[Efficacy and safefy of Polymyxin B treatment for neutropenic patients suffering from refractory Gram-negative bacterial bloodstream infection]

Objective: To assess the efficacy and safety of polymyxin B in neutropenic patients with hematologic disorders who had refractory gram-negative bacterial bloodstream infection. Methods: From August 2021 to July 2022, we retrospectively analyzed neutropenic patients with refractory gram-negative bacterial bloodstream infection who were treated with polymyxin B in the Department of Hematology of the First Affiliated Hospital of the Soochow University between August 2021 to July 2022. The cumulative response rate was then computed. Results: The study included 27 neutropenic patients with refractory gram-negative bacterial bloodstream infections. Polymyxin B therapy was effective in 22 of 27 patients. The median time between the onset of fever and the delivery of polymyxin B was 3 days [interquartile range (IQR) : 2-5]. The median duration of polymyxin B treatment was 7 days (IQR: 5-11). Polymyxin B therapy had a median antipyretic time of 37 h (IQR: 32-70). The incidence of acute renal dysfunction was 14.8% (four out of 27 cases), all classified as "injury" according to RIFLE criteria. The incidence of hyperpigmentation was 59.3%. Conclusion: Polymyxin B is a viable treatment option for granulocytopenia patients with refractory gram-negative bacterial bloodstream infections.

Multi-functionalized MOFs with Large-Pore Apertures as Luminescent Probes for Efficient Sensing of Quinones

Extensive research over the past few years has been focused on the synthesis of MOFs with high internal surface areas, however, introducing functional groups on their backbones at the same...

The crystal structure of 2-(2-methyl-6-phenyl-4H-pyran-4-ylidene)-1H-indene-1,3(2H)-dione, C21H14O3

C21H14O3, monoclinic, P21/c (no. 14), a = 4.8318(8) Å, b = 26.590(4) Å, c = 11.821(2) Å, β = 91.050(4)°, V = 1518.4(4) Å3, Z = 4, R gt (F) = 0.0401, wR ref (F) = 0.1038, T = 296(2) K.

CCDC no.: 2122345

[Analysis of early death factors and prognosis of acute promyelocytic leukemia]

目的

总结初诊急性早幼粒细胞白血病（APL）早期死亡患者的临床特征，分析早期死亡的危险因素和直接死亡原因，同时对患者进行生存分析。

方法

回顾性分析2011年1月至2017年12月苏州大学附属第一医院、苏州大学附属第一医院广慈分院、苏州弘慈血液病医院收治的368例初诊APL患者的临床特征，分析早期死亡的独立危险因素，比较出血性早期死亡与非出血性早期死亡患者的临床特征，并对所有APL患者进行生存分析。

结果

368例初诊APL患者中早期死亡31例，早期病死率为8.4%，从诊断至死亡的中位时间为7（0~29）d。比较早期死亡患者与非早期死亡患者的临床特征，应用Logistic回归模型进行多因素分析显示，年龄≥50岁和初诊时WBC≥10×10⁹/L为初诊APL患者发生早期死亡的独立危险因素（P值均<0.01）。31例早期死亡患者中有27例（87.1%）的直接死亡原因为出血，出血是<50岁患者的唯一死亡原因，≥50岁患者的主要死亡原因。比较出血性早期死亡患者与非出血性早期死亡患者的临床特征，提示出血性早期死亡患者的中位年龄和间接胆红素水平较非出血性早期死亡患者低（P<0.05）。所有患者中位随访时间为41.0（0.3~101.4）个月。2年总生存（OS）率为（93.5±1.3）%，5年OS率为（91.0±1.5）%。2年无病生存（DFS）率为（98.8±0.6）%，5年DFS率为（97.1±0.9）%。≥50岁与<50岁患者的2年OS率分别为79.3%和94.2%（P=0.000）；2年DFS率分别为92.3%和98.1%（P=0.023）。高危患者与非高危患者的2年OS率分别为77.3%和96.7%（P=0.000）；2年DFS率分别为94.0%和98.4%（P=0.139）。

结论

年龄≥50岁和WBC≥10×10⁹/L是APL患者早期死亡的独立危险因素；高危和低危APL的早期病死率有差异而DFS率差异无统计学意义。

[CAR T-cell bridging to allo-HSCT for relapsed/refractory B-cell acute lymphoblastic leukemia: the follow-up outcomes]

Objective: This study aims to investigate the efficacy and safety of chimeric antigen receptor (CAR) T-cell bridging allogeneic hematopoietic stem cell transplantation (allo-HSCT) in the treatment of recurrent and refractory acute B-lymphocytic leukemia (R/R B-ALL) . Methods: A total of 50 R/R B-ALL patients who underwent CAR T-scell therapy to bridge allo-HSCT in the First Affiliated Hospital of Soochow University from January 2017 to May 2019 were retrospectively analyzed. The overall survival (OS) rate, event-free survival (EFS) rate, cumulative recurrence rate (CIR) , and transplant-related mortality (TRM) of patients with different bone marrow minimal residual disease (MRD) levels were analyzed before and after CAR T-cell infusion and before allo-HSCT. Results: The response rate of CAR T-cell therapy and the incidence rate of severe cytokine release syndrome were 92% and 28% , respectively. During 55 infusions, no treatment-related deaths occurred in any of the patients. The median time of CAR T-cell infusion to allo-HSCT was 54 (26-232) days, the median follow-up time after CAR T-cell infusion was 637 (117-1097) days, and the 1-year OS and EFS rates were (80.0±5.7) % and (60.0±6.9) % . The 1-year CIR and TRM after allo-HSCT were (28.0±0.4) % and (8.0±0.2) % . After CAR T-cell infusion and before allo-HSCT, patients with bone marrow MRD<0.01% had a significantly longer EFS [ (70.0±7.2) % vs (20.0±12.6) % , P<0.001; (66.7±7.5) % vs (36.4±14.5) % , P=0.008]and lower CIR [ (25.0±0.5) % vs (70.0±2.6) % , P<0.001; (23.08±0.47) % vs (45.45±2.60) % , P=0.038]. Conclusion: CAR T-cell therapy bridging allo-HSCT is safe and effective for recurrent and refractory B-ALL.

Diagnostic Yield of Pneumococcal Antigen Detection in Cerebrospinal Fluid for Diagnosis of Pneumococcal Meningitis Among Children in China

OBJECTIVE

To determine the diagnostic accuracy of pneumococcal antigen detection in diagnosis of pneumococcal meningitis in children.

METHODS

Purulent meningitis was diagnosed according to European Society for Clinical Microbiology and Infectious Diseases (ESCMID) guideline between July 2014 and June 2016. Along with a cerebrospinal fluid (CSF) culture, pneumococcal antigen detection in cerebrospinal fluid (CSF) was performed, and further identification of pathogens was done with 16S rDNA-PCR and high-throughput sequencing.

RESULTS

CSF samples collected from 184 children (median age of 1.92 mo). CSF culture was used as the gold standard. 46 (25%) had positive results for culture and 10 (5.4%) were pneumococci; 34 (18.5%) were pneumococcal antigen positive. The sensitivity and specificity of pneumococcal antigen detection were 100% (95% CI: 89.4%-100%) and 86.2% (95% CI: 96.4%-99.9%), respectively. 92.3% (12/13) were confirmed by nucleic acid detection to be pneumococci.

CONCLUSIONS

Pneumococcal antigen detection in CSF has adequate sensitivity and specificity in diagnosing pneumococcal meningitis.

[Comparison of efficacy of first-line administration of generic dasatinib or imatinib in patients with Philadelphia chromosome positive acute lymphoblastic leukemia treated by hematopoietic stem cell transplantation]

Objective: To investigate the efficacy of first-line administration of generic dasatinib or first-generation TKI (imatinib) in patients with Philadelphia chromosome positive acute lymphoblastic leukemia (Ph(+) ALL) treated by hematopoietic stem cell transplantation (HSCT). Methods: Clinical features and prognoses of 63 newly diagnosed Ph(+) ALL patients from Jan 2014 to June 2017 treated by HSCT combined with first-line administration of generic dasatinib or imatinib were retrospective analyzed. Results: Of 63 Ph(+) ALL patients, 31 cases were administered generic dasatinib, and the other 32 ones imatinib. Complete remission (CR) rates at the fourth week of induction therapy in generic dasatinib and imatinib groups were 96.8% and 93.8% (P=1.000) , respectively. Meanwhile major molecular response (MMR; BCR-ABL/ABL reduce 3log) rates were 41.9% and 43.8% (χ(2)=0.021, P=0.884), respectively. Relapse rates before transplantation were 6.5% and 12.5% (P=0.672), respectively. MMR rates before HSCT were 83.9% and 68.8% (χ(2)=1.985, P=0.159), respectively. The 20-monthes overall survival (OS) rates of generic dasatinib and imatinib groups were 95.5% and 76.5% (χ(2)=0.990, P=0.320) respectively; 20-monthes event-free survival (EFS) rates were 93.5% and 61.4% (χ(2)=5.926, P=0.015), respectively. Statistically significant differences of EFS were reached. Multiple factors analysis showed that generic dasatinib (HR=0.201, 95% CI 0.045-0.896, P=0.035) and MMR before transplantation (HR=0.344, 95% CI 0.124-0.956, CI=0.041) could improve EFS. Conclusions: First-line administration of generic dasatinib could improve EFS for Ph(+)ALL patients treated by HSCT when compered with imatinib.

[Allogeneic hematopoietic stem cell transplantation for the treatment of acute myeloid leukemia with primary thrombocytosis: three cases report and literatures review]

目的

探讨原发性血小板增多症（ET）转化急性髓系白血病（AML）的病情变化特点及异基因造血干细胞移植（allo-HSCT）的治疗价值。

方法

回顾性分析3例ET转AML患者的临床特征、实验室检查结果及诊治经过，复习相关文献。

结果

例1，男，44岁，初诊ET时PLT 500×10⁹/L，3年后疾病转变为骨髓增生异常综合征时WT1基因由初诊时77拷贝/10 000 ABL拷贝升至13 171拷贝/10 000 ABL拷贝，染色体核型发生异常改变，在地西他滨治疗过程中快速进展为AML。例2，男，58岁，诊断ET时PLT 2 100×10⁹/L，9年后疾病进展为AML，WT1基因由初诊时130拷贝/10 000 ABL拷贝升至3 222拷贝/10 000 ABL拷贝，在化疗期间短期内复发。例3，男，60岁，初诊ET时PLT 900×10⁹/L，5年后疾病转化为AML，WT1基因由初诊时56拷贝/10 000 ABL拷贝升至3 696拷贝/10 000 ABL拷贝，化疗期间出现中枢神经系统侵犯。例1移植前未缓解，例2缓解后短期内复发，例3出现髓外侵犯。3例患者均顺利完成allo-HSCT，移植后骨髓缓解，染色体核型正常，例3中枢神经系统病灶消失，JAK2基因突变均转阴，WT1基因表达均<200拷贝/10 000 ABL拷贝，未发生严重并发症。

结论

ET转化的AML病情凶险，allo-HSCT是目前唯一可能治愈此疾病的方法。

[Outcome of combination of HLA-haploidentical hematopoietic SCT with an unrelated cord blood unit for 127 patients with acquired severe aplastic anemia]

目的

评价单倍型造血干细胞移植（haplo-HSCT）联合第三方脐血干细胞移植治疗重型再生障碍性贫血（SAA）的疗效及安全性。

方法

对2011年9月至2017年4月间接受haplo-HSCT联合第三方脐血干细胞移植的127例SAA患者进行回顾性研究。

结果

全部127例SAA患者中，男74例，女53例，中位年龄23.5（3~54）岁，其中极重型再生障碍性贫血65例。诊断至移植中位时间2（0.5~180）个月。单倍型造血干细胞来源为骨髓+外周血。脐血均选用单份，HLA配型≥4/6相合。127例患者均接受改良Bu/Cy+ATG/ALG预处理方案（白消安+环磷酰胺+抗胸腺细胞球蛋白/抗淋巴细胞球蛋白）。以环孢素A、霉酚酸酯联合短程甲氨蝶呤预防GVHD。回输单倍型供者单个核细胞10.87（3.61~24.00）×10⁸/kg，CD34⁺细胞3.49（1.02~8.89）×10⁶/kg；回输脐血单个核细胞2.22（1.10~7.30）×10⁷/kg，CD34⁺细胞0.56（0.16~2.27）×10⁵/kg。127例患者中5例发生早期死亡。在可评估的122例患者中，1例发生原发植入失败，其余121例患者成功植入（均为单倍型造血干细胞植入）。中性粒细胞、血小板植入时间分别为11（9~28）d、15（9~330）d，5例患者发生血小板植入不良。移植过程中74例（58.27%）发生感染。存活患者中位随访20.5（4.0~60.0）个月，Ⅱ~Ⅳ度急性GVHD发生率为24.79%（30/121），中/重度慢性GVHD发生率为14.15%（15/106），预期4年总生存率为（78.5±4.3）%，无失败生存率为（77.4±4.3）%。

结论

haplo-HSCT联合第三方脐血干细胞移植治疗SAA疗效确切且安全性较好，在无全相合供者情况下可作为有价值的治疗选择。

[An experimental study of CD4 targeted chimeric antigen receptor modified T cell with anti-lymphoma activity]

目的

探讨针对CD4膜蛋白的CAR-T细胞对CD4⁺T细胞淋巴瘤细胞的靶向特异性杀伤作用。

方法

采用重组DNA技术构建含4-1BB共刺激分子的第二代针对CD4的CAR慢病毒载体，应用293T细胞包装慢病毒，采用流式细胞术检测T细胞的转染效率及T细胞亚群动态变化，采用流式细胞术微球法检测培养上清中IFN-γ浓度。

结果

①构建的慢病毒载体转染激活的T细胞后CAR膜蛋白阳性率达到50.0%~70.0%。T细胞激活后部分CD8⁺T细胞弱表达（dim）CD4膜蛋白。T细胞转染针对CD4的CAR慢病毒后CD4⁺ T细胞、CD8⁺ CD4^dim T细胞逐渐被清除。②CAR-T细胞、对照组T细胞（空载体转染的T细胞）以8∶1效靶比分别与CD4⁺人T细胞淋巴瘤细胞株KARPAS 299细胞共培养24 h，杀伤效率分别为（96.9±2.1）%和（11.2±3.1）%，前者明显高于后者（t=7.137，P=0.028）。③CAR-T细胞单独培养，与转染慢病毒载体表达人CD4的K562细胞（K562-CD4细胞）、K562细胞共培养后上清中IFN-γ浓度分别为（1 785±268）、（15 648±2 168）、（1 978±354）pg/ml，CAR-T细胞与K562-CD4细胞共培养上清IFN-γ浓度明显高于其他两组，差异有统计学意义（P<0.01）。

结论

CD4特异性CAR-T细胞效应细胞免疫表型为CD8⁺ CD4⁺ T细胞，在体外具有杀伤正常CD4⁺ T细胞和CD4⁺ T细胞淋巴瘤细胞的活性，对于CD4^dim T细胞也有较好的清除活性。

[Efficacy comparison of sequential treatment with first-line administration of second-generation and first-generation tyrosine kinase inhibitors in patients with Ph+ acute lymphoblastic leukemia followed by allogeneic hematopoietic stem cell transplantation]

Objective: To investigate the efficacy of sequential treatment with first-line administration of second-generation tyrosine kinase inhibitors (TKI) and first-generation TKI (imatinib) in patients with Ph⁺ acute lymphoblastic leukemia (Ph⁺ ALL) followed by allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods: Retrospective analysis of clinical features and prognosis of 76 newly diagnosed Ph ⁺ALL patients from June 2011 to December 2015 treated by allo-HSCT combined with first-line administration of second-generation or first-generation TKI was performed and the efficacy compared. Results: Of 76 Ph⁺ ALL patients, first-generation TKI was administered in 57 cases, second-generation TKI in 19 cases, including 10 cases of nilotinib and 9 cases of dasatinib. There was no significant difference in age, WBC counts, additional chromosomal abnormalities, time form diagnosis to transplantation, transplantation type, conditioning regimen or TKI initiation time between the two groups. Complete remission (CR) rates at the fourth week of induction therapy in first-generation TKI group and second-generation TKI group was 93.0% and 94.7% (P=1.000), respectively. Major molecular response (MMR, BCR-ABL/ABL reduce 3 log) rates meanwhile were 46.0% and 40.0% (χ²=0.169, P=0.681). Relapse rates before transplantation were 14.0% and 10.5% (P=1.000). MMR rates before transplantation were 54.4% and 68.2% (χ²=1.152, P=0.283). The 2-year overall survival (OS) rates of first-generation and second-generation TKI group were 62.0% and 94.7% (χ²=5.765, P=0.016), 2-year event-free survival (EFS) rates were 46.3% and 84.2% (χ²=5.644, P=0.018), respectively. Univariate analysis showed that second-generation TKI could improve OS (HR=0.126, 95%CI 0.017-0.939, P=0.043). Multiple factors analysis showed that second-generation TKI (HR=0.267, 95%CI 0.081-0.873, P=0.029) and MMR before transplantation (HR=0.496, 95%CI 0.254-0.968, P=0.040) were good independent prognostic factors of EFS. Conclusions: There was significant difference in the efficacy of second-generation TKI and first-generation TKI for Ph⁺ ALL patients treated by allo-HSCT. First-line administration of second-generation TKI showed better efficacy than that of first-generation TKI for Ph⁺ ALL patients.

[Comparison of the efficacy of decitabine combined with micro-transplantation or priming regimen as consolidation treatment for older patients with acute myeloid leukemia]

目的

探索老年急性髓系白血病（AML）第1次完全缓解（CR₁）后采用地西他滨联合微移植巩固治疗的疗效与安全性。

方法

回顾性分析2012年11月至2015年9月诊治的37例CR₁老年（≥60岁）AML患者病例资料，比较分析地西他滨联合微移植（微移植组，19例）与地西他滨联合预激方案巩固治疗（化疗组，18例）的疗效和不良反应。

结果

两组患者起病时的年龄、WBC水平、疾病状态差异均无统计学意义（P值均>0.05）。两种巩固治疗方案的耐受性均良好，微移植组与化疗组的CTC 3~4级非血液学不良反应发生率差异无统计学意义[36.8%（7/19）对27.8%（5/18），χ²=0.347，P=0.728]。微移植组与化疗组中性粒细胞恢复的中位时间分别为12和13 d（z=1.599，P=0.110），血小板恢复的中位时间分别为14和12 d（z=−1.314，P=0.189）。微移植组患者均未发生移植物抗宿主病。微移植组与化疗组的2年无白血病生存率分别为50.7%和24.3%（P=0.047），2年总生存率分别为54.9%和30.0%（P=0.071）。

结论

对于老年AML患者，地西他滨联合微移植可能是一种安全有效的巩固方案。

[Efficacy and safety of IA regimen containing different doses of idarubicin in de-novo acute myeloid leukemia for adult patients]

目的

探讨含不同剂量去甲氧柔红霉素（IDA 8、10、12 mg/m²）的IA方案诱导治疗成人初发急性髓系白血病（AML）（非急性早幼粒细胞白血病）的临床疗效和安全性。

方法

采用多中心、单盲、非随机、临床对照研究，纳入2011年5月至2015年3月苏州大学附属第一医院及其他36家单位收治的1 215例成人初发AML患者，根据诱导化疗方案中IDA的剂量对患者进行分组，分析不同剂量IDA联合阿糖胞苷（100 mg/m²）组成的IA方案在成人初发AML诱导治疗中的完全缓解（CR）率、血液学及非血液学不良事件。

结果

可纳入缓解率分析的AML患者共1 207例，IDA 8 mg/m²、10 mg/m²和12 mg/m²组的CR率分别为73.6%（215/292）、84.1%（662/787）和86.7%（111/128），差异有统计学意义（P<0.001）；以IDA 8 mg/m²组为参照组，在调整了年龄、骨髓原始细胞比例、FAB分型、危险度分层后，IDA 10 mg/m²和IDA 12 mg/m²为影响患者CR的有利因素[OR=0.49（95% CI 0.34~0.70），P<0.001；OR=0.36（95%CI 0.18~0.71），P=0.003]。在中、低危组中三组CR率分别为76.5%（163/213）、86.9%（506/582）和86.1%（68/79），差异有统计学意义（P=0.007）；在调整了年龄、骨髓原始细胞比例、FAB分型因素后，IDA 10 mg/m²为影响患者CR的有利因素[OR=0.47（95% CI 0.31~0.71），P<0.001]。在高危组中，三组CR率分别为50.0%（18/36）、60.6%（43/71）和81.8%（18/22），差异无统计学意义（P=0.089），但在调整了年龄、骨髓原始细胞比例、FAB分型因素后，IDA 12 mg/m²为影响患者CR的有利因素[OR=0.22（95% CI 0.06~0.80），P=0.022]。8 mg/m²、10 mg/m²和12 mg/m²组中性粒细胞≤0.5×10⁹/L的中位持续时间分别为14（11~18）、15（11~20）和18（14~22）d，差异有统计学意义（P=0.012）；三组PLT≤20×10⁹/L的中位持续时间分别为14（7~17）、15（11~20）和17（15~21）d，差异有统计学意义（P=0.001）；三组肺部感染发生率分别为9.8%、13.5%和25.2%，差异有统计学意义（P<0.001）。

结论

在中国成人（18~60岁）初发AML中，建议中、低危组患者采用含IDA 10 mg/m²的IA方案进行诱导治疗；而高危组AML建议选择含IDA 12 mg/m²的IA方案进行诱导治疗。

[Comparison of allogeneic or autologous hematopoietic stem cell transplant for high-risk peripheral T cell lymphomas]

目的

比较自体造血干细胞移植（auto-HSCT）和异基因造血干细胞移植（allo-HSCT）治疗高危外周T细胞淋巴瘤（PTCL）疗效的差异。

方法

回顾性分析苏州大学附属第一医院60例接受HSCT治疗的高危PTCL患者临床资料。

结果

60例PTCL患者均为高危组患者（IPI评分≥3分），接受移植时中位年龄31 (12~58）岁。包括PTCL非特指型22例、ALK阴性的间变大细胞淋巴瘤22例、血管免疫母细胞淋巴瘤16例。其中接受auto-HSCT的有39例（63.5%），接受allo-HSCT的有21例（36.5%）。移植前40例完全缓解（CR），2例部分缓解（PR），18例未缓解（NR）。40例CR患者中10例接受allo-HSCT, 30例接受auto-HSCT。20例PR+NR患者中11例接受allo-HSCT, 9例接受auto-HSCT。移植后中位随访时间为39 (1~96）个月，auto-HSCT和allo-HSCT组的5年无进展生存率分别为61％和60%（P=0.724）。auto-HSCT和allo-HSCT组的5年总生存率分别为62％和61%（P=0.724）。auto-HSCT和allo-HSCT组的5年移植相关死亡率分别为22.7％和41.8%（P=0.250）。截至末次随访时间，auto-HSCT中7例患者复发，allo-HSCT组中2例复发，auto-HSCT和allo-HSCT组的5年累计复发率分别为37.2％和10.1%（P=0.298）。

结论

高危PTCL患者选择auto-HSCT或allo-HSCT治疗长期生存无明显差异，但allo-HSCT组患者移植前多为NR状态，表明对于NR患者，allo-HSCT效果可能较好。

[Allogeneic hematopoietic stem cell transplantation associated thrombotic microangiopathy: 16 cases report and literature review]

目的

分析异基因造血干细胞移植（allo-HSCT）相关血栓性微血管病（TA-TMA）患者临床特征、疗效及转归。

方法

回顾性分析2013年1月至2015年6月于苏州大学附属第一医院接受allo-HSCT后发生TA-TMA的16例患者临床资料。

结果

纳入研究的852例allo-HSCT患者，16例（1.9%）发生TA-TMA，中位随访时间14个月，1年累计发生率为（2.3±0.6）%。16例患者中，男7例，女9例，中位年龄41(12~54）岁，中位发病时间为移植后72(21~525) d, PLT中位数为20(11~36）×10⁹/L，HGB中位数为74(56~99）g/L，LDH中位水平为762(309~1 049) U/L，外周血破碎红细胞比例中位数为3%（2%~13%），所有患者ADAMTS13活性均>60%。10例出现精神症状，7例肌酐水平升高。TA-TMA确诊后的主要治疗措施为钙调磷酸酶体抑制剂的减停、激素及血浆置换疗法，8例经治疗后病情得以控制，治疗有效；8例患者治疗无效死亡。治疗无效组8例患者中5例合并急性肠道移植物抗宿主病（GVHD），治疗有效组患者无一例合并肠道GVHD；8例治疗无效患者中5例外周血破碎红细胞比例>5%，而治疗有效组破碎红比例最高为4%；治疗无效患者LDH及肌酐中位水平均高于治疗有效组，分别为826(674~1 310) U/L对636(309~941）U/L及127(70~215）µmol/L对56(22~101）µmol/L。

结论

TA-TMA是allo-HSCT后的一类严重并发症，可导致全身多器官功能损伤，即使采取治疗早期病死率仍较高，疗效与病情轻重及有无并发症有关。

[Distribution and drug resistance of pathogens at hematology department of Jiangsu Province from 2014 to 2015: results from a multicenter, retrospective study]

Objective: To describe the distribution and drug resistance of pathogens at hematology department of Jiangsu Province from 2014 to 2015 to provide reference for empirical anti-infection treatment. Methods: Pathogens were from hematology department of 26 tertiary hospitals in Jiangsu Province from 2014 to 2015. Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or agar dilution method. Collection of drug susceptibility results and corresponding patient data were analyzed. Results: The separated pathogens amounted to 4 306. Gram-negative bacteria accounted for 64.26%, while the proportions of gram-positive bacteria and funguses were 26.99% and 8.75% respectively. Common gram-negative bacteria were Escherichia coli (20.48%) , Klebsiella pneumonia (15.40%) , Pseudomonas aeruginosa (8.50%) , Acinetobacter baumannii (5.04%) and Stenotropho-monas maltophilia (3.41%) respectively. CRE amounted to 123 (6.68%) . Common gram-positive bacteria were Staphylococcus aureus (4.92%) , Staphylococcus hominis (4.88%) and Staphylococcus epidermidis (4.71%) respectively. Candida albicans were the main fungus which accounted for 5.43%. The rates of Escherichia coli and Klebsiella pneumonia resistant to carbapenems were 3.5%-6.1% and 5.0%-6.3% respectively. The rates of Pseudomonas aeruginosa resistant to tobramycin and amikacin were 3.2% and 3.3% respectively. The resistant rates of Acinetobacter baumannii towards tobramycin and cefoperazone/sulbactam were both 19.2%. The rates of Stenotrophomonas maltophilia resistant to minocycline and sulfamethoxazole were 3.5% and 9.3% respectively. The rates of Staphylococcus aureus, Enterococcus faecium and Enterococcus faecalis resistant wards vancomycin were 0, 6.4% and 1.4% respectively; also, the rates of them resistant to linezolid were 1.2%, 0 and 1.6% respectively; in addition, the rates of them resistant to teicoplanin were 2.8%, 14.3% and 8.0% respectively. Furthermore, MRSA accounted for 39.15% (83/212) . Conclusions: Pathogens were mainly gram-negative bacteria. CRE accounted for 6.68%. The rates of Escherichia coli and Klebsiella pneumonia resistant to carbapenems were lower compared with other antibacterial agents. The rates of gram-positive bacteria resistant to vancomycin, linezolid and teicoplanin were still low. MRSA accounted for 39.15%.

[A retrospective analysis of prognosis in favorable-risk acute myeloid leukemia patients with different consolidation regimens]

Objective: To explore the impact on prognosis in favorable-risk acute myeloid leukemia (AML) patients with different consolidation regimens after first complete remission (CR(1)). Methods: A total of 107 cases of non-refractory adult AML from January 2010 to June 2015 in single center were enrolled in the study. HD-Ara-C group (38 cases) as the control group, we explore the prognosis in three consolidation regimens, including micro-transplantation (16 cases) , autologous transplantation (auto-PBSCT, 14 cases) , allogeneic transplantation (allo-HSCT, 39 cases). Results: Of 107 patients (59 males and 48 females) , with a median age of 33 (16-59) years old and a median follow-up of 36.5 (5.3-79.1) months, the overall relapse rate was 20.6% (22/107) , and overall mortality rate was 18.7% (20/107). The 5 years cumulative relapse rate (CIR) of HD-Ara-C, micro-transplantation, auto-PBSCT and allo-HSCT group were 39.7%, 6.2%, 14.3% and 5.6%, respectively (P<0.001). The CIR of the observed group was lower than the HD-Ara-C group. The 5 years progression-free survival (PFS) rate of HD-Ara-C, micro-transplantation, auto-PBSCT and allo-HSCT group were 44.7%, 93.8%, 85.7% and 78.1%, respectively (P=0.011). The PFS of observed groups were similar, but superior to that in HD-Ara-C group. The 5-year overall survival (OS) in four groups was 54.9%, 100%, 92.9% and 77.4%, respectively (P>0.05). Multiple factors analysis showed that compared to HD-Ara-C regimen, allo-HSCT could improve PFS (HR=0.376, P=0.031) , but not OS (P>0.05) ; micro-transplantation and auto-PBSCT could not improve the PFS or OS (P>0.05). Conclusion: As compared with HD-Ara-C regimen, allo-HSCT could obviously decrease CIR, improve PFS, but treatment-related mortality is high. These results show that auto-PBSCT and micro-transplantation have similar outcomes, compared to HD-Ara-C regimen, so both can be used as a option of consolidation treatment for favorable-risk AML.

[Clinical analysis in a cohort of 102 patients with myelodysplastic syndrome characterized by erythroid hyperplasia]

Objective: To investigate the clinical and laboratorial characteristics of patients with myelodysplastic syndrome (MDS) and erythroid hyperplasia. Methods: MDS patients whose bone marrow was hypercellular with erythroid lineage more than 50% and blasts account for less than 20% of non-erythroid cells were enrolled in this study. The ratio of mature erythrocytes to nucleated erythrocytes was no more than 20, namely MDS patients with erythroid hyperplasia(MDS-E). The retrospective analysis comprised 102 patients with MDS-E from the First Affiliated Hospital of Suzhou University. Clinical characteristics, karyotype, and the prognostic significance of erythroid hyperplasia were evaluated. Results: A total of 48 MDS-E patients (47.1%) presented a variety of cytogenetic abnormalities. The most frequently involved chromosomes were chromosome 8 (39.5% of all abnormal karyotypes), chromosome 7 (22.9%), followed by chromosome 5 (18.8%), chromosome 1 (16.7%) and chromosome 20 (16.7%). Hemoglobin (Hb) level affected the prognosis by survival analysis. The overall survival (OS) of MDS-E patients with Hb equal or more than 70 g/L was longer than that of patients less than 70 g/L (P<0.001). Allogeneic hematopoietic stem cell transplantation (HSCT) significantly improved the OS compared with best supportive care (P<0.001) and chemotherapy (P<0.001). The extent of erythroid hyperplasia in bone marrow did not impact on prognosis (P=0.187). Conclusions: Compared with previous reports of MDS patients, MDS-E patients have higher level of erythroid hyperplasia, more common erythroid dyshematopoiesis, more frequent 8 and 1 chromosome abnormalities. The degree of erythroid hyperplasia is not correlated with prognosis. Allogeneic hematopoietic stem cell transplantation improves the prognosis.

[EVI1 expression, clinical and cytogenetical characteristics in 447 patients with acute myeloid leukemia]

Objective: To investigate EVI1 expression and its associated clinical and cytogenetic characteristics in 447 acute myeloid leukemia (AML) patients. Methods: EVI1 expressions were measured in 447 AML cases from Jan. 2007 to Apr. 2015 to couple with clinical, cytogenetic and mutations' characteristics to summarize the features of AMLs with high EVI1 expression. Results: 17.9% of AML were high EVI1 expression (EVI1 +), and the remainder low EVI1 expression (EVI1-). No significant differences between the two groups in terms of age, sex, hemoglobin level, white blood cell count and platelet count were observed. More M0, M5 and M6 subtypes were observed in EVI1+ group (P= 0.027, 0.004 and 0.011, respectively). Cytogenetic abnormalities of 11q15, 11q23/MLL, 3q26, -7/7q- and t (9;11) were observed more frequently in EVI1 + group (P<0.001, <0.001, <0.001, <0.001, =0.014, respectively). Normal karyotype, inv (16), t (8;21) were observed more frequent in EVI1- group (P=0.001, 0.009, 0.002, respectively). EVI1 + was more observed in high risk cytogenetics. Mutation of NPM1 was more observed in EVI1- group (P <0.001). Remission rate in EVI1 + group was significantly lower than EVI1- group (P<0.001). Leukemia-free survival was improved in EVI1 + AML patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT). Conclusions: High EVI1 expression was more observed in FAB subgroup M5, harbored more cytogenetic abnormalities of 11p15, 11q23/MLL, 3q26 rearrangement, -7/7q- and t (9;11). Remission rate of high EVI1 expression AML was lower, which could be improved by allo-HSCT.

[Establishment and assessment of a nomogram for predicting the differentiation syndrome of acute promyelocytic leukemia]

Objective: By analyzing the risk factors for occurrence of differentiation syndrome (DS) during induction therapy in newly-diagnosed acute promyelocytic leukemia (APL) patients, a prediction nomogram for DS was established and the accuracy of this nomogram was validated. Methods: The modeling group was made up of 130 classical APL patients during the period of 1st January 2011 to 31st December 2013. After single factor screening of clinical variables, the logistic regression model was used to identify the final model variables. A nomogram subsequently established by R software was validated by Bootstrap resampling as internal validation. Concordance index (C-index) was used for the accuracy evaluation of the nomogram, and calibration curves were painted to test the actual observation and the nomogram-prediction of occurrence rate of DS. Results: Occurrence rate of DS in 130 APL patients was 30.0%; In multivariate analysis, body mass index (BMI) ≥24 kg/m2 and without using steroids for prevention of DS were identified as independent risk factors. The C-index of the nomogram for predicting DS was 0.818 (95% CI 0.741-0.895). The calibration curves showed good concordance of occurrence rate of DS between nomogram-prediction and actual observation. Conclusion: The nomogram was successfully established as a more accurate and visible tool for predicting the occurrence rate of DS in APL patients.

[Improved clinical outcome of acute myeloid leukemia with FLT3-ITD mutation treated with sorafenib]

OBJECTIVE

To analyze the efficacy of sorafenib on the treatment of patients diagnosed as acute myeloid leukemia(AML) with FLT3-ITD mutation.

METHODS

From January 2012 to February 2015, 42 cases of AML with FLT3-ITD mutation according to MICM (morphology, immunology, cytogenetics and molecular) diagnosis system in our hospital were retrospectively analyzed. Thirty-two cases were refractory to chemotherapy or relapsed, who were treated with sorafenib or combined with chemotherapy. Ten patients relapsed after allogeneic hematopoietic stem cell transplantation (allo-HSCT), who were retreated with sorafenib or combined with donor lymphocyte infusion (DLI) or chemotherapy. In the first group, 13 of 32 patients accepted allo-HSCT.

RESULTS

The overall response rate of all 42 patients was 73.8%, including 4 (9.5%) complete molecular remission (CMR), 9 (21.4%) complete remission (CR), 8 (19%) complete remission with incomplete hematologic recovery (CRi), 10 (23.8%) partial remission (PR), and 11 (26.2%) none remission (NR). The response rate of sorafenib alone for 17 patients was 70.6%, and that of sorafenib plus chemotherapy was 66.7% (P=0.555). Thirteen patients who received allo-HSCT included 6 CMR/CR/CRi, 4 PR, and 3 NR before transplant. The 2-year overall survival (OS) rate and progress free survival (PFS) rate in all patients were 36.9% and 28.7%, and the corresponding median time were 18 months and 9 months respectively. The 2-year OS rate in 23 patients who received sorafenib combined with allo-HSCT was superior to that in 19 patients not receiving allo-HSCT (45.5% vs 23.9%, P=0.041), so was PFS rate (44.0% vs 9.7%, P=0.014). Twelve cases died of disease progression, four of infection, and one of chronic graft versus host disease after transplant.

CONCLUSIONS

Sorafenib combined with chemotherapy improves response rate of AML patients with FLT3-ITD mutation. Those who are treated with sorafenib plus allo-HSCT obtain better long-term survival.

Synergistic Function of Smad4 and PTEN in Suppressing Forestomach Squamous Cell Carcinoma in the Mouse

The genetic bases underlying esophageal tumorigenesis are poorly understood. Our previous studies have shown that coordinated deletion of the Smad4 and PTEN genes results in accelerated hair loss and skin tumor formation in mice. Herein, we exemplify that the concomitant inactivation of Smad4 and PTEN accelerates spontaneous forestomach carcinogenesis at complete penetrance during the first 2 months of age. All of the forestomach tumors were invasive squamous cell carcinomas (SCCs), which recapitulated the natural history and pathologic features of human esophageal SCCs. A small population of the SCC lesions was accompanied by adenocarcinomas at the adjacent submucosa region in the double mutant mice. The rapid progression of forestomach tumor formation in the Smad4 and PTEN double knockout mice corresponded to a dramatic increase in esophageal and forestomach epithelial proliferation. The decreased expression of p27, p21, and p16 together with the overexpression of cyclin D1 contributed cooperatively to the accelerated forestomach tumorigenesis in the double mutant mice. Our results point strongly to the crucial relevance of synergy between Smad4 and PTEN to suppress forestomach tumorigenesis through the cooperative induction of cell cycle inhibitors.

Isolation of Listeria monocytogenes small-plaque mutants defective for intracellular growth and cell-to-cell spread

To dissect the regulatory and structural requirements for Listeria monocytogenes intracellular growth and cell-to-cell spread, we designed a protocol based on transposon mutagenesis and the isolation of mutants which form small plaques in monolayers of mouse L2 cell fibroblasts. Two different transposable elements were used to generate libraries of insertion mutants: Tn916 and a derivative of Tn917-lac, Tn917-LTV3. Ten classes of mutants were isolated and evaluated for growth and cell-to-cell spread in J774 mouse macrophagelike cells, Henle 407 human epithelial cells, and mouse bone marrow-derived macrophages. Mutants were also evaluated for secretion of hemolysin and phospholipase (assayed by egg yolk opacity) and association with F-actin in the cytoplasm of cells, using NBD-phallacidin staining. The ten classes of mutants included (i) mutants showing abortive intracellular and extracellular growth; (ii) mutants showing abortive intracellular growth; (iii) rough mutants; (iv) mutants showing greatly reduced hemolysin and phospholipase secretion but showing normal growth in cells and little or no association with F-actin; (v) mutants with mutations mapping to an open reading frame (ORF) adjacent to hlyA and referred to as ORF U, lacking phospholipase activity, and with 50% normal hemolysin activity; (vi) mutants with reduced secretion of both hemolysin and phospholipase; (vii) nonhemolytic mutants with mutations mapping to the structural gene, hlyA; (viii) mutants with 25% normal hemolysin secretion and absolutely no association with F-actin; (ix) mutants with mutations mapping to ORF U, lacking phospholipase activity, and with normal hemolysin activity; and (x) mutants showing a mixed-plaque morphology but normal for all other parameters.