[Expression of SIL-2R in Patients with Multiple Myeloma and Its Clinical Significance].

OBJECTIVE: To investigate the expression and clinical significance of soluble interleukin-2 receptor(sIL-2R) in patients with multiple myeloma(MM). METHODS: 54 newly diagnosed MM patients in the Second Affiliated Hospital of Fujian Medical University from February 2020 to December 2021 were selected as the observation group, and 60 healthy people in our hospital in the same period were selected as the control group. The expression levels of sIL-2R in the serum of the two groups were detected by enzyme-linked immunosorbent assay. The differences of sIL-2R expression level among different clinical parameter groups in MM patients were compared. The clinical parameters include:gender, age, ISS stage, hemoglobin, albumin, serum creatinine, lactate dehydrogenase and ß2-microglobulin, blood calcium, bone marrow plasma cell ratio and treatment response. The relationship between sIL-2R expression level and progression-free survival(PFS) and overall survival(OS) in MM patients were analyzed. RESULTS: The expression of serum SIL-2R in MM patients was significantly higher than that in healthy control group (P<0.05). The expression of sIL-2R in MM patients who did not achieve complete remission(CR) was significantly higher than those of CR patients (P=0.037). There was no significant difference in the expression of serum sIL-2R between the groups of different sex, age, ISS stage, hemoglobin concentration, albumin content, serum creatinine level, lactate dehydrogenase level, the content of ß2-microglobulin, the concentration of blood calcium, and the proportion of bone marrow plasma cells(P>0.05). The PFS of sIL-2R high expression group(15 months) was shorter than that of sIL-2R low expression group (22 months), which was significant difference (P=0.041). But there was no significant difference in OS between sIL-2R high expression group and sIL-2R low expression group (P=0.124). Univariate analysis results showed that the high expression of serum sIL-2R was associated with poor PFS in MM patients. Multivariate analysis results showed that the high expression of serum sIL-2R was still an independent adverse prognostic factor for PFS in MM patients, However, the expression of serum sIL-2R was not statistically significant in evaluating OS in MM patients by univariate and multivariate analysis. CONCLUSION: The expression of serum sIL-2R in MM patients was significantly higher than that in healthy people. Serum sIL-2R is an independent prognostic factor of PFS in MM patients.

[The Types and Laboratory Characteristics of Non-Hodgkin Lymphoma with Bone Marrow Invasion as the First Manifestation].

OBJECTIVE: To investigate the types and laboratory characteristics of non-Hodgkin lymphoma(NHL) with bone marrow invasion as the first manifestation. METHODS: 81 non-Hodgkin lymphoma patients with bone marrow invasion as the first manifestation treated in our hospital from January 2010 to July 2019 were selected. The clinical features, blood routine, lactate dehydrogenase (LDH), EB virus results, bone marrow features, immunophenotyping, gene and genetic characteristics of all patients were analyzed retrospectivel. RESULTS: Among 81 patients, 73 cases(90%) were B-cell lymphoma, 5 cases(6%) were T-cell lymphoma and 3 cases(4%) were NK/T-cell lymphoma, while the mantle cell lymphoma and diffuse large B-cell lymphoma were the highest, which accounted for 21%(17 cases) and 19.7%(16 cases), and lymphoma accounted for 8.6%(7 cases). There were 44 cases(54.3%) showed B symptoms, 65 cases (80.2%) showed abnormal blood routine. The MYD88 gene was detected in 5 of 17 cases. 25 cases of patients underwent chromosome examination, the result showed that 5 cases were t(8; 14) (q24; q32), 3 cases were complex karyotype and 17 cases were normal karyotype. 23 cases(23.4%) were EB virus positive, 42 cases(51.9%) were LDH increased. The proportion of bone marrow lymphoma cells was 1%-92%. Among them, 32 cases were diagnosed as lymphoma leukemia, and 6 cases of bone marrow lymphoma cells showed mass distribution similar to extramedullary tumor cells with bone marrow metastasis. CONCLUSION: B-cell lymphoma is the predominant NHL with bone marrow invasion as the first manifestation, while mantle cell lymphoma and diffuse large B-cell lymphoma are the most common pathological types with blood routine abnormalities. Bone marrow lymphoma cells can also present clusters of bone marrow metastasis, different types of lymphoma cells can make directional diagnosis.

[Analysis of Essential Thrombocythemia to Acute Myeloid Leukemia].

OBJECTIVE: To improve the understanding of the transformation of essential thrombocythemia (ET) into acute myeloid leukemia (AML), and to explore the relationship between JAK2 V617F gene mutation and disease transformation. METHODS: The detection of bone marrow morphology,cytogenetics, JAK2 V617F gene were performed before and after transformation, as well as the immunological tests after transformation was performed in 3 patients with ET into AML. The characteristics, clinical features, diagnosis and treatment of the patients before and after transformation were compared. RESULTS: Case 1 transformed into AML-M2a 5 years after diagnosis of ET. The patient abandoned treatment and was discharged from hospital. Case 2 transformed into AML 6 years after diagnosis of ET. After one course of chemotherapy, bone marrow was partially relieved, and platelets continued to rise up to 702×109/L, presenting as ET bone marrow image. One year later, AML relapsed and no remission was observed after chemotherapy. Case 3 transformed into AML-M6a 7 years after diagnosis of ET. The patient abandoned treatment and was discharged from hospital. The morphological heteromorphism of 3 cases of AML transformed from ET was more obvious than that of patients with newly diagnosed acute leukemia. The AML could not be classified accurately based on morphology simply, but could be classified accurately based on immunological detection. JAK2 V617F gene was positive before and after transformation in case 1 and case 2 of ET, the case 3 showed that JAK2 V617F gene was positive at ET stage and negative after AML transformation. Complex chromosome karyotypes were detected by routine karyotype analysis after ET transformation into AML in case 1, while normal karyotypes were found in case 2 and case 3. CONCLUSION: The morphological abnormality of AML transformed from ET is more significant than that of newly diagnosed acute leukemia, and it needs immunological detection to classify it accurately. The transformation of ET into AML may not involve JAK2 V617F gene mutation, but may be related with the occurrence of abnormal chromosome karyotypes. The condition of AML transformed from ET is dangerous and the effect of chemotherapy is poor.

[Diagnostic Value of Cytomorphology in Acute Leukemia].

OBJECTIVE: To investigate the diagnostic value of cytomorphology (including cytochemical staining) in newly diagnosed acute leukemia, so as to improve the importance of cytomorphology. METHODS: The clinical data of 119 cases of acute leukemia diagnosed in our hospital from April 2016 to June 2018 were analyzed retrospectively. According to morphologic and immunological typing, accordance rate to final diagnosis was compared. RESULTS: The diagnostic accordance rate of simple morphological typing was 76.5%, and the diagnostic accordance rate of simple immunological typing was 79.8%, the difference of diagnostic coincidence rate was not significant between the two groups of acute leukemia. CONCLUSION: Cytomorphology is the cornerstone of the diagnosis of acute leukemia, it has similar value to immunological classification in the diagnosis of leukemia and should pay enough attention. MICM comprehensive diagnosis can improve the final diagnosis rate, showing a guidance significance for the treatment and prognosis of patients with acute leukemia.

[Analysis of Toxoplasma Gondii Infection Rate in Patients with Hematological Diseases].

OBJECTIVE: To investigate the infection rate of Toxoplasma gondii in patients with hematological diseases. METHODS: The Toxoplasma gondii IgM antibody in 200 patients with hematological diseases were tested, at the same time, IgM antibody in the persons received physical examination and other patients with common clinical diseases also were test, and their detection results were compared. RESULTS: The positive rate of Toxoplasma gondii IgM antibody in patients with hematological diseases was 7.50%, the positive rate in persons received physical examination was 0.67%, and the positive rate in patients with other common clinical diseases was 1.20%. The positive rate of IgM antibody in patients with hematological diseases was statistically significantly higher than that in the latter two kinds of persons(P<0.05). Among the patients with hematological diseases, the positive rate of Toxoplasma gondii IgM antibody in patients with bone marrow neoplastic diseases was 10.32%, which was statistically significantly higher than that in patients with bone marrow non-neoplastic diseases (2.70%). CONCLUSION: Patients with hematological diseases are susceptible to Toxoplasma gondii, and to whom enough attention should be paid.

[Mutation Rate and Clinical Characteristics of CALR, JAK2 V617F and MPL W515K Genes in Patients With Primary Thrombocythemia].

OBJECTIVE: To analyze the mutation rate and clinical characteristics of CALR, MPL W515K and JAK2 V617F genes in patients with primary thrombocythemia (PT). METHODS: Fifty-six patients with PT were selected as the research objects in our hospital. The CALR and MPL W515K gene mutations were determined by genomic DNA-PCR direct sequencing of the PCR products, and the JAK2 V617F gene mutation was detected by allele specific PCR method. RESULTS: Among the 56 patients with PT there were 14 cases of CALR gene mutation with the incidence rate of 25%, including 6 cases of type I, 5 cases of type II and 3 cases of type III. The sex, age, platelet(Plt) count, white blood cell (WBC) count and hemoglobin (Hb) level in the type I case of CALR gene mutation all were not significantly different from that in type II and III(all P>0.05); the WBC level in type III group significantly increased in comparison of type II group (P<0.05), while the sex, age, Hb and Plt levels showed no significant difference between the type III and type II groups (P>0.05). There were 3 cases of MPL W515K gene mutation with the incidence rate of 5.36%; 21 cases of JAK2 V617F gene mutation with the incidence rate of 37.50%. There were 13 cases of CALR gene mutation in negative patients with MPL W515K and JAK2 V617F (18 cases) with 72.22% incidence rate (13/18), and there was no cases of 1 or 2 gene mutations coexisted. The levels of Hb and WBC in peripheral blood of patients with CALR mutation were significantly lower than those of JAK2 V617F mutation (both P<0.05). In 56 cases, there were 3 cases of abnormal karyotype, with the incidence rate of 5.36%. The mutation rate of CALR gene in abnormal karyotypes (66.67%) was significantly higher than that of normal karyotypes (20.75%) (P<0.01). CONCLUSION: The incidence of JAK2 V617F gene mutation increases in the patients with primary thrombocythemia; CALR mutation rate is higher in the patients with negative MPL W515K and JAK2 V617F gene mutation, which may closely correlate with abnormal karyotype; the levels of peripheral Hb and WBC in PT the patients with CALR gene mutation are significantly lower than those in patients with JAK2 V617F mutation.

[Amount Change of Peripheral Blood NK Cells in Patients with Hematologic Malignancies and Its Clinical Significance].

OBJECTIVE: To study the amount change of peripheral blood NK cells in patients with hematologic malignancies and its significance. METHODS: A total of 200 patients with hematologic malignancies in our hospital from June 2013 to March 2015 were chosen as study objects, out of them 105 patients were in aute stage and 95 patients were in remisson stage. At same time 100 people from healthy medical examination in our hospital were chosen as control group. The mumber change and subgroups of their peripheral blood NK cells were analyzed and compared. RESULTS: In control group the absolute number of NK cells was (412.91 ± 167.35)/µl, the relative number of NK cells was (13.31 ± 2.56) %; in group at acute stage of leukemia the absolute number of NK cells was (97.84 ± 23.18)/µl, the relative number of NK cells was (6.79 ± 0.78) %; in group at acute stage of lymphoma, the absolute number of NK cells was (101.79 ± 25.63)/µl, and the relative number of NK cells was (7.12 ± 1.03) %; in group at remission stage of leukemia, the absolute number was (297.17 ± 87.56)/µl, and the relative number was (10.15 ± 1.64) %; In group at remission of lymphoma, the absolute number of NK cells was (288.52 ± 118.52)/µl, and the relative number of NK cells was (10.82 ± 1.97) %. The number of NK cells between different groups showed statistical difference (P < 0.05). In remission group, the number of NK cells before and after treatment had statistical difference (P < 0.05). In control group, the number of CD56(bright) subgroup was (25.28 ± 4.72) %, the number of CD56(bright) subgroup at the acute stage of leukemia was (65.46 ± 11.21) %, and the number of CD56(bright) subgroup at the acute stage of lymphoma was (70.71 ± 12.14) %, the number of CD56(bright) subgroup at remission stage of leukemia was (23.35 ± 4.67) %, the number of CD56(bright) subgroup at remission stage of lymphoma was (24.89 ± 4.58) %. The number of CD56(bright) subgroup between different groups showed statistical significance (P < 0.05). CONCLUSION: The number and function of peripheral blood NK cells in patients with hematologic malignancies have been confirmed to be obvious decrement, but after treatment the number of NK cells in those patients showed increment.