Cytogenetic disorders in chronic B-cell lymphoid leukemia and their relations with clinicobiological features and prognosis of the disease

AIM: To study a relationship between cytogenetic disorders, clinicobiological characteristics and prognosis in chronic B-cell lymphoid leukemia (B-CLL). MATERIAL AND METHODS: Cytogenetic examination of blood, bone marrow and lymph node cells from 135 patients (90 males and 45 females aged 23-84 years) with chronic B-CLL was made. The patients were followed up from 1 month to 25 years. Before the cytogenetic examination specific therapy was not given. B-CLL was staged by K. Rai, forms--by A.L. Vorobyev and M.D. Brilliant. All the patients have undergone standard cytogenetic examination, FISH with multicolor probe to loci with possible frequent aberrations (del3q14, del11q23, del17p13, trisomia 12), determination of CD38 antigen expression on circulating tumor cells. Mutation status of the genes of immunoglobulins variable region (IgVH) was defined in 61 patients. RESULTS: Del13q14 was detected in 34 cases, del11q23--in 26, trisomia of chromosome 12--in 17 cases, del 17p13--in 8, absence of q-arm of chromosome 13--in 3 cases. 61 patients had no karyotype defects. Three prognostic groups of the patients were identified: favourable prognosis--patients without disorders of karyotype and one chromosomal aberration--del13q14; intermediate prognosis patients with dell1q23 and trisomia of chromosome 12; poor prognosis--patients with del17p13 and complex disorders of karyotype. CONCLUSION. Cytogenetic study help determine prognosis of B-CLL and detect patients in need of early therapy.     

多种因素对脑出血患者功能预后的影响:682例回顾性分析

目的:为提高脑出血患者的生存率和生活质量,分析影响脑出血预后的因素。方法:回顾性分析上海市公利医院1993/2003收治698例急性脑出血患者的临床资料,探讨下列因素:初次收缩压、舒张压、平均动脉压、血糖、体温、出血量、出血部位、并发症、年龄、性别、是否降压治疗等与预后(分好转与未好转,后者包括病情无变化、恶化及死亡)的关系。结果:将上述因素与预后做多因素分析发现,初次收缩压、舒张压、平均动脉压、血糖、体温、出血量、出血部位、年龄、性别、是否降压治疗等对预后有一定的影响。女性、无脑干及脑室出血者、无并发症者、体温小于38.5℃者、无意识障碍者、无血糖增高者、收缩压和舒张压在(150±4)和(82±3)mmHg(1mmHg=0.133kPa)者病情预后较好。结论:脑出血预后的影响因素有许多,应全面积极考虑急性期血压的控制以及体温、血糖、并发症的处理,以使患者有较好的预后。     

Old age: a sign of poor prognosis in patients with chronic myelogenous leukemia

Fifty-four patients aged 60 years or older with a diagnosis of chronic myelogenous leukemia were referred to University of Texas M. D. Anderson Hospital between 1965 and 1982. Patients in this age group had a significantly shorter median survival than that of the 249 patients younger than 60 seen during the same period (26 vs 42 months; P = .01). Old age was associated with a higher incidence of poor performance status, hepatomegaly, and anemia. Fourteen other patient characteristics were correlated with poor prognosis, including black race, weight loss, symptoms, hepatomegaly, splenomegaly, anemia, thrombocytopenia or thrombocytosis, increased peripheral blast cells and promyelocytes or basophils, increased blasts or basophils in the bone marrow, decreased megakaryocytes, and additional cytogenetic abnormalities. A multivariate analysis that accounted for the interactions of these factors identified old age as being of primary adverse prognostic significance in patients with chronic myelogenous leukemia, suggesting a biologic difference in the disease in older patients. The poor prognosis in elderly patients receiving present available therapy justifies promising and well tolerated investigational approaches such as interferons in patients in this age group.     

Immunoglobulin diversity gene usage predicts unfavorable outcome in a subset of chronic lymphocytic leukemia patients

Survival of patients with B cell chronic lymphocytic leukemia (B-CLL) can be predicted by analysis of mutations in the immunoglobulin heavy chain variable gene (IGHV). Patients without mutations (unmutated [UM]) are at greater risk for disease progression and death than patients with mutations (M). Despite this broad prognostic difference, there remains wide intragroup variation in the clinical outcome of UM patients, especially those with low/intermediate Rai risk disease. We evaluated UM B-CLL patients with low/intermediate Rai risk to determine the relationship between IGHV, IGH diversity (IGHD), and IGH joining (IGHJ) gene usage and time to treatment (TTT). Irrespective of IGHV usage, UM patients whose B-CLL cells expressed the IGHD3-3 gene had a significantly shorter TTT than other UM B-CLL patients, and specifically, use of the IGHD3-3 gene in reading frame 2 (RF2) predicted shorter TTT. As expected, Rai risk was the best single prognostic factor for TTT; however, IGHD usage was also a significant variable for TTT. Therefore, both IGHD gene and IGHD RF usage have prognostic relevance in UM B-CLL patients with low/intermediate Rai risk disease. In addition, these data support the concept that antigen-driven selection of specific Ig receptors plays a role in the clinical course of B-CLL.     

Association of health-related quality of life with gender in patients with B-cell chronic lymphocytic leukemia

Purpose

This analysis examined associations between gender and health-related quality of life (HRQOL) in patients with B-cell chronic lymphocytic leukemia (CLL) as they initiate therapy for CLL outside the clinical trial setting.

Methods

Baseline data were collected as part of Connect® CLL Registry, a prospective observational study initiated in community, academic, and government centers. Patient demographics and clinical characteristics were provided by clinicians. Patients reported HRQOL using the Brief Fatigue Inventory (BFI), EQ-5D, and Functional Assessment of Cancer Therapy-Leukemia (FACT-Leu). Mean scores were analyzed, with statistical significance of differences determined by ANOVA. Multivariate analysis also considered age and line of therapy.

Results

Baseline HRQOL data were available for 1,140 patients: 710 (62 %) men and 430 (38 %) women from 161 centers. Patients were predominantly white (89 %) with mean age 69?±?11 years. Women reported significantly worse global fatigue (P <0.0001), fatigue severity (P <0.0001), and fatigue-related interference (P?=?0.0005) versus men (BFI). Pain/discomfort (P?=?0.0077), usual activities (P?=?0.0015), and anxiety/depression (P?=?0.0117) were significantly worse in women than in men (EQ-5D). With women reporting a better social/family score (P?=?0.0238) and men reporting a better physical score (P?=?0.0002), the mean FACT-G total score did not differ by gender. However, the mean FACT-Leu total score was better among men versus women (P?=?0.0223), primarily because the mean leukemia subscale score was significantly better among men (P <0.0001). Multivariate analysis qualitatively confirmed these findings.

Conclusions

Connect® CLL Registry results indicate that significant differences exist in certain HRQOL domains, as women reported greater levels of fatigue and worse functioning in physical domains.     

Clinical outcomes and survival analysis in patients with psycho-cardiological disease: a retrospective analysis of 132 cases

ObjectivesThe deleterious effects of psychological problems on coronary heart disease (CHD) are not satisfactorily explained. We explored influential factors associated with mortality in psycho-cardiological disease in a Chinese sample.MethodsOf 7460 cardiac patients, we selected 132 patients with CHD and mental illness. Follow-up was conducted via telephone. We analyzed clinical characteristics, clinical outcomes, and survival.ResultsThe clinical detection rate of psycho-cardiological disease in the overall patient population was 1.8%. Of these, 113 patients completed follow-up; 18 died owing to cardiovascular diseases during follow-up. Kaplan–Meier analysis showed dysphagia, limb function, self-care ability, percutaneous coronary intervention, low-density lipoprotein, total cholesterol, pro-brain natriuretic peptide and high-sensitivity (hs) troponin T had significant associations with cumulative survival. Cox regression analysis showed total cholesterol (hazard ratio [HR]: 2.765, 95% confidence interval [CI]: 1.001–7.641), hs troponin T (HR: 4.668, 95% CI: 1.293–16.854), and percutaneous coronary intervention (HR: 3.619, 95% CI: 1.383–9.474) were independently associated with cumulative survival.ConclusionsThe clinical detection rate of psycho-cardiological disease was far lower than expected. Normal total cholesterol and hs troponin T were associated with reduced cardiovascular disease mortality over 2 years. Percutaneous coronary intervention is a prognostic risk factor in patients with psycho-cardiological disease.     

结直肠肿瘤患者围手术期输血影响因素研究——附207例病例分析

目的探讨影响结直肠肿瘤患者围术期用血量的相关因素,以期进一步提高患者临床输血的合理性。方法收集本院207例结直肠肿瘤患者临床信息、实验室检测信息以及围术期输血情况等资料。对输血过程中涉及的主要因素如患者年龄、性别、术前血红蛋白水平、术前凝血、手术时间、肿瘤部位、肿瘤体积、等进行分类统计分析。结果手术患者术中出血量大于600 mL者18.8%(39/207),而术中输血率为28.5%(59/207),较高的输血率与20.29%(42/207)患者术前贫血(Hb100 g/L)相关。术中红细胞用血量占围术期用血量56.95%。通过多因素Logistic回归分析,对术中输红量影响最大的因素是手术时长和术前血红蛋白(P0.001)。肿物大小与红细胞输注总量相关性很高,"部位_结肠"也有一定影响(P0.05)。患者年龄、性别与围术期输血量无显著相关性(P0.05)。术中红细胞和血浆输注比例合理,无搭配"全血"输注情况。结论患者围术期输血量的主要影响因素有术前血红蛋白水平、手术时间、肿瘤大小及肿瘤部位,但与其年龄、性别关系不大。     

慢性粒-单核细胞白血病分型探讨--附24例分析

本文对24例慢性粒-单核细胞白血病(CMML)的临床特征和血液学表现进行分析.根据骨髓粒单核细胞系和红细胞系比例、血细胞病态造血、外周血白细胞计数以及脾脏肿大程度等特征,将CMML分为两种亚型,即具有骨髓增殖性疾病(MPD)特征的CMML为真性CMML,应归于MPD或慢性髓细胞白血病(CML)的一个亚型;具有骨髓增生异常综合征(MDS)特征的CMML为MDS-CMML,称单核细胞增多的难治性贫血(RAM).同时将这两种亚型的诊断标准进行提议.     

合并内科慢性疾病的传染性非典型肺炎患者临床流行病学特征:680例回顾性分析

目的:调查传染性非典型肺炎(severeacuterespiratorysyndrome,SARS)患者中合并有慢性病者的临床流行病学特点。方法:回顾性分析680例SARS患者中合并慢性病的种类、数目和患者的年龄、主要临床症状和体征。结果:有合并症的SARS患者平均年龄远高于无并发症者(t=12.6,P<0.05),具有1种以上并发症的病例数为87例,占12.8%,最多者1例有4种并发症。糖尿病、高血压是最常见的SARS患者并发症,分别为20和19例,检出率分别是2.9%和2.8%;合并慢性病者出现呼吸困难、腹痛症状的概率显著高于无合并慢性病者(χ2=11.955,8.265,P<0.05)。有慢性病患者的收缩压犤(16.0±2.4)mmHg,1mmHg=0.133kPa犦和舒张压犤(9.3±1.6)mmHg犦均显著高于无基础疾患者犤(15.3±1.1),(8.9±1.6)mmHg犦(t=5.054,3.120,P<0.05)。结论:①SARS患者最常见的并发症是糖尿病和高血压。②有并发症者多为老年SARS患者,有并发症者常预后不良。③有并发症的SARS患者呼吸功能更易受损,出现呼吸困难。     

109例慢性B淋巴系白血病免疫表型特征分析

本研究目的在于了解慢性B淋巴系白血病（B-CLL）的免疫表型特征,为临床的诊断、治疗、微小残留病灶检测及预后判断提供依据。应用流式细胞术及一组单克隆抗体,通过双色/三色流式细胞术,采用细胞表面与胞浆联合标记的方法,对109例序贯而来的B-CLL病例进行免疫表型分析。结果表明,109例B-CLL均表达CD19,其他B系抗原CD20、CD22、CD23阳性率分别为95.40%、94.50%、86.20%,无1例表达CD10。在105例B-CLL中有28.60%表达FMC-7,36.20%表达CD38。在所有B-CLL中CD5^＋B-CLL占86.23%,CD5^-B-CLL占13.76%。对50例B-CLL进行ZAP-70的检测,其中12例ZAP-70阳性。在73例B-CLL中,膜表面球蛋白κ轻链阳性多于λ轻链。结论：了解B-CLL的免疫表型特点对此类疾病的诊断及治疗后微小残留病灶的检测具有重要意义,而免疫表型与预后的关系则需作进一步研究。     

Serum NT-proCNP concentrations are elevated in patients with chronic liver diseases and associated with complications and unfavorable prognosis of cirrhosis

ObjectivesC-type natriuretic peptide (CNP) might be an important regulator of vasodilatation, fluid and sodium balance in liver cirrhosis. We aimed at assessing its regulation and prognostic relevance in liver disease patients.Design and methodsWe analyzed NT-proCNP serum levels in 193 patients with chronic liver diseases and 43 healthy controls.ResultsSerum NT-proCNP concentrations were significantly elevated in liver disease patients compared to healthy controls, with highest levels in established hepatic cirrhosis, independent of disease etiology. NT-proCNP was associated with complications of liver diseases and portal hypertension, namely ascites, esophageal varices and hepatic encephalopathy. Circulating NT-proCNP correlated inversely with renal function. Importantly, elevated NT-proCNP levels were identified as a predictor of mortality or necessity for transplantation. NT-proCNP levels > 2 pmol/L indicated adverse prognosis (sensitivity 66.7%, specificity 72.8%, RR 5.4 [95%-CI 2.6–11.2]).ConclusionsSerum NT-proCNP is elevated in advanced liver diseases and has prognostic value in cirrhotic patients.     

Factors influencing lengths of stay in the intensive care unit for surviving trauma patients: a retrospective analysis of 30,157 cases

Introduction

There are many potential influencing factors that affect the duration of intensive care treatment for patients who have survived multiple trauma. Yet the respective factors’ relevance to ICU length of stay (LOS) has been rarely studied. Thus, the aim of the present study was to investigate to what extent specific factors influence ICU LOS in surviving trauma patients.

Methods

We retrospectively analyzed a dataset of 30,157 surviving trauma patients from the TraumaRegister DGU® who were older than six years of age and received subsequent intensive care treatment for more than one day, from 2002 to 2011. Univariate analysis and multiple linear regression analysis were used to examine 25 categorical pre- and post-trauma parameters.

Results

Univariate analysis confirmed the impact of all analyzed factors. In subsequent multiple linear regression analyses, coefficients ranged from -1.3 to +8.2 days. The factors that influenced the prolongation of ICU LOS most were renal failure (+8.1 days), sepsis (+7.8 days) and respiratory failure (+4.9 days). Patients spent one additional day in the ICU for every 5 additional points on the Injury Severity Score (regression coefficient +0.2 per point). Furthermore, massive transfusion (+3.3 days), invasive ventilation (+3.1 days), and an initial Glasgow Coma Scale score ≤8 (+3.0 days) had a significant impact on ICU LOS. The coefficient of determination for the model was 44% (R²).

Conclusions

Treatment regimens, as well as secondary effects and complications of trauma and intensive care treatment, prolong ICU LOS more than the mechanism of trauma or pre-trauma patient conditions. Successful prevention of complicated courses of illness, such as sepsis and renal and respiratory failure, could significantly abbreviate the ICU stay in trauma patients. Therefore, the staff’s attention should be focused on preventive strategies.