Identifying the unmet supportive care needs, with concomitant influencing factors, in adult acute leukemia patients in China.

PURPOSE: To understand the supportive care needs (SCNs), with associated influencing factors, related to five unmet need dimensions in adult Acute Leukemia (AL) patients, in China. METHODS: This multi-center cross-sectional study enrolled 340 pathologically confirmed adult, Chinese AL patients who were requested to complete a self-reported questionnaire, detailing demographic information, general status and physical functions, and Supportive Care Needs Survey-Short Form 34 (SCNS-SF34), revealing their unmet SCNs. The variables were statistically analyzed. RESULTS: A total of 311 (91.4%) effective questionnaires were retrieved. Among the 5 dimensions, the health information dimension scored the highest, 47.72(43.18), followed by psychological dimension, 35.00(32.50), while the sexual need scored the lowest, 0.00(24.99). As per multiple stepwise regression analysis, marital status, treatment stages and Karnofsky Performance Status index (KPS) score significantly influenced the health information dimension, while the age and "whether the treatment was the initial one or not" influenced sexual need dimension. KPS score and income were the common factors influencing the rest of the three dimensions with treatment stage adding to two of them except "physiological and daily living needs" dimension. "Being informed about your test results as soon as possible", "Being informed about things you can do to help yourself to get well" and "Being informed about cancer which is under control or in remission" were the three highest scoring entries. CONCLUSIONS: The results of this study reveal the unmet SCN's, with its influencing factors, in AL patients, the understanding of which may be of assistance in designing/delivering effective clinical nursing intervention.

CD147 and VEGF co-expression predicts prognosis in patients with acute myeloid leukemia.

OBJECTIVE: To investigate the possible role of CD147 and vascular endothelial growth factor in progression and prognosis of acute myeloid leukemia. METHODS: Immunohistochemical staining was performed to detect the expression of CD147 and vascular endothelial growth factor in paraffin-embedded sections from 62 bone marrow biopsies obtained from an equal number of patients with newly diagnosed acute myeloid leukemia. RESULTS: CD147 and vascular endothelial growth factor expression in the bone marrow of acute myeloid leukemia patients were significantly higher than those in normal controls (both P < 0.001). Expression of them was significantly increased in patients with a high degree of microvessel density compared with those with a low degree (CD147: P = 0.009; vascular endothelial growth factor: P = 0.01) and correlated well with bone marrow microvessel density (CD147: P = 0.01; vascular endothelial growth factor: P = 0.02). In addition, higher levels of CD147 and vascular endothelial growth factor were also found in acute myeloid leukemia patients with an unfavorable karyotype compared with those with intermediate and favorable karyotypes (both P = 0.01). Moreover, the expression of CD147 was significantly correlated with that of vascular endothelial growth factor (P < 0.001). Furthermore, the co-expression of CD147 and vascular endothelial growth factor in the bone marrow indicated a poor prognosis in acute myeloid leukemia and was an independent prognostic factor for overall survival by multivariate analysis. CONCLUSIONS: Our data show for the first time that the co-expression of CD147 and vascular endothelial growth factor may indicate a poor prognosis in acute myeloid leukemia and may be a highly sensitive marker for predicting the clinical outcome of patients.

[PAD regimen for relapsed or refractory patients with multiple myeloma].

OBJECTIVE: To investigate the efficacy and safety of PAD [bortezomib (PS-341), doxorubicin and dexamethasone] regimen for relapsed or refractory multiple myeloma (MM). METHODS: Seventeen patients with relapsed or refractory MM received two to four 21-day cycles of PAD: an intravenous bolus of bortezomib (1.3 mg/m2) on days 1, 4, 8, and 11; doxorubicin 10 mg per day on days 1 to 4, and dexamethasone 40 mg on days 1-4. Response was evaluated according to International Myeloma Working Group Criteria (IMWG 2006), toxicity was graded according to NCI CTCAE (common terminology criteria for adverse events) v 3.0. RESULTS: After 2-4 courses of PAD, 14 patients (82.4%) response, including complete response (CR) in 4 (23.5%), very good partial response (VGPR) in 4 (23.5%), partial response (PR) in 6 (35.3%) and stable disease (SD) in 3 (17.6%). Median time to progression was 9.5 months. The median course to response was 1.6 (1-3). All of 5 patients with extramedullary plasmacytoma achieved at least PR after the first cycle therapy; the plasmacytoma disappeared after 1-2 cycles of PAD. The efficacy was independent of other prognostic factors such as beta2-MG. Adverse events included thrombocytopenia in 9 patients (52.9%), leukopenia in 4 (23.5%), peripheral neuropathy in 4 (23.5%), varicella herpes zoster in 3 (17.6%), fatigue in 6 (35.3%) and diarrhea in 2 (11.7%). All of these adverse reactions could be controlled with routine supportive treatment, only one patient died from respiratory failure during his fifth PAD cycle. CONCLUSIONS: PAD regimen should be considered as an appropriate treatment for relapsed or refractory MM, especially for MM with extramedullary plasmacytoma. Its efficacy is independent of traditional prognostic factors. The side effects are usually manageable.