1.Effect of obesity on the efficacy of allogeneic hematopoietic stem cell transplantation
Xing SHEN ; Han ZHU ; Ruize CHEN ; Hanxin WU ; Hua LU ; Lijuan CHEN ; Sixuan QIAN ; Yu ZHU ; Jianyong LI ; Kourong MIAO
Journal of Leukemia & Lymphoma 2021;30(9):529-533
Objective:To investigate the effect of obesity on the efficacy of allogeneic hematopoietic stem cell transplantation.Methods:The clinical data of 81 patients who underwent allogeneic hematopoietic stem cell transplantation from August 2017 to September 2020 in the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed. According to the body mass index (BMI), the patients were divided into the obese group (BMI≥28 kg/m 2, 11 cases) and the non-obese group (BMI<28 kg/m 2, 70 cases). The clinicopathological characteristics, hematopoietic stem cell implantation, post-transplantation complications, survival and recurrence were compared between the two groups. Univariate and multivariate survival analyses were performed by using Cox proportional hazards regression model. Results:The median follow-up time of 81 patients was 280 d (8-1 218 d). The 1-year overall survival (OS) rate was 77.9%, and the 1-year progression-free survival (PFS) rate was 73.8%. The 1-year OS rates of the non-obese group and the obese group were 82.6% and 46.2% ( χ2 = 15.54, P<0.01), and the 1-year PFS rates were 82.1% and 36.4% ( χ2 = 15.56, P<0.01). The non-recurrence mortality (NRM) rates of the non-obese group and the obese group were 7.1% and 32.7% ( χ2 = 6.463, P = 0.01), and the cumulative recurrence rate was 11.5% and 42.9% ( χ2 = 8.146, P = 0.004). Between the non-obese group and the obese group, the median engraft time of neutrophils and platelets, acute graft-versus-host disease, chronic graft-versus-host disease, hemorrhagic cystitis, cytomegalovirus infection and Epstein-Barr virus infection had no statistical difference ( P > 0.05). The result of multivariate analysis showed that obesity was an independent adverse influencing factor for OS of patients with allogeneic hematopoietic stem cell transplantation ( HR = 3.814, 95% CI 1.343-10.827, P = 0.012). Conclusion:Obesity is an important unfavorable factor that affects patient's survival after allogeneic hematopoietic stem cell transplantation, and the improvement of the efficacy and survival of these patients is worthy of further study.
2.Difference in Adverse Reactions between Colorectal Cancer Patients with or without Spleen-kidney Yang Deficiency Syndrome after Oxaliplatin-containing Chemotherapy
Yifan LI ; Yipang ZHAO ; Boyuan HAN ; Yixuan LIU ; Sixuan XING ; Wenjing YANG ; Qing ZHANG
Journal of Traditional Chinese Medicine 2024;65(19):2010-2017
ObjectiveTo compare the difference in adverse reactions after oxaliplatin-containing chemotherapy between colorectal cancer patients with or without spleen-kidney yang deficiency syndrome. MethodsA retrospective study was conducted using the electronic medical records of Beijing Hospital of Traditional Chinese Medicine, Capital Medical University. A total of 483 colorectal cancer patients from January 1, 2009 to December 31, 2022 were selected. Patients were divided into two groups based on their syndrome types, that was spleen-kidney yang deficiency syndrome (SKYDS) group (130 cases) and non-SKYDS group (353 cases). The incidence of adverse reactions including gastrointestinal reactions, liver damage, bone marrow suppression, and peripheral neurotoxicity after completing 2, 4, 6, and more than 6 cycles of chemotherapy was compared between the two groups. Univariate and multivariate logistic regression analyses were used to analyze the associations of age, gender, alcohol history, primary tumor location, tumor differentiation, tumor staging, chemotherapy courses, and syndrome types with the occurrence of gastrointestinal adverse reactions, liver function damage, bone marrow suppression and peripheral neurotoxicity in colorectal cancer patients who have completed 2, 4, 6 and more than 6 cycles of oxaliplatin-containing chemotherapy. ResultsThere were significant differences in the occurrence of gastrointestinal reactions after completing 2, 4, 6 and more than 6 cycles of chemotherapy between the two groups (P<0.01), with much more severe conditions in SKYDS group than non-SKYDS group (P<0.01). There was no significant difference in liver function damage and bone marrow suppression between groups (P>0.05). There were statistically significant differences in the occurrence of peripheral neurotoxicity after completion of 2 cycles (P=0.044), 4 cycles (P=0.002) and more than 6 cycles (P<0.001) of chemothe-rapy, with higher rate in SKYDS group than the non-SKYDS group (P<0.05). Univariate analysis showed that female, patients with stage Ⅲ tumors and patients having completed ≥ 6 cycles of chemotherapy had a higher incidence of bone marrow suppression (P<0.05), and patients with SKYDS had a higher incidence of gastrointestinal reactions (P<0.001). Patients with a history of drinking, stage Ⅳ cancer, and ≥6 cycles of chemotherapy had a higher incidence of liver function injury (P<0.05). Patients with stage Ⅲ cancer, ≥6 cycles of chemotherapy, and SKYDS had a higher incidence of peripheral neurotoxicity (P<0.05). Multivariate analysis showed that the risk factor for bone marrow suppression was chemotherapy ≥6 cycles (P=0.001), and SKYDS was the risk factor for gastrointestinal reaction (P<0.001). The risk factor for liver function damage was tumor stage Ⅳ (P=0.001) and SKYDS (P=0.039). All variables had no significant correlation with the occurrence of peripheral neurotoxicity. ConclusionFor colorectal cancer patients, being diagnosed with SKYDS is a risk factor for developing gastrointestinal adverse reactions and peripheral neurotoxicity following chemotherapy with an oxaliplatin-based regimen.