OBJECTIVE:To evaluate the cost and effectiveness of two chemotherapy regimens in the treatment of initially di-agnosed multiple myeloma (MM). METHODS:63 patients who were newly diagnosed as MM without transplant chance in our hospital were analyzed retrospectively,and then divided into MPT group (alkeran+metacortandracin+thalidomide,41 cases) and VDT group (bortezomib +dexamethasone+thalidomide,22 cases) according to chemotherapy regimens. Clinical efficacy,survival time and ADR of 2 groups were observed,and cost-effectiveness analysis of them were conducted. RESULTS:The overall re-sponse rates of MPT group and VDT group were 63.4% and 77.3%,respectively(P=0.260);the complete response rate of them were 12.2% and 36.4%,with statistical difference(P=0.024). The progression free survival of MPT group and VDT group were (14.314±0.488)months and(18.557±0.848)months,with statistical significance(P<0.001);the overall survival of MPT group and VDT group were(33.536±1.143)months and(41.048±1.868)months,with statistical significance(P=0.007). Leukocytope-nia,nausea and vomit and peripheral neurotoxicity of VDT group were both higher than those of MPT group,with statistical signif-icance (P<0.05). The cost-effectiveness ratio of MPT group was 247.48,and that of VDT group was 2 922.77;the incremental cost-effectiveness ratio was 15 125.18. The results were consistent with the sensitivity test. CONCLUSIONS:Clinical efficacy and survival time of VDT regimen is better than that of MPT regimen,but MPT regimen is superior to VDT regimen in respect of cost-effectiveness analysis and the incidence of ADR. which will more suitable for the MM patients without transplant chance or goood economic conditions.

Objective To investigate the treatment of recombinant human interleukin-11(rhIL-11)to chemotherapy-induced thrombocytopenia in acute leukemia(AL).Methods 42 AL patients whose platelet count dropped below 20×109/L after chemotherapy received rhIL-11 by 1.5 mg daily until the platelet count was increased above 40×109/L.The efficiency of chemotherapy to 17 newly diagnosed acute myelocytic leukemia(AML)patients was evaluated after receiving two periods of chemotherapy.35 AL patients and 15 newly diagnosed AML patients were used as controls.Results The mean time of platelet count increasing from 20×109/L to above 40×109/L Was shorter in treating group (9.8±2.7)d than in control group(14.6±4.8)d .The number of patients whose platelet＜15×109/L was less in treating group than in control group after second chemotherapy,and the minimum mean count of platelet Was higher in treating group(23.5±18.3)×109/L than that in control group(10.2±9.8)×109/L .CR and CR+PR rate were not different between treating group and control group. Conclusion rhlL-11 can safely and effectively promote chemotherapy-induced platelet recovery in patients of acute leukemia with persistent affection.

Objective To investigate the pathogenesis,clinical feature,laboratory examination characteristics and the prognosis of the bone marrow necrosis.Methods To analyze the clinical data of one case of diagnostic bone marrow necrosis and review the relevant literature.Results The peripheral blood examinations were as follows:the hemoglobin(HGB)level was 36g/L,platelet count was 17 ×109 /L.The biochemistry tests showed that lactate dehydro genase (LDH)was 1 454.9U /L and alkaline phosphatase(ALP)was 1 319.4U /L.Bone marrow necrosis was detected by bone marrow smear.Bone marrow biopsy was considered as a bone marrow metastatic carcinoma,which was prone to adenocarcinoma.Conclusion The bone marrow necrosis is mainly caused by the cancer,the serious infection and the drug.Its main performances were bone pain,fever,progressive decline in bloods cells,the LDH and ALP increasing and poor prognosis.In order to extend the lifetime of this kind of patients,the key lies in the early detection,the early diagnosis,and the early treatment of its primary diseases.

Objective:To analyze the clinical features and response to therapies of double hit multiple myeloma(MM) and non-double hit MM.Methods:The fluorescent in situ hybridization (FISH) was used for detection of del(17p13) and gain(1q21), the definition of double hit MM was international staging system Ⅲ plus gain(1q21) and(or) del(17p13). The clinical data of 146 newly diagnosed MM patients in the Affiliated Hospital of Southwest Medical University from January 2015 to June 2019 were analyzed retrospectively.There were 42 patients with double hit MM, and 104 patients with non-double hit MM.Results:The ratio of β 2-microglobulin, LDH, creatinine, blood calcium, myeloplasma cell and the proportion of high-risk group in the international working group of myeloma in the double hit MM group were higher than those in the non double hit group, and the differences between the two groups were statistically significant( Z=-6.636, -3.789, -5.116, t=2.288, Z=-5.091, χ 2=32.489, all P<0.05). The HB level in the double hit group [(75.14±20.65)g/L] was lower than that in the non-double hit group [(88.21±26.31)g/L]( t=-3.187, P=0.002). The 4-year overall survival rate was 42.7% in 146 patients, 51.4% in the non-double-hit patients, and 13.6% in the double-hit patients, the difference between the two groups was statistically significant ( Z=4.000, P<0.001). Among the 42 double-hit patients, 19 patients were treated with the " traditional regimen" , with a 4-year overall survival rate of 12.3%, and 23 patients were treated with the " bortezomib regimen" , with a 4-year overall survival rate of 25.4%.There was no statistically significant difference in the overall survival rate between the two groups. Conclusion:Compared with the non-double hit group, the double hit group has more severe clinical manifestations and a lower 4-year overall survival rate.Bortezomib may not improve the prognosis of the double-hit group.

Objective To investigate the clinical characteristics and prognosis of chronic myeloid leukemia (CML) with the initial symptoms of intracranial space - occupying lesion. Methods The clinical features of a 49 years old CML female patient with the initial symptoms of intracranial occupying lesions in the Affiliated Hospital of Southwest Medical University were analyzed. And the literatures were reviewed and summarized. Results The main clinical manifestations of the patient were headache and blurred vision. Cranial CT showed space occupying lesions in the left frontal lobe. The white blood cell counts(WBC) was 360. 09 × 109/L. Bone marrow smear showed 87. 0％ of granulocyte and 13.5％ of primitive granulocytes,and the patient was diagnosed as CML(accelerated phase). The patient was treated with imatinib 600mg qd,and the disease was controlled. Her intracranial mass was disappeared, and achieved long-term disease-free survival. Imatinib on CML intracranial lesions also had certain curative effect. Conclusion Tyrosine kinase inhibitors(TKIs) should also be individualized for different patients. Dasatinib is the first choice for CML with intracranial occupying lesions. However, this case suggests that imatinib also has clinical efficacy. It may be related to the release of intracranial tumor cells into the peripheral blood or imatinib,and also a small amount of penetration through the blood-brain barrier. In the treatment of CML,appropriate TKIs should be chosen according to the patients'condition.

Objective To deepen the understanding of curative effect and adverse drug reaction of brentuximab vedotin in the treatment of Hodgkin's lymphoma.Methods One case of newly diagnosed Hodgkin's lymphoma who treated with brentuximab vedotin was collected.The clinical features,laboratory examination,treatment procedure,prognosis were analyzed,and the relevant literature was reviewed.Results The patient was twenty years old,female,found the right neck masses for five days,diagnosed with Hodgkin's lymphoma,mixed cell type,stage Ⅳ group B.Chose the chemotherapy regimen BV + GABVD for 4 courses,the PET-CT indicated CR,then used GABVD 4 courses,now in the stage of clinical observation and followed up.Conclusion BV is a kind of antibody-drug conjugate which targeted on CD30 protein.The FDA approved for the treatment of Hodgkin's lymphoma and systemic anaplastic large cell lymphoma.The common adverse reactions are granulocyte,peripheral neuropathy,fatigue,nausea and vomiting.BV can significantly improve the prognosis of CD30 positive Hodgkin's lymphoma,but need to pay attention to the prevention of adverse reactions.

OBJECTIVESepsis is the major cause of death in pediatric intensive care unit (PICU). The clinical manifestations of early sepsis is very similar to systemic inflammatory response syndrome (SIRS) caused by non-infectious reason. This study aimed to investigate the expression of miRNA and inflammatory cytokines in plasma in pediatric sepsis patients and its clinical significance.

METHODForty children with sepsis seen in Shenzhen children's hospital PICU from April 2012 to March 2013 were enrolled in this study, the median age was 0.75 (0.52, 1.90) years; 27 were males and 13 females, of whom 16 had severe sepsis. We selected 20 postsurgical patients with SIRS and 15 healthy children as a control group. The expression levels of plasma miR-21, miR-125b, miR-132, miR-146a, miR-155 and miR-223 were detected by real-time quantitative PCR (qRT-PCR). The predictive value of miRNA, PCT and CRP for sepsis were evaluated by Receiver operating characteristic curve (ROC). TNF-α and IL-10 levels in plasma detected by Cytometric Beads Array (CBA). Quantitative data of normal distribution was compared with ANOVA among the three groups and LSD-t test between two groups. To non-normal distribution of data, multiple comparisons among three groups were conducted by Kruskal-Wallis H test and differences between two groups were assessed by Mann-Whitney U test for post hoc analysis.

RESULTThere were no significant differences between the age and gender of each group. Expression of miR-21, miR-125b, miR-132 and miR-155 in plasma had no significant difference in each group (all P > 0.05). MiR-146a and miR-223 levels in sepsis were upregulated compared with SIRS group and control group [(5.7 ± 3.5)×10(-5) vs. (2.4 ± 1.6)×10(-5) and (2.6 ± 1.2)×10(-5), (12.5 ± 7.7)×10(-4) vs. (8.3 ± 3.4)×10(-4) and (5.3 ± 2.2)×10(-4), all P < 0.01], expression levels of miR-223 in SIRS increased as compared to control group (P < 0.01). MiR-146a levels in severe sepsis were higher than those of the general sepsis [ (7.1 ± 3.3)×10(-5) vs. (4.6 ± 2.6)×10(-5), P < 0.01]. CRP and PCT levels are all higher in sepsis and SIRS groups than control group (all P < 0.01). The area under ROC curve (AUC) of miR-146a, miR-223, PCT and CRP to predict sepsis were 0.815 (95%CI: 0.708-0.922), 0.678(95%CI: 0.537-0.818), 0.706 (95%CI: 0.571-0.842) and 0.588 (95%CI: 0.427-0.748). Expression levels of IL-10 and IL-10/TNF-α in sepsis were upregulated compared with and SIRS group and the control group (all P < 0.01). There was a positive correlation between miR-146a, miR-223 and IL-10 and IL-10/TNF-α (r = 0.545, 0.305, 0.562, 0.373, all P < 0.01).

CONCLUSIONThe expression levels of miR-146a and miR-223 in plasma in pediatric patients with sepsis was significantly upregulated, and had a positive correlation with IL-10 and IL-10/TNF-α, which may be used as early diagnostic markers and can reflect the severity of condition to a certain degree.

Biomarkers ; blood ; Calcitonin ; blood ; Case-Control Studies ; Female ; Humans ; Infant ; Infant, Newborn ; Intensive Care Units, Pediatric ; Interleukin-10 ; blood ; Male ; MicroRNAs ; blood ; Prognosis ; ROC Curve ; Sepsis ; blood ; diagnosis ; Severity of Illness Index ; Systemic Inflammatory Response Syndrome ; blood ; diagnosis ; Tumor Necrosis Factor-alpha ; blood