Clinical efficacy and safety of chemoimmunotherapy with rituximab,fludarabine and cyclophosphamide for chronic lymphocytic leukemia / 中华血液学杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of a chemoimmunotherapy regimen of rituximab, fludarabine and cyclophosphamide (FCR) for patients with chronic lymphocytic leukemia(CLL).</p><p><b>METHODS</b>The clinical data of 26 CLL patients receiving FCR regimen in our hospital from April 2003 to January 2012 were analyzed retrospectively. Patients were grouped according to indicators including Rai risk stratification, β(2)-MG, LDH, ZAP-70, CD38, cytogenetics and immunoglobulin heavy chain variable region gene (IgVH) mutation status. Therapy efficacy and survival were evaluated and the safety of FCR regimen was assessed.</p><p><b>RESULTS</b>Among 26 patients, the overall response rate ( ORR ) was 76.9%, 10 patients (38.5%) achieved complete remission(CR) and 10(38.5%) partial remission(PR). With a median follow-up time of 30 ( 3-98 ) months, the median estimated progression-free survival(PFS) for all patients was 42(16-68) months and median overall survival(OS) was 63(41-85)months. Clinical parameters associated with higher CR rates were ＜2 courses of prior treatment regimens, proportions of bone marrow lymphocytes declining ≥ 50% after 2 courses of FCR, low LDH, low β(2)-MG and ZAP-70 negative (P = 0.014, 0.008, 0.027, 0.035 and 0.013, retrospectively). PFS and OS time in minimal residual disease(MRD)-negative, normal LDH and proportions of bone marrow lymphocytes declining ≥ 50% after 2 courses of FCR patients were significantly better than that of the control group (P＜0.05), PFS in the non-high-risk genetics group was significantly better than that in the high-risk genetics group (P = 0.005), while OS between two groups showed no statistically significant difference. The most common toxicities were gastrointestinal reactions (88.5%), followed by bone marrow suppression (80.8%): including neutropenia, anemia and thrombocytopenia. Infections accounted for 30.8%, mainly lung infection.</p><p><b>CONCLUSION</b>FCR is an effective and well-tolerated therapy for patients with CLL. Patients with MRD-positive, elevated LDH, proportions of bone marrow lymphocytes declining＜50% after 2 courses of FCR and high risk genetics patients are suitable for more effective treatment after achieving treatment response.</p>

Prognostic value of serum IL-6 in patients with multiple myeloma / 中国实验血液学杂志

This study was aimed to evaluate the prognostic value of serum IL-6 (sIL-6) in patients with multiple myeloma (MM). The sIL-6 level in 288 patients with MM was retrospectively analyzed, and the clinical characteristics and prognosis in patients with different IL-6 level were compared. The newly diagnosed patients with MM were divided into two groups: the low sIL-6 group (sIL-6 < 100 pg/ml) and the high sIL-6 group (sIL-6 ≥ 100 pg/ml). The results showed that high sIL-6 level was more common in patients with ECOG score>3, myeloma bone disease (MBD) between grade 2 to 4, and high creatinine level. There was no significant differences in age, abnormal karyotype percentage, chromosome 13q14 abnormality percentage, CD138(+)/CD38(+) cells percentage and the level of calcium, phosphorus, albumin, C-reactive protein, β2-MG, lactate dehydrogenase, hemoglobin, platelet between the two groups at diagnosis, and also no significant difference in response to initial induction chemotherapy among the two groups. The overall survival was significantly different between the low and high IL-6 groups (P = 0.04, 35 m vs 29 m), but no difference in time to progress between the two groups (P = 1.93, 23 m vs 14 m). It is concluded that the sIL-6 level correlates with the clinical characteristics and prognosis. Radioimmunoassay is an appropriate measurement for human IL-6 in serum, and suitable for clinical application.

Cytogenetic abnormality of chromosome 13q14 in 112 patients with multiple myeloma detected by using LSI-RB1 and LSI-D13S319 probes / 中国实验血液学杂志

Chromosome 13q14 deletion is one of the most common cytogenetic abnormalities in multiple myeloma (MM). LSI (locus-specific identification)-RB1 (13q14.1-14.2 region) and LSI-D13S319 (13q14.3 region) probes are usually used to detect 13q14 deletion. The aims of this study was to compare the incidence of chromosome 13q14.1-14.2 and 13q14.3 deletion and to detect 13q14 deletion size and number of involved cells in MM patients. The chromosome 13q14 region was detected by fluorescence in situ hybridization using probes LSI-RB1 and LSI-D13S319 in plasma cells of 112 MM patients. The results showed that 47.3% (53 out of 112) MM patients had both LSI-RB1 and LSI-D13S319 13q14 deletion (cut-off value: 7%), and the deletion rates detected by probes LSI-RB1 and LSI-D13S319 were accordant. The positive rates of 13q14 deletion were 46.4% and 47.3% respectively when the cut-off level was increased to 20%, and the corresponding rate was 98%. MM patients carrying 13q14 deletion showed 18% - 98% (median value: 72.5%) and 22% - 98.5% (median value: 76.5%) of deleted nuclei involving the RB1 and the D13S319 locus (P = 0.38). There were 67.9% (36 out of 53) and 66% (35 out of 53) cases carrying > 65% of 13q14.1-14.2 and 13q14.3 deleted nuclei as high proportion deletion patients, respectively (P = 0.188). The positive rate of the high proportion deletion patients had still no difference between LSI-RB1 and LSI-D13S319 groups when the cut-off value was defined as 85% (P = 0.439). In conclusion, in this cohort of 112 MM patients, there was no significant difference between the LSI-RB1and LSI-D13S319 probes to detect 13q14 deletion. Both LSI-RB1 and LSI-D13S319 probes can be selected to detect 13q14 deletion in MM patients. All the 53 MM patients with 13q14 deletion had deletions of 13q14.1-14.2 and 13q14.3 regions, which is a large deletion as one of the important characters in MM patients with 13q14 deletion.