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Objective: To investigate the efficacy and safety of bendamustine combined with anti-CD20 monoclonal antibody in the first-line treatment of older patients with indolent B-cell non-Hodgkin lymphoma (B-iNHL) . Methods: The clinical data of 159 patients with B-iNHL enrolled in 16 hospitals from Jiangsu Cooperative Lymphoma Group from December 1, 2019, to April 20, 2024, were analyzed for regimen efficacy and safety. Bendamustine plus rituximab (BR) and bendamustine plus obinutuzumab (BG) were administered to 139 (87.4% ) and 20 (12.6% ) patients, respectively. Results: Among the 159 patients, 101 (63.5% ) were male and 58 (36.5% ) were female, with a median age of 69 years (range: 60-84). Efficacy could be assessed in 138 (86.8% ) patients. The efficacy assessment demonstrated that the overall response rate was 92.0% with complete and partial remissions in 75 (54.3% ) and 52 (37.7% ) cases, respectively. With a median follow-up of 24 months (range: 4-64), the progression-free survival rate was (87.5 ± 3.0) % and the overall survival rate was (83.2 ± 3.3) %. Of the 27 patients who died, 6 (22.2% ) died due to disease progression. The mean applied dose of bendamustine per cycle was 73.0 (50.8-89.7) mg/m(2) per day, administered on days 1 and 2. Adverse events of grade 3 or higher were reported in 53 (33.3% ) patients, with infection (30 cases,18.9% ) and neutropenia (24 cases, 15.1% ) demonstrating the highest incidence. Conclusion: Bendamustine combined with anti-CD20 monoclonal antibody demonstrated good efficacy and is well-tolerated in the first-line treatment of elderly patients with B-iNHL.

Intravascular large B-cell lymphoma (IVLBCL) is a rare large B-cell lymphoma subtype. We report a patient who presented with "recurrent fever and pancytopenia." A 64-year-old female patient had previously been diagnosed with Waldenstrom's macroglobulinemia and had received zanubrutinib treatment. In February 2023, the patient revisited due to "recurrent fever and pancytopenia." A positron emission tomography/computed tomography scan demonstrated significant enlargement of the bilateral adrenal glands. After an adrenal biopsy, she was diagnosed with diffuse large B-cell lymphoma, not otherwise specified. The patient received chemotherapy with the R-CHOP regimen (rituximab + cyclophosphamide + doxorubicin + vincristine + prednisone). After three treatment courses, a cranial magnetic resonance imaging examination indicated central nervous system infiltration of the lymphoma. After reviewing the pathology of the adrenal biopsy, the final diagnosis was revised as IVLBCL. Despite aggressive treatment, the disease continued to progress, and the patient died two months later. According to a multidisciplinary level, this article discusses the case from the perspective of a multidisciplinary team collaboration, involving imaging, pathology, dermatology, and lymphoma, to provide reference opinions for the clinical diagnosis and treatment of IVLBCL.

Objective: To investigate the efficacy and safety of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for the treatment of BCR::ABL-negative chronic neutrophilic leukemia (CNL) and MDS/MPN with neutrophilia. Methods: This study retrospectively analyzed 12 cases of CNL and MDS/MPN with neutrophilia that underwent allo-HSCT from March 2017 to June 2024, comprising 7 males and 5 females with a median age of 48 (IQR: 28, 59) years. The 2-year overall survival (OS), disease-free survival (DFS), cumulative incidence of relapse (CIR), and transplantation-related mortality (TRM) rates were analyzed. Complications were also assessed. Results: Of the 12 patients, 6 received matched sibling HSCT and 6 received haploidentical HSCT. All patients had successful engraftment, and the median times of neutrophil and platelet engraftment were 17 (IQR: 11, 24) days and 15 (IQR: 9, 28) days, respectively. Grade Ⅱ-Ⅳ acute graft versus host disease (GVHD) and chronic GVHD occurred in 2 and 4 cases, respectively. The 2-year OS, DFS, CIR, and TRM rates were (65.6 ± 16.4) %, (41.7 ± 16.6) %, (47.2 ±18.2) %, and (11.1 ± 11.4) %, respectively, after a median follow-up time of 637 (IQR: 330, 943) days. One patient died from treatment-related complications due to respiratory failure caused by coronavirus disease 2019. Two patients died due to relapse. Conclusion: Allo-HSCT can be applied as a safe and effective approach to treat CNL and MDS/MPN with neutrophilia.

Objective: To compare the performance of next-generation sequencing (NGS) and Sanger sequencing in investigating somatic hypermutation (SHM) status of immunoglobulin heavy chain variable region (IGHV) genes. It specifically focuses on identifying key factors contributing to discrepancies between the two methods, particularly under complex clonal backgrounds, to inform optimized strategies for clinical application. Methods: This retrospective analysis included 53 samples, comprising 43 identified as non-monoclonal and 10 as monoclonal using Sanger sequencing. All samples were further analyzed using NGS to assess IGHV SHM. The two methods were used for systematic comparison. For discordant cases, in-depth attribution analysis was conducted, considering factors, including clonal abundance quantification, differences in primer design, and interpretation criteria. Results: Among the 53 patients who underwent both Sanger and NGS testing, 36 were male and 17 were female, with a median age of 64 years (range: 33-88). Diagnoses included chronic lymphocytic leukemia (CLL) in 35 (66.0% ), diffuse large B-cell lymphoma in 9 (17.0% ), follicular lymphoma in 3 (5.7% ), mantle cell lymphoma in 3 (5.7% ), and other types in 3 (5.7% ) cases. In the 43 cases with non-monoclonal profiles using Sanger sequencing, NGS revealed 23 cases as biclonal or polyclonal, 17 as monoclonal, and 3 with no detectable clonality. The primary discrepancies between the two methods involved variations in clonality assessment, IGHV gene rearrangement types, and mutation rates. Among the 10 cases identified as monoclonal using Sanger sequencing, NGS detected biclonality and markedly different IGHV rearrangement types in 2 and 4 cases, respectively. Minor differences were observed in SHM percentage between the two methods; however, these did not substantially affect the overall determination of mutational status. Conclusion: Compared with Sanger sequencing, NGS exhibits superior performance in assessing IGHV SHM status under complex clonal conditions. It provides greater sensitivity and accuracy in detecting subclonal components and quantifying clonal proportions, thereby providing a more precise molecular basis for diagnosing and prognostically assessing lymphoid malignancies, including CLL.

Autoimmune diseases (AID) are disorders in which the immune system mistakenly attacks the body's own tissues. However, current immunosuppressive therapies seldom achieve durable, drug-free remission, indicating the urgent need for therapeutic strategies that are both more precise and longer-lasting. Chimeric antigen receptor (CAR) -T cells are generated by genetically engineering T cells to specifically recognize and kill cells that express particular antigens, thereby providing a novel therapeutic approach for AID. This review summarizes the immunological mechanisms of CAR-T cells and -regulatory T cells (Treg) in treating AID, and systematically reviews the latest advances in applying these treatments to rheumatic AID, immune-mediated neurological AID, and refractory autoimmune hemolytic anemia, among others. Further, we discuss the safety-related limitations of CAR-T /CAR-Treg treatment for AID, and outline other CAR-based cellular therapies that can be used to treat AID beyond CAR-T and CAR-Treg cells.

Objective: To investigate the feasibility of the bortezomib, lenalidomide, and dexamethasone (VRD) regimen combined with autologous hematopoietic stem cell transplantation (auto-HSCT) in patients with multiple myeloma (MM) and renal impairment, analyze treatment efficacy and renal responses stratified based on renal dysfunction severity, and explore the prognostic significance of early renal response and its affecting factors. Methods: This retrospective study, conducted at the First Affiliated Hospital of Soochow University, categorized 316 patients with newly diagnosed MM (NDMM) from August 2018 to October 2022 based on renal function for analysis of clinical characteristics, treatment response, and prognosis. Continuous variables were compared using t-tests or Mann-Whitney U tests, categorical variables utilizing Chi-square tests, survival outcomes employing Kaplan-Meier and Log-rank tests, and renal response predictors with logistic regression. Results: Patients were stratified based on baseline estimated glomerular filtration rate (eGFR) : normal [≥90 ml·min(-1)· (1.73 m(2)) (-1), n=160], mild [≥60 ml·min(-1)· (1.73 m(2)) (-1) to <90 ml·min(-1)· (1.73 m(2)) (-1), n=55], moderate [≥30 ml·min(-1)· (1.73 m(2)) (-1) to <60 ml·min(-1)· (1.73 m(2)) (-1), n=39], and severe impairment [<30 ml·min(-1)· (1.73 m(2)) (-1), n=62]. Moderate and severe renal impairment correlated with advanced International Staging System/Revised International Staging System classification, lower hemoglobin levels, frailty, and higher light-chain/IgD subtype prevalence (P<0.05). Despite younger age (P=0.001) and higher transplant rates (P=0.041) in severe cases, overall response rates (ORR: 93.7% ; ≥VGPR: 82.9% ) were comparable across groups (P>0.05). Among 24 dialysis-dependent patients at diagnosis, 11 (45.8% ) achieved dialysis independence after induction [median: 3.0 (0.5-4.0) months], including 10 undergoing auto-HSCT. In 89 evaluable patients [baseline eGFR <50 ml·min(-1)· (1.73 m(2)) (-1)], renal ORR (RORR) was 70.8% [rapid complete response: 31.5% ; rapid partial response: 11.2% ; rapid minimal response (RMR) : 28.1% ]. Renal response predicted better survival (overall survival: HR=0.36, 95% CI: 0.13-0.99, P=0.049). Moderate-to-severe renal impairment was associated with increased transplant-related adverse events and delayed engraftment (P<0.05) ; however, auto-HSCT significantly improved outcomes after 33.5-month median follow-up (range: 2-65 months). Multivariate analysis identified 1q21+ (OR=3.58, 95% CI: 1.17-11.02, P=0.026) and light-chain subtype (OR=2.86, 95% CI: 1.08-7.69, P=0.036) as independent predictors of poor renal response. Conclusion: VRD regimen plus auto-HSCT demonstrates robust efficacy in NDMM, including patients with renal impairment, with a 70.8% RORR and manageable toxicity.

This study retrospectively analyzed data from 25 patients with paroxysmal nocturnal hemoglobinuria (PNH) admitted to Peking Union Medical College Hospital and Dongfang Hospital of Beijing University of Chinese Medicine from January 2023 to June 2024. Patients receiving sufficient eculizumab treatment for at least 3 months and who completed hemolytic complex (CH50) level testing pre- and post-treatment for 3 and 6 months were selected. Blood routine, biochemistry, and the 50% CH50-related indicators were monitored pre- and post-treatment. Among these patients, 24 completed 6 months of treatment and CH50 testing. After 3 and 6 months of eculizumab treatment, all patients with PNH showed significant improvement in symptoms, with lactate dehydrogenase (LDH) levels decreasing from a baseline of (1 814.4 ± 924.8) U/L to (248.5 ± 61.0) U/L and (239.3 ± 44.8) U/L. Hemoglobin levels increased from a baseline of (73.9±14.4) g/L to (99.9 ± 21.3) g/L and (99.6 ± 19.8) g/L. The baseline CH50 level was (32.4±14.7) %, which decreased to 2.0% (1.0% -8.0% ) and 1.0% (1.0% -4.0% ) at 3 and 6 months posttreatment, respectively. At baseline, a linear correlation was found between CH50 and LDH levels (P<0.001), and the trend of CH50 changes was significantly lower than LDH at 3 and 6 months post-treatment with eculizumab, with similar trends. However, no linear correlation was observed between CH50 and LDH levels or other parameters at 3 and 6 months of medication. Our case demonstrates that eculizumab is effective for PNH hemolysis treatment. The serum CH50 level may be a biomarker for complement blockade induced by eculizumab, which can, to some extent, reflect the intravascular hemolysis of PNH and the efficacy of eculizumab.

Epstein-Barr virus positive diffuse large B cell lymphoma (EBV(+) DLBCL) is a rare subtype of diffuse large B cell lymphoma with a poor prognosis. Due to the low incidence of EBV(+) DLBCL, the understanding of the disease has not been unified, and the treatment remains non-standardized. In order to strengthen the understanding of EBV(+) DLBCL in our country, improve the diagnosis and treatment level, and help promote multi-center clinical research, the Lymphoid Disease Group, Chinese Society of Hematology, Chinese Medical Association and Lymphoma Expert Committee of Chinese Society of Clinical Oncology (CSCO) organized relevant experts to discuss and form this consensus on the diagnosis and treatment of EBV(+) DLBCL, combined with the latest research progress in China and abroad.

Objective: To identify the prognostic value of the Revised 15-item Myelodysplastic Syndrome-specific frailty scale (FS-15) in Chinese patients with myelodysplastic syndromes (MDS) . Methods: This retrospective study analyzed 812 patients with newly diagnosed MDS admitted to the Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College from August 2016 to June 2023. Patients were assessed using the FS-15 and subsequently categorized into frail and non-frail groups. Clinical and laboratory characteristics, as well as overall survival (OS), were compared between these groups. Results: ① The median patient age was 55 years (IQR 45-64), with a median follow-up of 22.5 months (95% CI: 20.2-24.9) and a median OS of 43.3 months (95% CI: 36.8-49.8). The median FS-15 score was 0.42, with a cutoff value of 0.44. Male patients demonstrated higher median FS-15 scores than female patients (0.42 vs 0.38, P=0.006). In both the Revised International Prognostic Scoring System (IPSS-R; P=0.001) and Molecular International Prognostic Scoring System (IPSS-M; P=0.014) stratifications, FS-15 scores were significantly higher in the very high-risk group compared with the very low-risk group. ② The median OS was 54.7 months (95% CI: 47.5-NA) and 31.5 months (95% CI: 22.9-41.0) in the nonfrail (n=452) and frail groups (n=360), respectively (P<0.001). The 3-year OS rates were (63.2 ± 3.2) % and (46.4 ± 3.6) % for the non-frail and frail groups, with 5-year OS rates of (49.9 ± 4.7) % and (32.0 ± 4.3) %, respectively (P<0.001). ③Subgroup analysis revealed that nonfrail patients demonstrated significantly higher 3-year OS rates than frail patients in both the IPSS-M low-risk and very high-risk groups (all P<0.05). Similarly, nonfrail patients demonstrated superior 3-year OS rates compared with frail patients in the IPSS-R very low-risk, low-risk, and high-risk groups (all P<0.05). ④Among patients receiving hypomethylating agent therapy, the overall response rate was significantly higher in the non-frail group than in the frail group (86.7% vs 64.6%, P=0.007). Moreover, the frail group experienced higher rates of treatment-related adverse events, including febrile neutropenia (67.1% vs 47.4%, P=0.016) and liver function abnormalities (30.0% vs 14.5%, P=0.023), compared with the non-frail group. Conclusion: The FS-15 frailty score is a feasible and effective tool for assessing frailty in patients newly diagnosed with MDS in China and serves as a valuable prognostic indicator.