Value of red blood cell distribution width-to-platelet ratio in the prognostic evaluation of multiple myeloma / 白血病·淋巴瘤

Objective:To investigate the correlation of red blood cell distribution width-to-platelet ratio (RPR) with clinical features and prognosis of patients with multiple myeloma (MM).Methods:The clinical data of 137 patients with MM who were admitted to the Affiliated Hospital of Xuzhou Medical University from April 2013 to July 2019 were collected. The receiver operating characteristic (ROC) curve was used to determine the best cut-off value of RPR. According to the best cut-off value of RPR, the patients were divided into high RPR group and low RPR group, and the differences in clinical characteristics and prognosis between the two groups were analyzed.Results:The best cut-off value of RPR was 0.10, and according to the best cut-off value, the patients were divided into high RPR group (RPR ≥ 0.10, 52 cases) and low RPR group (RPR < 0.10, 85 cases). There were statistical differences between the high RPR group and low RPR group in the proportion of patients between different stratification of Durie-Salmon (DS) staging ( χ2 = 17.110, P < 0.01), International Staging System (ISS) staging ( χ2 = 10.817, P = 0.001), red blood cell distribution width standard deviation(RDW-SD) ( χ2 = 26.937, P < 0.01), hemoglobin ( χ2 = 17.140, P < 0.01), lactate dehydrogenase (LDH) ( χ2 = 7.926, P = 0.005), erythrocyte sedimentation rate (ESR) ( χ2 = 9.513, P = 0.002), β 2-microglobulin (β 2-MG) ( χ2 = 7.726, P = 0.005), and bone marrow plasma cell ratio (BMPC) ( χ2 = 6.621, P = 0.010). The overall response rate (ORR) in the low RPR group was higher than that in the high RPR group [82.4% (70/85) vs. 71.2% (37/52)], but the difference was not statistically significant ( χ2 = 2.366, P = 0.124). The deep remission rate in the low RPR group was higher than that in the high RPR group [56.5% (48/85) vs. 19.2% (10/52)], and the difference was statistically significant ( χ2 = 18.327, P < 0.01). The results of multivariate analysis showed that the albumin, RPR and degree of remission were independent influencing factors for the overall survival (OS) of newly treated MM patients (all P < 0.05). Conclusion:MM patients with elevated peripheral blood RPR have shorter OS time, and RPR may be one of the indicators for evaluating the prognosis of MM.

Maintenance therapy of multiple myeloma: is there a best drug or combinations ? / 白血病·淋巴瘤

Multiple myeloma (MM) is a kind of common hematologic neoplasms. The application of new drugs and autologous hemopoietic stem cell transplantation can significantly improve the response rate of MM. However, as it is impossible to eradicate the minimal residual disease, recurrence is unavoidable. Maintenance therapy has the potential to increase remission degree, thus lengthening the progression-free survival and overall survival time of MM patients.

Efficacy of high-dose dexamethasone plus low-dose rituximab as a second-line treatment in 65 patients with primary immune thrombocytopenia / 中华血液学杂志

<p><b>OBJECTIVE</b>To observe the efficacy of high-dose dexamethasone in combination with low-dose rituximab as a second-line treatment for patients with immune thrombocytopenia (ITP).</p><p><b>METHODS</b>65 patients with ITP, previously by conventional dose of glucocorticoids, received high-dose dexamethasone in combination with low-dose rituximab (dexamethasone 40 mg/d for 4 days, rituximab 100 mg, d 7, 14, 21, 28 intravenous infusion). Treatment response, regulatory T cells (Treg), cytokines levels and treatment-related adverse effects were observed.</p><p><b>RESULTS</b>Total response rate 1 month after treatment was achieved in 81.5% (53/65) of patients, and complete response at 3,6 and 12 months was 72.3% (47/65), 66.2%(43/65), 63.1%(41/65). The higher efficiency and complete response rate was achieved in preexisting glucocorticoid-dependent patients. For patients with complete response, Treg cells continued to show a high level state [(3.01 ± 0.95)% vs (1.69 ± 0.35)%, P=0.032], cytokines of BAFF [(648.03 ± 79.63) ng/L vs (972.35 ± 93.64) ng/L, P=0.001], IL-2 [(2.84 ± 0.32) ng/L vs (4.18 ± 0.46) ng/L, P=0.012], sCD40L[(4.55 ± 0.66) ng/L vs (7.73 ± 1.04) ng/L, P=0.006] significantly lower than that before treatment. The level of IL-10 was increased, but without significance compared with that before treatment (P=0.136). All patients completed the protocol with no serious adverse reactions.</p><p><b>CONCLUSION</b>The data show high-dose dexamethasone in combination with low-dose rituximab still has a satisfactory outcomes for patients previously with conventional dose of glucocorticoid.</p>

Potential relationship and clinical significance of miRNAs and Th17 related cytokines in patients with multiple myeloma / 中华血液学杂志

<p><b>OBJECTIVE</b>To explore the expression and significance of miRNAs and Th17 related cytokines in patients with multiple myeloma (MM).</p><p><b>METHODS</b>A total of 27 MM patients and 8 health controls were enrolled in this study. The expression of miR-15a/16,miR-34a,miR-194-2-192 cluster and miR-181a/b in bone marrow were detected by real-time quantitative PCR (qRT-PCR). Enzyme-linked immunosorbent assay (ELISA) was used to determine the levels of Th17 related cytokines interleukin-17 (IL-17), IL-21, IL-22, IL-23 and IL-27 in peripheral blood plasma. The role of miRNAs and Th17 related cytokines was analyzed in the development of MM.</p><p><b>RESULTS</b>The expression of miR-15a/16,miR-34a,miR-194-2-192 cluster in MM patients were significantly lower than those of the health controls, while miR-181a/b were exactly the reverse (P<0.05). The levels of IL-17, IL-21 and IL-27 were up-regulated in MM patients compared to health controls while IL-22 was down-regulated (P<0.05). There was no significant difference of IL-23 between the two groups. The levels of miRNAs and Th17 related cytokines had associated with ISS but not with some clinical parameters (such as gender, age, disease classification). Higher expression of IL-17, IL-21, IL-23, IL-27, miR-181a/b and lower expression of miR-15a/16,miR-34a,miR-194 and IL-22 were observed in the end stage than the early stage of MM patients (P<0.05). There was a significant correlation between miRNAs and Th17 related cytokines.</p><p><b>CONCLUSION</b>Up-regulated IL-17, IL-21 and IL-27 may potentially down-regulate the expression of several miRNAs in MM patients. Establishment of the relationship may be useful for understanding the pathogenesis of MM and for clinical diagnosis of the disease.</p>