with a median age of 57 (23-79) years old.Majority of patients had localized pathological changes.Among them,16 patients (76.2％) were in stage Ⅰ E,and 5 (23.8％) in stage Ⅳ E.Surgical resection as the sole treatment was performed in 13 patients (61.9％),and positron emission tomography CT(PET-CT) imaging demonstrated normal fluorine 18-fluorodeoxyglucose (FDG) uptake after surgical resection,who were managed with no further therapy.All the 13 patients were followed up for median 14 (5-38) months,and all in complete remission.Combination chemotherapy was given to 8(38.1％) patients.Three patients in stage Ⅰ E treated with COP (cyclophosphamide,vineristine and prednisone) or CHOP (cyclophosphamide,adriamycin,vincristine and prednisone) were all in partial remission.Five patients in stage ⅣE were treated with COP/CHOP in combination with rituximab,and all in complete remission.The 3-year overall survival rate and disease-free survival rate in the total patients were 100.0％ and 74.9％ respectively.Conclusions The patients with OAML generally have localized disease,show indolent clinical course,and present low lymphoma-related mortality.Surgical resection is a very important treatment in the patients with local disease.Systemic chemotherapy should be considered in patients at advanced stages.Rituximab in combination with chemotherapy can improve the remission rate.
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Nasal-type extranodal nature killer-T-cell lymphoma (NKTCL) originates from mature nature killer (NK) cell or NK-like T cell. This lymphoma cells are usually CD3ε, CD56 and Epstein-Barr Virus (EBV) positive and the later plays an important role in the pathogenesis. A number of cell lines and animal models of NKTCL have been established and used in experimental studies. NKTCL always has various chromosome aberrations and the most common is 6q- which are not specific for the disease. Various abnormalities in genes expression and epigenetic also have been found, which might provide potential targets for target therapy in the future.