Annals of Hematology最新文献

This study aimed to assess the predictive value of baseline ¹⁸F-FDG PET radiomics features, metabolic parameters, and clinical factors for PFS and OS in elderly DLBCL patients. Using LASSO COX regression, we derived Radscore from PET radiomics features. We constructed and externally validated prognostic models, evaluating their performance through various metrics. From 341 training set patients and 83 external validation set patients revealed significant correlations between PET radiomics features and survival outcomes. Multivariate COX analysis identified associations of radiomics features (Radscore), metabolic parameters (TMTV, Dmax), and clinical factors (ECOG PS, hemoglobin level) with PFS and OS. In external validation, the combined model incorporating radiomic features, metabolic parameters, and clinical factors showed superior predictive performance for PFS and OS compared to other models. The combined model had higher C-index values for both PFS and OS, and its td-ROC curves exhibited significantly higher AUCs. Calibration curves demonstrated good consistency, and DCA revealed a higher net benefit for the combined model. In conclusion, the combined model that incorporated ¹⁸F-FDG PET radiomics features, metabolic parameters, and clinical factors demonstrated superior prognostic predictive ability, providing a useful tool for personalized treatment decisions in elderly DLBCL patients.

Immunoglobulin light chain (AL) amyloidosis is a severe disorder caused by the accumulation of amyloid fibrils, leading to organ failure. Early diagnosis is crucial to prevent irreversible damage, yet it remains a challenge due to nonspecific symptoms that often appear later in the disease progression. A retrospective study analyzed data collected from 133 AL amyloidosis patients and 271 non-AL patients with similar symptoms but different diagnoses between January 1st, 2017, and September 30th, 2022. Demographic data and laboratory test results were collected. Subsequently, significant features were identified by both logistic regression and independent expert clinical ability. Eventually, logistic regression and four machine learning (ML) algorithms were employed to construct a diagnostic model, utilizing fivefold cross-validation and blind set testing to identify the optimal model. The study successfully identified nine independent predictors of AL amyloidosis patients with kidney or cardiac involvement, respectively. Two models were developed to identify key features that distinguish AL amyloidosis from nephrotic syndrome and hypertrophic cardiomyopathy, respectively. The light gradient boosting machine (LightGBM) model emerged as the most effective, demonstrating superior performance with the area under curve (AUC) of 0.90 in both models, alongside high sensitivity, specificity, and F1-score. This research highlights the potential of using a machine learning-based LightGBM model to facilitate early and accurate diagnosis of AL amyloidosis. The model's effectiveness suggests it could be a valuable tool in clinical settings, aiding in the timely identification of AL amyloidosis among patients with non-specific symptoms. Further validation in diverse populations is recommended to establish its universal applicability.

Bruton's tyrosine kinase inhibitors have been demonstrated preliminary efficacy in diffuse large B-cell lymphoma (DLBCL). To compare the safety and efficacy of zanubrutinib plus rituximab and lenalidomide (ZR2) and R-CHOP-like for elderly patients with newly diagnosed DLBCL, we conducted this single-center prospective study. Patients were treated with 6 cycles of ZR2 or R-CHOP-like regimen for the first-line treatment. The primary endpoint was complete response ratio (CRR). The secondary outcome measures were progression-free survival (PFS), overall survival (OS), and adverse events. Between June 15, 2020, and March 11, 2023, 30 patients with ZR2 and 60 patients with R-CHOP-like were enrolled. There were no significant differences observed in CRR (P = 0.878), PFS (P = 0.555) and OS (P = 0.769) between ZR2 and R-CHOP-like group. While, patients in ZR2 group had the following features: significantly older (P = 0.002), more unfit (P < 0.001) and higher prognosis risk scores (P = 0.025). The incidence of grade ≥ 3 anemia (P = 0.008) and pneumonia (P = 0.001) was significantly lower in ZR2 group. Patients with germinal center B-cell-like subtype (GCB), large masses or TP53 mutations had a satisfactory remission rate in ZR2 group (57.1%, 77.8% and 60.0%, respectively). ZR2 and R-CHOP-like regimen had similar efficacy and survival. While, the safety profile for ZR2 was superior. GCB subtype, large masses and TP53 mutations may benefit from ZR2 regimen as well. Patients with EBV-positive and CARD11 mutations may need additional treatment rather than ZR2. Patients with gastrointestinal DLBCL have to be monitored closely by abdominal enhanced CT every cycle. Overall, ZR2 chemo-free regimen might be more appropriate for elderly DLBCL patients.