Arsenicals ; therapeutic use ; Humans ; Leukemia, Promyelocytic, Acute ; drug therapy ; Medicine, Chinese Traditional ; Oxides ; therapeutic use

The big trouble for invasive fungal infection(IFI)is how to define the diagnosis.Delayed therapy is the main reason of the death in the IFI patients,which underlines the importance of empiric therapy.Both cost-effectiveness ratio and patients' particular status should be considered when choosing an antifungal drug.Amphotericin B,Itraconazole,voriconazole,caspofungin and micafungin are all recommended.But there are still plenty of questions unanswered about empiric therapy,for example,how to establish th therapy based on scientific evidence.

Hematopoietic stem cell transplantation (HSCT) is an effective and sometimes the only curative therapy for patients with certain hematological diseases.HSCT has been practiced in China for approximately fifty years,and great improvements have been made within the past decade,especially in fields such as haploidentical HSCT system,strategies to overcome relapse and GVHD.This review will describe the current situation and provide a prospective of these novel characteristics of HSCT system in China.

Objective To detect serum concentrations of Dickkopf-1(DKK-1) and soluble receptor activator of nuclear factor-κB ligand (sRANKL) in patients with multiple myeloma (MM) and to investigate its clinical significance. Methods Serum DKK-1, sRANKL, osteoporotegerin(OPG) and tartrate-resistant acid phosphatase 5b (TRACP-5b) levels were quantified in 30 newly diagnosed MM patients and 20 healthy control subjects by using sandwich ELISA. Results The serum DKK-1, sRANKL,OPG and TRACP-5b levels were significantly higher than those in the healthy controls (42.96 μg/L vs 5.33 μg/L, 1.83 pmol/Lvs 0. 79 pmol/L, 1799. 30 pmol/L vs 822.40 pmol/L, 5.81 U/L vs 0. 28 U/L, respectively; all P＜0. 05). Serum levels of DKK-1 were positively correlated with sRANKL and TRACP-5b, respectively.Serum concentrations of DKK-1 and sRANKL were significantly elevated in stage Ⅲvs stages Ⅰ and Ⅱaccording to International Staging System (ISS) (46. 33 μg/L vs 37.91 μg/L, 2.26 pmol/L vs 1.19pmol/L, respectively, all P ＜0.05). Serum concentrations of DKK-1 , sRANKL and TRACP-5b were significantly higher in patients with more than 3 lytic bone lesions than those with only 1-3 lytic bone lesions (46. 30 μg/L vs 31.98 μg/L, 2. 18 pmol/L vs 0. 69 pmol/L, 6.02 U/L vs 5. 13 U/L, all P ＜ 0.05).Conclusions MM patients have increased serum DKK-1, sRANKL, OPG and TRACP-5b levels as compared with the healthy controls. Serum concentrations of DKK-1 and sRANKL have close relationship with MM stage and lytic bone disease.

ObjectiveTo compare the sensitivity among three diagnostic criteria for multiple myeloma.MethodsA total of 220 patients with multiple myeloma were studied retrospectively to compare thesensitivity, aswellastheirclinicalmanifestations, cellmorphologyinbonemarrowand immunophenotype.Results (1) The sensitivity of domestic diagnostic criterion in 1975 was 79.1％ (174/220) and there were some drawbacks in type identify.The sensitivity of WHO diagnostic criterion in 2001 was 97.3％ (214/220) and the sensitivity of domestic diagnostic criteria in 2011 was 100％. (2) Immunoglobulin level in 12.7％ (28/220) patients was ＜ 30 g/L,plasma cells count in bone marrow in 13.6％ (30/220) was ＜ 10％ ; 2.7％ (6/220) patients had not met the standard in immunity globulin and bone marrow plasma cells count.(3) The immunophenotype was CD38 positive ( 100％ ),restricted light chain (kappa/lambda) and CD19 100％,CD138 (98.2％,216/220) negative.ConclusionsAmong the three diagnostic criteria,the highest was 2011 domestic diagnostic criteria.Comprehensive analysis include clinical manifestations,cell morphology,immunophenotype will contribute to the diagnosis for multiple myeloma.

Objective To investigate the effieacy and safety of intravenous itraconazole for the treatment of invasive fungal infection(IFI)in patients with hematological disease or undergoing allogeneic hematopoietic stem cell transplantation(HSCT).MethodsSix hundred and sixty-six patients with above mentioned conditions and diagnosed as IFI from January.2007 to July,2007 were enrolled.Intravenous itraconazole was administered at a dose of200 nag every 12 hours for 2 days and followed by 200 mg every 24 hours.Patients were then switched to oral itraconazole according to the clinical situation Responses were determined on the basis of clinical and microbiological criteria.Results The probability of defervescence Was 69.8%and the total response rates among related to itraconazole were the proven.probable and possible IFI patients were 73.7%.68.1%and 68.2%(P=0.380).Adverse effects were found in 58 patients (8.7%).which were mainly mild to medium reversible dysfunction of liver and gastrointestinal tract, Conclusion Itraconazole is an effective and safe antifungal agent for patients with hematological disease or undergoing HSCT and is suitable for empirical antifungal therapy.

Hematopoietic stem cell transplantation (HSCT) is the only effective curative therapy for patients with certain hematological diseases. Haploidentical HSCT has been practiced worldwide for approximately twenty years. Significant improvements on this therapy were made in China within the past decade, with the novel non-in-vitro, T-cell-depleted haploidentical HSCT system. This review de-scribes the current situation and provides a prospective overview of these novel HSCT systems in China.

The treatment for chronic myeloid leukemia is still a challenge,at present.Tyrosine kinase inhibitors can partially control chronic myeloid leukemia in blast crisis (CML-BC),but the effect is not durable.Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the only way that can cure CML-BC.This paper presents a review of the treatment before allo-HSCT for CML-BC,the selection of condition regimen,donor and hematopoietic stem cell,the monitoring of MRD post-transplant,the prophylaxis and intervention of relapse.

China ; Humans ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; diagnosis ; therapy ; Practice Guidelines as Topic

The indications for patients with Myelodysplastic Syndrome (MDS) to receive allogeneic hematopoietic stem cell transplantation (Allo-HCT) are:intermediate risk-2 and high risk groups according to IPSS,and intermediate risk-1 group with poor karyotype,severe multilineage cytopenia or infusion-dependent.Constant follow-up and evaluation is important for therapeutic decision.Unrelated or related haploidentical donor could be an alternative in case of absence of identical sibling donor.Remission through chemotherapy before the transplantation is recommended in patients with advanced MDS who receive reduced-intensity conditioning.Demethylation drugs followed by Allo-HCT do not show additional transplantation-related toxicity,whose efficiency remains to be determined.