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Benefit of Granulocyte Colony-Stimulating Factor-Primed Donor Lymphocyte Infusion using Cryopreserved Cells for Patients with Acute Leukemia Who Relapsed Late after Hematopoietic Cell Transplantation 冷冻保存细胞输注粒细胞集落刺激因子启动的供体淋巴细胞对造血细胞移植后晚期复发的急性白血病患者的益处
Pub Date : 2019-02-18 DOI: 10.26420/ANNHEMATOLONCOL.2019.1236
Sohn Sk
There is no standard therapy for relapse of acute leukemia after allogeneic Hematopoietic Cell Transplantation (allo-HCT). This study evaluated the efficacy of Granulocyte Colony-Stimulating Factor (G-CSF)-Primed Donor Lymphocyte Infusion (DLI) for patients with acute leukemia who relapsed after allo-HCT. We retrospectively reviewed 255 patients who received allo-HCT for acute leukemia/myelodysplastic syndrome. They were divided into two groups based on the CD34 + cell dose they received; patients in the lower CD34 + group received less than 6×10 6 cells/kg and those in the higher group received over 6×10 6 cells/kg. No significant differences were noted between the groups with respect to overall survival, relapse-free survival, and Graft- Versus -Host Disease (GVHD)-free/relapse-free survival. Among the 93 patients with relapse after allo-HCT, 39 patients received G-CSF-primed DLI. These 93 patients were classified into early or late relapse groups as defined by the median time to relapse. In the late relapse group, the one-year overall survival was significantly higher in the DLI group than in the non-DLI group (53.4±7.4% vs . 26.7±7.4%, p=0.039), whereas there were no differences in the early relapse group. In addition, the incidence of DLI-induced GVHD did not differ between the two groups. In conclusion, treatment with G-CSF-primed DLI after allo-HCT with a limited CD34 + cell dose is a feasible and effective option, which may replace a second HCT in late relapse patients.
异基因造血细胞移植(allo-HCT)后急性白血病复发尚无标准治疗方法。本研究评估了粒细胞集落刺激因子(G-CSF)-供体淋巴细胞输注(DLI)治疗急性白血病患者allo-HCT后复发的疗效。我们回顾性分析了255例接受异基因造血干细胞移植治疗急性白血病/骨髓增生异常综合征的患者。根据他们接受的CD34+细胞剂量将他们分为两组;CD34+较低组的患者接受的细胞数小于6×。在总生存率、无复发生存率和移植物抗宿主病(GVHD)无复发/无复发生存期方面,两组之间没有显著差异。在93名allo-HCT后复发的患者中,39名患者接受了G-CSF引发的DLI。根据复发的中位时间,这93名患者被分为早期或晚期复发组。在晚期复发组中,DLI组的一年总生存率显著高于非DLI组(53.4±7.4%vs 26.7±7.4%,p=0.039),而早期复发组没有差异。此外,DLI诱导的GVHD的发生率在两组之间没有差异。总之,在有限CD34+细胞剂量的allo-HCT后,用G-CSF引发的DLI治疗是一种可行且有效的选择,这可能会取代晚期复发患者的第二次HCT。
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引用次数: 0
Intermittent Low-Dose Thalidomide Plus Dexamethasone as Maintenance Therapy in Patients with Multiple Myeloma 间歇性低剂量沙利度胺加地塞米松作为多发性骨髓瘤患者的维持治疗
Pub Date : 2019-02-15 DOI: 10.26420/ANNHEMATOLONCOL.2019.1235
P. Galieni
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引用次数: 1
High Prevalence of Bone Pain and Fractures in Young Transfusion Dependent Patients with β-Thalassemia at Southern Pakistan 巴基斯坦南部β-地中海贫血年轻输血依赖患者骨痛和骨折的高患病率
Pub Date : 2019-02-08 DOI: 10.26420/ANNHEMATOLONCOL.2018.1234
B. Moiz
Standard thalassemia management is focused primarily on blood transfusions and iron chelation. Thalassemia caregivers grossly underestimate chronic pain due to bone and mineral related disorders. This study aimed to determine the frequency of bone pain, fractures, performance status and biochemical bone markers in children having transfusion dependent β-thalassemia major. We recruited 367 patients between 5 to 17 years of age from Fatimid Foundation Karachi, Pakistan. A questionnaire regarding clinical details such as demography, frequency of transfusion, iron chelation and fractures was administered. Wong-Baker Faces® pain rating scale and Eastern Cooperative Oncology Group Performance Status were used for assessment of bone pain and performance status respectively. Biochemical bone-health markers estimated included vitamin D, corrected calcium, intact parathyroid hormone, phosphorous, magnesium, zinc and ferritin levels. Among 367 children, 33.5% (n=123) were taking regular chelation and 50% (n=184) were on calcium and or vitamin D supplements. Eighty-two percent (n=303) patients experienced variable intensity of recurrent bone pain in past two years, which increased in frequency with advancing age. Forty-six patients (12.5%) reported multiple or recurrent fractures. Median 25OHD level was deficient (13.09ng/ ml IQR 18.6-8.56) with normal corrected calcium (8.81mg/dl IQR 9.4-7.97) while serum phosphate was at upper limit of reference range (5.1 IQR 5.9-4.3). Logistic regression analysis showed significant association of pain with age (OR 1.1 95% CI 1.0-1.2 p 0.001). The patients with and without fractures showed significant differences in age, corrected calcium, ferritin and zinc levels. Higher median phosphorus and iPTH were noted in patients with fractures but the difference was not significant. Binary logistic regression analysis showed statistically significant association with low levels of corrected calcium (OR 0.77% CI 0.6-0.9 p<0.04) and zinc (OR 0.08% CI 0.97-1.0 p<0.04). High prevalence of bone pains, fractures and biochemical abnormalities including hypovitaminosis D, hypocalcaemia and hyperphosphatemia were noted in patients with thalassemia. We need more studies to determine the impact on peak bone mass, prevalence of osteopenia and osteoporosis so that preventive intervention strategies can be planned in addition to adherence with optimum care for improving bone health in thalassemia.
地中海贫血的标准管理主要集中在输血和铁螯合方面。地中海贫血护理人员严重低估了骨和矿物质相关疾病引起的慢性疼痛。本研究旨在确定输血依赖性β地中海贫血患儿的骨痛、骨折频率、表现状态和骨生化标志物。我们从巴基斯坦卡拉奇法蒂玛基金会招募了367名5至17岁的患者。进行了一份关于临床细节的问卷调查,如人口统计学、输血频率、铁螯合和骨折。Wong Baker Faces®疼痛评定量表和Eastern Cooperative Oncology Group绩效状况分别用于评估骨痛和绩效状况。骨健康生化指标包括维生素D、校正钙、完整甲状旁腺激素、磷、镁、锌和铁蛋白水平。在367名儿童中,33.5%(n=123)正在服用常规螯合剂,50%(n=184)正在服用钙和/或维生素D补充剂。82%(n=303)的患者在过去两年中经历了不同强度的复发性骨痛,这种疼痛的频率随着年龄的增长而增加。46名患者(12.5%)报告多发性或复发性骨折。中位25OHD水平不足(13.09ng/ml IQR 18.6-8.56),校正钙正常(8.81mg/dl IQR 9.4-7.97),而血清磷酸盐处于参考范围的上限(5.1 IQR 5.9-4.3)。Logistic回归分析显示疼痛与年龄显著相关(OR 1.1 95%CI 1.0-1.2 p 0.001)。有骨折和无骨折的患者在年龄上存在显著差异,校正钙、铁蛋白和锌水平。骨折患者的中位磷和iPTH较高,但差异不显著。二元逻辑回归分析显示,校正钙(OR 0.77%CI 0.6-0.9 p<0.04)和锌(OR 0.08%CI 0.97-1.0 p<0.04。我们需要更多的研究来确定对峰值骨量、骨质疏松症和骨质疏松症患病率的影响,以便除了坚持最佳护理以改善地中海贫血患者的骨骼健康外,还可以制定预防性干预策略。
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引用次数: 5
Predictive Factors for Postrecurrence Survival in Epithelial Ovarian Cancer-a Consecutive Series of 368 Patients and Review of the Literature 上皮性卵巢癌复发后生存的预测因素——368例连续研究及文献综述
Pub Date : 2018-12-31 DOI: 10.26420/annhematoloncol.2018.1225
E. Petru
Purpose: Ovarian cancer is usually diagnosed at advanced stage. Thus, recurrences are common. The aim of this retrospective study was to analyze the prognostic value of selected clinical and biological factors with regard to overall survival after first recurrence. Methods: A total of 368 evaluable patients with primary epithelial cancer of the ovary, fallopian tube or peritoneum were included. Carcinosarcomas, sarcomas and borderline tumors of the ovary, the fallopian tube and the peritoneum were excluded. Patient and tumor characteristics were extracted from hospital records. Recurrence was defined as the first clinical manifestation of tumor progression after an interval of no clinical evidence of disease following primary surgery. Patients with an elevated tumor marker CA125 alone and those who had clinically evident tumor after primary surgery were not eligible for this study. Results: In the multivariate cox regression analysis, five parameters were identified as independent favourable prognostic factors for survival after first recurrence: Time to recurrence ≥ 2 years (p=0.000), Karnofsky status ≥ 80% at the time of recurrence (p=0.008), use of adjuvant chemotherapy (p=0.013), residual disease ≤ 1 cm at primary surgery (p=0.044), and isolated peripheral or paraaortic lymph nodes as localization of first recurrence (p<0.05). Conclusions: Prolonged interval to recurrence seems to be of utmost importance for longer postrecurrence survival. In addition, small or no residual tumor after primary surgery, administration of adjuvant chemotherapy, higher performance status at recurrence and metastases in the peripheral or paraaortic nodes are predictive for improved overall survival.
目的:卵巢癌通常在晚期被诊断出来。因此,递归是常见的。本回顾性研究的目的是分析选择的临床和生物学因素对首次复发后总生存率的预后价值。方法:共纳入368例可评估的原发性卵巢、输卵管或腹膜上皮癌。排除卵巢、输卵管和腹膜的癌、肉瘤、肉瘤和交界性肿瘤。从医院记录中提取患者和肿瘤特征。复发被定义为原发性手术后一段时间无临床证据后肿瘤进展的第一个临床表现。单纯肿瘤标志物CA125升高的患者和原发性手术后出现临床明显肿瘤的患者不符合本研究的条件。结果:在多变量cox回归分析中,5个参数被确定为首次复发后生存的独立有利预后因素:复发时间≥2年(p=0.000),复发时Karnofsky状态≥80% (p=0.008),使用辅助化疗(p=0.013),原发手术残留病变≤1 cm (p=0.044),孤立的外周或主动脉旁淋巴结作为首次复发的定位(p<0.05)。结论:延长复发间隔似乎对延长复发后生存至关重要。此外,原发性手术后肿瘤小或无残留、给予辅助化疗、复发和外周或主动脉旁淋巴结转移时表现较好是提高总生存率的预测因素。
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引用次数: 1
IVIG in Immunocompromised Pediatric Patients - Advances and Prospects? 免疫功能低下儿童患者的IVIG治疗进展与前景?
Pub Date : 2018-12-26 DOI: 10.26420/annhematoloncol.2018.1224
K. Derwich
Continuous development of effective antineoplastic therapies causes that immunodeficiencies are estimated to be one of the most vital problem of treatment. One of the possible keys for that could be Intravenous Immunoglobulins (IVIGs), but recommendations about substitution are not straightforward. if 4-5g/L is introduce a of pediatric patients with lack of unequivocal guidelines both should orientated in a role of on therapies and prevention for pediatric hemato-oncology
有效的抗肿瘤治疗方法的不断发展使得免疫缺陷被认为是最重要的治疗问题之一。其中一个可能的关键是静脉注射免疫球蛋白(IVIGs),但关于替代的建议并不直截了当地提出。如果在缺乏明确指南的情况下对儿童患者引入4-5g/L,则应针对儿童血液肿瘤的治疗和预防作用
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引用次数: 0
Autologous Stem Cell Transplantation in Elderly Patients is Safe and is not associated with a Higher Frequency of Readmission Compared to Younger Patients. A Single Center Experience 与年轻患者相比,老年患者的自体干细胞移植是安全的,并且与更高的再移植频率无关。单中心体验
Pub Date : 2018-11-08 DOI: 10.26420/ANNHEMATOLONCOL.2018.1222
M. Farina
Seventy-two of 231 (31%) ASCT pts were > 65 yrs. Diagnosis was MM in 52 (72%) and NHL in 20 pts (28%) respectively. Median age was 69 (range 65-76). Patients’ comorbidities or significant laboratory abnormalities are summarized in (Table 1). Based on clinical judgement, conditioning regimen dose intensity was reduced in 10 pts (14%). In 12% (6/52) of MM pts melphalan dose was reduced to 140 mg/m2 (4) or 100 mg/m2 (2). FEAM dose was reduced at 75% in 4 NHL pts (20%) [1,2]. Pts achieved hematology recovery after a median of 10 days (6-13) and were discharged after 13 days (929). Infectious complications were the most frequent adverse event during the aplastic phase [3-5].
231例ASCT患者中有72例(31%)为65岁。诊断为MM 52例(72%),NHL 20例(28%)。中位年龄为69岁(65-76岁)。患者的合并症或重大实验室异常汇总于(表1)。根据临床判断,10名患者(14%)降低了调理方案的剂量强度。在12%(6/52)的MM患者中,melphalan剂量减少到140 mg/m2(4)或100 mg/m2(2)。在4例NHL患者中,FEAM剂量减少了75%(20%)[1,2]。患者在平均10天(6-13天)后血液学恢复,13天(929天)后出院。感染并发症是再障期最常见的不良事件[3-5]。
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引用次数: 0
Disseminated Toxoplasmosis with Bone Marrow Involvement 骨髓受累的播散性弓形虫病
Pub Date : 2018-11-08 DOI: 10.26420/ANNHEMATOLONCOL.2018.1223
J. Finlayson
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引用次数: 0
A Rare Case of Acquired Hemophilia, Presenting with Postpartum Hemorrhage 罕见的获得性血友病,产后出血
Pub Date : 2018-11-02 DOI: 10.26420/ANNHEMATOLONCOL.2018.1218
Keni Begendi N
Acquired Hemophilia A (AHA) is a rare but serious bleeding disorder caused by autoantibody (inhibitory) against factor 8 (FVIII). The incidence of the disease is increasing with age, and is seen between 9-15/1,000,000 over 65 years of the age, while it is about 0.3/1,000,000 per year under 65 years of the age. The patient and his family usually do not have any known bleeding diathesis [1,2]. The disease is idiopathic in 40-50% of the cases, while many etiological factors play a role in the remainder. The main etiological factors according to frequency can be listed as; autoimmune diseases, malignancies (solid tumors, hematological neoplasm’s), pregnancy, especially in the postpartum period, drugs, vaccination and respiratory system diseases [1,2]. AHA presenting with postpartum hemorrhage constitutes 6-21% of the all cases [3].
获得性血友病A(AHA)是一种罕见但严重的出血性疾病,由抗因子8(FVIII)的自身抗体(抑制性)引起。该疾病的发病率随着年龄的增长而增加,65岁以上的发病率在9-15/100000之间,而65岁以下的发病率约为每年0.3/10000000。患者及其家人通常没有任何已知的出血素质[1,2]。这种疾病在40-50%的病例中是特发性的,而许多病因在其余病例中起作用。根据频率的不同,主要病因可列为:;自身免疫性疾病、恶性肿瘤(实体瘤、血液系统肿瘤)、妊娠(尤其是产后)、药物、疫苗接种和呼吸系统疾病[1,2]。以产后出血为表现的AHA占所有病例的6-21%[3]。
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引用次数: 0
Bilateral Hypoglossal Nerve Palsy in a Patient with Breast Cancer 乳腺癌患者双侧舌下神经麻痹1例
Pub Date : 2018-11-02 DOI: 10.26420/ANNHEMATOLONCOL.2018.1219
G. Hyun
We describe a case of a 64-year-old woman who presented with isolated bilateral hypoglossal nerve palsy. After an extensive workup including an unremarkable Computed Tomography (CT) scan, she was found to have skull base metastasis from breast cancer on thin-slice Magnetic Resonance Imaging (MRI). This is the first reported case of isolated bilateral hypoglossal nerve palsy and demonstrates that thin-slice MRI provides.
我们描述了一个病例64岁的妇女谁提出孤立的双侧舌下神经麻痹。经过广泛的检查,包括一次不起眼的计算机断层扫描(CT),她在薄层磁共振成像(MRI)上被发现患有乳腺癌颅底转移。这是第一例报道的孤立的双侧舌下神经麻痹,并证明薄层MRI提供。
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引用次数: 0
De Novo Acute Myeloid Leukemia Involving only Granulocyte-Macrophage Line in Octogenarians with Leucocytes over 15 × 109/L Exhibit a Favorable Response to Standard-Dose Induction Chemotherapy 在白细胞超过15×109/L的八旬老人中,仅涉及粒细胞巨噬细胞系的De Novo急性髓细胞白血病对标准剂量诱导化疗表现出良好的反应
Pub Date : 2018-10-31 DOI: 10.26420/annhematoloncol.2018.216
L. P
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引用次数: 2
期刊
Annals of hematology & oncology
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