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To analyze the clinical characteristics, diagnosis, treatment and outcome of patients with thrombotic thrombocytopenic purpura (TTP). The clinical data of 69 adult patients with TTP were retrospectively analyzed. There were 19 males and 50 females with a median age of 42 (18-79) years. PLASMIC score 6-7 was recognized in 82.8% (53/64) patients. The activity of von Willebrand factor-cleaving protease (ADAMTS13), which was detected in 21 patients before treatment, was less than 5% in 17 patients and 5%-10% in 3 patients. All 69 patients were treated with plasma exchange (PEX) and/or fresh frozen plasma infusion (PI), 43 of whom were also given glucocorticoid. In addition to PEX/PI and glucocorticoid, rituximab and/or immunosuppressants were administrated in 20 patients. The median follow-up time was 12 (1-57) months. The remission rate was 69.6%, while the relapse rate was 11.6%. The 2-year overall survival (OS) rate was 69.6%±5.5%. The univariate and multivariate analysis showed that relapsed/refractory disease was an independent risk factor for OS. The 2-year OS rate of relapsed/refractory patients was significantly lower than that of the rest patients (41.5%±9.8% vs. 83.7%±5.6%, P<0.001). Regarding the unfavorable prognosis in relapsed/refractory patients, rituximab and/or immunosuppressants are strongly recommended for sake of improving the overall survival.
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Objective:To explore the clinical characteristics, treatment and prognosis of myeloid sarcoma(MS).Methods:From January 2010 to May 2019, clinical data were reviewed for 89 MS cases. Age, gender, site of onset, type, comorbid diseases, lymphatic characteristics and disease remission status were analyzed. And 1-year survival rates were explored for different treatments including whether or not chemotherapy, transplantation and using hypomethylated drugs(HMAs)for maintenance after transplantation.Results:Among them, 21 cases had the data of chromosome karyotypic analysis and next generation sequencing and 8 patients underwent allogeneic hematopoietic stem cell transplantation(allo-HSCT). The 1-year overall survival rates(OS)of primary MS, MS with intramedullary disease and MS relapse after leukemic remission were 16.0%, 37.5% and 36.9% respectively( P=0.013). The 1-year OS of local treatment(surgical resection, intrathecal injection and local radiotherapy), chemotherapy plus local treatment and chemotherapy plus allo-HSCT was 0, 28.1% and 72.9% respectively( P=0.003). After two courses of treatment, the 1-year OS of patients with complete and incomplete remissions were 34.9% and 10.0% respectively( P=0.008). Half(4/8)MS patients relapsed within 1 year after transplantation and had a short survival.Three patients received decitabine after HSCT and all of them survived for a long time. Conclusions:Chemotherapy plus HSCT is efficacious for MS. Decitabine maintenance treatment after transplantation may prolong recurrence-free survival. However, a larger sample size is required for further clinical verifications.
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Objective:To compare the efficacy of haploid hematopoietic stem cell transplantation (haplo-HSCT) and intensive immunosuppressive therapy (IST) in children with severe aplastic anemia (SAA).Methods:The medical records of children newly diagnosed as SAA in the First Affiliated Hospital of Zhengzhou University from January 2013 to June 2018 were retrospectively analyzed.Among them, 33 patients received haplo-HSCT and 24 patients received IST that combined anti-thymocyte globulin(ATG) with Cyclosporine (CsA). The effective rate, overall survival (OS) rate, and failure free survival(FFS) rate of children in the haplo-HSCT group and the IST group were compared.Results:The median follow-up period was 25 months (9-60 months). There were 5 cases of early death in the haplo-HSCT group and 4 cases in the IST group, and the differences were not statistically significant ( P=0.822). Leaving out the early death cases, the effective rate in the haplo-HSCT group [100%(28/28 cases)] was higher than that in the IST group [30%(6/20 cases)] after 3 months of treatment, the difference was statistically significant ( χ2=27.671, P<0.01). After 6 months of treatment, the effective rate in the haplo-HSCT group [92.9%(26/28 cases)] was higher than that in the IST group [65.0%(13/20 cases)], and the difference was statistically significant ( χ2=5.943, P=0.015). After 12 months of treatment, the effective rate in the haplo-HSCT group [89.3%(25/28 cases)] was higher than that in the IST group [70.0%(14/20 cases)], but the difference was not statistically significant( P>0.05). The 3-year expected OS rate of children in the haplo-HSCT group and the IST group were 75.0% and 70.3%, respectively, with no statistically significant difference ( χ2=0.133, P=0.716). The 3-year expected FFS rate of children in the haplo-HSCT group (74.2%) was significantly higher than that in the IST group (48.7%), and the difference was statistically significant ( χ2=4.036, P=0.045). Conclusion:For children with SAA, haplo-HSCT is also an effective treatment if there is no sibling donor of hematopoietic stem cell transplantation.
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Objective:To compare the efficacy of the second generation tyrosine kinase inhibitor dasatinib combined with allogeneic hematopoietic stem cell transplantation(allo-HSCT)or chemotherapy in the treatment of Ph + acute lymphoblastic leukemia (Ph + ALL). Methods:A total of 56 Ph + ALL patients received dasatinib from January 2014 to June 2018. According to whether or not allo-HSCT was performed, they were divided into transplantation group(n=22)and chemotherapy group(n=34). The total survival rate(OS), disease-free survival rate(DFS), relapse and non-recurrence mortality(NRM)were compared between two groups. Results:The 2-year OS, DFS and cumulative recurrence rates were 69.1 % vs 47.8 %, 62.2 % vs 43.1 % and 14.6 % vs 44.1 % in transplantation and chemotherapy groups respectively. Significant inter-group differences existed in 2-year DFS, DFS and cumulative recurrence rates. The value of NRM was higher in transplantation group than that in chemotherapy group(18.6 % vs 14.1 %). However, the difference was statistically insignificant( P=0.476). Conclusions:The efficacy of dasatinib plus allo-HSCT is superior to that of dasatinib plus chemotherapy in the treatment of Ph + ALL.
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Objective@#To explore the clinical and laboratory characteristics and therapeutic effect of acute promyelocytic leukemia (APL) with t(2;17;15).@*Methods@#The G-banding technique was used for karyotypic analysis in a female patient with APL who was admitted to the First Affiliated Hospital of Zhengzhou University in December 2018. PML-RARα fusion gene was quickly detected by fluorescence in situ hybridization (FISH). The real-time quantitative polymerase chain reaction (RT-PCR) was used to detection 43 kinds of fusion gene, and the gene mutations were detected by next generation sequencing (NGS). The induction therapy was given with oral retinoic acid+ intravenous infusion of arsenic trioxide, followed by 3 courses of retinoic acid+ arsenic trioxide consolidation therapy.@*Results@#The G-banding karyotypic analysis demonstrated 46, XX, t(2;17;15) (q31;q21;q22)[8]/46, XX[2]. FISH results indicated that 62.0% of analyzed cells were positive for the PML-RARα fusion gene. RT-PCR further revealed the positive PML-RARα fusion gene transcript. NGS detection of gene mutations showed no obvious abnormalities. After 39 days of induction therapy with retinoic acid and arsenic trioxide, the patient achieved complete remission (CR). The karyotype was 46XX[20], and PML-RARα/ABL was 0/100. Then, the patient was treated with 3 courses of consolidation therapy, and the results remained in CR.@*Conclusions@#APL with complex t(2;17;15) (q31;q21;q22) is rare, and the morphological characteristics are not typical, but it is still associated with the formation of PML-RARα fusion gene. Retinoic acid+ arsenic trioxide has a good therapeutic effect, and the long-term efficacy still needs follow-up.
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Objective@#To investigate the clinical characteristics and prognostic factors in elderly patients with acute myeloid leukemia(AML).@*Methods@#Clinical data of 232 patients with acute myelocytic leukemia(AML, except for acute promyelocytic leukemia) admitted in our hospital from January 2012 to December 2015 were retrospectively analyzed.Factors affecting complete remission(CR) were analyzed by using χ2 test, and Kaplan-Meier survival analysis was conducted.Univariate and multivariate analysis of prognostic factors were performed by using Log-Rank test and Cox regression model respectively.@*Results@#Of 232 patients, 195 patients received induction chemotherapy, among whom 8 patients died in early phase, efficacy could not be evaluated in 25 cases, with 162 patients for final statistical study.The CR rate was 37.0%(60/162) after the first therapy course, and overall CR rate was 54.9%(89/162). Thirty-seven patients received palliative treatment, among whom 6 patients died in early phase and none achieved CR.Therefore, the 162 patients receiving an induction chemotherapy, whose efficacy can be evaluated, could be clinically analyzed.They were in 60-69 years old(χ2=4.102, P=0.043), with ECOG score≤2(χ2=9.917, P=0.002), NPM1+ FLT3-ITD-(χ2=6.423, P=0.038), favorable karyotypes(χ2=6.033, P=0.049), and related to a higher CR rate.The median overall survival(OS) was 205 days in the 232 patients.Univariate analysis results demonstrated that age(χ2=8.700, P=0.003), white blood cell(WBC) count≥100×109/L(χ2=4.249, P=0.039), karyotypes(χ2=4.807, P=0.028), palliative treatment(χ2=191.221, P=0.000) were influencing factors for the prognosis.Multivariable analysis showed that age(HR=0.464, 95%CI: 0.245-0.877, P=0.018), karyotypes(HR=3.618, 95%CI: 1.491-6.728, P=0.003) and whether or not to receive induction chemotherapy(HR=0.076, 95%CI: 0.030-0.194, P=0.000) were independent influencing factors for OS in elderly patients with AML.@*Conclusions@#The prognosis of elderly patients with AML is affected by multiple factors.Age, karyotypes and whether or not to receive induction chemotherapy are independent influencing factors for OS in elderly patients with AML.
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Objective To investigate the clinical characteristics and prognostic factors in elderly patients with acute myeloid leukemia(AML).Methods Clinical data of 232 patients with acute myelocytic leukemia(AML,except for acute promyelocytic leukemia) admitted in our hospital from January 2012 to December 2015 were retrospectively analyzed.Factors affecting complete remission (CR) were analyzed by using x2 test,and Kaplan-Meier survival analysis was conducted.Univariate and multivariate analysis of prognostic factors were performed by using Log-Rank test and Cox regression model respectively.Results Of 232 patients,195 patients received induction chemotherapy,among whom 8 patients died in early phase,efficacy could not be evaluated in 25 cases,with 162 patients for final statistical study.The CR rate was 37.0％ (60/162) after the first therapy course,and overall CR rate was 54.9％ (89/162).Thirty-seven patients received palliative treatment,among whom 6 patients died in early phase and none achieved CR.Therefore,the 162 patients receiving an induction chemotherapy,whose efficacy can be evaluated,could be clinically analyzed.They were in 60-69 years old (x2 =4.102,P =0.043),with ECOG score≤ 2 (x2 =9.917,P =0.002),NPM1 +FLT3-ITD-(x2 =6.423,P =0.038),favorable karyotypes(x2 =6.033,P =0.049),and related to a higher CR rate.The median overall survival(OS) was 205 days in the 232 patients.Univariate analysis results demonstrated that age(x2 =8.700,P =0.003),white blood cell (WBC) count ≥ 100 × 109/L (x2=4.249,P=0.039),karyotypes(x2=4.807,P=0.028),palliative treatment(x2 =191.221,P=0.000) were influencing factors for the prognosis.Multivariable analysis showed that age(HR =0.464,95％CI:0.245-0.877,P =0.018),karyotypes(HR =3.618,95％CI:1.491-6.728,P =0.003) and whether or not to receive induction chemotherapy (HR =0.076,95 ％ CI:0.030-0.194,P =0.000) were independent influencing factors for OS in elderly patients with AML.Conclusions The prognosis of elderly patients with AML is affected by multiple factors.Age,karyotypes and whether or not to receive induction chemotherapy are independent influencing factors for OS in elderly patients with AML.
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Objective To investigate the efficacy and safety of maintenance treatment with low-dose decitabine after allogeneic stem cell transplantation (allo-HSCT) for high-risk acute lymphoblastic leukemia (ALL). Methods The data of 10 patients with high-risk ALL who received maintenance therapy with low-dose decitabine after allo-HSCT in the First Affiliated Hospital of Zhengzhou University from July 2016 to March 2018 was collected. The incidence of post-transplant relapse and graft-versus-host disease (GVHD) and the safety of the treatment protocol were analyzed. The cumulative incidence of relapse (CIR) rate, disease-free survival (DFS) rate and overall survival (OS) rate were estimated by Kaplan-Meier method. Results Two patients relapsed and the median relapse time of these 10 patients was 575 days after transplantation. The 1-year CIR, OS and DSF rates were 16.7%, 100.0% and 83.3%, respectively. At the end of follow-up, the DFS time after transplantation of 2 patients with p53 mutation were 23 months and 11 months, respectively. There was no induction or alleviation of GVHD caused by decitabine treatment. Nine patients developed grade Ⅰ-Ⅱmyelosuppression. Three patients had unexplained thrombocytopenia after transplantation and their platelet counts recovered after decitabine treatment. Conclusion Maintenance therapy with low-dose decitabine has low hematologic toxicity without increasing GVHD, which could be a maintenance treatment option to prevent relapse after transplantation for patients with high-risk ALL.
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Objective To investigate the efficacy and safety of domestic bortezomibˉbased chemotherapy for patients with multiple myeloma (MM). Methods The clinical data of 60 MM patients treated with domestic bortezomibˉbased chemotherapy regimen (the observation group) in the First Affiliated Hospital of Zhengzhou University from April 2018 to October 2018 were retrospectively analyzed, which were compared with 112 MM patients treated with original treatment regimen (the control group) at the same hospital from November 2010 to November 2014. According to the disease stage, the patients were divided into newly diagnosed MM (NDMM) group and relapsed refractory MM (RRMM) group, and efficacy and adverse reactions of domestic bortezomib were evaluated. Results The total response rate (ORR) of the observation group was 71.7% (43/60), severe complete response (sCR) + complete response (CR) rate was 16.7% (10/60), very good partial response (VGPR) rate was 18.3% (11/60), and partial response (PR) rate was 36.7% (22/60). The ORR of NDMM group (45 cases) and RRMM group (15 cases) was 82.2% (37/45) and 40.0% (6/15), respectively, and the difference was statistically significant (χ2＝ 9.877, P < 0.05). There was no significant difference between ISS stage Ⅰ+Ⅱ and stage Ⅲ [ORR: 75.7% (28/37) vs. 65.2% (15/23), respectively; χ2＝0.764, P >0.05]. ORR and CR rates in the NDMM group and RRMM group of the observation group and the control group were not statistically different (all P>0.05). In the treatment of bortezomibˉbased chemotherapy, the common adverse reaction was peripheral neuropathy, mostly belonging to grade 1-2. Other side effects included hematocytopenia, gastrointestinal events and herpes zoster, which could be alleviated or restored to normality after supportive treatments. One patient died of pulmonary infection, respiratory failure and septic shock during the intermittent period of chemotherapy. Conclusion ORR of domestic bortezomibˉbased chemotherapy in treatment of the patients with MM is high, and the incidence of adverse reactions shows no significant increase compared with original drugs.
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Objective To investigate the expressions of CD28 and CD117 in patients with newly diagnosed multiple myeloma (MM) and their clinical significances. Methods The clinical data of 115 newly diagnosed MM patients in the First Affiliated Hospital of Zhengzhou University from May 2015 to December 2017 were retrospectively analyzed. The expressions of CD28 and CD117 were detected by using multiparameter flow cytometry. The relationship between the expressions of CD28 and CD117 and MM staging and clinical parameters was analyzed. The staging was performed according to the International Staging System (ISS). Results Among these 115 patients, there were 15 patients with CD117 positive and 30 patients with CD28 positive. Erythrocyte sedimentation rate (r ＝ -0.481, P ＝ 0.039), Cˉreactive protein level (r ＝ -0.314, P＝0.015), the proportion of plasma cells detected by bone marrow cytology (r＝-0.027, P＝0.001) were negatively correlated with CD117 positive expressions. CD28 positive expression was positively correlated with lactate dehydrogenase level (r ＝ 0.249, P ＝ 0.033) and ISS stage (r ＝ 0.319, P ＝ 0.017), while it was negatively correlated with hemoglobin level (r ＝ -0.372, P ＝ 0.026). CD28 positive was associated with light chain type, and nonˉsecretory type mostly occurred (P ＝ 0.016). The incidence of osteolytic lesions in CD28 positive group and CD117 positive group was high, but there was no statistical difference between CD28 positive group, CD117 positive group and CD28 negative group, CD117 negative group (P ＝ 0.052, P＝0.479). Conclusions The positive expression of CD117 in the early stage of MM patients is higher than that in the advanced stage, and the expression of CD28 positive in the advanced stage of MM patients is higher than that in the early stage. CD28 and CD117 can be used as indicators of prognosis stratification in the patients with newly diagnosed MM.
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Objective To observe the efficacy of maintenance treatment with decitabine and dasatinib after allogenic hematopoietic stem cell transplantation for myeloid sarcoma.Methods A 29-year-old male patient was diagnosed with abdominal myeloid sarcoma and acute myeloid leukemia with c-kit mutation and t(8;21).Allogeneic hematopoietic stem cell transplantation was performed after inducted remission.The conditioning regimen was decitabine + FLAG + modified Bu/Cy.Prophylaxis of GVHD was performed with cyclosporine mycophenolate mofetil and short-term methotrexate.The patient received 11.73 × 108 mononucleated cells/kg and 17.59 × 106CD34+ cells/kg from donor.At Day 13 post-transplantation,neutrophils reached 0.5 × 109/L and platelet count was 20 × 109/L.Decitabine was prescribed since Day 50 post-transplantation monthly for 5 courses.And dasatinib was offered orally since Day 100 for 4 months.Results It was followed up to 16 months post-transplantation.There were no obvious abnormalities of bone marrow cytology,AML/ETO fusion gene quantification,cerebrospinal fluid or abdominal enhanced computed tomography (CT).Conclusions Hematopoietic stem cell transplantation is an effective treatment for myeloid sarcoma.Decitabine has some efficacy for myeloid sarcoma and it may be used for maintenance treatment after transplantation.Tyrosine kinase inhibitors reduce recurrence in myeloid sarcoma with c-kit mutation.The treatment of decitabine and dasatinib after allogeneic hematopoietic stem cell transplantation yield excellent outcomes.This is the first report in domestic and foreign literatures.
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Objective To explore the efficacy and prognosis of haploidentical allogeneic hematopoietic stem cell transplantation (haplo-HSCT) for severe aplastic anemia (SAA).Methods The clinical data were retrospectively analyzed for 40 SAA cases undergoing haplo-HSCT from September 2013 to February 2018.The conditioning regimen contained cyclophosphamide,fludarabine and antithymocyte globulin with or without busulfan or low-dose total body irradiation.Cyclosporin A,short-term methotrexate and mycophenolate mofetil were dosed for preventing graft versus host disease (GVHD).The median counts of mononuclear cell and CD34+ stem cell were 5.3(2.0～13.5) × 108/kg and 5.6 (1.6 ～ 15.9) × 106/kg respectively.Results Among them,hematopoietic reconstitution was achieved (n =36,90.0 ％).The median times for myeloid engraftment and platelet engraftment were 15(10-25) and 17(10～58) days respectively.The incidence of acute graft-versushost disease(aGVHD)was (35.0± 6.8) ％.The incidence of chronic GVHD (cGVHD) was (23.0 ±7.4) ％.And 28 SAA cases (70.0 ％) survived during a median follow-up period of 353(30～1226)days,The cumulative overall survival (OS) was (67.8 ± 7.8) ％,the average survival time (883 ± 82)days and transplantation-related death (TRM) within 100 days (10.0 ± 3.1) ％.Conclusions Haplo-HSCT is an effective treatment for SAA patients.And a larger number of cases are required for enhancing OS.
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Objective To investigate the clinical features and prognosis of patients with acute leukemia (AL) in pregnancy.Methods The clinical data of 39 cases of acute leukemia in pregnancy at the First Affiliated Hospital of Zhengzhou University from January 2010 to April 2017 were collected.The clinical characteristics and prognosis were analyzed retrospectively.Results Except one case diagnosed before pregnancy,the incidence rates of AL in early,middle and late stage of pregnancy were 23.7 ％ (9/38),52.6 ％ (20/38) and 23.7 ％ (9/38),respectively.31 patients received chemotherapy and the complete response (CR) rates of AL patients in early,middle and late stage of pregnancy were 71.4 ％ (5/7),94.1％ (16/17),and 100.0 ％ (7/7),respectively.Among all the cases,31 patients received a miscarriage or induction of labor,and 8 cases had live births delivered by cesarean section.Twenty-two patients had abnormal karyotypes,which was mainly related to specific chromosomal rearrangement.Acute myeloid leukemia (AML) patients expressed high levels of CD117,CD13,CD33,and CD38,and acute lymphoblastic leukemia (ALL) patients had high expression of CD19,CD38,CD22,cCD79a,and CD58.After induction therapy,10 cases got positive minimal residual disease (MRD),7 of which achieved CR.After that,4 cases recurred,and 7 cases died in total.On the other hand,all the 19 MRD-negative patients achieved CR.Then,5 cases recurred,and 9 cases died intotal.In all patients,29 were AML while the other 10 were ALL,the CR rates in AML and ALL were 95.7 ％ (22/23) and 75.0 ％ (6/8),and the 1-year and 2-year survival rate were 53.1％ and 26.4 ％,respectively.The survival rate of AML patients was higher than that of ALL patients.Conclusions The clinical characteristics of AL patients in pregnancy are complicated and comprehensive treatment is needed.MDR is an important indicator of prognosis,and the prognosis of ALL is worse than that of AML.
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Objective To investigate the effect of postremission consolidation therapy with intermedium-dose cytarabine (MDAC) in elderly patients with acute myelogenous leukemia (AML). Methods Clinical data of 61 elderly AML patients (except M3) in postremission who achieved complete remission (CR) in two period of remission induction program were retrospectively analyzed. Results There were 26 cases in MDAC group and 35 cases in standard-dose cytarabine (SDAC) group. In MDAC group and SDAC group, the relapse free survival (RFS) time were 42.7 months and 16.0 months respectively (P= 0.002), the overall survival (OS) time were 44.6 months and 18.2 months respectively (P= 0.004), and the cumulative relapse frequencies rates were 26.9 % (7/26) and 54.3 % (19/35) respectively (x 2= 4.567, P= 0.033). However, 3 years OS rate of the two groups were 23.1%(6/26) and 8.6%(3/35) (x 2=2.496, P=0.114) , and there was no significant difference in the incidence of adverse reactions between the two groups (all P > 0.05). Conclusion MDAC could improve RFS and OS for the elderly AML patients in postremission who received CR in the early stage, and the incidence of adverse reactions is similar to that of SDAC.
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Objective To analyze the clinical features and prognosis of CD34-positive and CD34-negative adult patients with acute T-lymphoblastic leukemia (T-ALL),and to explore the value of CD34 expression for prognosis of patients with T-ALL.Methods 75 adult patients diagnosed with T-ALL from January 2012 to July 2015 in the Department of Hematology,the First Affiliated Hospital of Zhengzhou University,were analyzed retrospectively.According to the expression of CD34,the patients were divided into CD34-positive group and CD34-negative group,and then the clinical characteristics and prognosis of both groups were analyzed.Results In 75 patients,CD34-positive group had 24 (32.0 ％) patients and CD34-negative group had 51 (68.0 ％) patients.Between the two groups,there was no significant difference in these factors,such as sex,age,infiltration of liver,spleen and lymph nodes,thrombocytopenia,high white blood cell count,abnormal karyotype,complete remission within 4 weeks and central nervous system leukemia (CNSL).The proportions of patients with hemoglobin (Hb) ＜ 90 g/L and expression of myeloid lineage marker were higher in the CD34-positive group than those in the CD34-negative group (x2 =5.888,P=0.015;x2 =10.758,P =0.001,respectively).There were only 18 patients treated with hematopoietic stem cell transplantation (HSCT),57 patients were not.In patients without HSCT,the median survival time in the CD34-positive group and CD34-negative group was significant different (5 months vs.32 months,x2 =9.172,P =0.002).Conclusions CD34 expression in adult patients with T-ALL appears to be associated with Hb ＜ 90 g/L and the expression of myeloid lineage markers.For the patients without HSCT,CD34 is likely negatively related with the prognosis.
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Objective To analyze the clinical characteristics and prognostic factors of elderly patients with cytogenetically normal acute myeloid leukemia (CN-AML). Methods A total of 104 initial CN-AML patients were enrolled in this retrospective study. The clinical characteristics were collected and analyzed retrospectively. Factors affecting complete remission (CR) were analyzed by using chi square test. Univariate and multivariate analyses of prognostic factors were performed by using Kaplan-Meier and Cox hazard regression model respectively. Results After the first chemotherapy, 72 of 104 patients were able to be evaluated the efficacy, the CR rate was 38.9%(28/72) and total response rate was 55.6%(40/72). The white cell count<100 × 109/L and NPM1 mutation were related to a higher CR rate [59.4%(38/64) vs. 12.5%(1/8), 83.3%(10/12) vs. 36.4%(8/22), P<0.05]. Among 104 patients, the median overall survival (OS) was 6.9 months. Univariate analysis results demonstrated that age≥70 years, secondary AML, white cell count≥100×109/L, FLT3-ITD mutation, CD7 expression, achieving CR beyond 2 cycles of induction therapy and CCI score≥2 were influence factors on OS. In multivariable analysis, FLT3-ITD mutation (HR=7.61, 95%CI 1.80-32.11, P= 0.006) and achieving CR beyond 2 cycles of induction therapy (HR= 10.11, 95 % CI 2.38-43.03, P=0.002) were independent prognostic factors for OS in elderly patients with CN-AML. Conclusion The prognosis of elderly patients with CN-AML is the result of the combined effect of many factors, FLT3-ITD mutation and achieving CR beyond 2 cycles of induction therapy are independent prognostic factors in elderly patients with CN-AML.
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BACKGROUND:Cytokine induced kil er cells therapy as an effective means of adoptive immunotherapy, becomes a new way to treat acute myeloid leukemia. But, the researches about sequential cytokine induced kil er cells therapy after autologous peripheral blood stem celltransplantation in acute myeloid leukemia patients are stil less, which deserve further research. OBJECTIVE:To observe the clinical efficiency and safety of sequential cytokine induced kil er cells therapy after autologous peripheral blood stem celltransplantation in acute myeloid leukemia M2 patients. METHODS:Total y 45 patients with low-or intermediate-risk acute myeloid leukemia M2 were recruited in this study. Among them, 19 patients received sequential cytokine induced kil er cells therapy after autologous peripheral blood stem celltransplantation and 26 patients only received autologous peripheral blood stem celltransplantation. The relapse rate, disease-free survival, and overal survival were compared between two groups, and safety of cytokine induced kil er cells therapy was observed. RESULTS AND CONCLUSION:(1) Compared with the patients only receiving autologous peripheral blood stem celltransplantation, the relapse rate was lower (21.05%vs. 38.46%;P<0.05), and elevated percentages of the disease-free survival and overal survival were observed in the patients receiving sequential cytokine induced kil er cells therapy after autologous peripheral blood stem celltransplantation (P<0.05). (2) The 19 patients who received sequential cytokine induced kil er cells therapy after autologous peripheral blood stem celltransplantation al completed the treatment scheme successful y. Only four patients appeared to have chil s and fever, and no more side effects were observed. These findings suggested that the sequential cytokine induced kil er cells therapy after autologous peripheral blood stem celltransplantation can improve the disease-free survival and overal survival of low-or intermediate-risk acute myeloid leukemia M2 patients without remarkable side effects, which is a safe, effective and feasible way for the treatment of acute myeloid leukemia M2.
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Objective To observe curative effect and clinical outcome in 30 recipients undergoing allogcneic peripheral blood stem cell transplantation (PBSCT) combined with bone marrow transplantation (BMT). Methods 30 patients with a median age of 32.6 years underwent allo-HSCT, of which 11 patients with AML, 14 patients with ALL, and 5 patients with CML They all have a HLA-identical sibling. PBSCswere mobilized with G-CSF. Three hundreds milliliter bone marrow blood was transplanted to the patients on the day that the PBSC was transplanted. Amended Bu/Cy was used as the conditioning regimen. MTXcombined with CsA and MMF was used as GVHD prophylaxis. Results A median number of mononuclear cells of (5.13±2.6)x10~8/kg recipient's weight was collccted from peripheral blood, and (1.3±0.6)x10~8/kgrecipient' s weight from bone marrow blood. Engraftment of neutrophils and platelets was achieved at a median of (12.1±3.25) days and (14±5.33) clays respectively. Ⅰ - Ⅱ acute GVHD occurred in 40.0 % cases,Ⅲ - Ⅳ acute GVHD occurred in 3.3 % cases, and chronic GVHD developed in 43.3 % cases. Severe cGVHD developed in 3.3% cases. The 2 years disease free survival rate (DFS) by the day of transplantation was 72.0 %. Conclusion PBSCT combined with BMT was effective to cure leukemia. The results also suggested that PBSC recipients had an lower incidence of aGVHD and cGVHD as compared with previous reports.
ABSTRACT
BACKGROUND:The prognosis of malignant hematologic diseases has improved greatly with the application of the hematopoietic stem cell transplantation. Peripheral blood stem cell transplantation (PBSCT) has been used as an alternative to bone marrow transplantation (BMT).OBJECTIVE:To observe curative effect and clinical outcome in 53 patients with hematological malignancy undergoing allogeneic peripheral blood stem cell transplantation (allo-PBSCT) or autologous peripheral blood stem cell transplantation (auto-PBSCT).DESIGN:Randomized controlled study.SETTING:BMT Center, Hematology Department of the First Affiliated Hospital of Zhengzhou University.PARTICIPANTS:From July 2003 to May 2006, 53 patients (33 males and 20 females) with a median age of 37 years underwent PBSCT. Thirty-five patients received allo-PBSCT, including 13 of acute myelocytic leukemia (AML), 7 of acute lymphocytic leukemia (ALL), 10 of chronic myelocytic leukemia (CML), 2 of multiple myeloma (MM), and 3 of myelodysplastic syndrome (MDS). Eighteen patients underwent auto-PBSCT, including 7 AML, 6 ALL, 2 MM, and 3 non-Hodgkin lymphoma (NHL). Thirty-three donors (20 males and 13 females) with a median age of 35 age in the allo-PBSCT were HLA-identical siblings, 2 donors (5.7%) had one mismatch. Sixteen allografts were sex mismatched. Study was authorized by the Ethic committee of the hospital, and all patients had signed an inform consent.METHODS:① PBSC were mobilized with granulocyte colony-stimulating factor (G-CSF) or chemotherapy combined with G-CSF. A median of 6.2×106 CD34+ cells/kg was infused for allo-PBSCT and 3.0×106 CD34+ cells/kg was infused for auto-PBSCT. Amended BU/CY was used as conditioning regimen in allo-PBSCT and MAC was used in auto-PBSCT. Methotrexate (MTX) combined with cyclosporine A (CsA) and mycophenolate mofetil (MMF) was used as graft-versus-host disease (GVHD) prophylaxis. ALG was used in 1 patient with 1 locus mismatched in allo-PBSCT. ② Time to engraftment was calculated from the time of transplantation to neutrophil recovery ≥ 0.5×109 L-1 and platelet recovery ≥ 20×109 L-1, GVHD and relapse were observed until 1 year of follow-up.MAIN OUTCOME MEASURES:① Time to neutrophil and platelet recovery; ② GVHD occurrence after transplantation; ③ outcome of treatment.RESULTS:All the 53 patients were analyzed. ① Engraftment of neutrophils (> 0.5×109 L-1) and platelets (> 20×109 L-1) was achieved at a median of 13 days for neutrophils and 19 days for platelets in auto-PBSCT, and 12 days and 15 days respectively in allo-PBSCT. ② In allo-PBSCT, I-VI acute GVHD occurred in 31.4% cases, and chronic GVHD developed in 71.4% cases. ③ The relapse rate was 38.9% in auto-PBSCT, and 5.7% in allo-PBSCT. CONCLUSION:PBSCT can provide rapid hematopoietic reconstitution. It is an important method to cure the malignant hematologic diseases.