Sexual Functioning Among Childhood Sexual Abuse Survivors From an Attachment Perspective

BackgroundDespite the fact that childhood sexual abuse can affect a survivor's sexual functioning in adulthood, few studies have examined survivors' adult sexual functioning from the perspective of attachment theory.AimThe present study sought to examine how sexual abuse in childhood might shape the associations between attachment insecurities and sexual functioning among adults.MethodsThe study sample consisted of 265 participants (166 women and 99 men), 45 (16.9%) of whom were classified as survivors of childhood sexual abuse. Participants completed an online questionnaire about their history of childhood sexual abuse, attachment insecurities, and sexual functioning over the past 6 months.OutcomesThe findings of the present study suggest that attachment insecurities may have unique implications for sexual functioning among survivors of childhood sexual abuse.ResultsFindings indicated that a history of childhood sexual abuse significantly moderated the associations between attachment insecurities and sexual functioning. Whereas the effect of attachment avoidance in predicting sexual desire was not significant among nonabused participants, it was significant among survivors; specifically, higher levels of attachment avoidance predicted lower levels of sexual desire. A different pattern was found for attachment anxiety. Although attachment anxiety did not predict vaginal lubrication/penile erection among nonabused participants, it had significant effects among survivors; specifically, higher levels of attachment anxiety predicted higher levels of vaginal lubrication/penile erection.Clinical TranslationFindings from the present study may help facilitate sex therapy interventions for childhood sexual abuse survivors, from an attachment theory perspective.Strengths & LimitationsThe study included a nonclinical, convenience sample and used self-report measures, which are highly subjective and increase the possibility of social-desirability biases. However, on the plus side, it relied on simple, short, self-report questionnaires that are accessible and can be easily used by professionals to examine a survivor's current condition relative to any of the variables, establish intervention goals, and evaluate treatment.ConclusionA history of childhood sexual abuse is related to 2 opposite patterns of association between attachment insecurity (depending on type) and sexual functioning.Gewirtz-Meydan A, Lahav Y. Sexual Functioning Among Childhood Sexual Abuse Survivors From an Attachment Perspective. J Sex Med 2020;17:1370–1382.     

Treating acute myeloid leukemia in the modern era: A primer

Recent years have seen tremendous advances in treating acute myeloid leukemia (AML), largely because of progress in understanding the genetic basis of the disease. The US Food and Drug Administration approved 7 agents for AML in the last 2 years: the first new drugs in decades. In this review, the authors discuss these new approvals in the backdrop of an overall strategy for treating AML today. Treating AML in the modern era requires: 1) access to and use of upfront genetic and cytogenetic testing, not only to describe prognosis but also to help identify the best available therapy; 2) effectively working new therapies into a conventional backbone of treatment, including transplantation; and 3) continued commitment to clinical trials designed to capitalize on advances in genetics and immunology to foster the next wave of drug approvals.     

WT1 Expression in Peripheral Blood at Diagnosis and During the Course of Early Consolidation Treatment Correlates With Survival in Patients With Intermediate and Poor-Risk Acute Myeloid Leukemia

BackgroundUp to 55% of non-APL acute myeloid leukemias (AML) lack a molecular target suitable for standardized disease monitoring. We aimed to evaluate the prognostic significance of WT1 gene expression at early stages of intensive treatment.Patients and MethodsA total of 106 consecutive patients with intermediate and high-risk AML who had WT1 expression at diagnosis >500 copies/10⁴ ABL and who achieved remission after 1 to 2 cycles of induction treatment were analyzed. WT1 expression was measured in peripheral blood using a standardized European LeukemiaNet method. Overexpression was defined as >50 copies/10⁴ ABL. The median follow-up was 30 months.ResultsPatients with normal versus high WT1 expression after 2 cycles of chemotherapy had overall survival (OS) at 3 years of 66% versus 41% (P = .01); event-free survival (EFS) 45% versus 22% (P = .01). Prognostic significance of WT1 expression after 2 cycles of treatment was maintained in the group of patients treated with chemotherapy alone without hematopoietic stem cell transplantation in first line treatment (OS 70% vs. 36%, P = .02; EFS 35% vs. 0%, P = .03). Significant prognostic factors for EFS on multivariate analysis were the achievement of molecular remission (<50 copies of WT1) at any time during treatment (hazard ratio [HR] 0.47, P = .04) and increased WT1 expression after 2 cycles of chemotherapy (HR 2.0, P = .03).ConclusionIncreased WT1 expression after 2 cycles of chemotherapy is a negative prognostic factor for survival. WT1 remains a valuable molecular marker in AML without any leukemia-specific mutation, especially if next generation sequencing and/or digital polymerase chain reaction are not routinely available.     

FLAG方案治疗难治复发性急性白血病临床疗效

目的探究FLAG方案治疗难治复发性急性白血病的临床疗效。方法择取2017年3月—2018年12月期间医院收治的76例难治复发性急性白血病患者为研究对象,随机分为对照组与观察组,每组38例。对照组患者行MEA方案治疗,观察组患者行FLAG方案治疗,比较两组患者肿瘤控制效果以及不良反应发生率。结果观察组患者肿瘤控制效果73.68%高于对照组50.00%,差异有统计学意义(P<0.05);观察组患者总不良反应发生率31.58%低于对照组55.26%,差异有统计学意义(P<0.05)。结论FLAG方案治疗难治复发性急性白血病效果较为理想,同时具有较高的安全性。     

Intrahepatic cholangiocarcinoma as a rare secondary malignancy after allogeneic hematopoietic stem cell transplantation for childhood acute lymphoblastic leukemia: A case report

Secondary malignancies are a significant cause of non‐relapse mortality in patients who undergo allogeneic HCT. However, secondary liver cancer is rare, and ICC following HCT has never been reported in the literature. Secondary solid cancers typically have a long latency period, and cholangiocarcinoma is classically a malignancy occurring in older individuals. Here, we report the first case of secondary ICC, which presented just 3 years after HCT in a young adult with a history of childhood ALL. A 26‐year‐old male with history of precursor B‐cell ALL presented with asymptomatic elevated liver function tests 3 years after HCT. Laboratories were indicative of biliary obstruction. ERCP showed focal biliary stricturing of the common and left hepatic ducts. MRCP revealed left intrahepatic duct dilatation, suggestive of intrahepatic obstructing mass. Additional workup lead to a clinical diagnosis of ICC. The patient underwent left hepatectomy with extrahepatic bile duct resection and portal lymphadenectomy. Surgical pathology was consistent with moderately differentiated cholangiocarcinoma. Our case illustrates a rare SMN following HCT for ALL. It is the first case report of ICC occurring as a secondary cancer in this patient population. Although cholangiocarcinoma is characteristically diagnosed in the older population, it must remain on the differential for biliary obstruction in post‐HCT patients.     

Epigenetic priming with decitabine followed by low dose idarubicin and cytarabine in acute myeloid leukemia evolving from myelodysplastic syndromes and higher-risk myelodysplastic syndromes: a prospective multicenter single-arm trial

Patients with acute myeloid leukemia (AML) evolving from myelodysplastic syndrome (MDS) or higher-risk MDS have limited treatment options and poor prognosis. Our previous single-center study of decitabine followed by low dose idarubicin and cytarabine (D-IA) in patients with myeloid neoplasms showed promising primary results. We therefore conducted a multicenter study of D-IA regimen in AML evolving from MDS and higher-risk MDS. Patients with AML evolving from MDS or refractory anemia with excess blasts type 2 (RAEB-2) (based on the 2008 WHO classification) were included. The D-IA regimen (decitabine, 20 mg/m² daily, days 1 to 3; idarubicin, 6 mg/m² daily, days 4 to 6; cytarabine 25 mg/m² every 12 hours, days 4 to 8; granulocyte colony stimulating factor [G-CSF], 5 μg/kg, from day 4 until neutrophil count increased to 1.0 × 10⁹/L) was administered as induction chemotherapy. Seventy-one patients were enrolled and treated, among whom 44 (62.0%) had AML evolving from MDS and 27 (38.0%) had RAEB-2. Twenty-eight (63.6%) AML patients achieved complete remission (CR) or complete remission with incomplete blood count recovery (CRi): 14 (31.8%) patients had CR and 14 (31.8%) had CRi. Six (22.2%) MDS patients had CR and 15 (55.6%) had marrow complete remission. The median overall survival (OS) was 22.4 months for the entire group, with a median OS of 24.2 months for AML and 20.0 months for MDS subgroup. No early death occurred. In conclusion, the D-IA regimen was effective and well tolerated, representing an alternative option for patients with AML evolving from MDS or MDS subtype RAEB-2.     

急性髓系白血病异基因造血干细胞移植前微小残留病检测意义的Meta分析

目的:探讨急性髓系白血病(AML)异基因造血干细胞移植(allo-HSCT)前微小残留病(MRD)状态与预后之间的关系。方法:计算机检索PubMed数据库、Embase数据库、CNKI数据库、万方数据库，收集符合纳入标准的研究，检索时限均为2016年1月至2018年12月，由两位研究者独立进行文献筛选、资料提取和质量评价后，采用RevMan 5.3软件进行Meta分析。结果:Meta分析结果显示:allo-HSCT前MRD阳性与较低的总生存率(HR=2.72，95%CI:2.27~3.25，P<0.000 01)、无白血病生存率(HR=2.64，95%CI:1.93~3.60，P<0.000 01)及较高的累积复发率(HR=4.13，95%CI:3.15~5.40，P<0.000 01)和非复发死亡率(HR=1.64，95%CI:1.09~2.49，P=0.02)相关。结论:allo-HSCT前MRD阳性与移植后较差的预后具有明显的相关性。     

982例儿童急性淋巴细胞白血病流行病学研究

目的:分析982例儿童急性淋巴细胞白血病(ALL)临床病例,了解儿童ALL流行病学特征。方法:对本中心2008年4月至2015年5月收治的982例ALL患儿临床资料采用回顾性分析的方法,分析其性别、发病年龄、发病季节、发病相关危险因素及分子生物学特征等。结果:ALL患儿男女比例为1.5∶1,中位发病年龄5岁,发病年龄高峰为2-5岁。发病高峰季节为春季。出生和喂养史分析显示,足月产患儿占98.0%;55.9%患儿是顺产,44.1%患儿是剖腹产。母乳喂养者占79.8%,人工混合喂养儿占20.2%。中位出生体重3.5 kg,其中巨大儿占18.3%。有出生异常史者34例(3.5%),其中脐带绕颈者10例。发病近期有家庭装修史者占31.4%,中位装修环境暴露时间12个月。患儿一至三级亲属中,有血液系统疾病者44例(4.5%),有恶性肿瘤者53例(5.4%)。免疫表型分析结果显示,B-ALL占90.7%,T-ALL占9.3%。分子生物学检测中,TEL/AML1阳性者占21.0%,E2A/PBX1阳性者占5.2%,BCR-ABL阳性者占6.1%,MLL阳性者占2.5%。结论:本研究中儿童急性淋巴细胞白血病男性患儿较多,发病年龄高峰为2-5岁,发病季节高峰为春季,出生季节高峰为秋冬季,剖宫产术分娩、出生时为巨大儿及出生后非母乳喂养比例高于同期全国大部分地区婴儿的均值,有电离辐射及家居环境暴露史与亲属血液病、恶性肿瘤病史者比例较高。