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Objective:To investigate the relationship between the levels of serum cytokines and chemokines and the prognosis of patients with acute B-ALL after receiving chimeric antigen receptor (CAR)-T cell immunotherapy and acute graft-versus-host disease (aGVHD) in patients after bridging allogeneic hematopoietic stem cell transplantation (allo-HSCT).Methods:According to the case-control principle, Forty-two patients with B-ALL who received CD19-CAR-T cell immunotherapy bridged to allo-HSCT at Heibei Yanda Ludaopei Hospital from September 18, 2019 to May 9, 2022 were enrolled. Mann-Whitney U test was used to compare the changes of aGVHD-related cytokines and chemokine levels between CAR-T cell immunotherapy and bridging transplantation in different patients at the same time. Their plasma levels of cytokines and chemokines related to aGVHD were monitored at the day before CAR-T therapy and after CAR-T treatment at day 4, 7,14,21,28. The receiver operating characteristic curve was drawn to evaluate the predictive value of cytokines and chemokines in predicting the occurrence and the death of aGVHD patients. Kaplan-Meier method and Log-rank tests were used for Overall survival (OS) analysis. Results:Twenty-four of total 42 patients had aGVHD, of which 11 patients died and 31 patients survived. There was no significant difference in cytokines and chemokines between the aGVHD group and the non-aGVHD group on the day before CAR-T cell treatment. According to statistical analysis, the serum Elafin levels of aGVHD group was higher than that of non-aGVHD group at the 21st day [4 482 (2 811, 6 061) ng/L vs 2 466 (1 948, 3 375) ng/L, Z=3.145, P=0.001] and the 28st day [4 391 (2 808, 5594) ng/L vs 2 463 (1 658, 2 830) ng/L, Z=2.038, P=0.048] separately. At the 14th day, serum cytokines and chemokines levels between the two group were as follows,MIP-1 α [21.02 (12.36, 30.35) ng/L vs 5.56 (3.64, 10.79) ng/L], sCD25 [422.47 (257.99, 1 233.78) IU/ml vs 216.11 (133.75,457.39) IU/ml], Elafin [4 101 (2 393, 5 006) ng/L vs 2 155 (1 781, 3 033) ng/L], IL-6 [119.08 (23.97, 183.43) ng/L vs 8.39 (2.91, 17.42) ng/L] and IL-8 [13.56 (12.50, 24.52) ng/L vs 2.83 (1.73,6.87) ng/L] were at higher levels ( Z=2.653, P=0.007; Z=2.176, P=0. 030; Z=2.058, P=0.041; Z=3.329, P<0.001; Z=3.162, P=0.001). The KM survival curve showed that the cumulative survival rates of patients with higher serum levels of MIP-1α, sCD25, Elafin, IL-6 and IL-8 were lower than those with low levels at day 14, and the difference was statistically significant (χ 2=12.353, 4.890, 6.551, 10.563, 20.755, P<0.05). Conclusion:The outcomes of patients treated with CAR-T cell therapy bridged to allo-HSCT was correlated with serum MIP-1α, sCD25, Elafin, IL-6 and IL-8 levels after receiving CAR-T therapy. High concentrations of MIP-1α, sCD25, Elafin, IL-6 and IL-8 suggest poor prognosis and can be used as biomarkers to suggest appropriate clinical selection of therapy.
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Objective@#To evaluate the clinical characteristics of T-cell acute leukemia/lymphoma (T-ALL) and explore the prognosis significance of early T-cell precursor leukemia/lymphoma.@*Methods@#A cohort of 126 patients diagnosed with T-ALL from 2008 to 2014 in West China Hospital, Sichuan University were enrolled in this study. They were further categorized by immunophenotype according to the expression of T-cell lineage markers CD1a, CD8, CD5 and one or more stem cell or myeloid markers. The laboratory indicators and prognosis factors were also statistically analyzed.@*Results@#Of all patients, the ratio of male to female was 2.5∶1, with the median age of 25 years old (range 14 to 77) . The percentage of ETP-ALL was up to 47.6%. T-ALL patients showed higher ratio in first clinical remission rate (CR1) than T-LBL ones (64.4% vs 30.8%, P=0.032) . Group with WBC count higher than 50×109/L at presentation showed higher ration of achieving CR1 than those lower than 50×109/L (78.4% vs 50.9%, P=0.010) . In comparison with the non-ETP-ALL, ETP-ALL patients had older age of onset (P<0.001) , lower WBC count (P<0.001) , lower risk of CNS involvement (10.0% vs 30.2%, P=0.009) and slightly inferior overall survival (P=0.073) . T-cell lineage markers CD1a-, CD8- and CD4- positive patients had higher CR1 than their corresponding negative ones (P=0.002, P=0.000, P=0.001) , while CD33- and CD56- positive patients had lower ratio of achieving CR1 than their negative ones, respectively (P=0.035, P=0.035) .@*Conclusion@#Flow cytometry and associated markers for immunophenotyping was of significance in the diagnosis and prognosis monitoring of T-ALL/LBL. The percentage of ETP-ALL/LBL subtype was high in Chinese adolescent and adult T-ALL patients. ETP-ALL/LBL was a high risk subtype, which needs more precise standard for diagnosis and advanced therapies for better outcome.
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Objective To detect the expression of Hedgehog signaling pathway receptor Smoothened (Smo) protein in chronic myeloid leukemia (CML) CD34-positive (CD34+) cells, and to explore the role of Hedgehog signaling pathway in CML stem/progenitor cells. Methods Seventeen chronic phase (CP) and 6 advanced phase (AP) CML patients who were diagnosed in West China Hospital of Sichuan University from September 2010 to March 2011 and 10 People (healthy people and patients without hematologic malignances) as control were included in this study. The expression levels of Smo protein were detected by the protocol of indirect immunofluorescence labeling for cytometry and analyzed statistically. Results The mean of relative fluorescence intensity of Smo protein was 282.5±102.4, 188.8±55.4 and 354.0±297.9 in the CML-CP, CML-AD and control groups, respectively. The difference between CML-CP and CML-AD groups was statistically significant (P= 0.032). However, there were no significant differences between the CML-CP, CML-AD groups and control group (both P>0.05). The percentage of CD34+Smo+cells was (58.9±24.2)％, (42.6±17.6)％and (55.9±29.7) ％ in the CML-CP, CML-AD and control groups, respectively. There were still no significant differences between the CML-CP, CML-AD groups and control group (F= 0.950, P= 0.398). The mean of relative fluorescence intensity of Smo protein in the CML-CP patients with tyrosine kinase inhibitor (TKI) (9 cases) administered and without TKI (8 cases) were 282.3 ±122.6 and 282.6 ±82.4, respectively. There were no significant differences between the two groups(P=0.157). Conclusions Flow cytometry can qualitatively and quantitatively detect the expression level of Smo protein in CML CD34+cells. Smo expression is associated with stage of CML;TKI could not inhibit the activation of the Hedgehog signaling pathway in CML CD34+cells.
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Objective: In this study, we aimed to investigate changes of peripheral Th17 and Treg cells frequencies in the newly-diagnosed Chronic Lymphocytic Leukemia [CLL] patients for 12 months
Methods: In this research,50 CLL patients were enrolled
Circulating Th1, Th17 cells and CD4+CD25+Foxp3+Treg cells were analyzed by flow cytometry. Plasma levels of related cytokines were detected by enzyme-linked immuno sorbent assay [ELISA]
The study was carried out from January 2012 to October 2013 at Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, P.R. China
Results: Compared with healthy controls, Th17 cells related cytokines were significantly increased in CLL patients, while Treg cells related cytokines were significantly lowered. In the follow-up, we found that the frequency of Treg cells was irregular, while the frequency of Th17 cells was gradually decreased
Conclusion: Our study suggested that Th17 cells may play important role in the immune regulation of CLL, and may become a new target in CLL therapy
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Undergraduates in department of laboratory medicine were organized to participate in United Kingdom National External Quality Assessment Schemes. Case discussion was the main form and contents of cases cover the entire clinical biochemical field. One case was given every 20 days and undergraduates must answer in English. All answers would be summarized and reported by one of them. After results being returned, all undergraduates made a retrospective study. The highest score was 1.74 and the lowest score of-0.4, with the median score of 0.67. Time-window score ranged be-tween 0.98 and 0.41. After participating in the case discussion, students improved clinical problem-solving capa-bility, subjective initiative of clinical practice, English level and the team cooperation ability.
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Objective The immature platelet fraction (IPF) could be detected quantificationally in Sysmex XE-2100 with the software of XE-pro and IPF master.The study aimed to perform the methodological evaluation of IPF detection and investigate the clinical significance for the monitoring for bone marrow hyperplasia in cancer chemotherapy patients.Methods The high-level, middle-level and low-level whole blood samples were randomly chosen for detection repeatly 20 times to obtain interrun coefficient of variation (CV) for evaluation of the precision and reproducibility. Integrated quality controls were determined for continuous 20 days to obtain intrarun CV, and the stability and carryover was investigated.Furthermore, the correlation between results from Sysmex XE-2100 and results from flow cytometry was assessed.182 healthy subjects and 130 cancer patients undergoing chemotherapy were selected and the latter were divided into two groups according to platelet counts after therapy, one was normal PLT group, the other was decreased PLT group.The IPF of either group was measured and was compared with each other.Results The precision of IPF for high-level, middle-level and low-level were 4.71%, 4.33% and 4.95%, respectively, they were less than 5%.The interrun CV of IPF detection for middle-level and low-level were less than 5%.The interrun CV of IPF detection for high-level were less than 10%.The carryover ranged from 0.6% to 2.7%,and the average rate was 1.2%.A good correlation for IPF detection was shown between results from Sysmex XE-2100 and flow cytometry(r = 0.880 9,P ＜ 0.01).Regarding clinical utility of IPF detection in treatment monitoring for chemotherapy effect, the median of IPF levels in decreased PLT group, normal PLT group,control group were 14.45% ,7.35% and 15.68%, respectively.There was significant difference among the three groups (H =49.032,P ＜0.01 ).The IPF level was higher in decreased PLT group than normal PLT group (t = -5.681, P ＜ 0.O1 ), and was lower in normal PLT group after chemotherapy than the control group (t = -6.662 ,P ＜0.01 ).Conclusions The determination of IPF by the Sysmex XE-2100 owns high precision and good stability. IPF is an effective marker for evaluation of thrombopoietic condition in the cancer chemotherapy patients.
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Objective Comparative evaluation of flow cytometric immunophenotyping in the diagnosis and differentiation of lymphadenopathy,lymphoma and reactive lymphoid hyperplasia. Methods Ninty-nine fine-needle aspiration specimens from patients with tentative clinical lymphoprofierative disorders were consecutively analyzed by both cytology and flow cytometry with histology results as the gold standard. The three color antibodies including CD3,CD3,CD4,CD5,CD10,CD19,CD20,CD23,CD45,K,λ,FMC7 and CD34 were used for cell composition evaluation and cells with abnormal phenotype. Lymphoma cases were classified according to new WHO classification and subtypes were categorized by immunophenotypic analysis. The results from flow cytometry and cytology were compared. Results By cytological study, 40 of 99 cases were diagnosed with lymphoma, 29 cases were diagnosed with metastatic carcinoma, and 30 cases were diagnosed with reactive lymphoid hyperplasia, necrosis or tuberculosis. Among them, 2 non-Hodgkin lymphoma(NHL) cases were misdiagnosed as reactive lymphoid hyperplasia by cytology. Biopsy was performed in 18 cases of NHL including 16 B-NHL and 2 T-NHL By flow cytometry study, 35 of 99 eases were diagnosed with lymphoma, including 4 cases of lymphoblast lymphoma, 1 case of T-cell lymphoma, and 30 eases of other B-NHL For those 30 cases of B-NHL, 28 cases showed monoclonal light chain expression, and k: λ orλ: k atios exceed 3: 1, and B-cell proportion was (73. 2±27. 2)%. Twenty-six cases could be sub-classified by immunophenotyped. Among 16 histologically confirmed B-NHL cases, only 2 cases diagnosed with follicular lymphoma showed discrepancy with flow cytometry results. In all cases diagnosed with reactive lymphoid hyperplasia and metastasis carcinoma , no abnormal lymphocytes can be found, and k: λ or k: λ ratios were less than 3: 1. Conclusions Fine-needle aspiration analysis with flow eytometrie immunophenotyping can be helpful in diagnosis and differential diagnosis as well as sub-classification of NHL
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Objective To set up a calibration system for automated hematology analyzers with fresh blood in clinical laboratory.Methods Fresh blood assigned by a traceable measurement system was used to calibrate nine hematology analyzers, and compared the bias before and after calibration.Results In the parameters to be calibrated for the hematology analyzers, there was about 55.6% (25/45) over allowable bias before calibration but 15.6% (7/45) after calibration with fresh blood. Among the results of bias over allowable upper limit were mostly existed in 3-part differential hematology analyzers, and mainly focused on WBC and PLT.Conclusion It is available to calibrate different hematology analyzers with fresh blood in a clinical laboratory.