共查询到20条相似文献,搜索用时 15 毫秒
1.
To investigate whether the post-therapy lymphocyte/monocyte ratio (ALC/AMC ratio or LMR) predicts early relapse in patients with diffuse large B cell lymphoma (DLBCL), we enrolled 125 consecutive patients with DLBCL and followed up from 2005 to 2015 in our hospital. The LMR was measured following completion of first-line therapy. We found that the LMR following completion therapy was a strong predictor of early relapse, which is less than 12 months after diagnosis. A low LMR was significantly associated with early relapse in both univariate [odds ratio (OR)?=?8.8; P?=?0.006] and multivariate analysis (OR?=?8.951; P?=?0.011). The low-LMR group (<2.9) had poorer outcomes than the high-LMR group (≥2.9), with a lower 2-year progression-free survival rate (78.9 versus 97.1 %, P?=?0.002) and 2-year OS rate (82.5 versus 98.5 %, P?=?0.002). This study suggests that a lower LMR following completion of first-line therapy can be used as a marker to predict early relapse in patients with DLBCL. 相似文献
2.
Tai WM Chung J Tang PL Koo YX Hou X Tay KW Quek R Tao M Lim ST 《Annals of hematology》2011,90(7):809-818
Central nervous system (CNS)-directed prophylactic intrathecal (IT) therapy is indicated in patients with Burkitt and acute
lymphoblastic lymphoma. Its role in diffuse large B cell lymphoma (DLBCL), a heterogeneous subtype, is less well defined.
While addition of rituximab to standard cyclophosphamide–hydroxydaunorubicin–oncovin–prednisone (CHOP) chemotherapy (R-CHOP)
has improved the outcomes of DLBCL patients, its role in reducing CNS relapse is unclear. We aim to (1) evaluate the clinical
risk factors predictive of CNS relapse, (2) the role of rituximab in influencing CNS relapse, and (3) role of intrathecal
prophylaxis. Four hundred ninety-nine patients with DLBCL from 2000 to 2008 were included (CHOP 179 vs. R-CHOP 320). IT prophylaxis
was administered to 82 patients based on our institution’s guidelines. Baseline characteristics between CHOP- and R-CHOP-treated
patients were similar. Although R-CHOP significantly increased the complete remission rate from 71% to 81% (P < 0.01), CNS relapse rates remained unchanged (R-CHOP 6% vs. CHOP 5.1%). On multivariate analysis, poor performance status
(Eastern Cooperative Oncology Group >1; hazard ratio (HR) = 2.01, 95% confidence interval (CI) 1.29–3.14), failure to attain
remission (non-complete response (CR) vs. CR: HR = 2.39, 95% CI = 1.03 to 5.51), testicular (HR = 6.67, 95% CI = 1.62 to 27.53),
kidney (HR = 20.14, 95% CI = 5.23 to 77.46), and breast involvement (HR = 6.14, 95% CI = 1.61 to 23.37) were each independently
predictive of CNS relapse. Use of IT prophylaxis did not appear to decrease CNS relapse. Median survival after CNS relapse
was 3.2 months. CNS relapse, a fatal event, remains a challenge in R-CHOP-treated patients. IT prophylaxis may not be sufficient
to reduce CNS relapse, and strategies including systemic agents with high CNS penetration should be evaluated in high-risk
patients identified in this study. 相似文献
3.
Roohipour R Patil S Goodman KA Minsky BD Wong WD Guillem JG Paty PB Weiser MR Neuman HB Shia J Schrag D Temple LK 《Diseases of the colon and rectum》2008,51(2):147-153
Purpose The incidence of anal canal squamous-cell carcinoma is increasing. Limited data exist on predictors of treatment failure.
This study was designed to identify predictors for relapse/persistence after first-line therapy.
Methods Using one database, we identified 131 Stages I-III patients treated for primary anal canal squamous-cell carcinoma at our
institution from December 1986 to August 2006, with minimum six-month follow-up. Demographic, pathologic, treatment, and outcome
data were extracted. Treatment failure was defined as biopsy-proven persistence or relapse (local and/or distant). Univariate,
bivariate, and multivariate survival analyses were performed.
Results Of 131 patients (median age, 58.3 years; median follow-up, 2.9 (range, 0.6–11.2) years), 66 percent were females, 43.5 percent
were Stage II, and 11 (8 percent) were HIV-positive. Surgery only (local excision) was uncommon (6.9 percent, n = 9). One
hundred twenty-two patients (93.1 percent) received radiotherapy; two required preradiotherapy diversion. Although 114 (93.4
percent) completed radiotherapy, most required treatment breaks, making total duration of radiotherapy longer than planned.
Almost all patients undergoing radiotherapy (96.7 percent, 118/122) also had chemotherapy: 118 (100 percent, Stages I-III)
had concurrent chemotherapy: (98 (83.8 percent) mitomycin/5-fluorouracil, 12 (10.2 percent) cisplatin/5-fluorouracil, 8 (6.8
percent) 5-fluorouracil alone); 35 of 46 (76 percent) Stage III patients received induction chemotherapy (34 (97.1 percent)
cisplatin/5-fluorouracil, 1 (2.8 percent) 5-fluorouracil alone). Many (44 percent Stages I/II, 48.9 percent Stage III) required
dose adjustments. Thirty-seven patients (28.2 percent) failed first-line therapy. There were no differences between patients
with relapse (n = 22) or persistence (n = 15) of disease. Bivariate analyses demonstrated that T stage (P = 0.0019), completion of radiotherapy, and total radiotherapy dose (P = 0.03) were all significantly associated with treatment failure. On multivariate analyses, disease stage (P = 0.05) and completion of radiotherapy (P = 0.01) remained significant predictors of relapse-free survival.
Conclusions Tolerance of chemoradiation seems to be an important predictor of treatment success. Effective therapies with less acute toxicity
must be identified.
Dr. Temple is funded by the Society of University Surgeons and by the American Society of Clinical Oncology.
Read at the meeting of The American Society of Colon and Rectal Surgeons, June 2 to 6, 2007.
No reprints available.
An erratum to this article can be found at 相似文献
4.
Nozomi Niitsu Jun-ichi Tamaru Tadashi Yoshino Naoya Nakamura Shigeo Nakamura Kohichi Ohshima Hirokazu Nakamine Masataka Okamoto 《Annals of hematology》2011,90(2):185-192
In our previous study on nm23-H1 expression with diffuse large B-cell lymphoma (DLBCL), we found that patients with positive
nm23-H1 had significantly poorer prognosis than patients with negative nm23-H1. We examined whether nm23-H1 is a prognostic
factor of DLBCL in the rituximab era. The subjects were 101 DLBCL patients who underwent R-CyclOBEAP (rituximab, cyclophosphamide,
vincristine, bleomycin, etoposide, doxorubicin, and prednisolone) therapy and in whom markers could be analyzed. We evaluated
CD5, CD10, BCL2, BCL6, MUM1, and nm23-H1 expression by immunohistochemistry. Ninety-four DLBCL patients who underwent CyclOBEAP
therapy were assumed as historical controls. Among DLBCL patients who underwent CyclOBEAP therapy, BCL2 positivity, MUM1 positivity,
non-germinal center B-cell (non-GCB), and nm23-H1 positivity were associated with significantly shorter overall survival (OS)
and progression-free survival (PFS). On the other hand, among DLBCL patients who underwent R-CyclOBEAP therapy, the 5-year
OS rates of the nm23-H1-positive DLBCL (n = 32) and nm23-H1-negative DLBCL groups (n = 69) were 65% and 97%, respectively (p = 0.001), with 5-year PFS rates of 51% and 89%, respectively (p = 0.001). In the rituximab era, BCL2, MUM1, and non-GCB were not prognostic factors. We demonstrated that among patients
with DLBCL who underwent R-CyclOBEAP therapy, patients with nm23-H1 expression had a significantly poorer prognosis than patients
without nm23-H1 expression. These results suggest an important role for nm23-H1 in malignant progression and a potential therapeutic
target for DLBCL. 相似文献
5.
Tsuneaki Hirakawa Hiroki Yamaguchi Norio Yokose Seiji Gomi Koiti Inokuchi Kazuo Dan 《Annals of hematology》2010,89(9):897-904
CHOP-like regimen combined with rituximab is a standard chemotherapy for diffuse large B-cell lymphoma (DLBCL). The relative
dose intensity (RDI) was proposed as an index of the dose and administration interval of agents. Previous studies reported
that the maintenance of the RDI during CHOP therapy improved the treatment results. However, few studies regarding RDI have
reviewed patients receiving combination therapy with CHOP and rituximab. We investigated the influence of RDI maintenance,
involving combination therapy with rituximab, on therapeutic effects in patients with DLBCL. We retrospectively examined 152
DLBCL patients who were treated with CHOP-like regimen combined with rituximab in whom the RDI could be followed up. Multivariate
analysis revealed that international prognosis index (IPI) high intermediate-high (HI-H) (p = 0.005) and RDI of less than 70% (p = 0.007) were independent prognostic factors for low progression free survival. Concerning overall survival, IPI HI-H (p = 0.027) and an RDI of less than 70% (p = 0.002) were involved in an unfavorable prognosis. In addition, age over 60 years (p = 0.003), R-THPCOP (p = 0.034), or the presence of febrile neutropenia (p = 0.004) made RDI maintenance difficult, and prophylactic G-CSF therapy (p = 0.026) was useful for maintaining the RDI. Maintaining the RDI is important even in the era of rituximab-combined chemotherapy
for DLBCL. 相似文献
6.
Addition of rituximab to chemotherapy (R-chemo) has been shown to improve overall survival (OS) in patients with diffuse large
B cell lymphoma (DLBCL). Germinal center B cell-like (GCB) subtype of DLBCL has a significantly better clinical outcome than
those with non-germinal center B cell-like (non-GCB) subtype. Further research is needed to confirm this difference between
those two subtypes treated with R-chemo. We searched for randomized controlled trials that compared R-chemo with identical
chemotherapy alone in patients with newly diagnosed or relapsed DLBCL. A random versus fixed effects model was selected according
to heterogeneity. Six eligible trials involving 748 adult patients were included in this meta-analysis. Fixed-effects analysis
showed OS to be superior for the GCB patients treated with R-chemo (relative risk (RR) = 1.16, 95% confidence interval (CI) = 1.03–1.31,
P = 0.02). Superiority was also observed for the GCB subtype under R-chemo with respect to disease control (RR = 1.16, 95%
CI = 0.99–1.36) and overall response (RR = 1.19, 95% CI = 0.99–1.99). Both subtypes showed an increased OS (RR = 1.30, 95%
CI = 1.11–1.51; RR = 1.89, 95% CI = 1.52–2.35, respectively) and disease control rate (RR = 1.27, 95% CI = 1.05–1.54, P = 0.01; RR = 2.21, 95% CI = 1.68–2.90, respectively) following R-chemo. Therefore, treated with R-chemo, GCB patients still
has a significantly better clinical outcome than those with non-GCB subtype. 相似文献
7.
Shen Yang Yao Yu Li Jun-Min Mi Jian-Qing Chen Qiu-Sheng Chen Yu Zhao Wei-Li You Jian-Hua Zhao Hui-Jin Wang Yan Wang Li Cheng Shu Shen Zhi-Xiang 《Annals of hematology》2009,88(9):863-869
We performed this study to reassess the prognostic factors of diffuse large B-cell lymphoma (DLBCL) in the era of rituximab,
cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) in Chinese population. One hundred and twenty-five consecutive
patients with DLBCL were enrolled in this study from February 2000 to September 2006. They had received six courses of R-CHOP
regimen consisting of rituximab 375 mg/m2, intravenously, D1; cyclophosphamide 750 mg/m2, bolus infusion, D2; doxorubicin 50 mg/m2, bolus infusion, D2; vincristine 1.4 mg/m2, bolus infusion, D2; and prednisone 60 mg, orally, D2-6. All the patients were evaluated and followed-up after the treatment.
Eighty-six out of 125 enrolled patients (68.8%) achieved complete response (CR), 16 patients (12.8%) achieved partial response
(PR), 11 patients (12.8%) achieved stable disease, and 12 patients (9.6%) experienced progressive disease (PD). In univariate
analysis, IPI factors, except for age, was correlated with the treatment outcome of complete remission; however, only early
clinical stages and absence of bulky disease was statistically significantly associated with the better CR rate. Lactate dehydrogenase
(LDH), extranodal diseases, bulky disease, and obtaining CR after completion of four courses of treatment was correlated with
TTF (P = 0.038, 0.044, 0.034, and 0.000, respectively); performance status, LDH level, number of extranodal diseases, and obtaining
CR after completion four courses of treatment significantly influenced OS (P = 0.027, 0.000, 0.019, and 0.000, respectively); and presence of bulky disease and obtaining CR at the end of fourth cycle
of treatment were significantly correlated with DFS in multivariate analysis (P = 0.006 and 0.001, respectively) in Cox regression. IPI is still important in predicting the prognosis in the R-CHOP era
in DLBCL; however, obtaining CR after four cycles of R-CHOP and presence of bulky disease should be considered together.
Shen Yang and Yao Yu contribute equally to this work. 相似文献
8.
Lin PC Hsiao LT Poh SB Wang WS Yen CC Chao TC Liu JH Chiou TJ Chen PM 《Annals of hematology》2007,86(2):95-100
Although adding rituximab to standard cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy is an
efficacious and well-tolerated regimen in elderly patients with diffuse large B cell lymphoma (DLBCL), it may increase susceptibility
to opportunistic infections, and such cases have been reported. Our study was to identify the risk factors for fungal infection
in a retrospective case-control matched study of 34 elderly DLBCL patients treated with rituximab plus CHOP (R-CHOP) and 35
control patients treated with the standard CHOP regimen at the Taipei Veterans General Hospital, Taiwan. The rate of overall
infection was similar in both groups. However, subgroup analysis found that the fungal infection rate was significantly different,
41.7 and 17.1%, in the R-CHOP and CHOP groups, respectively, (P = 0.03). Univariate analysis identified the rituximab plus CHOP chemotherapy regimen (P = 0.03), age older than 80 years (P = 0.04), and bone marrow involvement (P = 0.04) as risk factors for development of fungal infection, whereas, multivariate regression analysis identified only rituximab
plus CHOP and old age. Adding rituximab to the standard CHOP regimen in elderly DLBCL patients might increase the incidence
of fungal infection especially in those older than 80 years old. 相似文献
9.
Luis F. Porrata Kay Ristow Thomas M. Habermann Thomas E. Witzig David J. Inwards Svetomir N. Markovic 《American journal of hematology》2009,84(2):93-97
Peripheral blood absolute lymphocyte count (ALC) is a survival prognostic factor in hematological malignancies. No reports have addressed whether ALC at the time of first relapse (ALC‐R) predicts survival. Thus, we assessed the prognostic significance of ALC‐R in diffuse large B‐cell lymphoma (DLBCL). Patients were required to have been diagnosed with first relapsed DLBCL, have ALC‐R values, and to be followed at Mayo Clinic, Rochester. From Feb 1987 until March 2006, 97 first relapsed DLBCL patients qualified for the study. The overall survival (OS) and progression‐free survival (PFS) were measured from the time of first relapse. The value of ALC‐R ≥ 1.0 × 109/L was used for the analysis. Both groups (ALC‐R ≥ 1 or < 1 × 109/L) were balanced for the international prognostic index at relapse (IPI‐R) (P = 0.3), and for autologous stem cell transplantation (P = 0.4). Superior OS and PFS were observed with an ALC‐R ≥ 1.0 × 109/L (N = 60) versus ALC‐R < 1.0 × 109/L (N = 37) [median OS: 28.7 months, 5 years OS rates of 39% versus median OS: 10.2 months, 5 years OS rates of 14%, P < 0.002; and median PFS: 14.8 months, 5 years PFS rates of 21% versus median PFS: 6.5 months, 5 years PFS rates of 8%, P < 0.004, respectively]. ALC‐R was an independent prognostic factor for OS [RR = 0.4, P < 0.01] and PFS [RR = 0.5, P < 0.005]. ALC‐R predicts survival suggesting that host immunity is an important variable predicting survival in first relapsed DLBCL. Am. J. Hematol. 2009. © 2008 Wiley‐Liss, Inc. 相似文献
10.
Elias Hallack Atta Danielle Saldanha Peixoto Dias Vera Lúcia Neves Marra Alexandre Mello de Azevedo 《Annals of hematology》2010,89(9):851-859
The best antithymocyte globulin preparation for first-line immune suppression in patients with severe aplastic anemia is still
not clear. The aim of this study was to compare hematological response and overall survival in patients submitted to horse
or rabbit antithymocyte globulin as first-line treatment for severe aplastic anemia. We retrospectively compared 71 consecutive
patients with severe aplastic anemia, classified according to the antithymocyte globulin preparation. Analyses included variables
related to patients and to immune suppression. Forty two patients (59.1%) received horse and 29 (40.9%) rabbit antithymocyte
globulin. Response rates were higher at 6 months in patients submitted to horse in comparison to rabbit antithymocyte globulin
(59.5% versus 34.5% respectively, p = 0.05). Median time to response was similar between the two groups (99 versus 88.5 days, respectively, for horse and rabbit
antithymocyte globulin; p = 0.98). Overall survival at 2 years was significantly higher in patients submitted to horse in comparison to rabbit antithymocyte
globulin (78.4% versus 55.4%, p = 0.03). Post-treatment response was strongly associated with survival at 2 years (97% in responders versus 41.2% in non-responders,
p < 0.001). Use of rabbit antithymocyte globulin was an independent predictor of death (odds ratio 2.5; 95% confidence interval
1.03–6.04; p = 0.04). Rabbit antithymocyte globulin was associated with a significant and prolonged lymphopenia in comparison with horse
antithymocyte globulin. Our data suggest the superiority of horse over rabbit antithymocyte globulin as first-line treatment
for severe aplastic anemia, both regarding hematological response and survival. 相似文献
11.
Tsai HL Yeh YS Yu FJ Lu CY Chen CF Chen CW Chang YT Wang JY 《International journal of colorectal disease》2009,24(2):177-183
Background and aim The aim of this retrospective study was to determine which clinicopathological factors influenced the incidence of postoperative
relapse and overall survival rates after radical resection of T2-4N0M0 colorectal cancer (CRC) patients via harvesting a minimum of 12 lymph nodes.
Materials and methods Between January 2001 and June 2006, a total of 342 T2-4N0M0 CRC patients who underwent radical resection were retrospectively analyzed in Kaohsiung Medical University Hospital. Of these
342 patients, 155 were observed by harvesting a minimum of 12 lymph nodes. These 155 patients were followed up intensively,
and their outcomes were investigated retrospectively.
Results Of 155 patients, 83 were men (53.5%) and 72 (46.5%) were women. The mean age was 65.5 ± 11.1 years (range, 24–89 years). The
median follow-up period was 49 months (range, 19–80 months). The present data showed invasive depth (P = 0.012), vascular invasion (P < 0.001), and perineural invasion (P = 0.009) as significantly prognostic factors for postoperative 5-year relapse rate by Kaplan–Meier analysis. Likewise, invasive
depth (P = 0.013), vascular invasion (P < 0.001), and perineural invasion (P = 0.008) were significant factors for postoperative 5-year survival rate. Meanwhile, using a Cox proportional hazards analysis,
depth of tumor invasion (P = 0.026) and vascular invasion (P = 0.001) were the independent predictors for postoperative relapse. Furthermore, the presence of vascular invasion was considerably
correlated to the higher postoperative relapse rate and the poorer overall survival rates by survival analyses (P < 0.0001).
Conclusions Besides the conventional depth of tumor invasion, this study highlights the potential for using vascular invasion as a means
of identifying a subgroup of T2-4N0M0 CRC patients with adequate lymph node harvest at higher risk who would potential benefit from adjuvant therapy after surgery. 相似文献
12.
The prognostic value of absolute lymphocytic count (ALC) has been a recent matter of debate in the study of non-Hodgkin-lymphoma.
To evaluate the prognostic value of ALC at diagnosis in patients with diffuse large B-cell lymphoma (DLBCL), we performed
a meta-analysis of published studies that provided survival information with reference to ALC at diagnosis. Six studies covering
a total of 1,206 subjects were included in this analysis. The summary hazard ratios of low ALC for overall survival were 2.72
(95% confidence interval (CI) 2.15–3.45, P < 0.001) in the entire population, 2.96 (95% CI 2.04–4.29, P < 0.001) in the population that received CHOP, and 2.78 (95% CI 1.87–4.13, P < 0.001) in the population that received R-CHOP. The corresponding ratios for progression-free survival were 2.79 (95% CI
1.90–4.11, P < 0.001) in the entire population, and 2.56 (95% CI 1.66–3.96, P < 0.001) in the population that received R-CHOP. In conclusion, our systematic analysis suggests that low ALC has an adverse
effect on outcome in DLBCL. Although it should be borne in mind that this meta-analysis was mainly based on data abstracted
from observational studies, these results may justify risk-adapted therapeutic strategies for DLBCL to account for ALC at
diagnosis. 相似文献
13.
Gastric mucosa-associated lymphoid tissue (MALT) lymphoma and diffuse large B cell lymphoma (DLBCL) show a spectrum of disease
characterized by varying proportions of low-grade and high-grade components. While the natural history and optimum treatment
for low-grade gastric MALT lymphoma and DLBCL is well established, the prognosis and optimal treatment of patients with both
low- and high-grade components is not well established. The purpose of our study was to evaluate the clinical characteristics,
survival outcomes, and prognostic factors of patients with gastric MALT lymphoma and gastric DLBCL. A retrospective review
of patients with gastric MALT lymphoma, gastric DLBCL, or MALT lymphoma with a high-grade component treated at our centers
from 1994 to 2006 was performed. Patients were divided into three categories: “pure MALT lymphoma,” “MALT lymphoma with high-grade
component” (mixed), and “pure DLBCL.” Seventy-six patients were included in our study—26 with pure MALT, 22 with MALT with
high-grade component (“mixed”), and 28 with pure DLBCL. Pure MALT lymphoma and mixed lymphoma patients had similar clinical
characteristics, whereas pure DLBCL patients had less favorable disease characteristics with significantly poorer performance
status, higher number of extranodal sites of disease, higher stage, and larger proportion of bone marrow involvement and international
prognostic index (IPI) scores compared with mixed lymphoma. The majority of mixed lymphoma (72.7%) and DLBCL patients (71.4%)
were treated with chemotherapy. Of patients receiving chemotherapy, a higher proportion of mixed lymphoma and DLBCL patients
received anthracycline-based combination chemotherapy regimens compared with MALT lymphoma (73% vs 71% vs 8%) whereas the
proportion of mixed lymphoma and DLBCL patients was similar (p = 0.919). At a median follow-up of 37 months, the 5-year overall survival was 66.9%. The 5-year overall survival was 78%
for MALT lymphoma, 84% for mixed lymphoma, and 45% for DLBCL. On univariate analysis, DLBCL histology, age, performance status,
serum albumin, lactate dehydrogenase, bone marrow, number of extranodal sites, stage, and IPI score were prognostic for inferior
survival. On multivariate analysis, DLBCL histology remained significantly prognostic for inferior survival, independent of
chemotherapy regimen (hazard ratio (HR) 6.66, 95% confidence interval (CI) 2.01–21.41, p = 0.001). Mixed histology was not prognostic for inferior survival (HR 1.13, 95% CI 0.28–4.54, p = 0.868). Other factors prognostic for inferior survival were serum albumin <37 g/L (HR 3.22, 95% CI 1.11–13.22, p = 0.034) and treatment with non-cyclophosphamide, doxorubicin, vincristine, and prednisolone chemotherapy (HR 4.89, 95% CI
1.67–14.36, p = 0.004). In conclusion, the clinical characteristics of mixed histology MALT lymphoma are similar to low-grade MALT lymphoma
and significantly different from pure DLBCL. The prognosis of mixed histology MALT lymphoma is significantly better than pure
DLBCL, independent of IPI and chemotherapy regimen, and pure DLBCL histology is independently prognostic of inferior survival
outcome. 相似文献
14.
Juan Xu Bing-Xin Ji Li Su Hui-Qing Dong Wan-Ling Sun Sui-Gui Wan Ya-Ou Liu Pu Zhang Cong-Yan Liu 《Annals of hematology》2011,90(3):343-348
To evaluate clinical outcomes of autologous peripheral blood stem cell transplantation (APBCST) between opticospinal multiple
sclerosis (OSMS) and conventional multiple sclerosis (CMS) during disease progressive stage in a Chinese population. Thirty-six
secondary progressive MS patients, among whom 21 were with OSMS and 15 with CMS, underwent APBSCT and were followed up for
an average of 48.92 months (range, 10–91 months). Peripheral blood stem cells were obtained by leukapheresis after mobilization
with granulocyte colony-stimulating factor. Modified BEAM conditioning regimen (Tiniposide, melphalan, carmustin, and cytosine
arabinoside) were administered. Outcomes were evaluated using the expanded disability status scale (EDSS). No maintenance
treatment was administered if there was no disease progression. No treatment-related mortality occurred. Among the 36 patients,
one OSMS patient dropped during the follow-up. Among the 22 relapse-free patients, 20 were with continuous neurological improvement
without any relapse events, and two remained in neurologically stable states. Among the 13 relapse patients, seven had experienced
of neurological relapse, but with no progression during the follow-up period; and six experienced neurological deterioration
after transplantation and needed further immunosuppressant treatment. The confirmed relapse-free survival rate was 62.9% and
progression-free survival rate was 83.3% after 91 months according to Kaplan and Meier survival curves. Eleven of the 20 OSMS
patients (55%) and two of the 15 CMS patients (13.3%) stayed in disease active group (P = 0.014). For the 20 OSMS patients, the overall EDSS score decreased significantly after transplantation (P = 0.016), while visual functions had no significant improvement (P = 0.716). Progressive OSMS has a higher relapse rate than CMS following APBSCT. 相似文献
15.
Choojitarom K Verasertniyom O Totemchokchyakarn K Nantiruj K Sumethkul V Janwityanujit S 《Clinical rheumatology》2008,27(3):345-351
This study is aimed to determine the predictors of nongravid vascular thrombosis in systemic lupus erythematosus (SLE) patients
with positive antiphospholipid antibodies (SLE-aPL). A cohort of 67 SLE-aPL patients who had at least one positive test for
lupus anticoagulant (LA), anticardiolipin (aCL), or anti-beta2glycoprotein-1(B2) was examined. Main outcome was the presence
of vascular thrombosis. Association between thrombosis and risk factors was examined by contingency table. The odds ratio
(OR) of significant predictors was determined by logistic regression. Three percent of patients were LA+, 6% were aCL+, 31% were B2+, 3% were aCL+LA+, 35.8% were aCL+B2+, 7.5% were LA+B2+, and 13.4% were positive for all tests. As for clinical manifestations, 79% had lymphopenia, 76% had lupus nephritis (LN),
41.8% had autoimmune hemolytic anemia, 34.3% had thrombocytopenia, 20.9% had abortion, and 19.4% had Raynaud’s phenomenon
(RP). Thrombosis occurred in 26 patients. The prevalence of thrombosis for SLE-aPL was 38.8%. Thrombosis was observed more
frequently in patients with LA+ (12 of 18) than the others (14 of 49; p = 0.01). Two-by-two table showed that oral contraceptive and LN were significantly associated with increased risk of thrombosis,
while lymphopenia and antimalarials were significantly associated with decreased risk of thrombosis. Multivariate analysis
confirmed that LN and RP were associated with increased risk of thrombosis (OR = 6.2 and 3.2; p = 0.005 and 0.008), while lymphopenia and antimalarials were associated with decreased risk of thrombosis (OR = 0.86 and
0.18; p = 0.02 and 0.034). LA is the strongest test to determine the risk of thrombosis in SLE-aPL. The presence of LN and RP strongly
predicts thrombosis, while lymphopenia and antimalarials are protective. These findings help to identify patients who may
benefit from prophylactic therapy. 相似文献
16.
Fotios V. Michelis Hans A. Messner David Loach Jieun Uhm Vikas Gupta Jeffrey H. Lipton Matthew D. Seftel John Kuruvilla Dennis D. Kim 《European journal of haematology》2014,93(4):273-280
Allogeneic hematopoietic cell transplantation (HCT) is potentially curative for acute myeloid leukemia (AML). Impact of lymphocyte recovery on post‐transplant outcomes has been suggested but reports are conflicting. We evaluated the impact of lymphocyte recovery at 28 d post‐HCT in 191 AML patients using peripheral blood stem cells as graft. Patients were divided into those with absolute lymphocyte count (ALC) ≥0.5 × 109/L (n = 111, 58%; high ALC group) and those with ALC <0.5 × 109/L (n = 80, 42%; low ALC group), at day 28 post‐transplant. With a median follow‐up of 49 months, overall survival (OS) was significantly improved in the high ALC group (59% at 3 yr) vs. patients with low ALC (40% at 3 yr, P = 0.03). Cumulative incidence of relapse (CIR) was significantly lower in the high ALC group (16% at 3 yr) vs. low ALC group (36% at 3 yr, P = 0.001). Multivariable analysis for CIR demonstrated high ALC group as an independent factor decreasing relapse risk (P = 0.03, HR = 0.49, 95% CI = 0.26–0.92). Multivariable analysis for OS and non‐relapse mortality did not demonstrate ALC ≥0.5 × 109/L at 28 d post‐transplant to be predictive. We conclude that lymphocyte recovery with ALC ≥0.5 × 109/L at day 28 post‐transplant is associated with less relapse in AML patients undergoing allogeneic peripheral blood HCT, but without survival benefit. 相似文献
17.
Yan-Li Li Yue-Yin Pan Yang Jiao Jie Ning Yin-Guang Fan Zhi-Min Zhai 《Annals of hematology》2014,93(4):617-626
To determine whether peripheral blood absolute lymphocyte/absolute monocyte counts ratio (ALC/AMC ratio) at diagnosis predicts survival of diffuse large B cell lymphoma (DLBCL) patients treated with standard first-line regimens, we retrospectively analyzed 244 patients with DLBCL who were treated with standard cyclophosphamide, hydroxydaunorubicin, vincristine, and prednisone, or rituximab–cyclophosphamide, hydroxydaunorubicin, vincristine, and prednisone. Progression-free survival and overall survival (PFS and OS) were estimated using the Kaplan–Meier method and two-tailed log-rank; The Cox proportional hazards model was used to evaluate ALC/AMC ratio as prognostic factors when adjusting for the International Prognostic Index (IPI). On univariate and multivariate analyses performed with factors included in the IPI, the ALC/AMC ratio at diagnosis remained an independent predictor of OS and PFS (OS: P?<?0.001; PFS: P?<?0.001). Patients with lower ALC/AMC ratio (<3.8) seemed to have lower complete remission rate, 2-year PFS and 3-year OS when compared to patients with ALC/AMC ratio ≥3.8, respectively (26 versus 90 %, P?<?0.001; 18 versus 82 %, P?<?0.001; 24 versus 86 %; P?<?0.001, respectively). Moreover, the ALC/AMC ratio was able to further risk-stratify IPI 0-2 and three–five risk patient groups, respectively. The ALC/AMC ratio at the time of diagnosis may provide additional prognostic information beyond that of the IPI for patients with DLBCL who receive standard first-line regimens. 相似文献
18.
Robert Rosenberg Ken Herrmann Ralf Gertler Beat Künzli Markus Essler Florian Lordick Karen Becker Tibor Schuster Hans Geinitz Matthias Maak Markus Schwaiger Jörg-Rüdiger Siewert Bernd Krause 《International journal of colorectal disease》2009,24(2):191-200
Background To evaluate the value of positron emission tomography using fluorodeoxyglucose and computer tomography scan (FDG-PET/CT) for
prediction of histopathological response of preoperative radiochemotherapy (RCTX) in patients with rectal carcinoma.
Methods Thirty patients with uT3 rectal carcinoma were examined by FDG-PET/CT at baseline, 14 days after initiation, and after completion
of preoperative RCTX. The FDG decreases seen with PET scanning from baseline to day 14 (early metabolic response) and after
completion of therapy (late metabolic response) were compared with histopathological tumor response. One patient denied surgery
after RCTX.
Results The mean (±SD) reduction of tumor FDG uptake in histopathologically responding compared to non-responding tumors was −44.3%
(±20.1%) versus −29.6% (±13.1%) (p = 0.085) at day 14 and −66.0% (±20.3%) versus −48.3% (±23.4%) (p = 0.040) after completion of RCTX. Best differentiation of histopathological tumor response was achieved by a cut-off value
of 35% reduction of initial FDG uptake at day 14 and 57.5% after completion of therapy. Applying the cut-off values as a criterion
for metabolic response, histopathological response was predicted with a sensitivity of 74% (14/19) at day 14 and 79% (15/19)
after completion of therapy. The positive predictive value for early metabolic response was 82% (14/17) and for late metabolic
response was 83% (15/18). Histopathological evidence of accumulated peritumoral inflammation cells was associated with a minor
FDG decrease in five histopathologically responding patients, and influenced the results with negative predictive values of
58% (7/12) and 64% (7/11) at the early and late time points, respectively.
Conclusions Metabolic response to a preoperative RCTX using FDG-PET/CT in rectal cancer patients can be correlated with histopathological
response, but FDG uptake of peritumoral inflammation cells limited the results and led to false negative results. 相似文献
19.
Malaguarnera M Vacante M Motta M Giordano M Malaguarnera G Bella R Nunnari G Rampello L Pennisi G 《Metabolic brain disease》2011,26(4):281-289
The aim of this study was to investigate the effects of ALC treatment on cognitive functions in patients with severe hepatic
encephalopathy. This was a randomized, double-blind, placebo-controlled study. 61 patients with severe hepatic encephalopathy
were recruited to the study. The 2 groups received either 2 g ALC twice a day (n = 30) or placebo (n = 30) for 90 days. Clinical and laboratory assessment, psychometric tests and automated electroencephalogram (EEG) analysis
were performed for all patients. At the end of the study period, between the 2 groups we observed a significant difference
in Everyday Memory Questionnaire −23.9 vs 4.4 (p < 0.001), Logical Memory (Paragraph recall) test 22.3 vs 0.7 (p < 0.001), Trail Making Test A −7.5 vs −2.6 (p < 0.001), Trail Making Test B −10.5 vs −3.1 (p < 0.001), Controlled Oral Word Association Test 4.2 vs 0.5 (p < 0.001), Hooper test 2.6 vs 0.1 (p < 0.05), Judgement of line orientation 2.8 vs 0.3 (p < 0.001), Digit Cancellation time −24.5 vs −2.4 (p < 0.001), NH4+ 30.5 vs 13.5 (p < 0.001), prothrombin time 2 vs 2.4 (p < 0.05), alanine transaminase −10.7 vs −13.6 (p < 0.001). 88% of patients treated with ALC vs 72% of patients treated with placebo showed a significant improvement in EEG.
The improvement of cognitive deficits, the reduction of ammonia, and the modification of EEG in patients treated with ALC
suggest that ALC could represent a new tool in the treatment of severe hepatic encephalopathy. 相似文献
20.
Ri Bo Tang Jian Zeng Dong Xing Peng Liu Dong Ping Fang De Yong Long Xiao Hui Liu Rong Hui Yu Fu Li Hu Chun Shan Lu Peng Hao Jérôme Kalifa Chang Sheng Ma 《Journal of interventional cardiac electrophysiology》2006,17(1):41-46
Background and objective Little is known about the outcome of catheter ablation of atrial fibrillation (AF) in patients with diabetes mellitus (DM).
We investigated the safety and efficacy of catheter ablation of AF in patients with DM.
Materials and methods Thirty one patients with DM from a group of 263 consecutive patients undergoing a first-time catheter ablation of AF procedure
were enrolled in a prospective study. The ablation protocol (guided by CARTO system) consisted in two continuous circular
lesions around ipsilateral pulmonary veins.
Results The following clinical characteristics differed between DM and no-DM patients: age (62.0 ± 10.8 vs. 56.1 ± 10.6 years, P = 0.004), longer AF history (9.6 ± 9.3 vs. 6.7 ± 6.3 years, P = 0.024), significantly larger left atrium size (41.1 ± 7.8 vs. 38.3 ± 5.8 mm, P = 0.021), hypertension (58.1 vs. 35.8%, P = 0.018) and structural heart disease (67.7 vs. 43.5%, P = 0.011). Despite a similar AF recurrence rate in DM and no-DM patients (32.3 vs. 22.4%, P = 0.240), the ablation procedure was complicated in 28 patients (11 hematomas, three cardiac tamponades and three strokes)
and the incidence of complications was significantly higher in DM than in no-DM patients (29.0 vs. 8.2%, respectively, P = 0.002). Multivariate analysis showed that DM was an independent risk factor for complications occurrence (odd ratio 5.936,
95% confidence interval 2.059 to 17.112, P = 0.001).
Conclusions First catheter ablation of AF procedure in DM patients was equally efficacious than in no-DM patients. However, DM patients
had a higher incidence of complications, mostly thrombotic or hemorrhagic. 相似文献