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Bao L, Wang YT, Liu P, Lu MQ, Zhuang JL, Zhang M, Xia ZJ, Li ZL, Yang Y, Yan ZY, Jing HM, Dong F, Chen WM, Wu Y, Zhou HB, Fu R, Gong YP, Huang WR, Zhang YQ. Ixazomib-based frontline therapy followed by ixazomib maintenance in frail elderly newly diagnosed with multiple myeloma: a prospective multicenter study. EClinicalMedicine 2024; 68:102431. [PMID: 38318126 PMCID: PMC10839574 DOI: 10.1016/j.eclinm.2024.102431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/23/2023] [Accepted: 01/09/2024] [Indexed: 02/07/2024] Open
Abstract
Background Frail elderly patients with newly diagnosed multiple myeloma (NDMM) have inferior survival and less benefit from high-dose therapies. This prospective study aimed to investigate the efficacy, safety, and quality of life (QoL) of induction treatment of ixazomib/lenalidomide/dexamethasone (IRd) and ixazomib/pegylated liposomal doxorubicin/dexamethasone (IDd) followed by ixazomib/dexamethasone (Id) maintenance therapy in frail, elderly patients with NDMM. Methods From July 2019 to December 2021, this non-randomized concurrent controlled clinical study enrolled 120 NDMM patients aged ≥65 years with frailty defined by the International Myeloma Working Group (IMWG) frailty score or Mayo geriatric scoring system. The enrolled patients received 6-8 cycles of IRd or IDd followed by Id maintenance therapy for a minimum of 2 years at the discretion of physicians based on patient's clinical characteristics (chiCTR1900024917). Findings The median age was 71 years and 55% of the patients were males. The overall response rate (ORR) was 82% and 77%, complete response (CR) rate was 25% and 12% for IRd and IDd groups, respectively. The difference in ORR of the Idd group minus the IRd group was -5.36% (95% CI: -18.9% to 8.19%), indicating that the ORR of the IDd group was neither inferior nor non-inferior to the IRd group. After a median follow-up of 34.3 months, the median progression-free survival (PFS) was 21.6 and 13.9 months, OS was not reached and 29.2 months in IRd and IDd groups, respectively. 28 and 33 patients discontinued induction therapy, 20 and 19 discontinued maintenance therapy in IRd and IDd groups, respectively. Cumulative Grade 3 or higher hematological adverse events (AEs) occurred in 10 of the 60 patients (17%) and non-hematological AEs occurred in 15 of the 60 patients (25%) in the IRd group, while 13 of the 60 patients (22%) and 21 of the 60 patients (35%) in the IDd group. Patients were observed with clinically significant improvement in QoL when compared with that at baseline in both IRd and IDd groups by evaluation per cycle (P < 0.0001). Interpretation The results demonstrated that compared with IRd regimen, IDd regimen showed no significant advantage, but the survival of the IDd group was shorter than that of the IRd group, indicating an all-oral outpatient triplet regimen with IRd, which has low toxicity and has improved QoL, could be the viable first-line treatment option for frail NDMM patients. Funding The Young Elite Scientist sponsorship program by bast of Beijing Association for Science and Technology (No. BYESS2023116) and Beijing Medical Award Foundation (No. YXJL-2018-0539-0073).
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Affiliation(s)
- Li Bao
- Department of Hematology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China
| | - Yu-Tong Wang
- Department of Hematology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China
| | - Peng Liu
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Min-Qiu Lu
- Department of Hematology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China
| | - Jun-Ling Zhuang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Mei Zhang
- Department of Hematology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shanxi, China
| | - Zhong-Jun Xia
- Department of Hematologic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zhen-Ling Li
- Department of Hematology, China-Japan Friendship Hospital, Beijing, China
| | - Ying Yang
- Department of Hematology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhen-Yu Yan
- Department of Hematology, Affiliated Hospital of North China University of Science and Technology, Tangshan, China
| | - Hong-Mei Jing
- Department of Hematology, Third Hospital of Peking University, Beijing, China
| | - Fei Dong
- Department of Hematology, Third Hospital of Peking University, Beijing, China
| | - Wen-Ming Chen
- Department of Hematology, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China
| | - Yin Wu
- Department of Hematology, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China
| | - He-Bing Zhou
- Department of Hematology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Rong Fu
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yu-Ping Gong
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China
| | - Wen-Rong Huang
- Department of Hematology, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, China
| | - Yong-Qing Zhang
- Department of Hematology, The Eighth Medical Center of Chinese PLA General Hospital, Beijing, China
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Chen M, Fan Q, Li H, Ma YP, Qin XQ, Suo XH, Yang C, Zhu TN, Duan MH, Han B, Wang SJ, Zhou DB, Zhuang JL. [Efficacy of different regimens and prognostic factors in patients with first relapsed multiple myeloma treated after front-line bortezomib, cyclophosphamide, and dexamethasone]. Zhonghua Nei Ke Za Zhi 2023; 62:1436-1443. [PMID: 38044070 DOI: 10.3760/cma.j.cn112138-20230619-00318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Objective: To analyze the efficacy of second-line regimens and prognostic factors in patients with first-relapsed multiple myeloma (MM) treated with bortezomib, cyclophosphamide, and dexamethasone (BCD). Methods: A retrospective cohort study. Clinical data were collected in first-relapsed MM patients after BCD treatment from three tertiary hospitals in north China from July 2009 to October 2022. Patients were classified according to the second-line regimen into the immunotherapy group, single novel agent group [either proteasome inhibitor (PI) or immunomodulatory drug (IMiD)], combination treatment group (both PI+IMiD), and traditional treatment group. Responses to second-line regimens and survival data were analyzed. The Kaplan-Meier method was used for survival analysis and the Cox proportional risk model was used for univariate and multivariate analyses. Results: A total of 217 patients were enrolled including 8.8% (19/217) in the immunotherapy group, 48.4% (105/217) in the PI/IMiD group, 29.9% (65/217) in the PI+IMiD group, and 12.9% (28/217) in the traditional treatment group. The median age was 62 years (range 31-83 years) and 56.2% (122/217) were males. The overall response rates (ORRs) in the four groups were 94.7% (18/19) vs. 56.2% (59/105) vs. 73.8% (48/65) vs. 32.1% (9/28) (χ2=24.55; P<0.001), respectively. The progression-free survival (PFS) of the second-line regimens (2ndPFS) was 17.7 vs. 9.0 vs. 9.2 vs. 4.6 months (χ2=22.74; P<0.001), respectively, among which patients in the PI/IMiD and PI+IMiD groups had comparable 2ndPFS (χ2=1.76; P=0.923). Patients with high-risk cytogenetic abnormalities (HRCAs) achieved the longest 2ndPFS of 22.0 months in the immunotherapy group (χ2=15.03; P=0.002). Multivariate analysis suggested that immunotherapy (HR=0.11, 95%CI 0.05-0.27), achievement of efficacy of partial response or better (HR=0.47, 95%CI 0.34-0.66), and non-aggressive relapse (HR=0.25, 95%CI 0.17-0.37) were independent prognostic factors of 2ndPFS. Conclusion: In this real-world study, immunotherapy was associated with a more favorable efficacy and PFS for first-relapsed MM patients after BCD treatment, with similar outcomes in patients with HRCAs.
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Affiliation(s)
- M Chen
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Q Fan
- Department of Hematology, Beijing Shunyi Hospital, Beijing 101399, China
| | - H Li
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Y P Ma
- Department of Hematology, Second Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - X Q Qin
- Department of Hematology, Second Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - X H Suo
- Department of Hematology, Handan Central Hospital, Handan 057150, China
| | - C Yang
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - T N Zhu
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - M H Duan
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - B Han
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - S J Wang
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - D B Zhou
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - J L Zhuang
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
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Zhu ZX, Wang Q, Zhuang JL, Han B, Chen M. [The 503rd case: monoclonal IgM immunoglobulinemia, severe anemia with recurrent fever]. Zhonghua Nei Ke Za Zhi 2023; 62:1369-1372. [PMID: 37935507 DOI: 10.3760/cma.j.cn112138-20230302-00127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
A 42-year-old woman was diagnosed with Waldenström macroglobulinemia (WM) with fatigue, anemia, and monoclonal IgM immunoglobulinemia 6 years prior. She experienced persistent severe anemia with only transient remission after initial chemotherapy and after multiple chemotherapy regimens and immunosuppressive therapies, which were accompanied by recurrent high fever with severe complications including urinary infection, sepsis and shock, rectal perforation, and severe obstructive jaundice. The anemia was diagnosed as warm autoimmune hemolytic anemia and aplastic crisis with inflammation anemia. She received ibrutinib 140 mg once a day, and her hemoglobin levels returned to normal. WM remained stable in very good partial remission with no infection.
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Affiliation(s)
- Z X Zhu
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Q Wang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - J L Zhuang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - B Han
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - M Chen
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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Jin XX, Han XL, Jia CW, Zhuang JL, Chen M. [The 502nd case: thrombocytopenia, splenomegaly, disseminated intravascular coagulation, and spontaneous rupture of the spleen]. Zhonghua Nei Ke Za Zhi 2023; 62:1249-1252. [PMID: 37766449 DOI: 10.3760/cma.j.cn112138-20221114-00846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
A young man with a history of thrombocytopenia for seven years presented with splenomegaly and fever and rapidly evolved to disseminated intravascular coagulation (DIC) and hemorrhagic shock. Spontaneous rupture of the spleen was diagnosed. The critical patient underwent an emergency splenectomy. Pathological examination revealed splenic peliosis, an extremely rare disease with unknown etiology and pathogenesis. Despite the high mortality rate due to spontaneous splenic rupture with DIC, the patient was successfully treated and the details of the case are presented in this report.
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Affiliation(s)
- X X Jin
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - X L Han
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - C W Jia
- Department of Pathology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - J L Zhuang
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - M Chen
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
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Zhang FJ, Zhou X, Liu SZ, Liu SJ, Liu Y, Zhuang JL. [Efficacy and prognostic analysis of orthopedic surgery in patients with newly diagnosed multiple myeloma]. Zhonghua Nei Ke Za Zhi 2023; 62:673-680. [PMID: 37263950 DOI: 10.3760/cma.j.cn112138-20220824-00621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Objective: To evaluate the efficacy and prognosis of orthopedic surgical resection surgery in patients with newly diagnosed multiple myeloma (NDMM). Methods: This retrospective cohort study collected clinical data of patients with NDMM who underwent surgery due to spinal cord compression or pathological long-bone fractures at the Peking Union Medical College Hospital from 1 January 2003 to 31 December 2021. Patients who received biopsy or vertebroplasty/kyphoplasty were excluded and patients with the same degree of bone disease and who did not undergo any surgical intervention were selected as controls. Visual analogue scale (VAS) and physical status (ECOG) scores, progression-free survival (PFS), and overall survival (OS) were compared. Statistical analysis included the χ2-test, t-test, and Kaplan-Meier methods. Results: Baseline data were compared between the surgical group (n=40 with 43 interventions) and the non-surgical group (n=80), and included sex, age, paraprotein type, International Staging System (ISS), number of lytic lesions, cytogenetic abnormalities, first-line treatment, and the proportion of patients receiving autologous stem cell transplantation (ASCT) (all P>0.05). Serum M protein levels in the surgical group were significantly lower than those of the non-surgical group [(21.95±16.44) g/L vs. (36.18±20.85) g/L, P=0.005]. The surgical lesions involved the axial skeleton (79.1%, 34/43) or the extremities (20.9%, 9/43). VAS and ECOG scores improved significantly after surgery (VAS: 2.30±0.80 vs. 6.60±1.50, P<0.001; ECOG: 2.09±0.59 vs. 3.09±0.73, P<0.001). The median follow-up time was 51 months. Kaplan-Meier survival analysis suggested that the median PFS (25 vs. 29 months) and OS (46 vs. 60 months) were comparable between the surgical and non-surgical intervention groups (both P>0.05). Subgroup analysis showed that among patients with ISS Ⅰ or those who had received ASCT, PFS in the surgical group was similar to that of the non-surgical intervention group (both P>0.05), while OS was worse (P=0.005, 0.017). Patients with ISS Ⅱ/Ⅲ scores or without ASCT had similar PFS and OS between the surgical and non-surgical intervention groups (all P>0.05). Cox multivariate analysis suggested that ISS and ASCT were independent prognostic factors for OS (ISS: HR=0.42, 95%CI 0.19-0.93, P=0.031; ASCT: HR=0.41, 95%CI 0.18-0.97, P=0.041), while orthopedic surgery did not influence survival (P=0.233). Conclusion: For patients with NDMM, orthopedic surgical resection decreased bone-related complications and improved quality of life, but did not affect survival.
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Affiliation(s)
- F J Zhang
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - X Zhou
- Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - S Z Liu
- Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - S J Liu
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Y Liu
- Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - J L Zhuang
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
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Wei C, Jin XX, Cai H, Wang X, Zhuang JL, Zhou DB. [Clinical and molecular characteristics and prognosis of classical hairy cell leukemia and hairy cell leukemia variant]. Zhonghua Nei Ke Za Zhi 2023; 62:416-421. [PMID: 37032137 DOI: 10.3760/cma.j.cn112138-20220414-00274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
Objective: To evaluate the clinical characteristics, treatment response, and outcomes in patients with classical hairy cell leukemia (cHCL) and HCL variant (HCL-V). Methods: This is a retrospective case series study. Between January 2011 and December 2021, clinical data of 30 patients newly with diagnosed HCL at Peking Union Medical College Hospital were analyzed. The main outcome measures include clinical characteristics, treatment efficacy and survival. The Kaplan-Meier method was used for survival analysis. Results: Twenty-one cases of cHCL and 9 cases of HCL-v were included. The median age at diagnosis was 55.5 (range, 30-86) years, with the ratio of male to female 2.75∶1. The main clinical manifestations included fatigue in 11 cases (36.7%), abdominal distension in 7 cases (23.3%), and infection in 4 cases, while 8 cases were asymptomatic. Splenomegaly was reported in 24 cases (80.0%), including 7 (23.3%) with megalosplenia. The white blood cell count, lymphocyte count, and the proportion of peripheral hairy cells in HCL-v group were significantly higher than those in cHCL group, whereas the development of anemia, thrombocytopenia, and monocytopenia in cHCL group was more remarkable than that in HCL-v group (all P<0.05). The BRAF-V600E gene mutation was detected only in cHCL patients (11/14 vs. 0/9, P<0.001). In terms of immunophenotype, the expression of CD25, CD103, CD123 and CD200 in cHCL group (20/20, 20/20, 4/7, 7/17) were all stronger than those in HCL-v group (3/9, 7/9, 0/4, 2/8). Twenty-two patients were treated, of which 13 cases (12 cases of cHCL and 1 case of HCL-v) with cladribine, and 9 cases (4 cHCL and 5 HCL-v) with interferon. Complete remission rate and overall response rate were comparable between cladribine and interferon treatment groups (both P<0.05). The median follow-up time was 31 (range, 1-125) months, and the median overall survival (OS) of the entire group was 125 months. The 5-year OS rate in HCL-v patients represented a trend of inferior (50.0% vs. 95.0%, P=0.207). Conclusions: The clinical features of HCL are unspecific, which includes fatigue, splenomegaly and recurrent infection. The clinical features, immunophenotype, treatment response and prognosis of HCL-v are different from those of cHCL. BRAF-V600E gene mutation is suggested as a key marker for differential diagnosis. Cladribine is recommended as front-line regimen of cHCL patients with satisfactory efficacy and prognosis. Conversely, response and clinical outcome in HCL-v patients still need to be improved.
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Affiliation(s)
- C Wei
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - X X Jin
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - H Cai
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - X Wang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - J L Zhuang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - D B Zhou
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
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Zhang MY, Bao M, Shi DY, Shi HX, Liu XL, Xu N, Duan MH, Zhuang JL, Du X, Qin L, Hui WH, Liang R, Wang MF, Chen Y, Li DY, Yang W, Tang GS, Zhang WH, Kuang X, Su W, Han YQ, Chen LM, Xu JH, Liu ZG, Huang J, Zhao CT, Tong HY, Hu JD, Chen CY, Chen XQ, Xiao ZJ, Jiang Q. [Clinical and genetic characteristics of young patients with myeloproliferative neoplasms]. Zhonghua Xue Ye Xue Za Zhi 2023; 44:193-201. [PMID: 37356980 PMCID: PMC10119718 DOI: 10.3760/cma.j.issn.0253-2727.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
Objectives: To investigate the clinical and genetic features of young Chinese patients with myeloproliferative neoplasms (MPN). Methods: In this cross-sectional study, anonymous questionnaires were distributed to patients with MPN patients nationwide. The respondents were divided into 3 groups based on their age at diagnosis: young (≤40 years) , middle-aged (41-60 years) , and elderly (>60 years) . We compared the clinical and genetic characteristics of three groups of MPN patients. Results: 1727 assessable questionnaires were collected. There were 453 (26.2%) young respondents with MPNs, including 274 with essential thrombocythemia (ET) , 80 with polycythemia vera (PV) , and 99 with myelofibrosis. Among the young group, 178 (39.3%) were male, and the median age was 31 (18-40) years. In comparison to middle-aged and elderly respondents, young respondents with MPN were more likely to present with a higher proportion of unmarried status (all P<0.001) , a higher education level (all P<0.001) , less comorbidity (ies) , fewer medications (all P<0.001) , and low-risk stratification (all P<0.001) . Younger respondents experienced headache (ET, P<0.001; PV, P=0.007; MF, P=0.001) at diagnosis, had splenomegaly at diagnosis (PV, P<0.001) , and survey (ET, P=0.052; PV, P=0.063) . Younger respondents had fewer thrombotic events at diagnosis (ET, P<0.001; PV, P=0.011) and during the survey (ET, P<0.001; PV, P=0.003) . JAK2 mutations were found in fewer young people (ET, P<0.001; PV, P<0.001; MF, P=0.013) ; however, CALR mutations were found in more young people (ET, P<0.001; MF, P=0.015) . Furthermore, mutations in non-driver genes (ET, P=0.042; PV, P=0.043; MF, P=0.004) and high-molecular risk mutations (ET, P=0.024; PV, P=0.023; MF, P=0.001) were found in fewer young respondents. Conclusion: Compared with middle-aged and elderly patients, young patients with MPN had unique clinical and genetic characteristics.
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Affiliation(s)
- M Y Zhang
- Peking University People's Hospital, Beijing 100044, China
| | - M Bao
- Peking University People's Hospital, Beijing 100044, China
| | - D Y Shi
- Peking University People's Hospital, Beijing 100044, China
| | - H X Shi
- Peking University People's Hospital, Beijing 100044, China
| | - X L Liu
- Nanfang Hospital, Southern Medical University, Guangzhou 510080, China
| | - N Xu
- Nanfang Hospital, Southern Medical University, Guangzhou 510080, China
| | - M H Duan
- Peking Union Medical College Hospital, CAMS & PUMC, Beijing 100730, China
| | - J L Zhuang
- Peking Union Medical College Hospital, CAMS & PUMC, Beijing 100730, China
| | - X Du
- Department of Hematology, Shenzhen Second People's Hospital (First Affiliated Hospital of Shenzhen University), Shenzhen 518035, China
| | - L Qin
- The First Affiliated Hospital and College of Clinical Medicine of Henan University of Science and Technology, Zhenzhou 471003, China
| | - W H Hui
- Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - R Liang
- Xi Jing Hospital, The Fourth Military Medical University, Xi'an 710032, China
| | - M F Wang
- Second Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - Y Chen
- Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - D Y Li
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - W Yang
- Shengjing Hospital Affiliated to China Medical University, Shenyang 110020, China
| | - G S Tang
- Nanfang Hospital, Southern Medical University, Guangzhou 510080, China
| | - W H Zhang
- First Hospital of Shanxi Medical University, Taiyuan 300012, China
| | - X Kuang
- Kaifeng Central Hospital, Kaifeng 475000, China
| | - W Su
- Dongfang Hospital, Beijing University of Chinese Medicine, Beijing 100078, China
| | - Y Q Han
- The Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010050, China
| | - L M Chen
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - J H Xu
- Department of Hematology, the First Hospital of Qiqihar, Qiqihar 161005, China
| | - Z G Liu
- Shengjing Hospital Affiliated to China Medical University, Shenyang 110020, China
| | - J Huang
- The Fourth Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 322000, China
| | - C T Zhao
- The Affiliated Hospital of Qingdao University, Qingdao 266003, China
| | - H Y Tong
- The First Affiliated Hospital of College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - J D Hu
- Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - C Y Chen
- Shandong University Qilu Hospital, Jinan 250012, China
| | - X Q Chen
- Northwest University School of Medicine, Xi'an 710069, China
| | - Z J Xiao
- Institute of Hematology and Blood Diseases Hospital, CAMS & PUMC, National Clinical Research Center for Blood Diseases, The State Key Laboratory of Experimental Hematology, Tianjin 300020, China
| | - Q Jiang
- Peking University People's Hospital, Beijing 100044, China
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Song YH, Zhang FJ, Hu RR, Chen M, Yang C, Wang W, Qin Y, Zhou DB, Zhuang JL. [The influencing factors of renal response in newly diagnosed multiple myeloma patients with renal impairment]. Zhonghua Xue Ye Xue Za Zhi 2023; 44:141-147. [PMID: 36948869 PMCID: PMC10033274 DOI: 10.3760/cma.j.issn.0253-2727.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
Objective: To investigate the causative factors of renal function in newly diagnosed multiple myeloma (MM) patients with renal inadequacy. Methods: 181 MM patients with renal impairment from August 2007 to October 2021 at Peking Union Medical College Hospital were recruited, whose baseline chronic kidney disease (CKD) stage was 3-5. Statistical analysis was performed based on laboratory tests, treatment regimens, hematological responses, and survival among various renal function efficacy groups. A logistic regression model was employed in multivariate analysis. Results: A total of 181 patients were recruited, and 277 patients with CKD stages 1-2 were chosen as controls. The majority choose the BCD and VRD regimens. The progression-free survival (PFS) (14.0 months vs 24.8 months, P<0.001) and overall survival (OS) (49.2 months vs 79.7 months, P<0.001) of patients with renal impairment was considerably shorter. Hypercalcemia (P=0.013, OR=5.654) , 1q21 amplification (P=0.018, OR=2.876) , and hematological response over a partial response (P=0.001, OR=4.999) were independent predictive factors for renal function response. After treatment, those with improvement in renal function had a longer PFS than those without (15.6 months vs 10.2 months, P=0.074) , but there was no disparity in OS (56.5 months vs 47.3 months, P=0.665) . Conclusion: Hypercalcemia, 1q21 amplification, and hematologic response were independent predictors of the response of renal function in NDMM patients with renal impairment. MM patients with CKD 3-5 at baseline still have worse survival. Improvement in renal function after treatment is attributed to the improvement in PFS.
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Affiliation(s)
- Y H Song
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - F J Zhang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - R R Hu
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - M Chen
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - C Yang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - W Wang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Y Qin
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - D B Zhou
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - J L Zhuang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
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9
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Wei C, He TH, Zhuang JL, Zhou D. [Paraneoplastic pemphigus associated with chronic lymphocytic leukemia: a case report]. Zhonghua Nei Ke Za Zhi 2022; 61:1369-1372. [PMID: 36456521 DOI: 10.3760/cma.j.cn112138-20211222-00905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Affiliation(s)
- C Wei
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - T H He
- Department of Internal Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - J L Zhuang
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Daobin Zhou
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
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10
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Yang C, Zhuang JL. [A case of multiple myeloma accompanied with breast cancer and lung cancer]. Zhonghua Nei Ke Za Zhi 2022; 61:1158-1160. [PMID: 36207971 DOI: 10.3760/cma.j.cn112138-20211023-00733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- C Yang
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - J L Zhuang
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
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11
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Wei C, Zheng KY, Dai JY, Cai HC, Zhu TN, Zhao JL, Zhou DB, Zhuang JL. [The 492nd case: recurrent thrombosis, thrombocytopenia]. Zhonghua Nei Ke Za Zhi 2022; 61:239-242. [PMID: 35090264 DOI: 10.3760/cma.j.cn112138-20210222-00149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
A 43-year-old female patient was admitted with recurrent thrombosis for more than 2 years and thrombocytopenia for more than 1 year. Both arterial and venous thromboses developed especially at rare sites even during anticoagulation therapy such as cerebral venous sinus thrombosis. Antinuclear antibody, anti-ENA antibody and antiphospholipid antibody were all negative. Platelet count elevated to normal after high dose glucocorticoid and intravenous immunoglobulin (IVIG). Immune thrombocytopenia was suspected. When 4 grade thrombocytopenia recurred, intravenous heparin, rituximab 600 mg, IVIG and eltrombopag were administrated. After 3 weeks, thrombocytopenia did not improve, and new thrombosis developed instead. Screening of thrombophilia related genes revealed PROS1 gene heterozygous mutation and MTHFR TT genotype. Low amount of serum IgG κ monoclonal protein was detected. Heparin-induced thrombocytopenia was differentiated and excluded. Finally, serum negative antiphospholipid syndrome was considered the most likely diagnosis. Dexamethasone 20 mg/day × 4 days combined with sirolimus 2 mg/day was prescribed. The patient was discharged with low molecular weight heparin. At one month, her headache was greatly relieved. The platelet count raised to 20-30×109/L, and no new thrombosis or bleeding was reported.
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Affiliation(s)
- C Wei
- Department of Hematology, Peking Union Medical College Hospital,Peking Union Medical College, Chinese Academy of Medical Sciences,Beijing 100730,China
| | - K Y Zheng
- Department of Internal Medicine, Peking Union Medical College Hospital,Peking Union Medical College, Chinese Academy of Medical Sciences,Beijing 100730, China
| | - J Y Dai
- Department of Emergency, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences,Beijing 100730,China
| | - H C Cai
- Department of Hematology, Peking Union Medical College Hospital,Peking Union Medical College, Chinese Academy of Medical Sciences,Beijing 100730,China
| | - T N Zhu
- Department of Hematology, Peking Union Medical College Hospital,Peking Union Medical College, Chinese Academy of Medical Sciences,Beijing 100730,China
| | - J L Zhao
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - D B Zhou
- Department of Hematology, Peking Union Medical College Hospital,Peking Union Medical College, Chinese Academy of Medical Sciences,Beijing 100730,China
| | - J L Zhuang
- Department of Hematology, Peking Union Medical College Hospital,Peking Union Medical College, Chinese Academy of Medical Sciences,Beijing 100730,China
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Gao YJ, Zheng WY, Liu HF, Zhuang JL, Wu D. [The 491st case: thrombocytosis, gastrointestinal hemorrhage, intestinal perforation]. Zhonghua Nei Ke Za Zhi 2021; 60:1193-1196. [PMID: 34856696 DOI: 10.3760/cma.j.cn112138-20210103-00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Essential thrombocythemia (ET) is a chronic myeloproliferative neoplasm (MPN) featured by clonal proliferation of platelets, thrombosis and hemorrhage. Portal hypertension is a serious complication of ET associated with poor prognosis. We report a patient with ET complicated with acute upper gastrointestinal hemorrhage and intestinal perforation due to portal hypertension. She had an uneventful recovery after surgical and endoscopic treatment.
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Affiliation(s)
- Y J Gao
- Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - W Y Zheng
- Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - H F Liu
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - J L Zhuang
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - D Wu
- Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
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Wang L, Zhang Y, Wang W, Zhang L, Yang C, Zhuang JL, Han B, Zhou DB, Chen M. [Clinical analysis in five patients with acute leukemia and HIV infection]. Zhonghua Xue Ye Xue Za Zhi 2021; 41:517-520. [PMID: 32654469 PMCID: PMC7378282 DOI: 10.3760/cma.j.issn.0253-2727.2020.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- L Wang
- Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Y Zhang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - W Wang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - L Zhang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - C Yang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - J L Zhuang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - B Han
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - D B Zhou
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - M Chen
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
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Mao XH, Zhuang JL, Zhao DD, Li XQ, Du X, Hao M, Xu Y, Yan YT, Liu JH, Fan HS, Sui WW, Deng SH, Li CW, Zhao JW, Yi SH, Du CX, Zou DH, Li ZJ, Zhao YZ, Zhan FH, Tai YT, Fang BJ, Song YP, Wang JX, Anderson KC, Qiu LG, An G. IgH translocation with undefined partners is associated with superior outcome in multiple myeloma patients. Eur J Haematol 2020; 105:326-334. [PMID: 32421883 DOI: 10.1111/ejh.13440] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND In multiple myeloma (MM), impact of specific chromosomal translocations involving IgH (14q21 locus, including t(4;14), t(11;14), and t(14;16)) has been explored extensively. However, over 15% MM patients harboring IgH translocation with undefined partners have long been ignored. METHODS A prospective non-randomized cohort study with a total of 715 newly-diagnosed MM cases was conducted, 13.6% of whom were t(14;undefined) positive. The whole cohort was divided into four groups: no IgH split (47.7%); t(14;undefined) (13.6%); t(11;14) (17.6%); and t(4;14) or t(14;16) group (21.1%). RESULTS Median OS for the four groups was 84.2, not reached (NR), 58.7, and 44.2 months, respectively, with P values for t(14;undefined) vs no IgH split, t(11;14), and t(4;14)/t(14;16) groups of 0.197, 0.022, and 0.001, respectively. In bortezomib-based group, the survival advantage gained by t(14;undefined) group was much more significant compared to t(11;14) and t(4;14)/t(14;16) groups. Importantly, t(14;undefined) turned out to be an independent predictive factor for longer OS of MM patients in multivariate analysis, especially in the context of bortezomib treatment. Similar results were also observed in the PUMCH external validation cohort. CONCLUSION Collectively, our data confirmed and externally validated the favorable prognosis of the t(14;undefined) groups, especially in the era of novel agents.
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Affiliation(s)
- Xue-Han Mao
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Jun-Ling Zhuang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Duo-Duo Zhao
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiao-Qing Li
- Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Xin Du
- Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Mu Hao
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Yan Xu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Yu-Ting Yan
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Jia-Hui Liu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Hui-Shou Fan
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Wei-Wei Sui
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Shu-Hui Deng
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Cheng-Wen Li
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Jia-Wei Zhao
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Shu-Hua Yi
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Chen-Xing Du
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - De-Hui Zou
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Zeng-Jun Li
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Yao-Zhong Zhao
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Feng-Huang Zhan
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Yu-Tzu Tai
- LeBow Institute for Myeloma Therapeutics and Jerome Lipper Center for Multiple Myeloma Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Bai-Jun Fang
- Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, China
| | - Yong-Ping Song
- Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, China
| | - Jian-Xiang Wang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Kenneth C Anderson
- LeBow Institute for Myeloma Therapeutics and Jerome Lipper Center for Multiple Myeloma Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Lu-Gui Qiu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Gang An
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
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Zhao JT, Ye WL, Zhuang JL. [Advances in diagnosis and treatment of monoclonal immunoglobulin deposit disease]. Zhonghua Xue Ye Xue Za Zhi 2020; 41:84-86. [PMID: 32023762 PMCID: PMC7357915 DOI: 10.3760/cma.j.issn.0253-2727.2020.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- J T Zhao
- Department of Hematology, Peking Union Medical College Hospital, Beijing 100730, China
| | - W L Ye
- Department of Nephrology, Peking Union Medical College Hospital, Beijing 100730, China
| | - J L Zhuang
- Department of Hematology, Peking Union Medical College Hospital, Beijing 100730, China
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Yu XC, Su W, Zhuang JL. [The value of serum heavy/light chain immunoassay to assess therapeutic response in patients with multiple myeloma]. Zhonghua Xue Ye Xue Za Zhi 2019; 39:281-285. [PMID: 29779321 PMCID: PMC7342143 DOI: 10.3760/cma.j.issn.0253-2727.2018.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To assess the value of immunoglobulin heavy/light chain (HLC) immunoassay on therapeutic response in patients with multiple myeloma(MM). Methods: A total of 45 newly diagnosed MM patients were retrospectively enrolled in Peking Union Medical College Hospital from 2013 to 2016, whose 115 serum samples were consecutively collected. HLC was tested to evaluate response and compare with other methods for M protein detection. Results: ①There were 30 males and 15 females in total of whom the monoclonal immunoglobulin was IgG in 27 (IgGκ∶IgGλ 12∶15) and IgA (IgAκ∶IgAλ 9∶9) in 18. The arerage age of the studied population was 59 (range 43-80) . ② In 34 patients with serum sample at diagnosis, 32 (94.1%) had abnormal HLC ratio (rHLC) while 2 patients with IgG had normal rHLC. The percentages of abnormal rHLC was 81.8% (18/22) at partial response、50.0%(9/18) at very good complete response and 16.0%(4/25) at complete response. ③In 25 patients reaching CR, there were 13 with IgG and 12 with IgA. 4 patients equally split of IgG and IgA had abnormal rHLC at complete response. ④By monitoring the rHLC of some patients consecutively, we found that the remission of rHLC was to some extent behind the remission of SPE and IEF, or even rFLC. Conclusion: Immunoglobulin HLC detection is one feasible method for minimal residual disease detection.
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Affiliation(s)
| | | | - J L Zhuang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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Chen M, Zhuang JL, Duan MH, Zhang W, Li J, Zhu TN, Cai HC, Cao XX, Feng J, Yang C, Zhang Y, Zhang L, Zhou DB, Han B. [Posaconazole as primary prevention of fungal infection in intensive immunosuppressive therapy for severe aplastic anemia]. Zhonghua Xue Ye Xue Za Zhi 2019; 39:128-131. [PMID: 29562447 PMCID: PMC7342574 DOI: 10.3760/cma.j.issn.0253-2727.2018.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
目的 评价在初治重型/极重型再生障碍性贫血(SAA/VSAA)患者抗胸腺/淋巴细胞免疫球蛋白(ATG/ALG)联合环孢素A的强化免疫抑制治疗(IST)中,采用泊沙康唑初级预防真菌感染的疗效及安全性。 方法 回顾性分析北京协和医院2013年4月至2017年5月接受强化IST及抗真菌初级预防的58例SAA患者资料,根据抗真菌预防药物分为泊沙康唑预防组和对照组(伊曲康唑或氟康唑预防),对比两组患者疾病特征、侵袭性真菌病(IFD)预防效果及药物不良反应。 结果 58例初治SAA/VSAA患者中,泊沙康唑预防组20例,对照组38例(伊曲康唑预防23例,氟康唑预防15例)。两组患者基线特征(性别、年龄、疾病严重程度、病因、起病到治疗间隔时间、ATG/ALG种类)差异均无统计学意义(P值均>0.1)。泊沙康唑预防组和对照组IFD发生率分别为0和15.8%(P=0.084),对照组6例IFD中确诊、拟诊、未确定各2例;5例为肺部感染,1例为血流感染。在VSAA中,8例泊沙康唑预防组患者无一例发生IFD,15例对照组患者5例发生IFD。泊沙康唑预防组未见明显不良反应。 结论 在SAA/VSAA的强化IST中,本回顾性分析结果提示采用泊沙康唑初级预防真菌感染有效、安全,对于VSAA患者效果明显。
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Affiliation(s)
- M Chen
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100730, China
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Cao XX, Wang SJ, Duan MH, Zhu TN, Zhang W, Han B, Zhuang JL, Cai HC, Chen M, Feng J, Han X, Zhang Y, Yang C, Zhang L, Zhou DB, Li J. [Long-term safety and efficacy of high-dose cytarabine consolidation in patients with acute myeloid leukemia]. Zhonghua Xue Ye Xue Za Zhi 2017; 38:330-333. [PMID: 28468096 PMCID: PMC7342724 DOI: 10.3760/cma.j.issn.0253-2727.2017.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Indexed: 11/17/2022]
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Cao XX, Wang SJ, Duan MH, Zhu TN, Zhang W, Han B, Zhuang JL, Cai HC, Chen M, Feng J, Han X, Zhang Y, Yang C, Zhang L, Zhou DB, Li J. [Analysis of the safety and efficacy of 60 mg·m -2·d -1daunorubicin combined with standard dose of cytarabine as induction therapy in acute myeloid leukemia patients under 65 years old]. Zhonghua Xue Ye Xue Za Zhi 2016; 37:892-897. [PMID: 27801323 PMCID: PMC7364868 DOI: 10.3760/cma.j.issn.0253-2727.2016.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Indexed: 11/18/2022]
Abstract
Objective: To evaluate the long- term safety and efficacy of high- dose daunorubicin(DNR)(60 mg·m-2·d-1)combined with standard dose of cytarabine(DA)as induction therapy in patients under 65 years old with newly diagnosed acute myeloid leukemia(AML). Methods: The complete remission(CR)rate, disease free survival(DFS), overall survival(OS)and side effects of therapy were retrospectively assayed in 116 patients with newly diagnosed AML who were younger than 65 years old and received daunorubicin(60 mg · m-2·d-1)combined with cytarabine(Ara- C 200 mg ·m-2·d-1)as induction therapy at Peking Union Medical College Hospital during July 2012 to February 2016. Results: Of 116 patients, 78 cases(67.2%)achieved CR after first course of induction treatment, 94(81.0%)achieved CR after two courses of induction, and early death occurred in only 3 patients(2.6%)during the first course of induction treatment. Only 1 patient had asymptomatic decreased ejection fraction after 6 months of induction treatment. Eighty nine patients received 1 to 4 courses of consolidation. With a median follow-up of 24(1-46)months, the median DFS was 25 months and median OS was not achieved yet. Cox regression multifactor analysis showed genetics risk groups was the only risk factor for DFS(HR=0.258, 95% CI 0.100- 0.664, P=0.005), while genetics risk groups(HR=0.309, 95% CI 0.126- 0.756, P=0.010)and whether patients received more than one cycle of high dose of Ara-C as consolidation therapy(HR= 0.370, 95% CI 0.179- 0.765, P=0.007)were independent factors associated with OS. Conclusions: In young adults with AML, intensifying induction therapy with a high daily dose of daunorubicin(60 mg/m2)could improve the rate of complete remission without obvious side effects.
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Affiliation(s)
- X X Cao
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
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Huang YH, Zhang W, Cai H, Li TJ, Li J, Han B, Zhuang JL, Zhu TN, Cai HC, Zhou DB. [CD200/CD200R Expression Levels and Its Significance after Allogeneic Hematopoietic Stem Cell Transplantation]. Zhongguo Shi Yan Xue Ye Xue Za Zhi 2016; 24:815-20. [PMID: 27342516 DOI: 10.7534/j.issn.1009-2137.2016.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND CD200 and its receptor CD200R are both type-1 membrane glycoproteins, which are members of the immunoglobulin superfamily (IgSF). Besides the inhibitory effect on macrophages, CD200/CD200R also play an important role in regulating the regulatory T cells, allergicreaction, autoimmune diseases, allograft, neurological diseases and other autoimmune-related diseases, etc. OBJECTIVE To investigate the role of CD200 and its receptor in the graft versus host disease (GVHD). METHODS Experimental samples were divided into aGVHD group, non-aGVHD group, cGVHD group and non-cGVHD group, the healthy persons were used as normal controls. Firstly, the expression levels of CD200 and CD200R on CD19+ cell, CD3+ cell and dendritic cell (CD19- CD14- CD1c+) surfaces in each group were detected by using flow cytometry, so as to determine whether there were expression differences among each groups. Then, the mRNA levels of each groups were tested by using real-time quantitative polymerase chain reaction for finding the differences of mRNA expression level among each group. Finally, the peripheral blood mononuclear cells of the patients and healthy controls were co-cultured with anti-CD200R1 antibody for 48 hours, and the interleukin-10 level in the co-culture system was tested by using enzyme linked immunosorbent assay for verifying the function of CD200/CD200R. RESULTS The CD200 expression level on CD19+ cell surface in the aGVHD group and non-aGVHD group was both lower than that in healthy control group; that in the non-aGVHD group was higher than that in the aGVHD group. The CD200 expression level on CD19+ CD200+ cells in the non-cGVHD group were higher than that in the cGVHD group and healthy control group. There were no significant differences of CD200 and CD200R expression levels on CD3 cells and dendritic cells among all groups. The CD200 mRNA expression levels in the aGVHD group and cGVHD group were both lower than the healthy control group. The CD200 mRNA expression level was lower in the aGVHD group than in the non-aGVHD group, and was lower in the cGVHD group than in the non-cGVHD group. There was no significant difference of the CD200R mRNA expression level among all groups. After the peripheral blood mononuclear cells of the patients and healthy controls were co-cultured with anti-CD200R1 antibody for 48 hours, the interleukin-10 concentration decreased with the increasing of anti-CD200R1 antibody concentrations in the co-culture system. CONCLUSION The CD200/CD200R may play a role in the pathogenesis of GVHD after allo-HSCT.
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Affiliation(s)
- Yue-Hua Huang
- Departments of Hematology, Peking Union Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Wei Zhang
- Departments of Hematology, Peking Union Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Hao Cai
- Departments of Hematology, Peking Union Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Tian-Jiao Li
- Departments of Hematology, Peking Union Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jian Li
- Departments of Hematology, Peking Union Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Bing Han
- Departments of Hematology, Peking Union Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jun-Ling Zhuang
- Departments of Hematology, Peking Union Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Tie-Nan Zhu
- Departments of Hematology, Peking Union Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Hua-Cong Cai
- Departments of Hematology, Peking Union Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Dao-Bin Zhou
- Departments of Hematology, Peking Union Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China. E-mail:
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Zhuang JL, Jiang QW, Xu Y, Wang SJ. Recombinant activated factor VII in hemophagocytic lymphohistiocytosis with disseminated intravascular coagulation. Chin Med J (Engl) 2011; 124:3189-3191. [PMID: 22040579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a lifethreatening disorder due to hyperinflammation resulting in infiltration of different organs with extensive hemophagocytosis. Severe coagulopathy was one of the main reasons for death in HLH. Over secretion of plasminogen activator by activated macrophages leads to hyperfibrinolysis. We reported a 36-year-old woman who was diagnosed as HLH probably secondary to lymphoma. Massive bleeding from gut and retroperitoneal area were not able to be controlled by conventional hemostatic treatments. This patient received one dose recombinant activated factor VII (rFVIIa) 3.6 mg (70 μg/kg). Hemostatic effect was achieved in 0.5 hour and lasted 24 hours. Prothrombin time (PT) and activated partial thromboplastin time (APTT) were quickly corrected to normal ranges. Fibrinogen level elevated from 0.5 g/L before using rFVIIa to 1.8 g/L 20 hours after. Although dexamethasone and etopside were administrated to treat HLH, this patient died from septic shock after persistent neutropenia. This suggests that rFVIIa may be effective in the management of intractable hemorrhage in patients with HLH.
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Affiliation(s)
- Jun-Ling Zhuang
- Department of Hematology, Peking Union Medical College Hospital, Beijing 100730, China
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Jiao L, Wang SJ, Zhuang JL, Zhao YQ, Zhou DB, Xu Y, Han B, Zhang W, Duan MH, Zou N, Zhu TN, Shen T. [Comparison of efficacy and adverse effects between arsenic trioxide and all-trans retinoic acid in patients with acute promyelocytic leukemia]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2009; 31:555-558. [PMID: 19968069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To compare the efficacy and adverse effects between arsenic trioxide (ATO) and all-trans retinoic acid (ATRA) in patients with acute promyelocytic leukemia (APL). METHODS The clinical data of 71 patients with newly diagnosed APL were retrospectively analyzed. Two groups were classified according to the induction regimens, namely ATO group (n = 41) and ATRA group (n = 30). The complete remission (CR) rate and the time to CR were compared between these two groups. RESULTS The CR rate was 97.5% in ATO group and 93.3% in ATRA group (P > 0.05). The median time to CR was 29 days (21-45 days) in ATO group, which was significantly shorter than 38.5 days (24-63 days) in ATRA group (P < 0.001). Retinoic acid syndrome occurred in 52.9% of patients treated with ATRA, which affected the further use of ATRA. CONCLUSIONS Both ATO and ATRA have high response rates for newly diagnosed patients with APL. Compared with ATRA, ATO induction therapy has shorter time to achieve CR and less adverse effects, and therefore may be the first-line therapy for APL.
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Affiliation(s)
- Li Jiao
- Department of Hematology, PUMC Hospital, CAMS and PUMC, Beijing 100730, China
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Sun WL, Wu YJ, Wang X, Li H, Zhuang JL. [DNA content and cell cycle analysis of myeloma cells in patients with multiple myeloma]. Zhongguo Shi Yan Xue Ye Xue Za Zhi 2008; 16:824-828. [PMID: 18718069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The study was aimed to investigate the genetic background and proliferation characteristics of multiple myeloma (MM). Myeloma cells were isolated from bone marrow of 19 MM patients by direct immunomagnetic cell sorting and the DNA content and cell cycle analysis were carried out by flow cytometry. The results showed that in 4 patients the myeloma cells were found to be hyperdiploid and in 15 patients those were found to be diploid respectively by DNA content analysis; the proportion of plasm cells from normal controls in S + G(2)/M phase was (1.15 +/- 0.60)%, and that of myeloma cells from MM patients was (10.06 +/- 12.60)% which was significantly higher than that in the former (p = 0.001). The incidence of hyperdiploid in newly diagnosed patients was 11.76%, and that of treated patients was 100.00% which was significantly higher than that in the former (p = 0.035); the proportion of myeloma cells from newly diagnosed patients in S + G(2)/M phase was (7.12 +/- 4.98)%, and that of treated patients was (35.10 +/- 32.56)% which was also significantly higher than that in the former (p = 0.001). It is concluded that the variety of myeloma cells in DNA content and cell cycle suggests the complicated genetic background and abnormal proliferation of MM, which relate with the course of disease to some extent.
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Affiliation(s)
- Wan-Ling Sun
- Department of Hematology, Peking Union Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
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Sun WL, Han B, Wang X, Zhong YP, Zhuang JL, Shen T, Wu YJ. [Long-term ability for hematopoiesis of CD34(+)CD59(+) cells from patients with paroxysmal nocturnal hemoglobinuria: experiment with mice]. Zhonghua Yi Xue Za Zhi 2007; 87:3012-3015. [PMID: 18261338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To obtain the evidence of long-term hematopoiesis by normal clone stem cells from patients with paroxysmal nocturnal hemoglobinuria (PNH). METHODS 10 ml fresh bone marrow was collected from 2 PNH patients. Normal bone marrow was obtained from the ribs resected during operation of 2 patients without hematopathy. CD34(+)CD59(+) cells were isolated, purified, and expended. 12 total body irradiated SCID mice were divided into 2 equal group to undergo transplantation of the expanded CD34(+)CD59(+) cells from PNH patients (experiment group 1) or normal patients (control group 1). Four mice underwent transfusion of cell-free medium as blank control group 1. 30 and 60 days after the transplantation peripheral blood samples were collected and 90 days after the transplantation heart blood samples were collected. Spleens were taken out to prepare suspension of splenocytes and bacterium-free bone marrow cell suspension was prepared from the bilateral femurs. 90 days after the primary transplantation another 16 mice underwent total body irradiation and then divided into 2 equal groups to undergo transplantation of the bone marrow cells of the mice of the experiment group 1 and control group 1 (experiment group 2 and control group 2). Another 4 mice were transfused with cell-free medium fluid (blank control group 2). The levels of blood cells of all groups were calculated 30, 60, and 90 days after the primary and 30 days after the secondary transplantation. The cell percentages of peripheral blood, spleen, and bone marrow after the primary transplantation and 30 days after the secondary transplantation were detected by flow cytometry. PCR was used to detect whether the sex determining region Y existed in the female SCID mice after transplantation. RESULTS Ninety days after primary transplantation, the peripheral blood cell levels of both experiment group 1 and control group 1 recovered to normal. Expression of CD45 was detected in the mice without significant difference between the 2 groups. Thirty days after the secondary transplantation, the peripheral blood cell levels of the experiment group 2 and control group 2. Expression of CD45 was detected in both the experiment group 2 and control group 2 without significant difference between these two groups. Human SRY gene could be detected by PCR in the female SCID mice after transplantation. CONCLUSION CD34(+)CD59(+) cells isolated from PNH patients and expanded in vitro can be successfully engrafted with long-term ability in hematopoiesis not different from that of the normal CD34(+)CD59(+) cells.
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Affiliation(s)
- Wan-Ling Sun
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Zhang W, Zhou DB, Zhao Y, Zhuang JL, Leng XM, Wang SJ, Jiao L, Tang FL, Zhang JP, Wang X, Shen T. Peripheral blood CD34+ cell mobilization in 42 patients with severe autoimmune disease. Chin Med Sci J 2007; 22:108-12. [PMID: 17763583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To evaluate the feasibility and safety of peripheral CD34+ cell mobilization in patients with severe autoimmune disease. METHODS Forty-two patients underwent a total of 46 mobilizations by the regimen of cyclophosphamide 2-3 g/m2+ recombinant human granulocyte colony stimulating factor (rhG-CSF) 5 microg x kg(-1) x d(-1). The positive selection of CD34+ cell was performed through the CliniMACS. RESULTS In 8.1 +/- 2. 3 days after administration of cyclophosphamide, the peripheral white blood cell and mononuclear cell (MNC) decreased to the lowest level. In 3.7 +/- 1.6 days after injection of rhG-CSF, the peripheral absolute MNC and CD34+ cell counts were 0.95 x 10(9)/L and 0.035 x 10(9)/L, respectively. After 2.4 +/- 0.6 times of leukapheresis, there gained 4.46 x 10(8)/kg of MNC and 5.26 x 10(6)/kg of CD34+, respectively. After mobilization, the underlying diseases were ameliorated more or less. In systemic lupus erythematosus (SLE) patients, SLE Disease Activity Index (SLEDAI) decreased from a median of 17 to 3 (P < 0.01). In rheumatic arthritis patients, an American College of Rheumatology criteria for 20% (ACR20) response was achieved in all five patients. Totally, 17.4% of patients whose absolute neutrophil count < 0.5 x 10(9)/L suffered infection, and 31.0% of patients had bone pain after the injection of rhG-CSF. Two patients suffered severe complications, one with acute renal failure and recovered by hemodialysis, the other died of thrombotic thrombocytopenic purpura. Failed mobilization occurred in three patients. CONCLUSIONS Sufficient CD34+ cells can be mobilized by low dose of cyclophosphamide and rhG-CSF. CD34+ cell mobilization for treatment of severe autoimmune disease not only is appropriate in both effectiveness and safety but ameliorates disease also.
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Affiliation(s)
- Wei Zhang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730
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Zhuang JL, Wang X, Zhang JP, Wu YJ. [Growth, immunophenotype and interleukin-6 level of bone marrow stromal cells in patients with multiple myeloma and acute leukemia]. Zhongguo Shi Yan Xue Ye Xue Za Zhi 2006; 14:700-3. [PMID: 16928303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
The aim of this study was to investigate the growth, immunophenotype and interleukin-6 (IL-6) level of bone marrow stromal cells (BMSC) in patients with acute leukemia (AL) and multiple myeloma (MM). BMSC was cultured by wall-adhesion method and the growth of BMSC was observed. The immunophenotype and cell cycle of BMSC were detected by flow cytometry. The level of interleukin 6 (IL-6) in BMSC culture system was detected by ELISA. The results showed that the primary (17.3 +/- 7.8 days) and continuous (10.3 +/- 3.5 days) growth cycle of BMSC in patients with AL were significantly shorter than those in patients with MM (26.5 +/- 6.3 and 16.5 +/- 4.1 days respectively), and shorter than those in normal controls (25.8 +/- 6.3 and 17.5 +/- 2.4 days) respectively. Similarly, S + G2% (17.4 +/- 3.6%) of BMSC in patients with AL was significantly higher than those in patients with MM (8.5 +/- 2.2%) and in normal controls (8.9 +/- 2.3%). All of the three groups showed positive antigen expressions with CD29 and CD44 were 100%, while CD138, CD34, CD54, CD56 positive were not expressed and CD106 was partially expressed positive. The supernatant IL-6 level of BMSC system in MM patients (1288.5 +/- 736.7 pg/ml) was significantly higher than those in AL patients (859.3 +/- 203.1 pg/ml) and normal controls (850.9 +/- 129.5 pg/ml). It is concluded that the growth, S + G2% of cell cycle and IL-6 level of BMSC in patients with MM, AL and normal control are significantly different, whereas the antigen expressions are similar.
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Affiliation(s)
- Jun-Ling Zhuang
- Department of Hematology, Peking Union Hospital, Beijing 100730, China.
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Zhuang JL, Wang X, Wu YJ. [Significance of CD138/syndecan-1 for multiple myeloma immunophenotypes]. Zhongguo Shi Yan Xue Ye Xue Za Zhi 2005; 13:1023-7. [PMID: 16403272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
To establish the method of immunophenotyping testing for patients with multiple myeloma (MM), to analyze the characteristics of antigen expression on myeloma cells, and to purify primary myeloma cells, CD45/side scatter (SSC) gating tri-color immunofluorescence (IF) flow cytometry (FCM) was used to test immunophenotype of 18 patients with MM, 20 patients with acute leukemia (AL) and 7 normal controls. Purified primary myeloma cells were obtained by means of anti-CD138 monoclonal antibody and immunomagnetic microbeads. The results showed that myeloma cells displayed a CD45 negative/low positive expression, and SSC was located between nucleated red blood cells and neutrophils. Both CD138 and CD38 were positive while most antigens of T cell, B cell and myeloid cell were negative. Positive rate of CD56 was 83.3% and HLA-DR was 44.4% positive. Compared with MM patients, CD138 was negative and CD38 was 100% positive in AL patients. CD56 was 25% positive. In normal controls, neither CD138 nor CD56 was positive. The positive rate of primary myeloma cells after purification was 73%-95% with a mean of 86%. It is concluded that CD45/SSC gating procedure is a stable and reliable method to detect immunophenotype of MM. CD138 is a correspondingly special antigen for myeloma cells. Highly enriched primary myeloma cells can be obtained by anti-CD138 antibody and immunomagnetic microbeads.
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Affiliation(s)
- Jun-Ling Zhuang
- Department of Hematology, Peking Union Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
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