ABSTRACT
Introducción: El mieloma múltiple es una neoplasia maligna de células B caracterizada por una proliferación clonal incontrolada de células plasmáticas. Se define como mortalidad precoz en el mieloma múltiple de nuevo diagnóstico, al porcentaje de muerte que ocurre dentro de los primeros seis meses y afecta entre el 10 y 14 % de los casos. Los biomarcadores han evolucionado desde la caracterización del tumor hasta el reconocimiento de las aberraciones cromosómicas y moleculares que desempeñan un papel en la supervivencia. Objetivo: Describir los principales predictores identificados con relación a la mortalidad precoz y su función en la patogénesis de la enfermedad. Métodos: Se analizó la literatura científica publicada. Se utilizaron motores de búsqueda como Google Scholar, PubMed y ScienceDirect. Se consultaron un total de 80 artículos y se incluyeron 52, en su mayoría de los últimos cinco años. Análisis y síntesis de la información: Se evidenciaron mecanismos genéticos y epigenéticos que contribuyen de manera decisiva en la mortalidad precoz de pacientes con mieloma múltiple de nuevo diagnóstico. Conclusiones: El aumento del riesgo de mortalidad precoz en pacientes con mieloma múltiple de nuevo diagnóstico está asociado a factores clínicos y biológicos, por lo que existe la necesidad de estratificación de los pacientes para un manejo personalizado que impone el uso de datos clínicos y biológicos de una forma integrada.
Introduction: Multiple Myeloma is a malignant B-cell neoplasm characterized by uncontrolled clonal proliferation of plasma cells. Early mortality in newly diagnosed Multiple Mieloma is defined as the percentage of death that occurs six months or less after diagnosis and, it affects 10 to 14 % of the cases. Biomarkers have evolved from the characterization of tumor to the recognition of chromosomal and molecular aberrations that play a rol in survival. Objective: To describe the main predictors identified related to early mortality and their role in the pathogenesis of the disease. Methods: The scientific literature was analyzed using search engines such as Google Scholar, PubMed and ScienceDirect. Consulted articles were 80 and included articles were 52, mostly from the last five years. Analysis and information synthesis: Genetic and epigenetic mechanisms that contribute decisively in the early mortality in new diagnosis Multiple Myeloma patients were evidenced. Conclusions: The increased risk of early mortality in patients with newly diagnosed Multiple Myeloma is associated with clinical and biological factors and there is a need to stratify patients in terms of early mortality risk for personalized management, for which it is imposed the use of clinics and biological data in an integrative way.
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HumansABSTRACT
Objective To explore the clinical efficacy of decitabine combined with HAG or HAG-like regimen for newly diagnosed and relapsed/refractory acute myeloid leukemia (AML) patients.Methods Thirty-one newly diagnosed (18 cases) and relapsed/refractory (13 cases) AML patients receiving decitabine combined with HAG or HAG-like regimen in Yinzhou Hospital Affiliated to Medical School of Ningbo University from January 2014 to December 2017 were analyzed retrospectively.Results The outcome of 18 newly diagnosed AML patients showed that the overall response rate (ORR) was 77.8 ％ (14/18),including 13 patients achieved complete response (CR) / CR with incomplete blood count recovery (CRi),and the 1-year overall survival (OS) rate was 39.2 ％,the l-year disease free survival (DFS) rate was 32.5 ％.The outcome of 13 relapsed/refractory AML patients showed that the ORR was 53.8 ％ (7/13),including 6 patients achieved CR/CRi,and the 1-year OS rate was 22.4 ％,the 1-year DFS rate was 7.7 ％.Eleven patients were transformed from myelodysplastic syndromes (MDS),the ORR was 90.9 ％ (10/11),including 9 patients achieved CR/CRi,and the 1-year OS and DFS rates were 63.8 ％ and 37.5 ％ respectively.The main adverse events of infection and bleeding were caused by myelosuppression,and non-hematological toxicity included gastrointestinal and liver dysfunction.After the anti-infection and supportive treatment,all 31 patients were safely through bone marrow suppression,with no treatment-related deaths.Conclusions Decitabine combined with HAG or HAG-like regimen is an effective and safe treatment strategy for hypoplastic newly diagnosed and relapsed/refractory AML patients.It is produced relatively higher curative effect for AML patients with MDS transformation.
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Objective To investigate the features of lipid ratios in patients with newly diagnosed T2DM, and the effects of intensive insulin treatment on them. Methods 90 patients with newly diagnosed T2DM and 58 matched people with normal glucose were enrolled to assess height,weight,waist circumference,blood glucose and lipid profiles. BMI,TC/HDL-C,TG/HDL-C,log(TG/HDL-C),LDL-C/HDL-C,HOMA-B and HOMA-IR were calculated respectively. All the patients received the continuous subcutaneous insulin infusion with insulin pump. The treatment continued for more 10~14 days after blood glucose reached the standard. All the above indi-cators were reexamined after treatment. Results Dyslipidemia in patients with newly diagnosed T2DM mainly showed as hypertriglyceridemia and decreased HDL-C compared to the control group(P<0.05). TC/HDL-C,TG/HDL-C,log(TG/HDL-C)and LDL-C/HDL-C significantly increased in these patients(P<0.01). After short-term intensive insulin therapy,all lipid ratios were significantly decreased and the changes of lipid ratios were positively correlated with the change of HOMA-IR(P<0.05). Conclusion Short-term intensive insulin therapy for patients with newly diagnosed type 2 diabetes can significantly lower the lipid ratios related to HDL-C. The effects may be closely related to improvement of insulin resistance.
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Objective To analyze the efficacy and safety of glimepiride treatment as initial monotherapy in newly diagnosed patients with type 2 diabetes mellitus (T2DM).Methods This was a subgroup analysis of the GREAT study,which investigated the efficacy and safety of glimepiride as initial monotherapy in Chinese patients with T2DM.This analysis was performed in 209 patients with disease duration less than 6 months and never received any anti-diabetic drugs.The change of HbA1C,fasting plasm glucose (FPG),2 h postprandial blood glucose (2hPPG),homeostasis model assessment for β-cell function index (HOMA-β),homeostasis model assessment for insulin-resistance index(HOMA-IR),the percentage of patients with HbA1C ＜ 7.0％ at endpoint and the incidence of hypoglycemia were evaluated after 16-weeks treatment.Results After 16-weeks glimepiride treatment,HbA1C value reduced significantly from baseline to endpoint,the reduction was statistically significant (9.21％ ± 1.65％ to 6.69％±0.83％,P＜0.001),69.7％ of the patients achieved HbA1C ＜7.0％ at study endpoint.Glimepiride-treated patients also achieved a significant improvement in FPG [from (10.15 ± 2.13) mmol/L to (7.23 ± 1.50) mmol/L,P＜0.001] and 2hPPG [from (17.21 ±4.14) mmol/L to (11.62 ± 3.34) mmol/L].HOMA-β was improved from 17.21± 15.19 [11.62 (2.90,115.8)] to 41.13 ± 44.12 [28.00 (5.1,360.00)],and HOMA-IR was reduced from 2.32± 1.90 [1.76 (0.60,12.80)] to 2.07 ± 1.74 [1.63 (0.4,12.3)].The incidence of all reported symptomatic hypoglycemia was 18.2％,and the incidence of confirmed hypoglycemia was 3.8％.Conclusion This analysis showed that glimepiride treatment as an initial mono-therapy could effectively improve blood glucose control in newly diagnosed patients with T2DM,and the treatment may improve islet β cell function,and the safety profile is reasonably good.