ABSTRACT
Objective:To investigate the causes of ineffective platelet transfusion in patients with hematologic malignancies during myelosuppression and the therapeutic effect of rituximab.Methods:A total of 180 patients with different hematologic malignancies in the First People's Hospital of Changzhou from January 2017 to December 2018 were selected. And the incidence of ineffective platelet transfusion during myelosuppression was observed. The changes of T and B lymphocyte subgroups and platelet counts before and after rituximab therapy in acute leukemia patients with platelet antibody-positive were compared, and the incidence of ineffective platelet transfusion with different platelet suspensions was analyzed.Results:The ineffective platelet transfusion was observed in 45 of 180 patients (25.0%) during myelosuppression, including 30 (27.8%) of 108 patients with acute leukemia, 10 (23.3%) of 43 patients with myelodysplastic syndrome, 2 (13.3%) of 15 patients with malignant lymphoma, and 3 (21.4%) of 14 patients with multiple myeloma. The incidence of ineffective platelet transfusion in patients transfused with irradiated leukocyte depleted apheresis platelets (17.0%, 16/94) was lower than that in those with apheresis platelets (33.7%, 29/86), and the difference was statistically significant (χ 2 = 6.68, P = 0.01). In 8 acute leukemia patients with platelet antibody-positive and the ineffective platelet transfusion after rituximab therapy, the increase of platelet count was observed in 5 patients. The differences of levels of CD19, CD20, CD4 and platelet count before and after treatment with rituximab were statistically significant (all P < 0.05). Conclusions:The incidence of ineffective platelet transfusion is the highest in acute leukemia patients. Transfusion of human leukocyte antigen-matched platelets can improve the effect of platelet transfusion. Rituximab is effective in the ineffective platelets transfusion caused by immune factors. The incidence of ineffective platelet transfusion in irradiated leukocyte depleted apheresis platelets is lower compared with that in apheresis platelets.
ABSTRACT
Objective@#To investigate the causes of ineffective platelet transfusion in patients with hematologic malignancies during myelosuppression and the therapeutic effect of rituximab.@*Methods@#A total of 180 patients with different hematologic malignancies in the First People's Hospital of Changzhou from January 2017 to December 2018 were selected. And the incidence of ineffective platelet transfusion during myelosuppression was observed. The changes of T and B lymphocyte subgroups and platelet counts before and after rituximab therapy in acute leukemia patients with platelet antibody-positive were compared, and the incidence of ineffective platelet transfusion with different platelet suspensions was analyzed.@*Results@#The ineffective platelet transfusion was observed in 45 of 180 patients (25.0%) during myelosuppression, including 30 (27.8%) of 108 patients with acute leukemia, 10 (23.3%) of 43 patients with myelodysplastic syndrome, 2 (13.3%) of 15 patients with malignant lymphoma, and 3 (21.4%) of 14 patients with multiple myeloma. The incidence of ineffective platelet transfusion in patients transfused with irradiated leukocyte depleted apheresis platelets (17.0%, 16/94) was lower than that in those with apheresis platelets (33.7%, 29/86), and the difference was statistically significant (χ2 = 6.68, P = 0.01). In 8 acute leukemia patients with platelet antibody-positive and the ineffective platelet transfusion after rituximab therapy, the increase of platelet count was observed in 5 patients. The differences of levels of CD19, CD20, CD4 and platelet count before and after treatment with rituximab were statistically significant (all P < 0.05).@*Conclusions@#The incidence of ineffective platelet transfusion is the highest in acute leukemia patients. Transfusion of human leukocyte antigen-matched platelets can improve the effect of platelet transfusion. Rituximab is effective in the ineffective platelets transfusion caused by immune factors. The incidence of ineffective platelet transfusion in irradiated leukocyte depleted apheresis platelets is lower compared with that in apheresis platelets.
ABSTRACT
Objective@#To evaluate the efficacy and prognostic factors in core binding factor (CBF) acute myeloid leukemia (AML) under current therapy modalities, therefore optimizing the treatment strategies.@*Methods@#Standard cytological and immune methods including next generation sequencing (NGS) were used for risk stratification. Complete remission (CR) rate, disease-free survival (DFS) and overall survival (OS) were assessed by multivariate Logistic and Cox regression models in a total of 206 adults (aged 16-65 years) with CBF-AML, including 152 AML patients with t(8;21) and 54 with inv(16).@*Results@#The CR rate of inv(16) patients after first course was 54/54(100%), significantly higher than that of t(8;21) patients [127/147(86.4%), P=0.005]. The fusion transcript level and KIT mutation were independent factors related to CR rate in t(8;21) patients (P=0.044 and 0.027; respectively). DFS and OS in inv(16) patients tended to be more superior than that in t(8;21) patients (P=0.066 for DFS; P=0.306 for OS; respectively). Multivariate Cox identified negative expression of CD19 and female gender the independent predictors of inferior DFS in t(8;21) patients (P=0.000 for CD19; P=0.006 for sex; respectively). Analysis of combining CD19 with gender indicated that females/CD19-subpopulation had significantly poor DFS than did males/CD19+ ones (Bonferroni-P<0.000 01). The number of mutations in each patient, FLT3-ITD and additional karyotype abnormalities did not affect CR rate and DFS (all P>0.05).@*Conclusions@#Patients with inv(16) have better induction response than those with t(8;21). High level of fusion transcripts and positive KIT mutation are associated with low CR rate in t(8;21) patients. Negative CD19 expression and female gender are independent predictors of inferior DFS in t(8;21) patients.
ABSTRACT
Objective To investigate the characteristics of activation-induced cytidine deaminase (AID) expression level in de novo acute leukemia (AL) patients, chronic myeloid leukemia chronic phase (CML-CP), chronic myeloid leukemia blastic crisis (CML-BC) patients and leukemia cell lines. Methods The expression level of AID mRNA was measured in 89 cases of newly-diagnosed acute lymphoblastic leukemia (ALL) patients, 79 cases of de novo acute myeloid leukemia (AML) patients, 5 cases of CML-BC patients, 5 cases of CML-CP patients and leukemia cell lines NB4, THP-1, KG-1, Raji, K562 by real-time quantitative reverse transcriptase polymerase chain reaction (RT-PCR), bone marrow mononuclear cells of 16 normal healthy donors were used as the control group. Results The expression levels of AID mRNA in 89 cases of ALL and 79 cases of AML were 0.006-7 463.175 and 0.005-69.107, the median expression levels were 3.785 and 1.812, the expression level of AID mRNA in the normal control group was 0.146-4.707, and the median expression level was 1.483, respectively. The AID expression levels of ALL, B-ALL, Burkitt leukemia, M4 patients and Raji cells were significantly higher than those of the normal control group (all P <0.05). Nevertheless, the AID mRNA expression levels of M3 patients and NB4, KG-1 cells were lower than those of the normal control group (all P <0.05). Furthermore, the AID mRNA expression levels of K562 cell were strikingly higher than that of the CML-CP patients (P<0.001), so were those of CML-BC, chronic myeloid leukemia myeloid blast crisis (CML-MBC), chronic myeloid leukemia lymphoblastic blast crisis (CML-LBC) patients. Conclusion AID gene shows high expression level in B-ALL, Burkitt leukemia and M4, low expression level in M3 and KG-1 cells, and obvious high expression level in CML-BC.
ABSTRACT
ObjectiveTo evaluate the clinical efficacy and toxicity of reduced dose idarubicin and cytarabine,semustine(IAS) regimen as induction therapy in patients with acute myeloid leukemia.MethodsA total of fifty-eight newly acute myeloid leukemia(AML) patients were randomly divided into 2 groups,including 30 cases with IAS regimen,28 cases with DA regimen The IAS regimen was treated with reduced dose idarubicin (8 ～ 10 mg/m2,days 1 to 3) and cytarabine( 100 ～ 150 mg/m2,days 1 to 7),semustine(200mg,d0).The DA regimen was treated with daunorubicin(40 ～60 mg/m2,days 1 to 3) and cytarabine ( 100 ～ 150 mg/m2,days 1 to 7).The responses ( CR and overall response rate ) were compared between the 2 groups.Results Complete remission(CR) rate in IAS and DA groups were 24 of 30( 80.0％ ) and 16 of 28 (57.1％ ) respectively,while the overall response rate were 26 of 30 ( 86.7％ ) and 18 of 28 ( 64.3％ ) respectively.There was significant difference in CR rate and overall response rate between IAS group and DA group( P ＜ 0.05 ).Myelosuppression and infections due to neutropenia were the most frequent adverse effects,severe nonhematologic toxicity was not observed.The incidence rates of toxicities in the 2 groups were not significantly different ( P ＞ 0.05 ).Conclusion The effect of reduced dose idarubicin and cytarabine,semustine regimen in the treatment for acute myeloid leukemia is superior to that of DA regimen,and the toxicities are tolerable.IAS regimen can be as the optional induction therapy in newly patients with acute myeloid leukemia.
ABSTRACT
Objective To investigate the effect of simvastatin (SV) in combination with cytosine arabinoside (ARA-C) on the proliferation and apoptosis of K562 cells. Methods Human K562 cells were incubated with SV and cytosine arabinoside alone or in combination and K562 cells without any treatment were taken as normal control. Cells in different groups were collected at 24, 48 and 72 h after incubation for further detections. Morphological changes by Wright stain were performed. MTT method was used to assay the growth inhibition rate and cytoflowmetry was used to detect the early stage apoptosis ratio and cell necrosis ratio. Results Compared with Ara-C group and SV group, cells in the group treated with SV combined with Ara-C showed obvious karyopyknosis,apoptosis bodies formation and significant cell growth inhibition, which were positively correlated with culture time. Combination of 15 μmol/L SV and Ara-C showed the most significant cell growth inhibition with a inhibition rate of (72±1) % at 72 h of culture, as was significantly higher than that of 15 μmol/L SV group (45±2) % and 20 μmol/L Ara-C group (44±0) % (P ＜0.01),furthermore, combination of 15 μmol/L simvastatin and Ara-C showed synergistic inhibition with Q value of 1.24 and 1.19 at 24 h and 48 h in each. The apoptosis rates at early stage (AnnexinV) detected by flow cytometry in 20 μmol/L, 15 μmol/L and 10 μmol/L SV treated K562 cells were significantly higher than that in normal K562 cells (P ＜0.01), as were positively correlated with culture time and SV dose (P ＜0.05). There were no significant difference of early apoptosis rate between the 20 μmol/L SV and 15 μmol/L SV groups (P ＞0.05), yet the very two were both higher than that of 10 μmol/L SV group (P ＜0.05). There were no statistic differences of late apoptosis rate (PI) amongdifferent treated groups (P ＞0.05). Conclusion SV inhibited K562 cell proliferation and induced cell apoptosis in vitro, and combination of SV and Ara-C exhibited obvious synergistic inhibition and apoptosis, which may increase the sensitivity of K562 cell to chemotherapy. SV at 15 μmol/L may be the best concentration for K562 cells in vitro.
ABSTRACT
Objective To explore the clinical significance of the coagulation and fibrolysis parameters changes for the knowledge of complicated thrombosis after chemotherapy in malignant lymphomas. Methods Morning fasting anti-coagulation blood samples were taken to detect plasma prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB) and thrombin time (TT) with automatic coagulation analyzer in 71 hospitalized malignant lymphomas and 20 normal controls. The plasma D-dimer levels of the two groups were detected with immunoturbidimetry. Results The levels of plasma APTT, Fib and D-dimer in 71 malignant lynphomas were (30.44±1.43) s, (3.28±0.20) g/L, (297.05±56.59) μg/L respectively, which were significantly higher than those in normal controls at the levels of (23.72±0.76) s, (2.57±0.22) g/L, (94.50±26.07) μg/L respectively (P ＜0.05). The coagulation and fibrolysis parameters were of no statistic differences between the normal controls and lymphomas of stage Ⅰ and Ⅱ (P ＞0.05). The APTT and Fib levels in lymphomas of stage Ⅲ and Ⅳ were higher than those in normal controls and lymphomas of stage Ⅰ and Ⅱ (P ＜0.05). There are 7 malignant lymphomas complicated venous thrombosis . Of the 7 cases, the FIB and D-dimer levels were higher than those of stage Ⅰ and Ⅱ, furthermore the D-dimer levels were higher than those of stage Ⅲ and Ⅳ. Conclusion The abnormalities of coagulation and fibrolysis parameters occurred in malignant lymphomas with requirement of periodic monitoring. After chemotherapy, the lymphoma patients had a high incidence of venous thrombosis, which need early prevention for prolongation of the survival.
ABSTRACT
Objective To investigate the effects of simvastatin (SV) on the proliferation,differentiation and apoptosis of human promyelocytic leukemia cell line NB4.Methods NB4 cells were incubated with SV at different concentration with or without all-trans retinoic acid (ATRA),and NB4 cells without any treatment were taken as normal control.Cells of different groups were collected at 24 h,48 h and 72 h after incubation for further detection.Morphological changes by Wright stain were performed.MTT method was used to assay the growth inhibition rate and flow cytometry was used to detect the surface CD11b expression levels,the early stage apoptosis ratio and cell necrosis ratio.Results Treated with 15 μ mol/L SV,10 μ mol/L SV and 5 μ mol/L SV respectively,with the NB4 cells growth,the cell inhibition rates gradually increased (F =7.15,P =0.000),as well as CD11b expression levels (F =3.41,P =0.014) and AnnexinVexpression levels (F =43.38,P =0.000).Furthermore the NB4 cells treated with 15 μ mol/L SV exhibited the most significant changes with cell inhibition rate of 0.96±0.02,CD11b expression level increased to (62.41±6.37) ％ and AnnexinV expression level increased to (87.38±2.94) ％ after 72 h incubation.Combination of 15 μmol/L SV with 0.5 μmol/L ATRA displayed obvious interaction for increasing CD11b expression levels (F =4.093,P =0.025),while no significant interaction for cell inhibition rates and Annexin V expression levels were observed.After 72 h incubation,the CD11b expression levels (89.46±9.13) ％ in NB4 cells treated with 15 μ mol/L SV in combination with 0.5 μ mol/L ATRA were significantly higher than those treated with ATRA (71.27±7.27) ％ and SV (62.41±6.37) ％ (t =2.71,P =0.054; t =4.37,P =0.017)' solely.Conclusion Simvastatin in vitro inhibits NB4 cell proliferation,promotes cell apoptosis,and synergistically induces cell differentiation with ATRA dose-dependently in vitro,which indicates that SV may have the effect of synergistic anti-promyelocytic potency with ATRA.
ABSTRACT
Objective To investigate the relationship between serum cholesterol levels and immunoglobin types and clinical stages in the patients with multiple myeloma (MM). Methods We retrospectively analyzed the blood lipid levels in 65 patients with MM at diagnosis, including total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), apolipoprotein Al (apo-Al) and apolipoprotein B (apo-B), and explored relationship between lipid parameters and immunoglobulin types or clinical stages in patients with MM. Thirty healthy persons were served as controls. Results Of the 65 MM patients, 53.85% were IgG type, 63.1 % were at stage Ⅲ. The levels of TC, HDL-C, LDL-C, apo Al and apo B in the patients with MM were significantly lower than that in the controls (P 0.05). Except one case of IgD type, the levels of TC, HDL-C, LDL-C, apo Al and apo B in Ig G and Ig A types of patients were significantly lower than that in the light chain type among other 64 cases (P <0.05), and TG levels in different immunoglobulin types was found no statistical differences. The levels of TC, HDL-C, LDL-C and apo A1 in the patients with stage Ⅲ were lower than that of stage I and controls (P <0.05), furthermore, the level of LDL in stage Ⅱwas lower than that in stage Ⅰ. Conclusion Hypocholesterolemia are seen in the patients with MM and serum cholesterol levels are related to MM staging.
ABSTRACT
Objective To evaluate the mental status of malignant hematologic patients, explore the morbidity of depression in malignant hematologic patients, and investigate valid interventional treatment on them. Methods 134 malignant hematologic patients were evaluated by SDS and HAMD, and 49 patientswere selected who was diagnosed depressive disorder then randomly divided into 2 groups. One was experimental group and the other control group. The patients of experimental group were treated with antidepressant drug and mental intervention during common therapy, while the patients of control group only took common therapy. The change of immunological function after treatment was detected. Results The morbidity of depression in malignant hematologic patients was 37 %. The scores of SDS and HAMD were significandy decreased and the depressive symptoms were notablely improved in experimental group and there were significant differences after treatment and before treatment (P 0.1). The NPY plasma levels significantly increased after treatment in experimental group(P 0.05); the CD+4/CD+4 values of patients in the experimental group were significantly increased after treatments. Statistical analysis revealed significant differences in the experimental group patients between pre-treat and after-treat (P 0.5). Conclusion Mental intervention and antidepressive treatment can improve all of the depression, immunological function and quality of life of malignant hematologic patients.
