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Objective To explore the clinical features, diagnosis and treatment of chronic diarrhea with primary systemic amyloidosis (AL). Methods The clinical experience of an AL patient with chronic diarrhea who was admitted to chinese PLA General Hospital in November 2017 was presented, and the related literature was reviewed. Results The patient was definitely diagnosed as AL with chronic diarrhea onset;after treatment with VCD regimen, the condition was improved obviously and achieved complete remission. Conclusion AL patient with chronic diarrhea onset needs to undergo various detections to make a clear diagnosis and differential diagnosis, and the bortezomib-based treatment scheme can achieve good curative effect.
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<p><b>OBJECTIVE</b>To explore the influence of relapse and survival by chronic graft versus host disease (cGVHD) in patients with acute myeloid leukemia (AML) after allogeneic hematopoietics stem cell transplantation (allo-HSCT).</p><p><b>METHODS</b>Fifty-five AML patients received allo-HSCT were retrospectively reviewed. Relapse rate and overall survival (OS) were analyzed according to cGVHD.</p><p><b>RESULTS</b>cGVHD significantly decreased the relapse rate of AML patients after transplantation within 2 years when compared with those without cGVHD (8.7% vs 38.6%, P=0.019), however, cGVHD had no effect on the long-term relapse rate (22.8% vs 5.9%, P=0.217). cGVHD had no effect on OS within 2 years (78.3% vs 61.0%, P=0.155) but could decrease the rate of long-term survival (63.7% vs 100%,P=0.01). cGVHD also could reduce the rate of relapse (8.3% vs 46.2%, P=0.044) and enhanced the rate of survival (83.3% vs 47.2%, P=0.045) in patients with high risk AML after allo-HSCT in 2 years, while it had no effect on the relapse rate and OS in patients with low and intermediated risk AML in early and late phase. Moreover, compared with the rate of relapse(38.6%) in patients without cGVHD, the rate of relapse were lower in patients with limited cGVHD and intensive cGVHD (27.3% and 31.3%, respectively) but the long-term survival was significantly lower (53.3%, P=0.001) in those patients with intensive cGVHD after all-HSCT.</p><p><b>CONCLUSION</b>The benefit effect of cGVHD mainly took place within 2 years after allo-HSCT in AML patients especially in those with high risk, while in late phase after allo-HSCT, cGVHD especially intensive cGVHD had an effect on reducing long-term survival.</p>
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Humans , Chronic Disease , Graft vs Host Disease , Hematopoietic Stem Cell Transplantation , Leukemia, Myeloid, Acute , Recurrence , Retrospective Studies , Transplantation, HomologousABSTRACT
<p><b>BACKGROUND</b>Allogeneic peripheral blood stem cell transplantation from unrelated donors (UR-PBSCT) is an alternative treatment for many hematologic diseases due to lack of human leukocyte antigen (HLA)-identical sibling donors. This study aimed to evaluate the impact of the degree of the HLA match on the clinical efficacy of UR-PBSCT.</p><p><b>METHODS</b>Patients who underwent UR-PBSCT from September 2003 to September 2012 were retrospectively investigated. They were divided into three groups according to high-resolution molecular typing. SPSS version 17.0 was used to analysis and compare the statistics of engraftment, incidence of GVHD, other complications and survival among the groups.</p><p><b>RESULTS</b>One hundred and eleven patients received UR-PBSCT, 60 of them with an HLA matched donor (10/10), 36 of them with a one locus mismatched donor (9/10), and 15 of them with a two loci mismatched donor (8/10). Similar basic characteristics were found in the three groups. No differences were found in engraftment of myeloid cells or platelets in the three groups (P > 0.05). Two-year cumulative incidence of relapse, overall survival (OS) and disease-free survival (DFS) among those three groups were similar (P > 0.05). The cumulative incidence of 100-day III-IV aGVHD in the HLA matched group and the one HLA locus mismatched group were significantly lower than that in the two HLA loci mismatched group (3.3%, 8.6%, and 26.7%, P = 0.009). The occurrence rate of new pulmonary infections in the HLA matched group was lower than in the two HLA mismatched groups (26.67%, 52.78%, and 41.18%, P = 0.035). The cumulative incidence of 100-day and 2-year transplantation related mortality (TRM) in two HLA loci mismatched group was higher than in the HLA matched group and in the one HLA locus mismatched group, (8.4%, 11.8% and 33.3%, P = 0.016) and (12.3%, 18.7% and 47.5%, P = 0.002).</p><p><b>CONCLUSIONS</b>HLA mismatch will not significantly impact the engraftment or 2-year survival after UR-PBSCT, but two mismatched HLA loci may increase the cumulative incidence of severe aGVHD and TRM.</p>
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Adolescent , Adult , Child , Female , Humans , Male , Middle Aged , Young Adult , HLA Antigens , Allergy and Immunology , Peripheral Blood Stem Cell Transplantation , Reference Standards , Unrelated DonorsABSTRACT
Objective To compare the efficacy and adverse effects of bortezomib+adriamycin+dexamethasone (PAD) and vincristine + adriamycin + dexamethasone (VAD) regimens in untreated multiple myeloma (MM). Methods There were 26 and 28 new diagnosed MM patients in PAD and VAD groups. Both clinical effects and adverse effects were observed. Patients accepted VAD or PAD regimens for 2-4 cycles and followed up for 7-27 months. Results There were 10, 5 and 11 patients accepted 2, 3 and 4 cycles in PAD group, and 6, 11 and 11 in VAD group. In PAD group, there were 2, 14, 9, 1 and 0patients achieved complete remission (CR), very good partial remission (VGPR), partial remission (PR),stable disease (SD) and progressive disease (PD); in VAD group, the number were 0, 4, 12, 10 and 2.The rate of patients who achieved good efficacy (CR+VGPR) in PAD group was 61.5%, which was higher than that in VAD group (14.3%).The incidences of infection and gastrointestinal symptoms were similar in the two groups, while the incidences of peripheral neuropathy, thrombosis and Herpes Zoster infection in PAD group were higher than those in VAD group. Conclusions Compared with the conventional VAD chemotherapy, PAD may improve CR and VGPR rates in new diagnosed MM, while it may bring more and severer toxicities in peripheral neuropathy, thrombosis and Herpes Zoster infection. Preventive medical care is necessary in PAD protocol.
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Objective To retrospectively analyze the diagnosis and treatment of multicentric Castleman's disease (MCD) ,and review related literatures. Methods A total of six patients were first-ever diagnosed as MCD and treated with combination chemotherapy and/or interferon α. The clinical manifestation, laboratory findings and therapeutic strategies were recorded in detail. Results In the six HIV-negative patients, histologically, four of them were diagnosed with plasma cell type of Castleman's disease, two with mixed type. All the six patients showed multiple lymphadenopathy, polyclonal hypergammaglobulinemia and hypoalbuminemia. One of the two patients treated with interferon α achieved complete remission, and the other,who showed no effects with hormone and combination chemotherapy ,achieved sustained partial remission after treatment with interferon α for 3 months. Of the four patients treated with combination chemotherapy, three achieved partial remission, and one died of no effects. Conclusions Interferon α and combination chemotherapy might be the most effective and convenient therapeutic methods for MCD. Serum albumin level may be used as a diagnostic and monitoring index for MCD.
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Objective To retrospectively evaluate the incidence and treatment of fungous infection compli-cations after hematopoietic stem cell transplantation. Methods The incidence, pathogenic microorganism, prophy-laxis,treatments of infectious complications in 150 patients, who accepted hematopoietic stem cell transplantation from September 1990 to Martch 2000 in our hospital were analyzed. Results The incidence of infectious complica-tions was 89.3% (134/150) in all 150 cases. Three patients (2%) died of the fungal infection. The incidence of the fungal infections was 32.5% (26/80) in patients who accepted treatment with impenem or/and ceftazidine, and 15.7% (11/70) in other patients without the above treatment (P<0.05). 12 fungal infection cases were treated with small-dosage of amphotericin B(10 mg/d) ,with the healing rate was 100%. Conclusion The strong antibac-terial prophylaxis can't reduce the incidence of infection ,but may increase the risk of fungal infection;small-dosage of amphotericin B is a new effective way to treat fungal infection.
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OBJECTIVE To evaluate retrospectively the incidence and treatment of infectious complications within the first 60 days after hematopoietic stem cell transplantation,and to find more efficient anti-infective regimens. METHODS To study the incidence,pathogenic microorganism,prophylaxis,treatments of infectious complications in 150 patients accepted hematopoietic stem cell transplantation from April 1984 to March 1998 in our hospital.The results were analyzed statistically.RESULTS Incidence of infectious complications was 89.3% in all 150 cases.Three patients(2%) died of the fungal infection.The incidence of the infections was 32.5% in patients accepted treatment with imipenem or／and ceftazidine,and 15.7% in other patients without the treatment with imipenem or／and ceftazidine(P＜0.02).CONCLUSIONS The strong antibacterial prophylaxis can′t reduce the incidence of infection,and may increase the chance of fungal infection.