Acute Lymphoblastic Leukemia following Treatment with Human Growth Hormone in a Boy with Possible Preanemic Fanconi's Anemia

The patient had a low birth weight and was born with appearenceanomalies including microcephalus, microphthalmia, hypoplasticmandible, double chin due to cutaneous fold, micropenis. Abilityto move and intelligence appeared to develop normally, but growthwas markedly retarded. In June 1982, at the age of 2 yr 4 mo,the patient underwent tolerance tests whereby a deficiency ofhuman growth hormone (GH) was proved by poor GH secretion response.GH was administered until April 1985 when acute lymphoblasticleukemia developed. The patient's younger brother, born in 1986,had similar birth anomalies and was diagnosed as having Fanconi'sanemia. It therefore seems possible that our patient developedhis acute leukemia through the stimulatory effect which GH hadon a predisposition to leukemia.     

雄激素联合维生素D3、细胞因子治疗MDS-RA的临床疗效观察

目的　观察雄激素联合维生素D3和细胞因子对难治性贫血 (RA)的疗效。方法　将 41例RA病人随机分为治疗组和对照组 ,治疗组联用雄激素、维生素D3、细胞因子 ,对照组采用雄激素 ,比较治疗组和对照组的疗效和副作用。结果　治疗组的总有效率为 76.0 % ,对照组的总有效率为 43.75 % ,二者差异有显著性 (P <0 .0 5 )。结论　雄激素联合维生素D3和细胞因子是RA的有效治疗方法     

环孢素A联合化疗方案治疗复发、难治性白血病

目的：探讨用环孢素A联合化疗方案治疗复发、难治性白血病的疗效。方法：18例急性非淋巴细胞白血病患者，采用CsA+DA方案治疗6例，CsA+MAE方案治疗12例。结果：CsA+DA组完全缓解率为33％。CsA+MAE组完全缓解率为50％。两组病例的有效率及完全缓解率经统计学分析没有显著差异，P值均大于0.5。结论：环孢素能够逆转难治性白血病的耐药性，在难治性白血病的治疗中有一定作用，但缓解后的治疗需要引起重视。     

Detection of Minimal Residual Disease in Adult Acute Lymphoblastic Leukemia by Analysis of Gene Rearrangements and Correlation with Early Relapses

While more than 75% of the adult patients with acute lymphoblastic leukemia (ALL) achieve a complete remission after treatment with intensive chemotherapy, about 40% of them relapse within five years. These relapses are probably due to residual leukemic cells. Gene rearrangements are used as markers of clonality and thereby monoclonal leukemic lymphoid cells can be detected with high sensitivity. In this study, we have applied the analysis of gene rearrangements to detect minimal residual disease in patients considered to be in complete remission. Serial bone marrow samples were studied in 35 patients before and four weeks after initiation of a standardized induction chemotherapy. Gene probes for the joining regions of the human immunoglobulin heavy chain and the constant regions of the human T-cell receptor β-chain were used.

In five of the 35 patients, the same gene rearrangements found before therapy persisted and indicated residual disease. Four of them relapsed within a median time of 10 weeks. Six of the 30 other patients without detectable gene rearrangements after induction therapy also relapsed, but median time to relapse was 30 weeks. Two of them had a relapse in the central nervous system without detectable bone marrow infiltration. Our data suggest that minimal residual disease, detected by analysis of gene rearrangements, is associated with a high early relapse rate. Analysis of gene rearrangements at the time of assessing the response to primary therapy seems to be of prognostic value in ALL and may contribute to a stratification of further therapy.     

Factors Potentially Associated with Chemotherapy-induced Anemia in Patients with Solid Cancers

Purpose: Chemotherapy-induced anemia (CIA) is one of the most important causes of anemia in cancerpatients. This study was conducted to describe the prevalence and characteristics of CIA in solid cancer patientsin the Chinese population, and to explore the relationship of white blood cell (WBC) or platelet decrease withCIA. Methods: Data on age, gender, tumor diagnosis, anti-cancer treatment and blood cell analyses were availablefrom 220 untreated non-anemic cancer patients who received at least 2 cycles of chemotherapy, and the data wereanalyzed to assess their relationship with CIA or its severity. Results: 139 patients (63.2%) presented anemia,most being Grade 1 or 2. Esophageal and lung cancers were associated with a high prevalence. G3/4 leucopeniaand decrease of platelets were identified as independent risk factors for the occurrence of CIA. Moreover, G3/4leucopenia, decrease of platelet and G3/4 thrombocytopenia were found to be also associated with the severity ofCIA. Cisplatin-containing regimens were a main potential factor in causing CIA, although significant associationwas only found on univariate analysis. Conclusion: Anemia or decrease in hematoglobin are common in Chinesecancer patients receiving chemotherapy. Cisplatin-containing regimens might be an important factor influencingthe occurrence of CIA. Our analysis firstly described some risk factors, such as decrease of platelets or WBCs,severity of leucopenia or thrombocytopenia, associated with the occurrence and severity of CIA.     

高剂量顺铂联合化疗治疗晚期恶性肿瘤：（附116例报告）

本文采用高剂量顺铂联合化疗116例晚期恶性肿瘤(DDP50～108mg/m~2/次),对睾丸癌和乳腺癌疗效较好,缓解率为100％和81％,对非小细胞肺癌、食管癌,恶性黑色素瘤和鼻咽癌也有效。2例成骨肉瘤肺转移病灶有明显缩小。副作用主要为呕吐(83％),骨髓抑制不重,未见明显肾功异常。     

Autoimmune Hemolytic Anemia in Chronic Lymphocytic Leukemia Patients Treated with Fludarabine

Autoimmune hemolytic anemia (AHA) is a frequent complication of chronic lymphocytic leukemia (CLL). Although the pathogenesis of AHA is still unknown, an imbalance of normal residual T cells is believed to play a central role. Since fludarabine is reported to affect primarily T lymphocytes, we conducted a retrospective study to evaluate the incidence and outcome of AHA in 112 CLL patients treated with fludarabine alone. Eight patients had AHA before therapy; only one achieved remission of both CLL and AHA after fludarabine alone. In the other seven patients, we observed no effect or even a worsening of AHA, although the CLL was responding to fludarabine. Five patients developed AHA from 1 to 19 months after fludarabine therapy while the CLL was responding. One additional patient developed pure red cell aplasia (PRCA) 3 months after starting therapy. Most patients in both groups responded to steroids or other immunosuppressive therapy. The study showed that in these patients, AHA evolved independently of CLL and was not affected by fludarabine.     

Single dose total lymphoid irradiation combined with cyclophosphamide as immunosuppression for human marrow transplantation in aplastic anemia.

Six patients with aplastic anemia underwent bone marrow transplantation following conditioning with high dose cyclophosphamide and single dose total lymphoid irradiation with 750 rad, 26 rad/min at the midplane of the patient. They all received bone marrow from human leukocyte antigens/mixed lymphocyte culture (HLA/MLC) matched siblings. Five of 6 patients were alive without complications at 12, 11, 7, 4 and 4 months respectively. The remaining patient died from sepsis which he had prior to transplantation. There were no graft rejection, graft-vs-Host Disease (GVHD) or interstitial pneumonitis among these patients. The procedure was well tolerated with minimal side effects. The results will be compared with those of groups whose bone marrow was previously transplanted with different immunosuppressive methods.     

Systematic Review and Meta-analysis of CD19-Specific CAR-T Cell Therapy in Relapsed/Refractory Acute Lymphoblastic Leukemia in the Pediatric and Young Adult Population: Safety and Efficacy Outcomes

Acute lymphoblastic leukemia (ALL) typically responds better when treated with multiagent chemotherapy in the pediatric and young adolescent populations. Treatment of relapsed/refractory (RR) ALL remains a challenge. Even after stem-cell transplantation and intensive chemotherapy, the prognosis of RR-ALL remains grave. The advent of chimeric antigen receptors has demonstrated promising results in RR-ALL. Chimeric antigen receptor–modified T cells (CAR-T) and engineered T cells are used to target cancer cells. In 2017, the US Food and Drug Administration approved CD19-specific CAR-T (tisagenlecleucel) therapy for RR–B-cell ALL in patients under 25 years old. In this systematic review, we discuss the efficacy and safety of CD19-specific CAR-T therapy in RR–B-cell ALL in the pediatric and young adult population. We searched the PubMed, Embase, Web of Science, Cochrane Library, and clinical trials databases. A total of 448 patients received a CD19-specific CAR-T product, and 446 patients had evaluable data. The age range was 0 to 30 years. The incidence rate of complete remission was 82%. The cumulative incidence of relapse after CD19-specific CAR-T therapy is 36%. Similarly, the incidence rate of grade 3 or higher adverse events of neutropenia, thrombocytopenia, neurotoxicity, infections, and cytokine release syndrome were 38%, 23%, 18%, 29%, and 19%, respectively. Our subgroup analysis shows the incidence rate of minimal residual negative complete remission was 69% with the CD28z costimulatory domain, 81% with the 4-1BB domain, and 77% with fourth-generation CD19-specific CAR-T therapy.     

持续滴注异长春花碱联合异环磷酰胺治疗难治性非霍奇金淋巴瘤

目的：临床研究持续性静脉滴注诺维本(Navelbine，NVB)联合异环磷酰胺(Ifosfamide，IFO)治疗难治性非霍奇金淋巴瘤(NHL)的近期疗效与毒副反应。方法：入组22例经CHOP治疗失败的NHL患，给予持续性静脉滴注NVB联合IFO化疗，至少2个周期，疗效及毒性判定按照WHO标准。结果：完全缓解(CR)6例，部分缓解(PR)13例，稳定(NC)1例，进展(PD)2例，总有效率86．4％。主要毒副作用为骨髓抑制。结论：持续静脉滴注NVB联合IFO治疗难治性NHL有较高的疗效，并较为安全，患可耐受。     

蔗糖铁注射液联合促红细胞生成素治疗癌症相关贫血的临床观察

 目的观察蔗糖铁注射液联合促红细胞生成素（rHuEPO）治疗癌症相关贫血的疗效、安全性和对患者生活质量的影响。方法将56例癌症相关贫血患者随机分为两组各28例：治疗组静脉滴注蔗糖铁每次100mg,2次/周;对照组口服富马酸亚铁每次300mg,3次/日;两组均同时皮下注射rHuEPO 40 000 IU/周;疗程为6周。观察治疗前后贫血状况和铁代谢指标的变化及治疗的安全性,并应用卡氏功能状态（KPS）进行生活质量测评。结果治疗组与对照组比较血红蛋白（Hb）、红细胞压积（Hct）、铁蛋白（SF）和转铁蛋白饱和度（TSAT）均明显升高（P<0.001）,患者的主观症状和生活质量有明显改善（P<0.05）,且不良反应发生率低（P<0.05）。结论蔗糖铁注射液联合rHuEPO治疗癌症相关性贫血的疗效和安全性,优于富马酸亚铁联合rHuEPO,并能够提高患者生活质量。     

Clinical Efficacy and Safety in Relapsed/Refractory Diffuse Large B-Cell Lymphoma: A Systematic Literature Review

This systematic literature review was designed to assess information on the clinical efficacy and safety of interventions used in the treatment of refractory or relapsed diffuse large B-cell lymphoma (R/R DLBCL) and to perform a meta-analysis if possible. We searched databases (PubMed, EMBASE, and Cochrane Library for articles from 1997 to August 2, 2012 reported in English), conference abstracts, bibliographic reference lists, and the ClinicalTrials.gov database for phase II to IV studies with results. Studies had to report on patients with R/R DLBCL who were not eligible to receive high-dose therapy (HDT) with stem cell transplantation (SCT) (autologous or allogeneic). Mixed-type non-Hodgkin lymphoma (NHL) studies were required to report R/R DLBCL outcomes separately. We identified 55 studies that presented outcomes data separately for patients with R/R DLBCL. Of 7 comparative studies, only 4 were randomized controlled trials (RCTs). In the 2 RCTs with a common regimen, the patient populations differed too greatly to perform a valid meta-analysis. The 48 single-arm studies identified were typically small (n < 50 in most), with 31% reporting median progression-free survival (PFS) or overall survival (OS) specifically for the R/R DLBCL population. In these studies, median OS ranged from 4 to 13 months. The small number of RCTs in R/R DLBCL precludes identifying optimal treatments. Small sample size, infrequent reporting of OS and PFS separated by histologic type, and limited information on patient characteristics also hinder comparison of results. Randomized studies are needed to demonstrate which current therapies have advantages for improving survival and other important clinical outcomes in patients with R/R DLBCL.     

Two Ocular Infections during Conventional Chemotherapy in a Patient with Acute Lymphoblastic Leukemia: A Case Report

Viral retinitis due to cytomegalovirus (CMV) infection is rare in patients with acute leukemia who did not receive hematopoietic stem cell transplantation. We report a case of CMV retinitis that developed in a 49-year-old patient with acute lymphoblastic leukemia. The patient was treated with salvage chemotherapy using a hyper-CVAD regimen and did not receive hematopoietic stem cell transplantation. The incidence of CMV retinitis in this subgroup of patients is not described in literature. He had a very complicated course during chemotherapy but was successfully treated, with preservation of visual acuity, and to date he is in complete remission. Interestingly, prior to CMV retinitis, the patient had been diagnosed with and treated for candida retinitis. This case shows the importance of eye examination and care in patients diagnosed with hematological malignancies.Key Words: Cytomegalovirus retinitis, Acute lymphoblastic leukemia, Chemotherapy, Hyper-CVAD, Candida     

Spontaneous Splenic Rupture in a Patient with Acute Lymphoblastic Leukemia of Burkitt Type

We describe a case of spontaneous splenic rupture occurred in a patient with acute lymphoblastic leukemia of Burkitt type before starting cytotoxic chemotherapy. Left hypochondrial pain radiating to the homolateral shoulder was the only clinical symptom. Emergency computed tomography showed splenic laceration and hemoperitoneum. The patient underwent immediate laparotomy with splenectomy and experienced an uneventful postoperative recovery. Eight days after surgery, chemotherapy could be administered and complete remission was achieved. Although spontaneous rupture of the spleen is rare in leukemia and related disorders, this diagnosis should be taken in account also when clinical symptoms are mild. Following immediate operative management, patients may completely recover and receive cytotoxic chemotherapy with substantial possibilities of achieving complete remission.     

改良ProMACE-CytaBOM方案治疗复发、难治侵袭性NHL的疗效评价

目的评价改良ProMACE-CytaBOM方案治疗复发、难治侵袭性NHL的疗效及安全性。方法回顾性分析2005年5月至2010年9月期间,我院收治的27例复发、难治性侵袭性淋巴瘤患者,其中男19例,女8例,中位年龄47（15～74）岁;均采用改良ProMACE-CytaBOM方案;21天为1周期。结果27例患者均可评价疗效,总有效率51.8%（完全缓解率22.2%）。中位无进展生存期为7月,中位总生存期为19月。B细胞、LDH正常NHL患者中位无进展生存期长于T细胞、LDH高者,差异均有统计学意义（P＜0.05）。B细胞、IPI≤2、LDH正常的NHL患者中位总生存期长于T细胞、IPI＞2、LDH高者,差异均有统计学意义（P＜0.05）。不良反应主要有Ⅱ～Ⅲ度血液学毒性及Ⅰ～Ⅱ度非血液学毒性,6例并发轻度感染,经一般抗生素治疗可控制。结论ProMACE-CytaBOM改良方案治疗复发、难治侵袭性NHL疗效肯定,不良反应可耐受,值得进一步研究。