[Efficacy and prognosis of newly diagnosed multiple myeloma patients treated with bortezomib, lenalidomide and dexamethasone].

Objective: To evaluate the efficacy of VRD (bortezomib+lenalidomide+dexamethasone) in newly diagnosed multiple myeloma (NDMM) patients as well as the effect of the regimen on the long-term prognosis. Methods: The clinical characteristics, survival rates, response rates and minimal residual disease (MRD) of patients with NDMM at Institute of Hematology & Blood Diseases Hospital from January 1, 2013 to January 1, 2020 were retrospectively analyzed. Subgroup analysis was also performed among groups according to the cytogenetics and autologous stem cell transplantation (ASCT) of patients. Results: A total of 87 patients were retrospectively analyzed. The age[M(Q1,Q3)] of all patients was 56 (51, 61) years and males and females accounted for 58.6% (51/87) and 41.4% (36/87), respectively. The overall response rate (ORR) was 95.9% (71/74) after 2 courses of induction therapy, with 13.5% (10/74) achieving the deep response [complete response (CR) or better] and 51.3% (38/74) of patients achieving a very good partial response (VGPR) or better. After 4 courses of induction therapy, the ORR achieved 95.2% (60/63), and the proportions of the deep response and VGPR or better grew up to 46.0% (29/63) and 77.7% (49/63). According to the treatment, the patients (≤65 years old) were divided into transplantation group and non-transplantation group. After the induction therapy, 88.8% (32/36) of patients in the transplantation group achieved VGPR or better, and 55.5% (20/36) reached the deep response. After the transplantation, the proportion increased to 97.1% (34/35) and 77.2% (27/35), respectively(88.8% vs 97.1%,P=0.174;55.5% vs 77.2%,P=0.055), with the rate of undetectable MRD increasing from 44.4% (16/36) to 77.8% (28/36) (P=0.004). In the non-transplantation group, 74.2% (23/31) of patients achieved VGPR or better after 4 courses of induction therapy, 35.5% (11/31) of the patients achieved deep response and the rate of undetectable MRD was 37.0% (10/27). Compared with the non-transplantation group, transplantation was associated with a higher rate of complete response (89.5% vs 53.1%, P<0.001) and a lower rate of MRD detection(78.4% vs 55.2%, P=0.045). The median follow-up time of all patients was 26.3 months (20.8, 33.8). The median progression-free survival and overall survival were not reached. The three-year PFS and OS rates were 78.4% and 87.2%, respectively. None of the standard-risk group, the high-risk group, the transplantation group and non-transplantation group achieved the median PFS and OS. Conclusions: VRD regimen has a promising efficacy and results in a substantial survival benefit. ASCT after VRD induction therapy is associated with higher rate of deep response, higher rate of undetectable MRD and longer survival.

[Clinical characteristics and prognosis of 46 patients with macrofocal multiple myeloma].

The clinical characteristics, laboratory results, response to treatment, and prognosis of 46 macrofocal multiple myeloma(MFMM) patients at our center from January 2013 to December 2019 were analyzed retrospectively. The other 92 patients were selected as matched-controls based on diagnostic period and treatment. Among the 1 137 MM patients, 46 patients met the definition criteria of MFMM (4.0%), with median age 56 years, which was not statistically different from whole MM population (P=0.066). According to the international staging system (ISS) and Revised ISS, the proportion of patients with advanced stage in MFMM group was less common than that of controls (P<0.05). More plasmacytomas in MFMM patients were presented (43.5% vs. 18.5%, P<0.05). Regarding cytogenetic abnormalities, there were minor patients manifesting high-risk features in MFMM group (15.8% vs. 32.2%, P=0.058). Translocation(11;14) could be detected in 32.4% MFMM patients and 9.4% typical myeloma patients (P<0.05). The treatment regimens were comparable. As to the best response of treatment, the complete response (CR) rate in MFMM group was significantly higher than that of controls (78.3% vs. 60.9%, P<0.05). The median follow-up time was 37.9 months. The median progression-free survival in MFMM and control groups were 77.5 vs. 39.8 months, respectively (P<0.05). The overall survival (OS) of MFMM patients was significantly longer (not reached vs. 68.2 months, P<0.05).

[Central nervous system toxicity caused by bortezomib: five case reports and a review of literature].

Objective: To investigate the clinical features, diagnosis, and treatment of the central nervous system (CNS) toxicity caused by bortezomib. Methods: This study reports five new cases of CNS toxicity caused by bortezomib to elucidate its characteristics along with a review of the literature. Results: CNS toxicity caused by bortezomib presents in three clinical forms: syndrome of inappropriate antidiuresis (SIAD) , posterior reversible encephalopathy syndrome (PRES) , and central fever, which is the most common clinical manifestation. Four of our five patients developed central fever after the administration of bortezomib, manifested as persistent high fever, anhidrosis, and absence of infective foci; the symptom could be improved by discontinuance of bortezomib. Of these patients, three concurrently presented with refractory hyponatremia and one was clearly diagnosed with SIAD. The bortezomib could have caused damages to the hypothalamus and induced both central fever and SIAD. In addition, one patient was diagnosed with PRES due to disturbance of consciousness and epilepsy after taking bortezomib. After discontinuation of bortezomib, the symptoms disappeared and did not recur. We also found that thrombocytopenia may be related to the severity of the CNS toxicity of bortezomib. Conclusion: Cases of CNS toxicity of bortezomib are extremely rare and present as SIAD, PRES and central fever. Early detection and treatment of bortezomib are very important to prevent irreversible neurological complications.

[Immunoglobulin M multiple myeloma: a six-case report and literature review].

Objective: To investigate the clinical characteristics, responses, and prognosis of immunoglobulin M multiple myeloma (IgM MM) . Methods: The clinical characteristics, laboratory results, bone marrow biopsy results, response, and prognosis of six cases of IgM MM in the Blood Diseases Hospital, Chinese Academy of Medical Sciences, from December 18, 2009 to October 29, 2020 were collected and analyzed. Results: All six cases met the diagnosis criteria of IgM MM. There were four males and two females. The median age at first diagnosis was 70 (59-81) years. According to Durie-Salmon (DS) staging, 2 cases were in ⅠA, and 4 cases were in ⅢA. According to the International Staging System (ISS) , 4 cases were in Ⅱ, and 2 cases were in Ⅲ. The initial symptoms were as follows: 4 cases of bone pain, 3 cases of hyperviscosity, and 2 cases of lymphadenopathy or hepatosplenomegaly. Laboratory results showed the following: median blood M protein: 39.11 (3.61-75.56) g/L; median serum IgM: 69.35 (4.35-137.00) g/L; median hemoglobin: 87.0 (70-131) g/L; median blood creatinine: 83.6 (53.0-129.6) µmol/L; median blood calcium: 2.12 (2.11-2.50) mmol/L. The median ratio of bone marrow plasma cells was 0.390 (0.255-0.590) , and in four cases, plasma cells were observed in blood smears. Karyotype analysis and fluorescence in situ hybridization (FISH) examination showed the following: 1 case of hypodiploidy, 2 cases of P53 gene deletion, 1 case of 1q21 amplification positive, and 4 cases of RB-1 gene deletion positive. The immunoglobulin heavy chain (IgH) rearrangement was positive in all cases, of which 3 cases were CCND1/IgH fusion gene-positive identified with t (11;14) rearrangement. Immunophenotyping revealed that all cases were positive for CD38, CD138, and monoclonal light chain and four cases were weakly positive for CD20. All cases accepted proteasome inhibitor-based regimens and attained the response of partial remission to strict complete remission. Conclusion: In addition to the typical clinical manifestations of myeloma, IgM MM is also characterized by hyperviscosity, lymphadenopathy, or hepatosplenomegaly, and t (11;14) is the most frequent cytogenetics aberration. Furthermore, the response and prognosis of IgM MM are similar to other common myeloma subtypes.

Nano-porous architecture of N-doped carbon nanorods grown on graphene to enable synergetic effects of supercapacitance.

A novel nano-porous 3D architecture of N-doped carbon nanorods arrays grown on the surface of graphene has been prepared by carbonizing polyaniline/graphene oxide (PANI-GO) composite with PANI nanorod arrays on both sides of GO nanosheets. The obtained carbon materials are entirely composed of regularly grown carbon nanorods on graphene with height of about 100 nm and width about 30 nm, showing porous property due to the decomposition of PANI chains. The morphology of PANI grown on GO at the different growth stages was investigated to demonstrate the mechanism of the finally hierarchical architecture formation. Due to its large specific surface area and incorporation of the nitrogen groups into the carbon matrix, the obtained 3D carbon material enhances the ionic transport and the super-capacitance by synergetic effect of both double-layer and faradaic capacitances. This study provides a controllable approach to fabricate hierarchical carbon material based on conducting polymers and graphene oxide with promising applications in the high-rate electrode material of supercapacitors.

Study on the enhanced protein adsorption of microwave sintered hydroxyapatite nanoceramic particles: Role of microstructure.

Currently, nanobioceramics have received much attention due to their potentially high biological performance. In the present study, the interactions between proteins and two types of hydroxyapatite (HA) ceramic particles with distinct microstructures were studied in vitro. Protein adsorption on the microwave sintered and conventionally sintered HA ceramic particles (named as HAMS and HACS, respectively) were carried out in simulated body fluid (SBF) containing model proteins or rat serum and then subjected to protein quantitative evaluation, SDS-PAGE, and Western blotting analysis. The ceramic particles were characterized by nitrogen sorption, Hg penetration, zeta potential, and solubility analysis. It was found that HAMS with nanosized crystallites had greater specific surface area and pore volume and wider pore size distribution ranging from 0.02 to 2 µm than HACS. Although bovine serum albumin and lysozyme have different electrical properties in SBF, both the model proteins showed higher adsorption amounts per gram solid on HAMS than HACS, as could be ascribed to the contribution of the micropores structure of HAMS. Similarly, HAMS adsorbed more serum proteins per gram solid than HACS when incubating in rat serum, and here the surfaces of both particles were almost completely covered by serum proteins, leading to almost the same protein adsorption amounts per unit area solid of HAMS and HACS. SDS-PAGE patterns proved that HA ceramic particles had different binding capacities for different serum proteins and was not highly dependent on the concentrations of the competing protein components present in rat serum. Western blotting analysis confirmed the enhanced adsorption of fibronectin and vitronectin on HAMS, indicating that HAMS might have better bioactivity than HACS.

The effect of loading icariin on biocompatibility and bioactivity of porous ß-TCP ceramic.

In order to enhance the ability of calcium phosphate-based biomaterials for bone defect repair, icariin (Ica), one natural product with ability of promoting osteoblasts differentiation in vitro and enhancing bone formation in vivo, was loaded into porous ß-tricalcium phosphate ceramic (ß-TCP) disks. The obtained Ica-loaded porous ß-TCP ceramic (Ica/ß-TCP) disks were characterized by SEM. The SEM photos indicated that the disks had porous structure and the surface morphology of the porous ß-TCP ceramic (ß-PTCP) disks had no obvious difference from the Ica/ß-TCP disks. The Ica release curve of Ica/ß-TCP disks showed a burst release during the first 1 day and the concentration of released Ica during the first 3 days had low cytotoxicity. The loading Ica in Ica/ß-TCP disks hardly affected the attachment and morphology of Ros17/28 cells, however, the Ica/ß-TCP disks were favorable to supporting the proliferation and differentiation of Ros17/28 cells better compared with the ß-PTCP disks. There was plenty of bone-like apatite formed on the surface of Ica/ß-TCP disks soaked in SBF solution for three days. After back intramuscular implantation of rats for three months, no obvious osteogenic evidence was detected in ß-PTCP disks, but new bone formation was observed in Ica/ß-TCP disks. Fibrous tissues and slight inflammatory reaction was also found in the Ica/ß-TCP disks and ß-TCP disks. Therefore, the loading Ica did not change the biocompatibility of ß-TCP ceramic, but enhanced the bioactivity of ß-TCP ceramic in vivo. The Ica/ß-TCP ceramic had potential to be used for bone defect repair.

Chondrogenic differentiation of mesenchymal stem cells induced by collagen-based hydrogel: an in vivo study.

Chondrogenic differentiation of mesenchymal stem cells (MSCs) relies on inductive media of chondrogenic environment. With proper design, a cellular microenvironment mimicking chondrogenic environment might be created to induce chondrogenesis of MSCs. In this study, bone marrow mesenchymal cells (BMSCs) were encapsulated in collagen-based hydrogel, and then enclosed in diffusion-chambers which allow the body fluid to permeate and preclude the host cells to invade. Then, the chamber with the hydrogel-BMSCs composite was implanted in the back of rabbits subcutaneously. The specimens in the chamber were harvested for histological, immunohistochemical, and RT-PCR analyses after 8 weeks. The results showed that cells with the characteristic of chondrocytes were homogenously distributed and the extracellular matrix (ECM) of cartilage has been secreted, indicating the chondrogenic differentiation of BMSCs. As control, nothing was obtained with only BMSCs. Moreover, the expression of collagen type II, indicator of cartilage ECM, was less in tissues with collagen-alginate-hydrogel (CAH) than that with collagen-hydrogel (CH). The results showed that both CH and CAH may induce the chondrogenesis and the induction is materials dependent. From in vitro experiments, TGF-beta is a necessary signal molecule for chondrogenesis, and it was suggested that the material may take in vivo growth factors to trigger chondrogenesis. From the studies, the chondrogenic induction of the hydrogel may be ascribed to that the hydrogel may provide a suitable environment and aggregate the signal molecule for chondrogenesis in vivo. The results would lend valuable reference in clinical for selection of appropriate scaffold for cartilage repair.

Effect of phase composition and microstructure of calcium phosphate ceramic particles on protein adsorption.

The biological performance of biomaterials is strongly influenced by their protein adsorption characteristics, which are related to the structures and properties of both the biomaterial and the protein. In the present study two groups of hydroxyapatite (HA) and biphasic calcium phosphate (BCP) ceramic powders were fabricated by different drying processes. The roles of the phase composition and microstructure of the powders in the adsorption of various model proteins were evaluated. The experimental results showed that BCP always had a higher ability to adsorb fibrinogen, insulin or type I collagen (Col-I) than HA. The microporosity and micropore size of the CaP particles also had a strong impact on their protein adsorption characteristics. HA and BCP particles with higher microporosities and/or more micropores >20 nm in diameter could adsorb more fibrinogen or insulin. However, amounts of adsorbed Col-I were largely unaffected by the microstructure of HA and BCP particles.

Effect of surface structure on protein adsorption to biphasic calcium-phosphate ceramics in vitro and in vivo.

Protein adsorption affects the function of cells and determines the bioactivity of biomaterial implants. Surface structure and properties of materials determine the behavior of protein adsorption. In the present study, two biphasic calcium-phosphate ceramics (BCPs) with different surface structures were fabricated by pressing and H2O2 foaming methods. Their surface characteristics were analyzed and the in vitro and in vivo protein adsorption on them was investigated. Porous BCP showed higher ability to adsorb proteins, and transforming growth factor-beta1 (TGF-beta1) adsorption notably increased with increasing in vivo implantation time. The strong affinity of BCP to TGF-beta1 might provide important information for exploring the mechanism of the osteoinduction of calcium phosphates.

Controllable release of salmon-calcitonin in injectable calcium phosphate cement modified by chitosan oligosaccharide and collagen polypeptide.

The aim of this research is to study the effect of the controlled releasing character of the salmon calcitonin (S-CT) loaded injectable calcium phosphate cement (CPC) modified by adding organic phase, chitosan oligosaccharide (CO) and collagen polypeptide (CP). The uniform design was used to determine the basic formulation with suitable injectable time for clinical application, and then the changes of the physical characters, the controlled releasing character of the modified CPC along with the ratio of the organic phase were also evaluated in vitro. The surface morphous of the modified CPC been implanted in the abdominal cavity or soaked into the serum of rat was also observed by scanning electron microscope (SEM). The result shows that a suitable formulation of modified CPC could be got, and the injectable time is 12 min, the compressive strength is 12 MPa, and the final setting time is 40 min. Comparing with the CPC without organic phase, the releasing rate of S-CT would increase along with the increase of the organic phase after 7th day. Therefore, a novel S-CT loaded bioactive injectable CPC for treating osteoporosis induced bone defect was obtained, and the release of the containing S-CT was controlled easily through adjusting the ratio of CO and CP.

Competitive adsorption of bovine serum albumin and lysozyme on characterized calcium phosphates by polyacrylamide gel electrophoresis method.

Characterizations of hydroxyapatite (HA), biphasic calcium phosphate (BCP) and beta tricalcium phosphate (beta-TCP) ceramic particles were carried out using X-ray diffusion (XRD), Scanning electron micrograph (SEM), Particle Sizer and Zeta potential analyzer. Competitive adsorption of bovine serum albumin (BSA) and lysozyme (LSZ) on the three calcium phosphates were investigated by polyacrylamide gel electrophoresis (PAGE) method. The results showed that HA, BCP and beta-TCP ceramic particles with irregular shapes and similar size distributions all had negative surface net charges in pH7.4 phosphate buffered saline (PBS) solution and exhibited alike behaviors of BSA and LSZ adsorption. LSZ had higher affinity for calcium phosphate ceramics than BSA and its adsorption on them didn't be almost influenced by the increasing of BSA concentration in the solution. Electrostatic interaction played an important role on the competitive adsorption of BSA and LSZ on the surface of calcium phosphate ceramic particles.