[Long Non Coding RNA RP11-69I8.3 Expression in Acute Leukemia and Its Cinical Significance]

OBJECTIVE

To investigate the expression of long non coding RNA RP11-69I8.3 in acute leukemia and its clinical significance.

METHODS

lncRNA RP11-69I8.3 expression was detected by RT-PCR in bone marrow samples from 17 healthy controls, 32 newly diagnosed AML patients and 32 newly diagnosed ALL patients, and 25 ALL patients of complete remission after chemotherapy. Meanwhile, the clinical data were collected and the relation of lncRNA RP11-6918.3 expression with the clinical characteristics was analyzed.

RESULTS

Compared with the control group, there was no significant difference in the expression of lncRNA RP11-69I8.3 in AML group(P>0.05). lncRNA RP11-69I8.3 lowly expressed in untreated ALL group(P=0.001). Compared with the de novo ALL group, lncRNA RP11-69I8.3 was highly expressed in complete remission ALL group (P<0.013). In 32 de novo ALL patients,the expression of lncRNA RP11-69I8.3 in children was significantly lower than that in adult(P=0.017). There was no correlation of the expression of lncRNA RP11-69I8.3 with the sex, WBC count, HB level, Plt count, LDH level, T or B type, ratio of bone marrow blast cell, BCR/ABL and WT1 fusion gene expression, chromosome karyotype, extramedullary infiltration, whether complete remission after one chemotherapy, whether relapse. In 26 B-ALL patients, there was no correlation between lncRNA RP11-69I8.3 and the immunophenotype.

CONCLUSION

The expression of lncRNA RP11-69I8.3 in the untreated AML is not significantly different from the control group. lncRNA RP11-69I8.3 is low expressed in ALL group, highly expressed in ALL group with complete remission. In untreated ALL, the expression of lncRNA RP11-69I8.3 in children is significantly lower than that in adult. In B-ALL patients, the lncRNA RP11-69I8.3 is not relevant with the immunophenotype.

[Expression of CD146 in Adult and Children's Acute B Cell Lymphoblastic Leukemia and Its Significance]

OBJECTIVE

To explore the differences of CD146 expression in adult and children's acute B cell lymphoblastic leukemia(B-ALL), and its relation with clinical features, molecular biological and cytogenctic claracteristics.

METHODS

The expression of CD146 in bone marrow samples from adult and children's B-ALL patients were detected by flow cytometry (FCM) and the relation of CD146 abnormal high expression with the patients' clinical features, molecular biological and cytogenetical characteristics, as well as other antigens were analyzed.

RESULTS

The abnormal high expression rates of CD146 in adult and children's B-ALL patients were 29.17% and 9.09% respectively, showing that the expression rate of CD146 in adult patients was higher than that in children's patients(P<0.05). In adult B-ALL, CD146 was positively related with CD64 and CD117, while in children's B-ALL CD146 was positively related with CD71 and CD58 (P<0.05). After 1 course of standardized chemotherapy, the complete remission rates in adult and children's B-ALL patients with abnormal high expression of CD146 both were low as compared with adult and children's B-ALL without abnormal high expression of CD146 (P<0.05).

CONCLUSION

The expression rate of CD146 in adult B-ALL is higher than that in children's B-ALL. The CD146 positively relates with poor prognostic antigens, the CD146 may be one poor prognosis marker.

[Expression of CC-chemokine Receptor 7 in Patiens with Multiple Myeloma and Its Relationship with Extramedullary Disease]

OBJECTIVE

To investigate the expression of CC-chemokine receptor 7(CCR7) in patients with multiple myeloma(MM) and its correlation with clinical features of MM.

METHODS

The level of CCR7 expression in bone marrow samples from 53 newly diagnosed MM patients was detected by flow cytometry(FCM). Statistical methods were used to analyze the correlation between CCR7 expression and clinical features, such as sex, age, M protein, peripheral blood cell count, biochemical indicators, plasma cell ratio of bone marrow, immunophenotype, osteopathy and extramedullary disease.

RESULTS

The plasma cells in 24 out of 53 cases(45.28%) expressed CCR7. The rate of extramedullary disease in CCR7 positive group was significantly higher than that in CCR7 negative group (29.17% vs 3.45%)(P<0.05).

CONCLUSION

The expression of CCR7 in patients with MM is high, moreover this high expression correlates with extramedullary disease, thus CCR7 can be used as an effective indicator for prediction of extramedullary disease.

[Clinical Analysis for 42 Imatinib-resistant Patients with Chronic Myelogenous Leukemia]

OBJECTIVE

To analyze the kinase mutation ratio, related factors, effectiveness and safety of the second generation drugs for imatinib-resistant patients with chronic myeloid leukemia(CML).

METHODS

COX proportional hazard regression model was used for unvariate and multvariate analysis of various factors affecting the kinase mutation and for evaluating the effectiveness and safety of second generation tyrosine kinase inhibitor(TKI).

RESULTS

13 kinds of mutation were detected in 19 out of 42 cases for 22 times, including 4 times of F359V, 3 times of E255K, 2 time for F359C, F317L, T315I, Y253H, 1 time for D256R, C250R, D276G, F486S, M244V, Y256H and G250E, 3 cases with mixed mutations. The main adverse effects of patients receiving nilotinib were skin rash and fluid retention, while that for patients receiving dasatinib were eyelid edema and elevated bilirubin.

CONCLUSION

The WBC count, spleen enlargement degree, chromosome karyotypes, disease staging, drug used before treatment and time of acheiving CCyR are the related factors of the kinase mutations, but the patients receiving the second generation TKI can survive well.

[Expression and Clinical Significance of N-cadherin in Bone Marrow Leukemic Cells Derived from Patients with Acute Leukemia]

OBJECTIVE

To investigate the expression of N-cadherin in bone marrow leukemic cells derived from acute leukemia patients and its clinical significances.

METHODS

A total of 113 patients with acute leukemia were enrolled in this study. Flow cytometry was employed to detect the expression of N-Cadherin in bone marrow leukemic cells from acute leukemia patients and the relationships between the N-cadherin expression and the clinical characteristics of patients with acute leukemia were analyzed.

RESULTS

The expression of N-Cadherin in bone marrow leukemic cells deriveted from patients with acute leukemia was variable with 0%-99.7%. For adult AML patients, the positive rate of CD34 in N-cadherin⁺ group was significantly higher than that in N-cadherin^- group(67.39% vs 33.33%)(P=0.013), while the differences of total CR rate and rate of CR after 1 cycle of induction treatment were not significant between these 2 groups(P>0.05). As to ALL patients, N-cadherin⁺ group had significant lower WBC count (21.31±7.07 vs 51.10±23.69)(P=0.008) and lower percentage of peripheral blood blast (43.22±5.75% vs 66.45±5.65%)(P=0.015). The CR rate after 1 cycle of induction treatment and rate of overall CR were lower and the relapse rate was higher in N-cadherin⁺ ALL group than those in N-cadherin^- ALL group, but the differences were not significant (P>0.05). For childhood ALL, the positive rate of CD33 in N-cadherin⁺ group was significantly higher than that in N-cadherin^- group(47.62% vs 0%)(P=0.012). The relapse rate was higher in N-cadherin⁺ group than that in N-cadherin^- group (30.00% vs 0%)(P=0.115). The median survival time, 3-year overall OS rate and 3-year relapse-free survival rate in N-cadherin^- groups of adult AML, non-M3 AML, ALL and chidhood ALL paients were superior to N-cadherin⁺ groups, but the differences were not significant.

CONCLUSION

The expression of N-cadherin in bone marrow leukemic cells relates to some clinical features of patients with acute leukemia and to some extent has inferior effect on survival of patients with acute leukemia.

[Clinical Analysis of Recombinant Human Thrombopoietin for Treatment of 46 Adult Patients with Newly Diagnosed Primary Immune Thrombocytopenia]

OBJECTIVE

To evaluate the efficacy and safety of recombinant human thrombopoietin (rhTPO) for treatment of patients with newly diagnosed immune thrombocytopenia (ITP).

METHODS

The clinical data of 96 patients with newly diagnosed ITP from August 2013 to August 2015 were analyzed retrospectively, 96 patients were divided into the rhTPO group (46 cases) and the control group (50 cases). Patients in the rhTPO group received subcutaneous injection of rhTPO at a dose of 300 U/(kg·d) for a maximum of 14 days, and control group was treated with glucocorticoid (standard dose) for 28 days. Then the efficacy and adverse reactions between the 2 groups were compared.

RESULTS

Compared with the control group, the patients in rhTPO group achieved higher complete response (CR) rate (56.5% vs 34.0%) (P = 0.03), shorter median time when platelet counts reached 100 × 10(9)/L[10 (5-14) d vs 14 (6-26) d, P < 0.01] and less adverse reactions (4.4% vs 82.0%) (P < 0.01). After the withdrawal of rhTPO, platelet counts gradually decreased. Sex, age and the presence of HP infection had no influence on efficacy of rhTPO (P > 0.10), but when Plt count was too low (≤10 × 10(9)/L), the proportion of patients obtaining CR showed an decreased tendency, as compared with those with Plt>10 × 10(9)/L (38.9% vs 67.9%) (P = 0.06).

CONCLUSION

rhTPO has satisfactory therapeutic effect and enough safety for patients with newly diagnosed ITP, however, its long-term efficacy should be furtherly improved.

[Comparison of CCR5 Expression on T Lymphocytes between the Bone Marrow and Peripheral Blood Grafts after Mobilization]

OBJECTIVE

To compare the expression of C-C chemokine receptor type 5 (CCR5) on T cells between bone marrow grafts (G-BM) and peripheral blood grafts (G-PB) nobilized by recombinant human granulocyte colony-stimulating factor (rhG-CSF), and to analyze the correlation of CCR5+ T lymphocyte expression in the grafts with the occurrence of acute GVHD.

METHODS

Forty-six healthy donor and their recipient pairs of related allogeneic hematopoietic stem cell transplantation (allo-HSCT) were enrolled in this study. All the recipients were received the infusion of G-BM and G-PB. The relative proportion and quantity of CCR5+ T cell subset in G-BM and G-PB were detected and compared. Then the correlation of the quantity of infused CCR5+ T cells with the occurrence of acute GVHD was analyzed.

RESULTS

After mobilization, the proportions of CD4+ CCR5+ and CD8+ CCR5+ T cells occupying T cells in G-PB were both lower than those in G-BM. However, the absolute counts in G-PB were 15-25 times more than those in the bone marrow. And the absolute counts could not predict the occurrence of acute GVHD after transplantation (P>0.05).

CONCLUSION

The difference of CCR5+ subsets between G-PB and G-BM may partially explain that grafts from different sources have different immunologic characteristics. Besides, the quantity of CCR5+ T cells in the grafts are not related with the occurrence of acute GVHD. However, the relative proportion of CCR5+ T cell subset in the grafts may be predictive of acute GVHD.

[Clinical Characteristics and Therapeutic Efficacy of Multiple Myeloma Combined with Renal Amyloidosis]

OBJECTIVE

To evaluate the clinical characteristics of multiple myeloma (MM) combined with renal amyloidosis and its curative efficacy and prognosis.

METHODS

The clinical data of 22 cases of newly diagnosed multiple myeloma combined with renal amyloidosis treated in our hospital from November 2011 to July 2015 were analyzed retrospectively.

RESULTS

According to Intenational Staging System (ISS), among above-menthioned 22 patients the ISS II accounted for 77.2% (17/22), ISS III accounted for 22.8% (5/22). The patients with renal impairment accounted for 36.4% (8/22), with anemia 40.9% (9/22), with serum album < 35 g/L 86.4% (19/22), with urinary protein positive 100% (22/22). The evaluation of the curative efficacy of the 22 cases was as follows: CR 13.6% (3/22); VGPR 4.5% (1/22); PR 22.8% (5/22); SD 45.5% (10/22); PD 13.6% (3/22). Out of 9 patients with effective treatment, 3 cases (3/9, 33.3%) achieved "improved" in renal amyloidosis, 4 cases (4/9, 44.5%) achieved stable in renal amyloidosis, 2 cases (2/9, 2%) achieved "worsened" in renal amyloidosis. Among 17 cases who were followed up, 7 cases died, 10 cases survived, the average duration of follow-up for these cases was 11 (1-37) months, the median overall survival (OS) time was 19 (95% CI 9.2-28.8) months.

CONCLUSION

MM with renal amyloidosis is rare, refractory and has a poor prognosis. Whether there is impairment of kidney function or not, renal amyloidosis shall be taken into consideration if the MM patients got massive proteinuria especially nephritic syndrome. Bortezomib may improve the curative efficacy.

[Expression and Clinical Significance of CC-chemokine Receptor 7 in Adult Acute Leukemia]

OBJECTIVE

To explore the expression of CC-chemokine Receptor 7 (CCR7) in adult acute leukemia patients, and to analyze the relationship of CCR7 expression with the clinical characteristics of patients.

METHODS

The expression of CCR7 in bone marrow samples from adult acute leukemia patients were detected by flow cytometry (FCM), the relationship of CCR7 expression with the clinical characteristics of patients such as sex, age, WBC count, blast cell ratio, CD56 expression, molecular biology, cell genetics, risk stratification, extramedullary infiltration was analyzed.

RESULTS

The expression rate of CCR7 in adult ALL and AML patients was 36.8% and 9.6%, respectively, and the expression level of CCR7 in ALL patients was higher than that in AML patients (P < 0.05). The extramedullary infiltration rate was 100% and 41.7 % for CCR7 positive and negative groups of ALL, respectively (P < 0.05). While the mean fluorescence intensity (MFI) in extramedullary infiltration group of ALL was higher than that in none-extramedullary infiltration group of ALL (50.00 ± 10.42 vs 18.14 ± 1.39), respectively (P < 0.05).

CONCLUSION

CCR7 is higher expressed in adult acute leukemia cells, moreover its expression rate in ALL is higher than that in AML, and the expression of CCR7 is related with extramedullary infiltration in ALL.

[Expression of Programmed Death Ligand-1 (PD-L1) in Human Acute Leukemia and Its Clinical Significance]

OBJECTIVE

To explore the expression of PD-L1 in acute leukemia patients, and to analyze the relationship of PD-L1 expression with the patients' clinical characteristics and prognosis.

METHODS

The expression of PD-L1 in leukemia cells of 75 patients including 59 de novo patients and 16 relapse/refractory patients with acute leukemia was detected by the flow cytometry, the clinical information was collected, and the therapeutic efficacy of de novo patients was analyzed.

RESULTS

The PD-L1 was expressed in human acute leukemia cells with total expression rate 32% (24/75), and its expression level in AML-M5 was higher than that in other leukemias [56.3% (9/16) vs 25.4% (15/59)], there was statistical significance (P = 0.019). The PD-L1 possitive rate in relapse/refractory group was higher than that in de novo patient group [(56.3% (9/16) vs 25.4% (15/59)], and there was statistical significance (P = 0.019). In 59 de novo patients, the CR rate of PD-L1 positive group after 1 course of chemotherapy was lower than that in PD-L1 negative group (66.7% vs 71.4%), the CR rate of PD-L1 positive group after 2 courses of chemotherapy was also lower than that in PD-L1 negative group (70% vs 88.6%). The relapse rate and the proportion of refractory patients in PD-L1 possitive group were higher than those in PD-L1 negative group. The expression of PD-L1 did not correlated with the clinical parameters, such as sex, age, extramedullary infiltration, percentage of blast cells in bone marrow, counts of WBC, RBC and platelet, as well as molecular biological features and cytogenetical characteristics.

CONCLUSION

PD-L1 is expressed in human acute leukemia cells, and may be involved in the immune escape and primary resistant mechanisms, PD-L1 may be used as an indicator for evaluation of the the patients' prognosis and reocurrence.

[Expression of N-Cadherin in Patients with Multiple Myeloma and Its Clinical Significance]

OBJECTIVE

To investigate the expression of N-Cadherin in the patients with multiple myeloma (MM) and to explore its clinical significance.

METHODS

A total of 64 patients with multiple myeloma were enrolled in this study. The expression of N-Cadherin in bone marrow CD38⁺/CD138⁺ cells from multiple myeloma patients was detected by flow cytometry. The relationship between N-Cadherin expression and clinical prognostic factors was analyzed.

RESULTS

Among 64 cases of MM, the expression of N-Cadherin in 17 patients (26.56%) was high (> 20%), while that in 47 cases (73.44%) was low (< 20%); The differences of N-Cadherin expression in disease staging and classification, known prognostic factors, myeloma cell antigen expression and bone damage between patients with high and low N-Cadherin expression were not statistically different; the difference N-Cadherin expression in genetic abnormalities such as D13S319 deletion, RB1 deletion and IGH gene rearrangement between above-methioned two groups was not significant. The 1q21 amplification rate in the group with high expression of N-Cadherin was enhanced significently; the overall survival (OS) times of patients with abnormally high and low expression levels of N-Cadherin were 26.7 months and 55.5 months respectively, and the difference was statistically significant (P < 0.05).

CONCLUSION

The high expression of N-Cadherin in multiple myeloma may be one of the indicator for poor prognosis of MM, which may be related with 1q21 amplification.

[Clinical curative efficacy of inducing remission for the newly diagnosed aged AML patients by chemotherapy with IA and DA regimens]

This study was aimed to explore the clinical efficacy and toxicity of idarubicin (IA regimen) and daunoru-bicin combined with cytarabine (DA regimen) for treating aged patients with AML as induction chemotherapy. The clinical data of 60 newly diagnosed AML aged patients treated with IA or DA regimen were analyzed retrospectively. IA regimen group included 22 patients (8 male and 14 females with median age of 66 yrs), while the DA regimen group included 38 patients (20 males and 18 females with median age of 64 yrs). The complete remission rate, total effective rate and adverse effects after one chemotherapy course were compared. The results showed that the CR rate in IA regimen group was 63.63%, which was significantly higer than that in DA regimen group (31.58%) (P < 0.05). The total effective rate was 63.63% and 36.84% respectively in IA and DA regimen groups, there was significant difference between the two groups (P < 0.05). Both the hematological and non-hematological adverse effects were observed and no difference was found in the two regimen groups, neither in myelosupression (P > 0.05), the major hematological adverse effects, nor in non-hematological adverse effects (P > 0.05). It is concluded that for aged AML patients, IA regimen can achieve a higher CR rate and higher total effective rate than that in DA regimen without increase of adverse effects after one induction chemotherapy course.

[Clinical characteristics of CD56(+) patients with acute monocytic leukemia and their prognostic significance]

This study was aimed to investigate the clinical features of CD56(+) patients with acute monocytic leukemia (AML-M5) and their prognostic significance. The data of 76 newly-diagnosed patients from our hospital were analyzed retrospectively. Patients were divided into two groups: CD56(+) group (21 patients) and CD56(-) group (55 patients). The clinical features, CR rate, relapse rate, the duration of CR, and survival time of patients between the two groups were compared. The results indicated that the CD56(+) antigen was observed in 21 patients (27.6%), their median age was 51.5 years and with a range 16 - 70 years. Of the 21 CD56(+) patients, the high WBC count was found in 57.1% CD56(+) patients (12/21), but it only in 15% CD56(-) patients (P < 0.05). The extramedullary infiltration was seen in 13 CD56(+) patients, and accounted for 62% (13/21), meanwhile this infiltration was found in 18 CD56(-) patients (18/55) and accounted for 33% (P < 0.05). All cases immunophenotypically highly expressed CD13, CD33, CD64, CD11b, cMPO, CD38, in which only the expression frequency of CD11b was positively related with CD56 (r = 0.59, P < 0.05). The CR rate in CD56(+) group accounted for 60.0%, and had no significant difference in comparison with that in CD56(-) group. In CD56(+) group the relapse rate was 75% (P = 0.042), the mean duration of CR was 5.5 months (95%CI, 3.1 - 8.6, P = 0.002), the median overall survival time was 10.1 months (95%CI, 2.3 - 16.3, P = 0.001). and all these had statistical significance as compared with that in CD56(-) group. It is concluded that CD56(+) AML-M5 patients always complicate with high WBC count and extramedullary infiltration, their CR rate and duration of CR are lower and shorter respectively, their relapse rate and prognosis are high and poor respectively.

[Dynamically monitoring minimal residual disease in acute leukemia after complete remission by multiparameter flow cytometry and its relation with prognosis]

This study was purposed to investigate the dynamically monitoring minimal residual disease (MRD) by flow cytometry (FCM) in patients with acute leukemia (AL) after complete remission and its relation with prognosis. From October 2010 to May 2012, 58 cases of AL (including 45 cases of AML and 13 cases of ALL) were regularly monitored for MRD in bone marrow by FCM and their bone marrow morphology was observed by light microscopy at the same time which continued to relapse or to follow-up deadline in the Department of Hematology, the First Affiliated Hospital of Zhengzhou University. Through average follow-up for 9 months (3 - 21 months), the average MRD level of patients with CR was got. And the prognostic value of MRD level at different time points in AL patients after CR was analysed and summarized. MRD ≥ 1% was defined as positive, otherwise, as negative. The results showed that the maximum and minimum MRD levels of 45 AML patients were 9.57% and 0.01% respectively, the average was 0.67%; the maximum and minimum MRD levels of 13 cases of ALL patients were 7.9% and 0.0016% respectively, the average was 0.99%. Among 44 cases after induction therapy, the relapse rate of MRD(+) group was 53.3% (8/15), the relapse rate of MRD(-) group was 10.3% (3/29), and the relapse rate of MRD(+) group was higher than that of MRD(-) group (χ(2) = 7.58, P = 0.006). Among 58 cases after the first consolidatory therapy, the relapse rate of MRD(+) group was 62.5% (5/8), the relapse rate of MRD(-) group was 16.0% (8/50), and the relapse rate of MRD(+) group was higher than that of MRD(-) group (χ(2) = 6.11, P = 0.013). It is concluded that MRD detected by FCM has a large range (10(-6) - 10(-2)), which can not be used as a single indicator of complete remission. When MRD ≥ 1% after induction therapy and the first consolidatory therapy, the relapse rate significantly increases, MRD can be used as a sensitive indicator for prognosis.

[Correlation of chromosome karyotype with dyshaematopoiesis and reticulin in myelodysplastic syndrome]

This study was purposed to explore the correlation of chromosome karyotype with dyshaematopoiesis and reticulin in myelodysplastic syndrome (MDS). The data of 202 MDS patients diagnosed and treated in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed in term of chromosome karyotype, dyshaematopoiesis and reticulin detection results. The chromosome karyotypes were categorized according to the International Prognostic Scoring System (IPSS). The results showed that there was a positive correlation between chromosome karyotype grading and number of lineages with dyshaematopoiesis (r = 0.443, P < 0.05). The detected rates of multilineage dyshaematopoiesis in patients with good, intermediate and poor chromosome karyotypes were 44.4%, 71.4% and 96.3% respectively. There was a positive correlation between chromosome karyotype grading and reticulin grading (r = 0.451, P < 0.05). The positive rates of reticulin in patients with good grading, intermediate and poor chromosome karyotypes were 36.8%, 64.3% and 92.6% respectively. The detected rate of multilineage dyshaematopoiesis, number of lineages with dyshaematopoiesis, the positive rate of reticulin and reticulin grade in patients with poor karyotypes were higher than those in patients with intermediate or good chromosome karyotypes (separately P < 0.01). The above data in patients with intermediate chromosome karyotypes were higher than those in patients with good chromosome karyotypes (separately P < 0.01). It is concluded that the chromosome karyotype grading positively correlates with the number of lineages with dyshaematopoiesis and reticulin grading. When the chromosome karyotype changed from good to poor, the detected rate of multilineage dyshaematopoiesis, number of lineages with dyshaematopoiesis, positive rate of reticulin and reticulin grading became higher and higher.

[Clinical observation of thalidomide combined with VAD regimen for treatment of osteosclerotic myeloma (POEMS syndrome)]

This study was purposed to analyze the clinical features and evaluate the efficacy of thalidomide combined with VAD regimen for treatment of osteosclerotic myeloma (POEMS syndrome). The data of 27 patients with POEMS syndrome in the First Affiliated Hospital of Zhengzhou University were analyzed retrospectively, including clinical manifestations, laboratory tests, treatments and prognosis. The results showed that the polyneuropathy was observed in 27 patients (27/27), hepato-spleno-lymphadenectasis was found in 15 patients (15/27), endocrinopathy was found in 24 patients (24/27), skin changes was observed in 22 patients (22/27). M protein was found in 23 patients (23/27); in addition to these clinical manifestations, the papilledema serous cavity effusion and sclerotic bone lesion were also frequently observed in patients with POEMS syndrome. The remission rates of treatment of POEMS syndrome with thalidomide combined with VAD regimen for organomegaly, edema, skin changes, and endocrinopathy were 60, 58.3, 41 and 45.8 respectively. The level of serum M protein and the nervous system ODSS value decreased greatly after treatment (P < 0.01). It is concluded that the clinical characteristics of POEMS syndrome are complicated and easy to be misdiagnosed, and the evidence of monoclonal plasma cell hyperplasia should be actively searched for those patients whose serum M protein is negative. Thalidomide combined with VAD regimen for treatment of patients with POEMS syndrome has advantages such as significant curative effects, less side-effects, good tolerance, and higher safety and can be chosen as a preferred approach.

[Clinical study on efficiency of fludarabine-based regimen for the patients with chronic lymphocytic leukemia]

The aim of this study was to evaluate the therapeutic effects and adverse reactions of fludarabine-based regimen for patients with chronic lymphocytic leukemia(CLL).18 patients with CLL were treated with F regimen [fludarabine 30 mg/(m(2)·d) intravenously for 3 d, repeatedly every 28 days]. 22 patients were treated with FC regimen [fludarabine 25 mg/(m(2)·d) plus cyclophosphamide 250 mg/(m(2)·d) intravenously for 3 d, repeatedly every 28 days]. The results showed that the rate of complete remission (CR), partial remission (PR) and overall remission (OR) reached 16.7%, 61.1% and 77.8% in the F regimen groups and 59.1%, 40.9% and 100% in the FC regimen groups (P < 0.05, P > 0.05 and P > 0.05), respectively. FC regimen resulted in significantly higher CR rate than that in single-agent fludarabine regimen. The main adverse reactions were myelosuppression and immunosuppression. No significant differences were found between the two regimens. FC regimen did not increase the rate of severe infections. It is concluded that FC regimen can give higher CR rate as compared with F regimen, fludarabine-based regimens is effective and safe first-line regimen for patients with CLL.

Occupational chromate allergy in Singapore: a study of 87 patients and a review from 1983 to 1995

BACKGROUND

The prevalence of chromate allergy among all patients tested at the Contact and Occupational Dermatoses Clinic at the National Skin Centre in Singapore had fallen progressively from 1983 to 1989. Chromate has also become a less common occupational allergen because of the decline in the number of cases of allergic contact dermatitis from cement.

OBJECTIVE

The aim of this report was to study and update the epidemiology of occupational chromate allergy among workers seen in a tertiary dermatology referral centre in Singapore from 1990 to 1995 and to review the changing trends of occupational chromate allergy in our local setting since 1983. The occurrence of concomitant contact allergens among was also studied.

METHODS

All patients diagnosed to have occupational allergic contact dermatitis together with positive reactions to chromate, at the Joint Occupational Dermatosis Clinic at the National Skin Centre in Singapore, between January 1990 to December 1995, were included. Causes of chromate allergy and frequency of occurrence of concomitant contact allergens among construction and nonconstruction workers were compared.

RESULTS

Eight hundred and fifty workers were seen during the 6-year-study period. Six hundred and thirty three (74.5%) were diagnosed to have occupational contact dermatitis, of which 257 (40.6%) had allergic contact dermatitis. Eighty-seven (33.8%) of these workers had positive reaction to chromate on patch testing. Ninety-five percent of these workers were men with a mean age of 33.4 years. The construction industry contributed 59% of the workers with chromate allergy. Cement (61%) remained the most common source of chromate allergy in our workers, and chromate from sources other than cement (39%) accounted for the rest. Of workers allergic to chromate from cement, 96% (51 of 53) came from the construction industry. Sixty percent of the workers with chromate allergy had concomitant contact allergens and the coexistence of two or more allergens was significantly more common among nonconstruction workers (53%) than construction workers (22%). The three most common concomitant contact allergens were cobalt (28%), rubber chemicals (21%) and nickel (18%). Nonconstruction workers had significantly higher rates of nickel allergy (36% v 6%) than construction workers (P < .03). Simultaneous reactivity to cobalt and nickel was also significantly more common among nonconstruction workers (22%) than construction workers (6%) (P < .03).

CONCLUSION

Chromate has progressively become a less common occupational allergen at the National Skin Centre in Singapore from 1983 to 1989, because of a progressive fall in the number of cases of allergic contact dermatitis from cement. However, our study showed that occupational chromate allergy had now increased from 1990 to 1995, because of an increase in chromate allergy from sources other than cement. Chromate allergy from cement is declining, although still frequent, and sources other than cement are increasing in recent years. Concomitant nickel allergy, as well as simultaneous nickel and cobalt allergies, were more common among nonconstruction workers than construction workers.

Sickness absence in private sector establishments in Singapore

AIM

A study was conducted in June 1995 to determine the current level of sickness absence in Singapore.

METHOD

The questionnaire survey was part of a larger labour market survey conducted quarterly by the Ministry of Labour, and covered 3,553 private sector establishments employing 25 or more employees.

RESULTS

Overall, 14.4% of the 628,477 employees took sick leave, while the percentage of working days lost due to sick leave, excluding maternity leave, was 1.1%. An average of 3.2 days of medical leave were taken per person per year. Industry specific characteristics seemed to have more influence on sickness absence than establishment size, employee's sex and occupation (viz, professional versus clerical versus production staff), number of hours worked and overtime work. Over 60% of the establishments, particularly larger companies and those in manufacturing, implemented measures to control sickness absence, most commonly counselling, disciplinary procedures and attendance allowance or bonus. Over 13% monitored sickness absence using computerised records.

CONCLUSION

Comparing with overseas sickness absence (lost time) rates, the rates observed in this study do not appear high.

Change in cement manufacturing process, a cause for decline in chromate allergy?

Hexavalent chromate in cement is the commonest cause of allergic contact dermatitis, especially among construction workers. Over the past decades, there has been a general decline in the prevalence of chromate allergy among construction workers. We suspect that a change in the constituents of cement, resulting in the lowering of hexavalent chromate, contributed to the decline. Slag (free from hexavalent chromate) from the iron-quenched, blast furnace process has been used as a substitute for clinker (which contains high hexavalent chromate) in manufacturing cement. As a result, the slag has diluted the hexavalent chromate content of cement. Our analytical study showed that slag is free from hexavalent chromate and that the hexavalent chromate of clinker ranged from 6-17 micrograms/g. Substituting slag for clinker resulted in dilution of hexavalent chromate in the cement. The hexavalent chromate content of cement declines proportionately with increasing proportion of slag, e.g., a cement containing 5% slag has a total hexavalent chromate concentration of 17.5 micrograms/g, whereas increasing the proportion of slag to 60% reduced the hexavalent chromate content to 7.1 micrograms/gm in the same cement.

Cadmium hazard in silver brazing

This study evaluates the usage of cadmium-containing silver brazing alloys in Singapore and the potential cadmium hazard from its use. Of the 137 factories which responded to the survey questionnaire, only 28 (20.4%) carried out brazing. Of these, only 7 factories used cadmium-containing filler alloys. One hundred and six out of 123 workers from one of these factories had cadmium-in-blood concentrations exceeding 10 mcg/l. Thirty-one (29.2%) of the workers with excessive cadmium absorption had urinary beta-2 microglobulin levels exceeding 28 mcg/g creat. Workers in the other factories who were intermittently exposed had cadmium-in-blood concentrations of 10 mcg/l and below.

Urinary beta 2- and alpha 1-microglobulin levels in normal subjects in Singapore

Differing normal values for urinary beta 2-microglobulin have been reported for different countries. In this study, we have attempted to establish the urinary beta 2- and alpha 1-microglobulin levels of apparently healthy subjects in Singapore. Urine samples collected from 271 subjects were analysed. The subjects ranged from 19 to 62 years old, with a mean age of 36.8 years. The majority (84.5%) were non-smokers. Urine samples with a pH level < 5.5 were excluded from the analysis. The urinary beta 2- and alpha 1-microglobulin values followed log normal distributions. Their 95th percentiles were 288 micrograms/g creatinine and 7.35 mg/g creatinine, respectively. Statistically significant differences were found between sexes and ethnic groups for urinary beta 2-microglobulin values. Both alpha 1- and beta 2-microglobulin values increased significantly with age. Smokers had significantly higher urinary alpha 1-microglobulin values.

Efficacies of a barrier cream and an afterwork emollient cream against cutting fluid dermatitis in metalworkers: a prospective study

We compared the point prevalence of cutting fluid dermatitis and transepidermal water vapour loss (TEWL) changes in groups of new machinists who (a) used a barrier cream; (b) used an afterwork emollient cream; and (c) did not use any cream (controls) over a 6-month period. All machinists handled cutting fluid (neat mineral oil) during their work. There was no significant difference in the prevalence of cutting fluid dermatitis in the 3 groups throughout the study period. The prevalence of cutting fluid dermatitis in all groups increased rapidly during the first 6 weeks and thereafter remained steady throughout the remainder of the study period. The prevalence of cutting fluid dermatitis was slightly lower in machinists using afterwork emollient cream compared to those using barrier cream and controls (not significant). The differences in the mean TEWL changes during the study period among the 3 groups were also not statistically significant. The mean TEWL values in the 3 groups increased rapidly during the first 6 weeks of exposure to cutting fluids and thereafter remained fairly constant throughout the remainder of the study period. Barrier cream and afterwork emollient cream did not appear to have any significant effect against either cutting fluid dermatitis or TEWL changes in machinists exposed to cutting fluid. However, afterwork emollient cream appeared clinically to help reduce the prevalence of cutting fluid irritation.

The incidence of cutting fluid dermatitis among metalworkers in a metal fabrication factory: a prospective study

We compared the incidence of occupational dermatitis and transepidermal water vapour loss (TEWL) changes from cutting fluids (neat mineral oils) in 24 new machinists with 27 armed forces paramedics (controls) over a 6-month period. The cumulative incidence of occupational dermatitis in positive controls increased from 38% at week 3 to 77% at week 6. It then decreased to 50% at week 9 and thereafter remained constant at about 50% throughout the remaining study period. 2 workers sought medical treatment for their dermatitis. Only 1 worker had a job transfer because of his dermatitis. None of the paramedics developed dermatitis during the study period. The mean basal TEWL values on the hands of machinists and controls were 17.6 and 14.5 g/m2/h (n.s.) respectively. The mean TEWL values of machinists increased to 22 g/m2/h by week 3 and then remained fairly constant throughout the remaining study period. The mean TEWL of negative controls remained fairly constant (at about 14 g/m2/h) from the beginning to the end of the study period. The mean TEWL value of machinists was significantly higher than that of negative controls throughout the study period. There was no significant difference in the prevalence of cutting fluid dermatitis between machinists with high basal TEWL values (> or = 17 g/m2/h) and those with low basal TEWL values (< 17 g/m2/h).

Use of a computerized postural sway measurement system for assessing workers exposed to manganese

1. Computerized postural sway measurement systems have been used recently in human physiology and pharmacology for determining postural stability, but their applicability for the assessment of the effects of exposure to neurotoxic agents is lacking. 2. We have examined the feasibility of using a computerized postural sway measurement system to assess the postural sway parameters of manganese exposed workers compared with a control group. 3. Sway parameter data were collected using a KISLTER multicomponent measuring platform (Type 9281B) connected to VICON motion analysis system for 13 exposed and 16 control subjects. 4. Significant differences in several of the sway parameters (Px, Py--mean distance (mm), from the centre of the platform along the X-axis [anterior-posterior movement] and Y-axis [lateral movement], respectively) between the exposed and control groups were observed even after adjustment for possible confounders. Computerized postural sway measurement system may be a useful method of assessing workers exposed to neurotoxic agents affecting posture.

Neurobehavioral functions among workers exposed to manganese ore

The Neurobehavioral Core Test Battery of the World Health Organization was performed on 17 baggers (mean age 36.6 years) in a manganese ore milling plant and 17 referents (mean age 35.7 years). The baggers had a mean exposure period of 7.4 (range 1-14) years with a mean blood manganese concentration of 25.3 (range 15-92.5) micrograms.l-1 [0.46 (0.27-1.68) mumol.l-1]. Of the 37 symptoms related to the nervous system, 20 were more frequently reported by the exposed workers. No significant differences were noted between the nerve conduction of the median and ulnar nerves of the dominant forearm of the two groups. The exposed workers had significantly poorer motor speed, visual scanning, visuomotor coordination, visuomotor and response speed, and visuomotor coordination and steadiness. A clinical examination did not reveal any abnormality among the two groups. Hence a neurobehavioral test battery may be a more sensitive method than a clinical examination in detecting early changes in motor function among manganese-exposed workers.

Study on the health of female electronics workers on 12 hour shifts

Health complaints, blood pressure, sleep and sickness absence experience were studied in 308 female electronics workers employed for at least one year on 12 h shifts--253 on permanent and 55 on rotating schedules. Seventy-five 8 h day workers acted as controls. There were no significant differences in symptom prevalence between the controls and 12 h shift workers, except for complaints of tiredness, with a higher proportion of the rotating shift group also having headaches. No significant differences in prevalence of hypertension were noted. Although subjects on the night shift had shorter sleep than controls and 12h day workers, only the group on rotating schedule had a higher proportion of workers who did not sleep well compared to the controls. Sickness absence was not increased in the 12 h shift groups when compared to the controls. The results indicate no serious health problems among workers on 12 h shift for over a year.

Shiftwork in Singapore

In 1985, over 94,000 persons were engaged in shiftwork. With the continued emphasis on capital-intensive industries and growing demand for "round-the-clock" services, shiftwork is increasingly becoming an economic necessity in many industries in Singapore. A survey in 1991 confirmed this trend. The study covered 4,996 private sector establishments employing 25 or more paid employees. 34.4% of the establishments had shiftworkers. In terms of employees, 32% or 206,965 employees were working shifts. While the 8-hour shift schedule was still the predominant pattern, there was a ten-fold increase in the number of 12-hour shiftworkers. A trend towards permanent shift schedules was also noted. It was interesting that the proportion of shiftworkers doing nightwork decreased to 36.9% from 45.1% in 1985. The health implications of shiftwork have been widely reported. So far, our own studies indicate no serious long-term health effects among shiftworkers. However, further studies are needed to determine if preventive measures can be taken to minimise the common complaints of sleep problems and tiredness, particularly among rotating shiftworkers.

Persistent liver dysfunction among workers at a vinyl chloride monomer polymerization plant

Thirteen workers with persistent abnormalities in one or more liver function tests (LFT) at a vinyl chloride monomer (VCM) polymerization plant were investigated. Twelve workers were found to have VCM-induced liver dysfunction based on circumstantial evidence. They were employed between 1971 and 1982 when the VCM levels ranged from 1 to 21 p.p.m. After 1982 when the environmental VCM levels were controlled to below 1 p.p.m., no cases of VCM-induced liver dysfunction were detected. In most cases, glutamic pyruvic transaminase was the earliest parameter to be raised. The second most common parameter is serum gamma glutamyl transpeptidase. The latent period ranged from 1 to 13 years. An improvement in their LFT results was shown by 83.3 per cent of workers within 6 months to 2 years after removal from further VCM exposure. For workers who returned to VCM work, their LFT became abnormal again. Liver scans showed hepato and/or splenomegaly in most cases. Liver biopsies on 9 workers were reported as 'non-specific fatty changes' of varying degrees. These observations highlight the need for continual vigilance with environmental monitoring and medical surveillance of VCM-exposed workers.

Sleep-wake patterns and subjective sleep quality of day and night workers: interaction between napping and main sleep episodes

Five hundred and ninety-three women electronics workers were studied to determine if there was any association between their subjective sleep quality and their sleep patterns. They were 108 day workers, 107 permanent night workers, 216 workers on weekly phase-advance (night/afternoon/morning), and 162 workers on two-weekly phase-delay (morning/afternoon/night) rotating shift schedules. The study was part of a larger survey on night workers involving a self-administered questionnaire. The proportion of nappers was higher in night workers than in day, morning, and afternoon shift workers. Nappers had shorter main sleep, but their total sleep duration was generally the same as that of nonnappers. Compared to nonnappers, a higher proportion of day and morning shift workers who napped did not sleep well. Permanent night workers, with the highest proportion of nappers, had more workers sleeping well than rotating night workers. Subjects who slept well were those with longer total and main sleep and generally started the main sleep earlier. The results indicate a relationship between subjective sleep quality, sleep length, main sleep start, and napping behavior. Whether this relationship is causal is difficult to establish as sleep quality may also reflect the general health status, and this may result in differences in sleep behavior.

Chlamydial infection in female prostitutes in Singapore

Three studies conducted in 1982, 1985 and 1988 investigated chlamydial infections in female prostitutes. In 1982, 115 prostitutes with culture-positive gonorrhoea were studied; 8% were coinfected with Chlamydia trachomatis. In 1985, 86 female prostitutes and in 1988, 100 female prostitutes attending for routine tests were examined. Chlamydia trachomatis was isolated in 12% and 9% of the cases, respectively. Gonorrhoea was detected in 10% and 11% of the cases. In the 1988 study, one (9%) of the 11 women with gonorrhoea had concomitant chlamydial infection. Syphilis was diagnosed in 3% of the female prostitutes investigated in 1988. Our findings indicate that concomitant chlamydial infection occurs in about 8-9% of female prostitutes with gonorrhoea and that 9-12% of the female prostitutes screened harboured Chlamydia trachomatis in their endocervices. A chlamydial control programme in prostitutes is desirable.

Occupational dermatosis among sanders in the furniture industry

The prevalence of occupational skin disease was found to be 3.8% in a study of 479 sanders in the furniture-making industry in Singapore. 17 species of wood imported from South East Asia were used. The most common dermatoses from wood dust were pruritus (1.6%), irritant contact dermatitis (1.6%) and xerosis (1.4%). 2 sanders had miliaria. None had allergic contact dermatitis from wood dust. The arms and trunk were the most common site for pruritus and dermatitis from wood dust. It appeared that the woods commonly used in the furniture making industry are weak sensitizers. Appropriate preventive measures against irritant dermatitis such as dust control, protective clothing, and good personal hygiene should be adequate to prevent occupational dermatoses among the sanders.

Occupational dermatitis in a prefabrication construction factory

In a field study of occupational dermatoses in a prefabrication construction factory, 272 workers were interviewed, examined and patch tested to chromate, cobalt, nickel, rubber mixes, epoxy resin, melamine formaldehyde and conplasts. The prevalence of occupational dermatitis was 14% (38/272); 57% (22/38) were irritant dermatitis from cement; 39.5% (15/38) were allergic contact dermatitis from cement (2 with concomitant rubber glove allergy); and 2.5% (1/38) were allergic to rubber chemicals in gloves. The overall prevalence of chromate sensitivity was 8.5% (23/272), with the highest rate from the concreting bays of the factory. The rate was unrelated to the duration of workers' engagement in construction work. 34.8% (8/23) had asymptomatic chromate allergy. The prevalence of cobalt reactions was 17.4% (4/23) and all were associated with chromate allergy.

Cobalt and nickel content of Asian cements

The total cobalt and nickel concentration of 11 brands of Asian cement ranged from 8.1 to 14.2 micrograms/g and 14.9 to 28.5 micrograms/g, respectively. These metals exist mainly as insoluble salts; the water-soluble concentration of cobalt and nickel in the cements ranged from 0.39 to 0.65 micrograms/g and from 0-1.2 micrograms/g, respectively. 1.5% (4/272) of construction workers in a prefabrication construction factory had cobalt sensitivity. All had allergic contact dermatitis from chromate in cement. No worker had isolated cobalt sensitivity and cement dermatitis. It appeared that sensitization to cobalt in cement occurs only secondarily to an existing cement dermatitis. 1.8% (5/272) workers had nickel sensitivity: 2 with allergic contact dermatitis to nickel in their watches, 2 were asymptomatic and 1 had allergic contact dermatitis to chromate and cobalt in cement. The low prevalence of cobalt and nickel sensitivity from cement was probably related to the low concentration of soluble cobalt and nickel salts in the cement. However, these insoluble salts can form soluble complexes with body fluids on eczematous skin and sensitize the skin.

Chromate allergy: total chromium and hexavalent chromate in the air

This is a study on atmospheric concentration of total chromium and hexavalent chromate and its role in chromate sensitivity. Air concentration of total chromium and hexavalent chromate in a construction factory, a busy city area, a suburban area, a residential area, and a heavy industrial area were measured by air sampling pumps. Hexavalent chromate was not detected in any sampled areas. Two (concreting areas) of 8 locations in the construction factory had total chromium of 0.2 and 2.3 micrograms/m3 in the atmosphere. It appeared that the atmospheric concentration of total chromium and hexavalent chromate was negligible. These findings indicate that unexplained chromate sensitivity, as so often seen in patients attending a contact dermatitis clinic, is not attributable to exposure to hexavalent chromate in the air.

Five cases of arsine poisoning

Arsine is one of the most potent haemolytic agents found in industry. Four workers presented with abdominal pain, jaundice and passing tea-coloured urine. A fifth worker also passed dark urine but had no other symptoms. Investigation revealed that all five workers were from a tin smelting plant where they were involved in mixing tin ore with dross. They were exposed to arsine gas after mixing a particularly large quantity of dross with tin ore which was wet because of rain. Three of the cases developed renal impairment and also a mild sensory neuropathy. All survived with proper management in hospital which included exchange blood transfusions, and peritoneal dialysis where indicated. Prevention of such poisoning includes keeping dross away from all moisture, good ventilation in work areas, and adding dross directly to the furnace.