Mismatched donor cell infusion-related syndrome following microtransplant in patients with acute myeloid leukemia / 中华医学杂志(英文版)

BACKGROUND@#Immunotherapies such as adoptive immune cell infusion and immune-modulating agents are widely used for cancer treatment, and the concomitant symptoms, including cytokine release syndrome (CRS) or immune-related adverse events (irAEs), are frequently reported. However, clinical manifestations induced by mismatched donor granulocyte colony-stimulating factor mobilized peripheral blood mononuclear cell (GPBMC) infusion in patients receiving microtransplant (MST) have not yet been well depicted.@*METHODS@#We analyzed 88 cycles of mismatched GPBMC infusion in patients with acute myeloid leukemia receiving MST and 54 cycles of chemotherapy without GPBMC infusion as a comparison. Clinical symptoms and their correlation with clinical features, laboratory findings, and clinical response were explored.@*RESULTS@#Fever (58.0% [51/88]) and chills (43.2% [38/88]) were the significant early-onset symptoms after GPBMC infusion. Patients possessing less human leukocyte antigen-matching loci with the donor or those with unrelated donors experienced more chills (3 [2-5] loci vs. 5 [3-5] loci, P  = 0.043 and 66.7% [12/18] vs. 37.1% [26/70], P  = 0.024). On the other hand, those with decreased CD4 + /CD8 + T-cell ratio developed more fever (0.8 [0.7-1.2] vs. 1.4 [1.1-2.2], P  = 0.007). Multivariable analysis demonstrated that younger patients experienced more fever (odds ratio [OR] = 0.963, 95% confidence interval [CI]: 0.932-0.995, P  = 0.022), while patients with younger donors experienced more chills (OR = 0.915, 95% CI: 0.859-0.975, P  = 0.006). Elevated ultra-sensitive C-reactive protein levels in the absence of cytokine storm were observed following GPBMC infusion, which indicated mild and transient inflammatory response. Although no predictive value of infusion-related syndrome to leukemia burden change was found, the proportion of host pre-treatment activated T cells was positively correlated with leukemia control.@*CONCLUSIONS@#Mismatched GPBMC infusion in MST induced unique infusion-related symptoms and laboratory changes, which were associated with donor- or recipient-derived risk factors, with less safety and tolerance concerns than reported CRS or irAEs.

Efficacy of carbamazepine combined with ENP in the treatment of epilepsy patients and its influence on intel- ligence and electroencephalogram / 中国基层医药

Objective To study the effect of carbamazepine and ENP in the treatment of epilepsy and its influence on intelligence and electroencephalogram .Methods Eighty-six patients with epilepsy were enrolled . According to the random number method,they were divided into observation group and the control group ,43 cases in each groups.The observation group was given carbamazepine combination with ENP ,while the control group was given carbamazepine.The duration of epileptic seizure and the number of seizures ,intelligence,P300 wave amplitude and wave latency,and adverse effects were compared between the two groups .Results The total effective rate in the observation group was significantly higher than that in the control group [93.02%(40/43) vs.74.42%(32 /43)] (χ2 =5.460,P <0.05).The duration of seizure of the observation group was shorter than that of the control group [(2.31 ±0.26)times /min vs.(3.16 ±0.38)times /min](t =12.106,P <0.05),and the frequency of seizures of the observation group was shorter than that of the control group [(0.82 ±0.11)time/year vs.(1.34 ±0.15)time/year](t =18.332,P <0.05).The ability of self-discernment,analogical comparison,comparative reasoning,series relation and abstract reasoning ability of the observation group were significantly higher than those of the control group (t =7.557,13.075,2.082,7.615,9.903,all P <0.05).The improvement of SPM level in the observation group was better than that in the control group (t =4.705,P <0.05).The amplitude of P300 wave of the observation group was significantly higher than that of the control group [(6.87 ±0.68)μV vs.(5.24 ±0.51)μV](t =12.575,P <0.05). The latency of P300 wave of the observation group was significantly lower than that of the control group [(305.32 ± 17.34)ms vs.(326.45 ±19.15)ms](t =5.363,P <0.05).There was no statistically significant difference in the incidence rate of adverse reaction between the observation group and the control group (P >0.05).Conclusion The combination of carbamazepine and ENP in the treatment of epilepsy can reduce the duration and frequency of seizures,and improve the intelligence level and electroencephalogram .The clinical efficacy is good and the safety is high .