Objective To investigate the safety and efficacy of decitabine combined with CAG regimen in treatment of acute myeloid leukemia (AML) ineligible for conventional chemotherapy. Methods The data of 20 cases with AML ineligible for conventional chemotherapy from January 2013 to May 2015 were retrospectively analyzed. Decitabine combined with CAG regimen was used during induction therapy. The primary induction regimen was used 26 times after remission, the standard 3+7 regimen were used 7 times, and intermediate-dose cytarabine were used 3 times. The total course of treatment included 2-8 cycles. Results All of the 20 patients completed the first cycle of induction therapy, including 11 cases of complete remission (CR), 5 cases of partial remission and no response in 4 cases, and the overall response rate (ORR) was 80 % (16/20). ORR was 69.2 % (9/13) and 100.0 % (7/7) in high-risk group and middle-low risk group respectively. ORR was 60.0%(6/10) in AML evolving from MDS. 8 patients were infected during the induction therapy and the infection rate was 40.0% (8/20). 2 patients were died of pulmonary infection. The median number of suspended red blood cell and platelet infused were (9.1±5.7) U and (57.5±51.9) U respectively. Neutrophil recovery time was (8.7±5.6) days during induction therapy. All patients were followed up for at least 1 year, and 12 cases were dead. Overall survival rate was 85.0%at 3 months, 80.0%at 6 months, and 40.0%at 1 year. While in 12 CR patients relapse-free survival rate was 75.0%at 3 months, 75.0%at 6 months,and 65.6%at 1 year respectively. Conclusion Decitabine combined with CAG regimen with high remission rate and well tolerance, can be used as a first therapy for AML ineligible for conventional chemotherapy.

Objective: To investigate the value of next-generation sequencing (NGS) technology in the prognosis monitoring and treatment guidance for molecular minimal residual disease (MRD) in acute myeloid leukemia (AML) patients with complete remission (CR). Methods: The clinical data of 68 AML (non-acute promyelocytic leukemia) patients who received gene mutation spectrum by using NGS technology at initial diagnosis and in CR phase in Tangdu Hospital of Air Force Military Medical University from January 2016 to July 2018 were retrospectively analyzed. The recurrence and survival of both molecular MRD positive group and negative group were analyzed and compared, and the value of NGS technology and multiparameter flow cytometry (MFC) were also analyzed in MRD monitoring. Results: There were 39 males (57.4%) and 29 females (42.6%) in 68 patients, and the median age was 52 years old (8-82 years old). Molecular MRD positive group included 38 patients, while negative group included 30 patients. Residual mutation gene type in CR phase was most frequently detected in epigenetic regulator gene mutations, such as ASXL1, TET2, DNMT3A and IDH1/IDH2. Statistical analysis showed that the 2-year cumulative recurrence rate (CIR) in the molecular MRD positive group was higher than that in the molecular MRD negative group (86.8% vs. 51.3%; χ² = 9.249, P = 0.002); the 2-year relapse-free survival (RFS) rate in the molecular MRD positive group was lower than that in the molecular MRD negative group (13.2% vs. 48.7%; χ² = 9.249, P = 0.002); the 2-year overall survival (OS) rate in the molecular MRD positive group was lower than that in the molecular MRD negative group (58.0% vs. 100%; χ² = 4.122, P = 0.042). Up to follow-up date, 3 patients with molecular MRD positive and 1 patient with molecular MRD negative who received allogeneic hematopoietic stem cell transplantation (allo-HSCT) were still in disease-free survival. The results of monitoring MRD showed high consistency (76.7%, 33/43) in NGS and MFC. Compared with the other groups, the patients with both positive NGS and MFC had a higher relapse rate, and the difference was statistically significantly (P < 0.05). Conclusions Molecular MRD of AML patients is detected by using NGS technology, which could be used to predict the relapse and survival, suggesting that molecular MRD may guide post-remission treatment regimens and the determination of allo-HSCT indications.

Objective To investigate the repairing effect and mechanism of Chinese patent medicine Weiyangning pill on gastric mucosal injury in rats induced by anhydrous ethanol,and to establish a high-performance liquid chromatography(HPLC)method to determine the five main components of Weiyangning pill.Methods The five components of paeoniflorin,psoralen,atractylenolide Ⅲ,liquiritin and hesperidin in Weiyangning pill were detected by HPLC.SD male rats were randomly divided into normal control group,model control group,Weinaian group,and large and small dose group of Weiyangning pill.All rats were fasted for 24 hours without water fasting.The normal control group and the model control group were given purified water by gavage.While Weinaian group was given Weinaian(3 g·kg-1),the test group were given intragastric perfusion of Weiyangning(3,1.5 g·kg-1)respectively.After 2 hours,all the rats,except the normal control group,were intragastrically administered with anhydrous ethanol(5 mL·kg-1)to establish the model of gastric mucosal injury.An hour later,the experimental materials were collected,and the gross score of gastric mucosal injury was observed and calculated.The gastric mucosal slices were stained by hematoxylin-eosin(HE)to calculate the pathological scores.Immunohistochemistry was employed to detect the expression of gastric mucosa-related proteins.Results The high-performance liquid chromatogram of Weiyangning pill was obtained,and the absorption peaks with the same retention time as the five standard substances(paeoniflorin,psoralen,atractylenolide Ⅲ,liquiritin and hesperidin)were observed.The general score and pathological score of gastric mucosal injury in Weiyangning groups(3,1.5 g·kg-1)were lower than those of the model control group(P<0.05 or P<0.01).Weiyangning pill(3,1.5 g·kg-1)ameliorated the decrease expression of tight junction protein(Claudin-7),adhesion junction proteins(E-cadherin and β-catenin),mucins(MUC1 and MUC5AC),and the gastric transcription factor SOX2 in the gastric mucosa of the rats modeled in anhydrous ethanol(P<0.05 or P<0.01 compared with the model control group).Conclusion The repairing effect of Weiyangning pill on gastric mucosal injury induced by anhydrous ethanol in rats is related to the increase of the expression of tight junction protein,adhesion junction protein,mucin and gastric transcription factor.