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Objective:To explore the risk factors of bortezomib-related peripheral neuropathy (BIPN) and the clinical and electrophysiological characteristics of patients in treatment of multiple myeloma (MM).Methods:The clinical data of 71 newly diagnosed MM patients treated with BD (bortezomib + dexamethasone) regimen in Yancheng First People's Hospital from March 2016 to December 2019 were retrospectively analyzed. The bone marrow morphology, immunology, cytogenetics, molecular biology (MICM), routine electrophysiological examination before and after treatment were performed. All patients were divided into the peripheral neuropathy (PN) group and the non-PN group according to the presence or not of BIPN, and the clinicopathological differences of both groups were also compared; a binary logistic regression model was used to analyze the factors affecting the occurrence of PN. The electrophysiological characteristics were summarized and fluorescence in situ hybridization (FISH) was used to detect karyotype of BIPN patients.Results:Among 71 MM patients, there were 40 cases (56.3%) of PN and 31 cases (43.7%) of non-PN. The proportion of patients at international staging system (ISS) staging Ⅲ, and the levels of IgA, IgG, IgM, serum creatinine, β 2-microglobulin (β 2-MG) in the PN group were higher than those in the non-PN group, and hemoglobin (Hb) level in the PN group was lower than that in the non-PN group, and the differences were statistically significant (both P < 0.05). Binary logistic regression analysis showed that increased IgA ( OR = 1.151, 95% CI 1.012-1.309, P = 0.033), increased IgG ( OR = 1.055, 95% CI 1.000~1.112, P = 0.049), increased IgM ( OR = 1.010, 95% CI 1.001-1.018, P = 0.022), increased serum creatinine ( OR = 1.037, 95% CI 1.011~1.065, P = 0.005), increased β 2-MG ( OR = 1.564, 95% CI 1.039-2.354, P = 0.032) were risk factors for BIPN. Among 40 patients with BIPN, 33 cases (82.5%) of sensory nerve conduction velocity (SCV) were abnormal, 23 cases (57.5%) of motor nerve conduction velocity (MCV) were abnormal; 31 cases (77.5%) showed demyelination damage, 9 cases (22.5%) had axonal damage. Among 40 patients with BIPN, 24 cases underwent FISH detection, including 19 cases (79.2%) with chromosomal mutations, of which 12 cases (50.0%) were mixed subtype abnormal. Conclusions:MM patients with high levels of β 2-MG, IgA, IgG, IgM and serum creatinine are more prone to PN when treated with bortezomib. The electrophysiology of patients with BIPN is mainly characterized by demyelination of sensory nerves.
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Objective:To investigate the expression of Toll-like receptor 8 (TLR8) in diffuse large B-cell lymphoma (DLBCL) and its correlation with clinicopathological characteristics and prognosis of patients.Methods:The data in the Oncomine database was used to analyze the difference of TLR8 mRNA expression between DLBCL tumor tissues and normal lymphocytes, and the result was verified in two independent subsets GSE 25638 and GSE 32018 of the NCBI-GEO database. The OSDLBCL online survival analysis tool was used to analyze the correlation of TLR8 mRNA relative expression level with overall survival (OS) and progression-free survival (PFS) of DLBCL patients. Gene ontology bioprocess (GO_BP) enrichment analysis was performed by using GSEA software. The correlation of TLR8 mRNA expression with tumor immune cell infiltration degree and immune checkpoint-related molecule expression was analyzed by TIMER online tool website. A total of 53 DLBCL patients who underwent lymph node biopsy in Yancheng No. 1 People's Hospital from June 2020 to June 2021 were selected. Immunohistochemistry was used to detect the expression of TLR8 protein, and its relationship with the clinicopathological characteristics of patients was analyzed.Results:The analysis result of data from Oncomine and GEO databases showed that the relative expression levels of TLR8 mRNA in tumor tissues of patients with DLBCL or activated B cell-like DLCBL were higher than those in normal lymphocytes (all P < 0.001). The results of OSDLBCL online survival analysis indicated that the OS ( P = 0.020) and PFS ( P = 0.004) in DLBCL patients with high TLR8 mRNA expression were worse than those in patients with low TLR8 mRNA expression. The level of TLR8 was related to the abnormal function of immune response, cytokine metabolism and DNA damage monitoring; the result of TIMER online analysis showed that the expression level of TLR8 mRNA was positively related to the degree of neutrophil infiltration ( r = 0.78, P < 0.001) and the expression of immunosuppressive molecules [HAVCR2 ( r = 0.85, P < 0.001), LAG3 ( r = 0.63, P < 0.001), CD274 ( r = 0.77, P < 0.001), TIGIT ( r = 0.32, P = 0.037), and C10ORF54 ( r = 0.34, P = 0.029)]. Among 53 DLBCL patients, 29 patients (54.7%) had low expression of TLR8 protein and 24 patients (45.3%) had high expression of TLR8 protein. There were statistical differences in the expressions of TLR8 protein in DLBCL patients with different serum lactate dehydrogenase and β 2-microglobulin levels (both P < 0.05). Conclusions:TLR8 is highly expressed in DLBCL patients, and TLR8 may be a prognostic marker of DLBCL.
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Objective:To investigate the familial inheritances, clinical features, treatments and outcomes of familial Waldenstrom macroglobulinemia (WM) patients.Methods:The clinical manifestations, laboratory examinations, diagnosis and treatments, and follow-up data of 6 familial WM patients who were admitted to Yancheng No.1 People's Hospital from June 2002 to July 2019 were retrospectively analyzed, and the literature was reviewed.Results:Among 6 WM patients, 4 patients had dizziness and fatigue at the onset, 1 patient had recurrent low-grade fever and abnormal sweating as the first manifestations, 1 patient was hospitalized due to pulmonary infection, and WM was found later. Two brothers of the patients were diagnosed with WM, another 2 brothers of the patients had IgM-type monoclonal gammopathy of undetermined significance (MGUS) during the physical examination. All the 6 patients were middle-aged/elderly men, with a median age of 63 years old (51-70 years old). The median follow-up time were 71.5 months (4-217 months), and by the end of the follow-up (June 2020), 2 cases died of pulmonary infection, and 1 of them developed acute myeloid leukemia; the other 4 cases were in regular chemotherapy. Two IgM-MGUS patients were followed up without symptoms.Conclusions:WM patients have familial aggregation, and their clinical manifestations are highly heterogeneous. Patients with family history may have poor prognosis. It is necessary to strengthen the awareness of WM and family history screening.
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Objective:To explore the prognostic value of lymphocyte subsets in adult hemophagocytic syndrome (HPS).Methods:A total of 172 adult HPS patients diagnosed in 8 medical centers from January 2013 to August 2020 were selected for the study, of whom 87 were male (50.6%, 87/172), and 85 were female (49.4%, 85/172), with 68 survivors and 104 deaths. The clinical data were summarized, and variables such as lymphocyte subsets, immunoglobulin characteristics and fibrinogen were retrospectively analyzed, and the correlation between the mentioned variables and patient prognosis was analyzed. The optimal cut-off values of continuous variables were calculated by MaxStat, and the prognostic factors of HPS patients were screened based on the Cox proportional hazard regression model.Results:The median age of HPS patients was 56 (42, 66) years old, and the 5-year cumulative survival rate was 37.4% (37.4/100). The median age, platelet and albumin were 48 (27, 63) years, 84×10 9/L and 32.3 g/L in the survival group, and 59 years, 45.5×10 9/L, and 27.3 g/L in the death group, respectively. The differences between the two groups was statistically significant ( Z=?3.368, P=0.001; Z=?3.156, P=0.002; Z=?3.431, P=0.001). Patients with differentiated cluster 8+(CD8+)<11.1%, CD3+<64.9%, CD4+>51%, and CD4/CD8 ratio>2.18 had poor prognosis (χ 2=7.498, P=0.023; χ 2=4.169, P=0.041; χ 2=4.316, P=0.038; χ 2=9.372, P=0.002). Multivariable analysis showed that CD4/CD8 ratio, age, fibrinogen and hemoglobin were independent prognostic factors in HPS patients ( HR=2.435, P=0.027; HR=5.790, P<0.001; HR=0.432, P=0.018; HR=0.427, P=0.018). Conclusion:Peripheral blood lymphocyte subsets can be used to evaluate the prognosis of patients with HPS; CD4/CD8 ratio, age, fibrinogen, and hemoglobin are independent prognostic factors in HPS patients.
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Objective:To explore the prognostic influencing factors of adult lymphoma-associated hemophagocytic syndrome (LAHS) based on multicenter data.Methods:The clinical data of 86 LAHS patients diagnosed in 9 medical centers of Huaihai Lymphoma Working Group from January 2015 to August 2020 were retrospectively analyzed. The optimal cut-off value of continuous variables was obtained based on MaxStat algorithm. Cox proportional hazard regression model was used for univariate and multivariate analyses. Kaplan-Meier method was used for survival analysis, and log-rank test was performed.Results:Among the 86 adult LAHS patients, 50 (58.1%) were males and 36 (41.9%) were females, the median age of the patients was 57 years old (19-76 years old), and the median overall survival (OS) time was 1.67 months (95% CI 0.09- 3.24 months). The most common pathologic type was diffuse large B-cell lymphoma (58 cases, 67.44%). Based on MaxStat algorithm, the optimal cut-off values of age, albumin, serum creatinine, lactate dehydrogenase, fibrinogen and platelet count were 64 years old, 30.1 g/L, 67 μmol/L, 1 045 U/L, 4.58 g/L and 72×10 9/L, respectively. Multivariate analysis showed that patient's age, lactate dehydrogenase, albumin and fibrinogen levels were independent influencing factors for OS (all P < 0.05). Conclusions:LAHS is dangerous and progresses quickly. Patients with age ≥ 64 years old, lactate dehydrogenase ≥ 1 045 U/L, fibrinogen ≥ 4.58 g/L and albumin < 30.1 g/L have poor survival.
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Objective:To analyze the feasibility of surgical therapy and the risk factors affecting prognosis for patients with abdominal aortic aneurysms in Tibetan plateau.Methods:Data of 48 abdominal aortic aneurysm cases were retrospectively analyzed at our hospital from Jun 2013 to Dec 2017.Results:Five cases received conservative treatment for suspected rupture of abdominal aortic aneurysm and all died. Eight cases left hospital without treatment, among them 5 cases died for rupture of abdominal aortic aneurysm.Thirty-five patients had abdominal aortic aneurysm resection and artificial vascular reconstruction. Successful rate was 100%. Perioperative complications developed in 5.7% patients; blood transfusion rate was 11.4%, there were non-perioperative death. Single-factor regression analysis showed that chronic altitude erythrocytosis as an independent risk factor with poor surgical prognosis ( P<0.05). Conclusion:Even in Tibet plateau, traditional surgery is a safe and effective method for treating abdominal aortic aneurysms. Chronic altitude erythrocytosis is an independent risk factor for poor surgical prognosis.
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Objective:To analyze the relevant risk factors for restenosis after percutaneous transluminal angioplasty of patients with Takayasu′s arteritis.Methods:Clinical data of 43 patients undergoing percutaneous angioplasty due to Takayasu arteritis were retrospectively analyzed. Univariate and multivariate Logistic regression analysis was used to explore the relevant risk factors for restenosis after percutaneous transluminal angioplasty.Results:There were 9 males and 34 females. The mean age was 23 (18-33) years old, 59 times of PTA were performed, including 44 in renal artery, 9 in aorta, 2 in iliac and 2 in carotid artery, 1 in brachiocephalic trunk and 1 in left subclavian artery. The mean follow up time was (64±42) months. The rate of restenosis was 47.5%(28/59)and the mean time of restenosis was (23±27) months. The restenosis rate of aorta and iliac artery was 9.1%, that of renal artery was 52.3% and that of supra aortic artery was 100% . The rate of restenosis was higher in patients with symptoms of headache, syncope and low back pain, the elevated ESR and CRP increased the risk of restenosis (all P<0.05). Multivariate Logistic analysis showed that preoperative elevation of ESR and CRP were risk factors for restenosis after percutaneous angioplasty for Takayasu arteritis. Conclusions:PTA was safe and effective in Takayasu arteritis involving aorta-iliac and renal artery, the elevated ESR and CRP was related to high risk of restenosis.
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Objective@#To study the clinicopathological features and therapeutic regimens of primary testicular lymphoma (PTL).@*Methods@#The clinical data of 16 patients diagnosed with PTL from January 2005 to December 2015 in Jiangsu Province Hospital were collected, and the clinicopathological characteristics were retrospectively analyzed. Kaplan-Meier method was used to make the survival analysis.@*Results@#The median onset age of 16 patients was 63 years old (33-81 years old). According to Ann Arbor stage, there were 8 cases of stage ⅠE, 2 cases of stage ⅡE, 6 cases of stage Ⅲ-Ⅳ. The initial symptoms included painless solid enlargement of the testis (9 cases), painful testis (3 cases), distending pain of testis (1 case), and the patients had no other systemic symptoms. The pathological type was diffuse large B-cell lymphoma (DLBCL), of which 2 patients were germinal center B-cell (GCB) type and the other 14 patients were non-GCB type. All the patients received the orchiectomy, of which 14 received chemotherapy alone after the operation, 2 received chemotherapy and radiotherapy. Complete follow-up data were available for 14 patients, and the median follow-up time was 23.5 months (1.0-97.0 months). Among 14 patients, complete remission was achieved in 11 patients, partial remission in 1 patient, no response in 1 patient, and 1 patient was undergoing treatment. Among 11 patients with complete remission, 5 patients relapsed, and the recurrence occurred at the central nervous system (3 cases), skin of right lower extremity (1 case), and contralateral testis (1 case). The mean progression-free survival (PFS) time was 19.0 months (14.0-95.0 months).@*Conclusions@#Most PTL is primary testis DLBCL, and the comprehensive treatment based on surgery is the main therapy of PTL. Postoperative chemotherapy with or without radiotherapy is recommended to prevent relapse.
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Primary testicular lymphoma (PTL) is a rare extranodal non-Hodgkin lymphoma (NHL), accounting for 1%-2% of NHL. The most common pathological type is diffuse large B-cell lymphoma, while some rare pathologic subtypes are mantle cell lymphoma, NK/T cell lymphomas, and other T cell lymphomas. The typical clinical manifestations are unilateral and painless testicular swelling with several weeks to months. Due to relapse in central nervous system (CNS) or contralateral testicle, PTL has a very poor prognosis. Thus, it is necessary for the combination therapy (orchiectomy + chemotherapy with anthracycline-containing regimen + testicle and involved field radiotherapy + CNS prophylaxis). This review discusses some controversial issues including the prognostic markers of PTL, the choice of rituximab immunotherapy, the therapeutic value of radiotherapy, and the best strategy for preventing the relapse of CNS.
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c-Met is one member of the receptor tyrosine kinases (RTKs).It is closely related between the over-expression of c-Met and a wide variety of tumor occurrence, development, invasion, metastasis, prognosis and drug resistance.Therefore, c-Met is a potential target for oncotherapy, and researches on its inhibitors have become a hot spot in the field of tumor treatment.Aptamers targeting c-Met are gained from systematic evolution of ligands by exponential enrichment (SELEX).They can bind to c-Met with high specificity and affinity, resulting in the activation or inhibition of c-Met.We envision that anti-c-Met aptamers would be ideal new c-Met inhibitors after optimization, and could be developed into potential targeted drugs for cancers.
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Updated guidelines on the management of non-Hodgkin lymphoma (2015.V2) have been issued by the National Comprehensive Cancer Network (NCCN) in March 3, 2015.The Castleman disease (CD) is included for the first time.References from relevant publications, the standards for diagnosis and treatment of CD are described in detail and it also provides professional healthcare with clear guidance on the management of patients with CD.