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Assessment the Effect of Human Umbilical Cord Wharton's Jelly Stem Cells on the Expression of Homing Genes; CXCR4 and VLA-4 in Cell Line of Breast Cancer. 人脐带沃顿果冻干细胞对归巢基因表达影响的研究CXCR4和VLA-4在乳腺癌细胞系中的表达。
Q3 Medicine Pub Date : 2022-04-01 DOI: 10.18502/ijhoscr.v16i2.9204
Vida Vahdanikia, Masoud Maleki, Roya Asl Irani Fam, Adel Abdi

Background: Breast cancer is the most common cancer in women.  The prevalence of breast cancer in Western women is one in eight.  Although the prevalence of breast cancer in Iran is lower than in Western countries (one in every 10-12 women), the incidence of breast cancer in it is 5-10 years earlier than in Western countries. Breast cancer is the second leading cause of cancer death among women after lung cancer. Therefore, finding new therapeutic methods could potentially help to reduce breast cancer mortality and increase the survival rate. Wharton jelly stem cells with mesenchymal morphology play an important role in inhibiting the progression of ovarian, osteosarcoma, and breast cancer by inducing apoptosis and reducing metastasis. Several environmental and genetic factors are involved in the occurrence of breast cancer. CXCR4 and VLA-4 genes are important genetic factors in breast cancer that play a role in cell survival, migration, proliferation, and metastasis of several types of cancer, especially breast cancer. Therefore, inhibition of these two genes by Wharton's Jelly Stem Cells could be a novel and effective therapeutic target in breast cancer.  The aim of this study was to investigate the effect of Wharton jelly stem cells secretion on the expression of CXCR4 and VLA-4 genes in cancer cells. Materials and Methods: These cells were exposed to Wharton's Jelly Stem Cells after culturing breast cancer cells. RNA was extracted from treated cells. The expression of CXCR4 and VLA-4 genes was evaluated by real-time PCR. Results: The results of the MTT and Scratching tests showed a significant difference compared to the control group. Also, the results of Real-time PCR showed a significant decrease in the expression of CXCR4 and VLA-4 genes compared to the control group. Conclusion: The results of this study showed that different concentrations of Wharton Jelly Stem Cells reduce cancer cell growth and expression of CXCR4 and VLA-4 homing genes in MDA-MB-231 breast cancer cells. Therefore, Wharton Jelly Stem Cells can be considered as an effective treatment for breast cancer.

背景:乳腺癌是女性中最常见的癌症。西方女性的乳腺癌患病率为八分之一。虽然伊朗的乳腺癌患病率低于西方国家(每10-12名妇女中有1名),但其乳腺癌发病率比西方国家早5-10年。乳腺癌是女性癌症死亡的第二大原因,仅次于肺癌。因此,寻找新的治疗方法可能有助于降低乳腺癌死亡率,提高生存率。具有间充质形态的沃顿果冻干细胞通过诱导细胞凋亡和减少转移,在抑制卵巢癌、骨肉瘤和乳腺癌的进展中发挥重要作用。一些环境和遗传因素与乳腺癌的发生有关。CXCR4和VLA-4基因是乳腺癌的重要遗传因子,在多种癌症,尤其是乳腺癌的细胞存活、迁移、增殖和转移中发挥重要作用。因此,Wharton’s Jelly Stem Cells抑制这两个基因可能是一种新的有效的乳腺癌治疗靶点。本研究旨在探讨沃顿果冻干细胞分泌对癌细胞中CXCR4和VLA-4基因表达的影响。材料和方法:培养乳腺癌细胞后,将这些细胞暴露于沃顿果冻干细胞中。从处理过的细胞中提取RNA。实时荧光定量PCR检测CXCR4和VLA-4基因的表达。结果:与对照组相比,MTT和搔抓试验结果有显著性差异。Real-time PCR结果显示,与对照组相比,CXCR4和VLA-4基因的表达明显降低。结论:本研究结果表明,不同浓度的沃顿果冻干细胞可抑制MDA-MB-231乳腺癌细胞中癌细胞的生长及CXCR4和VLA-4归巢基因的表达。因此,沃顿果冻干细胞可以被认为是治疗乳腺癌的有效方法。
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引用次数: 0
The Diagnostic Value of Ultrasound-Guided Cervical Core Needle Biopsy in Diagnosis of Lymphoma in Suspected Patients. 超声引导下颈椎芯针活检对疑似淋巴瘤的诊断价值。
Q3 Medicine Pub Date : 2022-04-01 DOI: 10.18502/ijhoscr.v16i2.9200
Mohammad Ali Kazemi, Farzad Yazdani, Hashem Sharifian, Keyvan Aghazadeh, Behnaz Moradi, Hengameh Behravan, Mohsen Mikelani

Background: Core needle biopsy (CNB) guided by imaging modalities seems to be an acceptable modality for diagnosis of lymphoma due to its safety, good applicability, availability as well as diagnostic accuracy, however; Studies have not reached a consensus on its diagnostic accuracy and factors affecting its performance. The present study aimed to assess the value of ultrasound-guided cervical CNB in the diagnosis of lymphoma in suspected patients. Materials and Methods: This cross-sectional study was performed on 46 consecutive patients (20 to 82 years) with cervical mass or lymphadenopathy suspected of lymphoma and were candidates for diagnostic evaluation. Ultrasound-guided core needle biopsies (UGCNB) were done by a single radiologist under guided ultrasonography. The diagnostic value of UGCNB in the diagnosis and determination of specific lymphoma subtypes was assessed. Results: Using UGCNB led to the diagnosis of lymphoma in 34.8% and non-lymphoma lesions in 43.5%, while the diagnosis remained unclear in other 21.7% with a total UGCNB-based identification rate of 78.3%. No patient with lymphoma was missed. All patients were followed up over a 6-month period. In none of the cases, clinical diagnosis and treatment response were found contrary to the initial pathologic diagnosis. No significant complication such as hematoma or infection was reported. Conclusion: UGCNB has a high diagnostic value for determining the nature of the cervical lesions suspected of lymphoma.

背景:影像学引导下的核心穿刺活检(CNB)由于其安全性、适用性好、可获得性和诊断准确性,似乎是一种可接受的淋巴瘤诊断方式;关于其诊断准确性和影响其表现的因素,研究尚未达成共识。本研究旨在探讨超声引导下宫颈CNB对疑似淋巴瘤患者的诊断价值。材料和方法:本横断面研究对46例疑似淋巴瘤的宫颈肿块或淋巴结病变患者(20 - 82岁)进行了连续研究,这些患者是诊断评估的候选者。超声引导下的核心穿刺活检(UGCNB)由一名放射科医生在超声引导下完成。评估UGCNB在诊断和确定特定淋巴瘤亚型中的诊断价值。结果:使用UGCNB诊断为淋巴瘤的占34.8%,非淋巴瘤病变的占43.5%,诊断不清的占21.7%,基于UGCNB的总识别率为78.3%。未遗漏淋巴瘤患者。所有患者随访6个月以上。在所有病例中,临床诊断和治疗反应均未发现与最初的病理诊断相反。无血肿、感染等明显并发症。结论:UGCNB对判断宫颈疑似淋巴瘤病变的性质有较高的诊断价值。
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引用次数: 0
Hematopoietic Adverse Events Associated with BNT162b2 mRNA Covid-19 Vaccine 与BNT162b2 mRNA Covid-19疫苗相关的造血不良事件
Q3 Medicine Pub Date : 2022-03-30 DOI: 10.4999/uhod.226097
B. Erdogdu
Our second case is a 49-year-old female patient, two days after receiving BNT162b2 mRNA COVID-19 vaccine, petechiae was started in arms and then in lower extremities. The complaints of weakness and fatigue continued to increase within days. The patient, who was admitted to the hospital ten days later with these complaints, was found to have bi-cytopenia. Bone marrow aspiration and biopsy reported that 20-30% stained with cd19 diffuse positive Terminal deoxynucleotidyl transferase (TdT) in blastic cells. HyperCVAD chemotherapy was started with the diagnosis of b-acute lymphoOur third case is a 57-year-old male patient, difficulty in swallowing, and oral ulceration after vaccination of BNT162b2 mRNA COVID-19 vac
我们的第二个病例是一名49岁的女性患者,在接种BNT162b2 mRNA COVID-19疫苗两天后,手臂开始出现瘀点,然后是下肢。几天之内,对虚弱和疲劳的抱怨不断增加。患者10天后因上述症状入院,诊断为双细胞减少症。骨髓穿刺和活检报告20-30%的母细胞cd19弥漫性阳性末端脱氧核苷酸转移酶(TdT)染色。第三例患者为男性,57岁,接种BNT162b2 mRNA COVID-19 vac后出现吞咽困难、口腔溃疡
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引用次数: 7
225730Comparison of Treatment Results and Prognostic Factors of Elderly and Young Patients Receiving Neoadjuvant Chemoradiotherapy in Rectal CancerBerrin 225730老年与青年直肠癌新辅助放化疗患者治疗效果及预后因素比较[j]
Q3 Medicine Pub Date : 2022-03-30 DOI: 10.4999/uhod.225730
Berrin Inanc
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引用次数: 0
Diagnostic Performance of the CUT Score in Assessing the Malignancy Risk of Thyroid Nodules CUT评分在评估甲状腺结节恶性风险中的诊断价值
Q3 Medicine Pub Date : 2022-03-30 DOI: 10.4999/uhod.225701
Ş. Akın
Various scoring systems in order to predict the malignancy risk in thyroid nodules (TNs) have been developed. CUT is one of the novel scoring systems. In this study, we aimed to evaluate its performance in predicting the malignancy risk in TNs and validity in the presence of Hashimoto’s thyroiditis (HT). We retrospectively evaluated a total of 252 TNs with a fine needle aspiration biopsy. The CUT scores (Clinical, Ultrasonographic, and Thyroid Cytological scoring system) of the nodules were compared with ATA, ACR-TIRADS and KWAK-TIRADS scores and the histopathology of the nodules. Patients with HT were also compared with m-TIRADS classification. The CUT scores of nodules with malignant histopathology were significantly higher than the benign nodules (3.59 vs. 4.63, p< 0.001). The area values under the ROC curve of ACR-TIRADS, KWAK-TIRADS, ATA and CUT scoring systems were similar and significantly higher than the reference line [ACR-TIRADS, AUC was 0.762 (95% CI: 0.702-0.822, p< 0.001); KWAK-TIRADS, AUC was 0.759 (95% CI: 0.699-0.819, p< 0.001); CUT score, AUC was 0.759 (95% CI: 0.700-0.819, p< 0.001); ATA, AUC was 0.748 (95% CI: 0.687-0.810, p< 0.001)]. The areas under the ROC curve were similar when the efficiency of the CUT score was compared with m-TIRADS [CUT score, AUC was 0.772 (95% CI: 0.669-0.876, p< 0.001); m-TIRADS, AUC was 0.770 (95% CI: 0.667-0.874; p< 0.001)] in patients with HT. Our study showed that CUT scoring system was as effective as other scoring systems in predicting the risk of malignancy in thyroid nodules. Furthermore, CUT score is also effective in the presence of HT.
为了预测甲状腺结节(TNs)的恶性风险,各种评分系统已经被开发出来。CUT是一种新颖的评分系统。在这项研究中,我们旨在评估其在预测TNs恶性风险方面的表现以及在桥本甲状腺炎(HT)存在时的有效性。我们通过细针穿刺活检对252例TNs进行回顾性评估。将结节的CUT评分(临床、超声、甲状腺细胞学评分系统)与ATA、ACR-TIRADS、KWAK-TIRADS评分及结节的组织病理学进行比较。同时对HT患者进行m-TIRADS分型比较。恶性结节的CUT评分明显高于良性结节(3.59比4.63,p< 0.001)。ACR-TIRADS、KWAK-TIRADS、ATA和CUT评分系统的ROC曲线下面积值相似且显著高于参考线[ACR-TIRADS, AUC为0.762](95% CI: 0.702 ~ 0.822, p< 0.001);KWAK-TIRADS, AUC为0.759 (95% CI: 0.699 ~ 0.819, p< 0.001);CUT评分,AUC为0.759 (95% CI: 0.700 ~ 0.819, p< 0.001);ATA, AUC为0.748 (95% CI: 0.687-0.810, p< 0.001)。CUT评分的有效性与m-TIRADS [CUT评分,AUC为0.772 (95% CI: 0.669-0.876, p< 0.001);m-TIRADS, AUC为0.770 (95% CI: 0.667-0.874;p< 0.001)]。我们的研究表明,CUT评分系统在预测甲状腺结节恶性风险方面与其他评分系统一样有效。此外,CUT评分在HT存在时也有效。
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引用次数: 1
New Perspectives on the Recurrent BRCA Mutations and Clinical Variability 复发性BRCA突变和临床变异性的新观点
Q3 Medicine Pub Date : 2022-03-30 DOI: 10.4999/uhod.225476
I. Sahin
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引用次数: 0
Improving Survival Besides the High Early Mortality Rate in Acute Promyelocytic Leukemia 提高急性早幼粒细胞白血病的生存率及高早期死亡率
Q3 Medicine Pub Date : 2022-03-30 DOI: 10.4999/uhod.225992
Umit Yavuz Malkan
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引用次数: 0
Evolution of the Solid Human Tumor Cells Properties in Various Experimental Systems in Vitro 实体人肿瘤细胞特性在不同体外实验系统中的演化
Q3 Medicine Pub Date : 2022-01-19 DOI: 10.14302/issn.2372-6601.jhor-22-4061
A. Danilova, N. Efremova, T. Nekhaeva, I. Baldueva, Mykhail A. Maydin, A. A. Murashkina, E. Artemyeva, Anna S. Artemyev
BackgroundHuman malignant cell models which reflect the structural and physiological complexity of tumor tissue are of great importance for preclinical research in oncology. Spheroids/tumoroids derived from solid tumors are of great interest as cellular models mimicking the first vascular-free growth phase of a tumor node. The fact of the identity between artificially created tumor multicellular aggregates and the real tumor tissue, however, needs to be specified, described and validated in order to see how closely the spheroids are biologically similar to the malignized tissues in vivo compared to the monolayer cell cultures traditionally used. We present here a comparison study of the characteristics of solid tumor cells of different histogenesis (melanomas, soft tissue sarcomas and bone sarcomas, epithelial tumors) cultured in two dimensions (monolayer culture) and three dimensional space (spheroid), namely: spatial organization, multiplication, metabolic activity.Patients and MethodsFor the creation of 2 D and 3D cell models the cells isolated from the patient's solid tumor fragments obtained intraoperatively were used. 15 samples of skin melanoma, 20 samples of soft tissue and osteogenic sarcomas (STBS), and 9 samples of epithelial tumors (ET). The tumor cells were all cultivated for at least 10 passages. We used phase contrast, confocal microscopy, and immunohistochemistry to investigate spheroids and monolayer cultures. The supernatants of tumor cells grown in 2D and 3D cultures were studied using ELISA and multiplex analysis for the production of a spectrum of chemokines and cytokines supporting the immunosuppression, invasion and metastasis processes.ResultsTumor specimens received were predominantly of metastatic origin (75%). In 100% of cases 2D cultures were received, in 88.6% of cases (39 out of 44) we succeeded in obtaining spheroids. There was no direct correlation between the efficiency of tumoroid formation and the tumor's histogenetic origin and the stage of the cancer process (primary tumor, recurrence, metastasis). The median size of spheroids by 4-5 days of cultivation with a starting concentration of 10000 cells per well was 657.14 μm for melanoma (min 400 - max 1000 μm), 571.42 μm (min 400 - max 700 μm), 507.14 μm (min 300 - max 600 μm) for soft tissue sarcomas, 650.0 μm (min 400 - max 900 μm) for osteogenic sarcomas. Immunochemical analysis of Ki-67, GLUT1, and Ecadherin markers was carried out for tumor tissue samples, single-layer tumor cultures, and tumoroids of every patient. The distribution of the stained groups in the spheroids was distinct from the monolayer cultures and more in accordance with the distribution of such in the tissue tumor, the number of Ki-67+ cells was increasing in the spheroids. We detected no dependence of Ki-67+ and GLUT1+ cell localization grade on spheroid size. We identified E-cadherin in tumor tissue and tumoroids of breast carcinoma and one melanoma culture. Monolayer cultures did
人类恶性细胞模型反映了肿瘤组织的结构和生理复杂性,在肿瘤学临床前研究中具有重要意义。源自实体瘤的球状/类瘤是非常有趣的细胞模型,模拟肿瘤淋巴结的第一个无血管生长阶段。然而,人工制造的肿瘤多细胞聚集体与真正的肿瘤组织之间的同一性这一事实需要加以说明、描述和验证,以便了解与传统上使用的单层细胞培养相比,球体与体内恶性组织的生物学相似性有多接近。本文比较研究了不同组织发生形式的实体瘤细胞(黑色素瘤、软组织肉瘤、骨肉瘤、上皮性肿瘤)在二维(单层培养)和三维空间(球形)培养的特点,即:空间组织、增殖、代谢活性。患者和方法采用术中分离的实体瘤细胞建立二维和三维细胞模型。皮肤黑色素瘤15例,软组织及骨源性肉瘤(STBS) 20例,上皮性肿瘤(ET) 9例。肿瘤细胞均培养至少10代。我们使用了相衬、共聚焦显微镜和免疫组织化学来研究球体和单层培养。利用ELISA和多重分析,研究了2D和3D培养的肿瘤细胞上清,以产生一系列支持免疫抑制、侵袭和转移过程的趋化因子和细胞因子。结果肿瘤标本以转移性肿瘤为主(75%)。在100%接受二维培养的病例中,88.6%的病例(44例中有39例)成功获得球体。类肿瘤的形成效率与肿瘤的组织遗传学起源和肿瘤过程的分期(原发肿瘤、复发、转移)无直接关系。在初始浓度为每孔10000个细胞的条件下,培养4-5天,球体的中位数大小依次为:黑色素瘤(最小400 -最大1000 μm)为657.14 μm,软组织肉瘤(最小300 -最大600 μm)为571.42 μm,成骨肉瘤(最小400 -最大900 μm)为507.14 μm。对每位患者的肿瘤组织标本、单层肿瘤培养物和类肿瘤进行Ki-67、GLUT1和Ecadherin标记物的免疫化学分析。染色组在球体中的分布不同于单层培养,更符合其在组织肿瘤中的分布,球体中Ki-67+细胞的数量呈增加趋势。我们发现Ki-67+和GLUT1+细胞定位等级与球体大小无关。我们在乳腺癌的肿瘤组织和类肿瘤组织以及一个黑色素瘤培养中发现了e -钙粘蛋白。单层培养没有表达。CCL2、CCL3、CXCL1、CXCL16、MIF、IL10、MICA的分泌细胞活性随CCL2、CCL3、CXCL1、CXCL16的表达而升高(p<0.01)。结论与单层培养相比,实体瘤患者特异性细胞在三维环境中的存在导致增殖和代谢过程的激活,这使得这些模型接近真实世界的临床情况。趋化因子的产生可以吸引肿瘤各种类型的免疫系统细胞,包括它们的未成熟版本,以及细胞因子和免疫抑制因子的产生,当高浓度存在于肿瘤微环境中时,有助于形成具有抑制能力的免疫细胞,这发生在3D细胞系统中。肿瘤初始结节形成阶段的三维模型由此展示了肿瘤细胞形成过程中对其有利的微环境。构建三维模型-不同组织发生的肿瘤细胞球体需要个性化的方法和更深入的研究
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引用次数: 1
Red Blood Cell Immunization and Contributing Factors in 685 Thalassemia Patients. 685例地中海贫血患者红细胞免疫及影响因素分析
Q3 Medicine Pub Date : 2022-01-01 DOI: 10.18502/ijhoscr.v16i1.8435
Mojgan Shaiegan, Mostafa Moghaddam, Mahtab Maghsudlu, Azita Azarkeivan, Sima Zolfaghari, Ali-Akbar Pourfatollah, Peyman Soleimanzadeh, Ehsan Shahverdi

Background: An analysis of red blood cell alloimmunization in patients with thalassemia can help to devise specific strategies to decrease the alloimmunization rate. This study explored the frequency and specificity of alloantibodies and autoantibodies against red blood cell (RBC) antigens in patients with thalassemia referring to the Iranian Blood Transfusion Organization (IBTO) Immunohematology Reference Laboratory (IRL) in Tehran. Materials and Methods: This study first examined the laboratory records of 23,113 patients suffering from different diseases referring to IBTO's IRL for pretransfusion testing in the 2008-2015 period. ABO and Rh(D) typing and antibody screening tests were performed for all 23,113 patient records and 685 (2.97%) beta-thalassemia patients with positive pre-transfusion test results (antibody screening and/or DAT) were selected for further investigation. Results: The antibody screening test was positive in 640 out of 685 thalassemic patients (93.4%). DAT was performed for 529 patients, 226 (33%) of which showed positive results. Meanwhile, 161 out of 685 beta-thalassemia patients (23.5%) had positive auto control test results, reflecting the possible presence of allo- and/or autoantibodies. The most common antigen-specific alloantibodies were directed against K and E RBC antigens with a frequency of 25% (Anti-K) and 11.91% (Anti-E), respectively. The development of two antibodies (double antibodies) in one patient was observed in 80 individuals (11.46%). Conclusion: Age, gender, history of pregnancy, and splenectomy were not contributing factors to the antibody presence in the patient population under study. Extended red blood cell phenotyping should be considered as an essential procedure for expected multi-transfused thalassemia patients before blood transfusion. Considering the high frequency of anti-K and anti-E observed in this study, it is recommended that thalassemia patients in Iran are tested through phenotyping of RBC units for K and E antigens before transfusion.

背景:分析地中海贫血患者的红细胞同种异体免疫情况有助于制定降低同种异体免疫率的具体策略。本研究探讨了伊朗输血组织(IBTO)免疫血液学参考实验室(IRL)在德黑兰的地中海贫血患者中针对红细胞(RBC)抗原的同种抗体和自身抗体的频率和特异性。材料与方法:本研究首先查阅了2008-2015年期间23113例不同疾病患者的实验室记录,参考IBTO的IRL进行输血前检测。对所有23,113例患者进行ABO和Rh(D)分型和抗体筛查试验,并选择685例(2.97%)输血前试验结果(抗体筛查和/或DAT)阳性的β -地中海贫血患者进行进一步调查。结果:685例地中海贫血患者中,抗体筛查阳性640例(93.4%)。529例患者行DAT,其中226例(33%)阳性。同时,685例β -地中海贫血患者中有161例(23.5%)的自身对照试验结果呈阳性,反映出可能存在同种异体抗体和/或自身抗体。最常见的抗原特异性同种抗体是针对K和E红细胞抗原,分别为25% (Anti-K)和11.91% (Anti-E)。1例患者出现双抗体(双抗体)80例(11.46%)。结论:年龄、性别、妊娠史、脾切除术等因素均不是影响抗体存在的因素。对于预期多次输血的地中海贫血患者,应考虑在输血前进行扩展红细胞表型分析。考虑到本研究中观察到的抗K和抗E的高频率,建议伊朗地中海贫血患者在输血前通过红细胞单位表型检测K和E抗原。
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引用次数: 0
A Comparison of Dexamethasone Plus Vincristine versus Standard Regimen in Induction Therapy of Adult Acute Lymphoblastic Leukemia Patients Undergoing Hematopoietic Stem Cell Transplantation. 地塞米松加长春新碱与标准方案诱导治疗成人急性淋巴细胞白血病行造血干细胞移植的比较。
Q3 Medicine Pub Date : 2022-01-01 DOI: 10.18502/ijhoscr.v16i1.8439
Mohammad Vaezi, Amirhoushang Pourkhani, Amir Kasaeian, Maryam Souri, Marjan Yaghmaie, Bahram Chardouli, Kamran Alimoghaddam, Ardeshir Ghavamzadeh

Background: Current treatment options of acute lymphoblastic leukemia(ALL) include chemotherapy alone or hematopoietic stem cell transplantation (HSCT) following induction chemotherapy both along with CNS prophylaxis. The usual and standard induction regimens currently administered could have severe complications and mortality. Materials and Methods: To lessen induction regimen complications in ALL patients who undergo HSCT, we used a cytoreduction induction regimen including dexamethasone (8 mg, IV, three times a day, for 28 days) and vincristine(1.4 mg/m2, IV, on days 1,8,15 and 22) for 49 newly diagnosed adult ALL patients followed by an early sibling donor HSCT within two months. The results were matched with outcomes of HSCT in 172 ALL patients inducted by standard induction regimen. Results: Median follow-up time was 5.41 years in the standard group and 5.27 years in the other. All patients of the case group (100%) achieved complete remission. Landmark analyses were performed to scrutinize the effect of treatments on different time intervals: first two years and 2nd to end years. Type of treatment had no significant effect on the hazard of death in the first landmark (HR=0.87, P=0.64). Cytoreduction regimen amplified the hazard of death 3.43 times more than the standard regimen in the second landmark (HR=3.43 P=0.035). Multivariate analysis showed that the cytoreduction regimen reduced the hazard of relapse about 22%, but not statistically significant (HR=0.78, P-value=0.24). Conclusion: Overall, it seems despite achieving complete remission in induction therapy, depth of response is a critical predictor for long-term outcomes of HSCT in ALL patients, and the use of multiple agents may be necessary to decrease tumor cell burden and minimal residual disease(MRD).

背景:目前急性淋巴细胞白血病(ALL)的治疗选择包括单独化疗或诱导化疗后的造血干细胞移植(HSCT)以及中枢神经系统预防。目前使用的常规和标准诱导方案可能会产生严重的并发症和死亡率。材料和方法:为了减少接受HSCT的ALL患者诱导方案的并发症,我们对49名新诊断的成年ALL患者使用了细胞减少诱导方案,包括地塞米松(8mg,静脉注射,每天三次,持续28天)和vincristine(1.4 mg/m2,静脉注射,第1、8、15和22天),随后在两个月内进行了早期兄弟姐妹供体HSCT。结果与172例采用标准诱导方案的ALL患者的移植结果相匹配。结果:标准组中位随访时间为5.41年,对照组中位随访时间为5.27年。病例组所有患者(100%)均获得完全缓解。进行里程碑式分析以仔细检查治疗对不同时间间隔的影响:头两年和第2年至最后一年。治疗方式对第一个标志的死亡危险无显著影响(HR=0.87, P=0.64)。细胞减少方案在第二个里程碑上的死亡风险是标准方案的3.43倍(HR=3.43 P=0.035)。多因素分析显示,细胞减少方案使复发风险降低约22%,但无统计学意义(HR=0.78, p值=0.24)。结论:总体而言,尽管诱导治疗实现了完全缓解,但反应深度是ALL患者HSCT长期预后的关键预测因素,并且可能需要使用多种药物来减少肿瘤细胞负荷和最小残留病(MRD)。
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引用次数: 0
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International Journal of Hematology-Oncology and Stem Cell Research
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