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Progress of tumor-associated myeloid cells in multiple myeloma

Journal of Leukemia & Lymphoma.2021;30(12):705-709. doi:10.3760/cma.j.cn115356-20210523-00125

Multiple myeloma (MM) is a kind of hematologic malignancy. Although there are lots of therapies for MM, it is still incurable. Except for the drug-resistance, another important reason for the incurability is the immunosuppressive effect derived from interactions between tumor cells and the bone marrow microenvironment, which makes our body cannot clear resident tumor cells completely. As a vital part in the immunosuppressive microenvironment, tumor-associated myeloid cells (TAMC) play an extremely significant role in the immune escape of MM and become the reason for limiting the effectiveness of immunotherapy, furthermore, TAMC have become potential targets for the treatment of MM. This article reviews the composition and the latest progress of the mechanisms of TAMC in the immune microenvironment of MM.

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Clinical characteristics of acute myeloid leukemia patients with TET2 gene mutation and effects of TET2 mutation on therapeutic efficacy and prognosis

Wenxia SHI ; Yongxin GUO ; Junjie SHEN ; Wenming CHEN ; Wenwen GUO ; Yanyan TANG ; Shuige YANG ; Zhongliang SUN ; Daoping SUN

Journal of Leukemia & Lymphoma.2021;30(12):719-725. doi:10.3760/cma.j.cn115356-20210508-00110

Objective:To investigate clinical features of adult patients with acute myeloid leukemia (AML) with TET2 gene mutation and effects of TET2 mutation on therapeutic efficacy and prognosis.Methods:A total of 123 newly diagnosed adult AML patients (except for acute promyelocytic leukemia) admitted to Jining No.1 People's Hospital from March 2017 to April 2021 were selected. Mutations of 24 AML-related genes including TET2 mutation were detected by using second-generation sequencing technology. Patients were divided into two groups according to the presence of TET2 mutation: TET2 mutation group and TET2 wild type group. The differences in clinicopathological characteristics, short-term efficacy and survival of both groups were compared.Results:Among 123 patients, TET2 mutation was detected in 28 cases (22.8%). Compared with TET2 wild type group, the patients were older [(59±15) years vs.(49±16) years, t = 2.984, P = 0.003], French-American-British (FAB) Corporative Group M 4 and M 5 subtypes were more common [75.0% (21/28) vs. 51.6% (49/95), χ2 = 4.838, P = 0.028], and the positive rate of CD34 in AML patients was lower in TET2 mutation group [46.4% (13/28) vs.72.6% (69/95), χ2 = 6.685, P = 0.010]. Moreover, TET2 mutation was more likely to be accompanied with ZRSR2 mutation [10.7% (3/28) vs. 1.1% (1/95), P = 0.037] and NPM1 mutation [35.7% (10/28) vs.17.9% (17/95), χ2 = 4.008, P = 0.045], but less likely to be accompanied with IDH1/2 mutation [0 vs.17.9% (17/95), P = 0.012]. However, there were no statistically significant differences in gender, peripheral blood leukocyte count at initial diagnosis, hemoglobin level, platelet count, bone marrow blasts ratio, cytogenetics and the European LeukemiaNet (ELN) risk stratification between the two groups (all P>0.05). In addition, there were no significant differences in the overall response rate (ORR) of 1 cycle chemotherapy [75.0% (12/16) vs. 66.7% (42/63), χ2 = 0.410, P = 0.522] and demethylation therapy [66.7% (4/6) vs. 44.4% (8/18), P = 0.640]. The difference in overall survival (OS) of both groups was not statistically significant [median OS time: 23 months (95% CI 5-41 months) vs. 35 months (95% CI 18-52 months, P = 0.498]. Conclusions:In AML patients, TET2 mutation is associated with advanced age, M 4 and M 5 subtypes, and low expression of CD34 on AML blasts. TET2 mutation is commonly accompanied by ZRSR2 and NPM1 mutation, but not IDH1 or IDH2 mutation. TET2 mutation may have no significant effects on therapeutic efficacy and survival in the whole cohort of AML patients without risk stratification.

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Expressions of interleukin 6, interleukin 8 and interleukin 10 in the peripheral blood of patients with diffuse large B-cell lymphoma and their clinical significances

Li ZHANG ; Long LIU ; Caiyan WANG ; Haijun ZHAO ; Yong ZHOU ; Bing XU

Journal of Leukemia & Lymphoma.2021;30(12):726-729. doi:10.3760/cma.j.cn115356-20210811-00176

Objective:To explore expressions of interleukin 6 (IL-6), interleukin 8 (IL-8) and interleukin 10 (IL-10) in the peripheral blood of patients with diffuse large B-cell lymphoma (DLBCL) and their clinical significances.Methods:The clinical data of 78 newly diagnosed patients with DLBCL from March 2018 to March 2021 in the First Affiliated Hospital of Xiamen University were retrospectively analyzed, and 58 healthy people receiving physical examination during the same period were taken as the healthy controls. The expressions levels of IL-6, IL-8 and IL-10 in peripheral blood were tested by using cytometric bead array (CBA), and the association of the levels of IL-6, IL-8 and IL-10 with clinical characteristics, disease staging and prognosis was analyzed.Results:The expression levels of IL-6, IL-8 and IL-10 in DLBCL group were higher than those in the healthy control group [(171.81±70.91) pg/ml vs. (2.71±0.28) pg/ml, (47.95±13.04) pg/ml vs. (3.69±0.47) pg/ml, (38.02±10.35) pg/ml vs. (1.77±0.23) pg/ml], and differences were statistically significant ( t values were 2.38, 3.39, 3.50, all P<0.05). In DLBCL group, the expression levels of IL-6, IL-8 and IL-10 in patient with bone marrow invasion, international prognostic index (IPI) 3-5 scores and clinical staging Ⅲ-Ⅳ were higher than those in patients with bone marrow non-invasion, IPI 1-2 scores and clinical stagingⅠ-Ⅱ(all P<0.05). There was a relationship between the expression levels of IL-6 and IL-8, IL-6 and IL-10, IL-8 and IL-10 in peripheral blood of DLBCL patients ( r2 value was 0.93, 0.89, 0.89, respectively; all P < 0.05). Among patients with high expressions of IL-6, IL-8 and IL-10, the proportion of patients not receiving remission after 6 cycles of treatment in clinical staging Ⅲ-Ⅳ was higher than that of patients with high expressions of IL-6, IL-8 and IL-10 alone or any two of them, and differences were statistically significant (all P < 0.05). Conclusions:There is a high correlation of IL-6, IL-8 and IL-10 expression levels; the increasing expression levels of them may predict the later disease stage and poor prognosis for DLBCL patients.

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Efficacy observation of recombinant human granulocyte macrophage stimulating factor combined with R-CHOP regimen in treatment of diffuse large B-cell lymphoma

Su GAO ; Li CHEN ; Jie CHEN ; Weiping ZHANG ; Xiong NI ; Jianmin YANG

Journal of Leukemia & Lymphoma.2021;30(12):730-734. doi:10.3760/cma.j.cn115356-20210521-00123

Objective:To observe the clinical efficacy and safety of recombinant human granulocyte macrophage stimulating factor (rhGM-CSF) combined with R-CHOP regimen in treatment of diffuse large B-cell lymphoma (DLBCL).Methods:The clinical data of 39 patients with newly diagnosed DLBCL treated with rhGM-CSF combined with R-CHOP regimen, and 39 patients with newly diagnosed DLBCL treated with R-CHOP regimen in Naval Medical University (Changhai Hospital) from February 2017 to November 2019 were retrospectively analyzed. The total response rate (ORR), remission rate (CR) rate, overall survival (OS), progression-free survival (PFS) and adverse reactions of both groups were compared.Results:In rhGM-CSF combined with R-CHOP regimen group and R-CHOP regimen group, ORR was 87.2% (34/39) and 82.1% (32/39), respectively, and the difference was statistically significant ( χ2 = 0.394, P = 0.53); CR rate was 71.8% (28/39) and 56.4% (22/39), respectively, and the difference was statistically significant ( χ2 = 2.006, P = 0.157). Until the last follow up on September 19, 2020, 32 patients survived and 7 patients died in rhGM-CSF combined with R-CHOP regimen group, of which 1 case died of bowel cancer, and the primary disease was still in CR. In the R-CHOP regimen group, 32 survived and 7 died. The 2-year OS rates of the two groups were 82.5% and 73.9%, respectively ( χ2 = 0.038, P = 0.845); the 2-year PFS rates of the two groups were 67.1% and 55.2%, respectively ( χ2 = 0.457, P = 0.499). Subgroup analysis results showed that there were no statistically significant differences in CR rates among germinal center B-cell (GCB) and non-GCB subgroups, Lugano stage Ⅰ-Ⅱ and Lugano stage Ⅲ-Ⅳ subgroups, aged <60 years and aged ≥60 years subgroups in rhGM-CSF combined with R-CHOP regimen group and R-CHOP regimen group (all P > 0.05). The major adverse reactions included bone marrow suppression and its inducible infections. There were no significant differences in the incidence of grade 3-4 hematological adverse reactions and infections between the two groups (all P > 0.05). All patients safely went through bone marrow suppression after support treatments without treatment-related deaths. Conclusions:rhGM-CSF combined with R-CHOP regimen is safe and effective in treatment of newly diagnosed DLBCL.

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Rituximab combined with ABVD regimen in treatment of Hodgkin lymphoma with autoimmune hemolytic anemia: report of one case and review of literature

Yan YAN ; Xiaofei CHAI ; Jianwei DU ; Xue GAO ; Yufu LI ; Yongping SONG ; Quande LIN

Journal of Leukemia & Lymphoma.2021;30(12):735-738. doi:10.3760/cma.j.cn115356-20210505-00107

Objective:To explore the efficacy of rituximab combined with ABVD (epirubicin+ bleomycin+ vindesine +dacarbazine) regimen in treatment of Hodgkin lymphoma (HL) complicated with autoimmune hemolytic anemia (AIHA).Methods:The clinical data of 1 HL patient complicated with AIHA in November 2019 in Henan Cancer Hospital were retrospectively analyzed, and literatures were reviewed.Results:The patient received left cervical lymph node biopsy and bone marrow biopsy, and then lymphoma-related gene mutations and whole genetic genome detection were performed. The patient was diagnosed as HL (tuberous sclerosis in stage Ⅳ) complicated with AIHA. After 6 cycles of rituximab combined with ABVD regimen, the efficacy was evaluated. This patient's anemia was recovered, and HL also achieved complete remission.Conclusions:Rituximab combined with ABVD regimen is effective in treatment of HL patients complicated with AIHA.

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Monomorphic epithelial intestinal T-cell lymphoma: a clinicopathological characteristic analysis

Mei TANG ; Linlin HUANG ; Jing ZHU ; Hong CHEN ; Jing LI ; Wenbo ZHOU ; Liqun YANG

Journal of Leukemia & Lymphoma.2021;30(12):739-743. doi:10.3760/cma.j.cn115356-20210622-00148

Objective:To investigate the histopathological morphology, immunophenotype, molecular pathological features, clinical prognosis and treatment of monomorphic epithelial intestinal T-cell lymphoma (MEITL).Methods:The clinicopathological data of 5 patients with MEITL in Sichuan Jinyu Medical Laboratory Center Co., Ltd from March 2019 to February 2021 were retrospectively analyzed, and literatures were reviewed. All cases were tested by using histopathology, immunohistochemistry, in situ hybridization of Epstein-Barr virus (EBV) and T-cell clonability assessment, and 1 case had second-generation sequencing (NGS) test. Clinical follow-up was performed in 2 patients.Results:All 5 MEITL cases were middle-aged and old men. The histopathology showed that intestinal wall was diffuse with tumor cells infiltrating, and the cells were obviously epitheliophilic. All the tumor cells CD3, CD8, CD56, GrB were positively expressed, and expressions of other T-cell markers were different, among which 1 case had CD30 positive and 1 case had CD20 positive. All 5 cases were negative for EBV by in situ hybridization. Monoclonal rearrangement of T-cell receptor gene was detected in all 5 cases. Mutations of BCOR, JAK3, STAT5B and ATM were detected in 1 case by using NGS. Among 2 cases followed-up, 1 patient relapsed 7 months after he had the initial onset and underwent the first operation, and then he had another operation. This patient finally died of extensive metastasis in the lung, liver and abdominal cavity as well as ascites 13 months later; another patient died 1 month after emergency surgery for perforation.Conclusions:MEITL is a rare primary T-cell lymphoma of the digestive tract. The oncogenic event in the pathogenesis of MEITL mainly involves mutations in the tumor suppressor gene SETD2 and mutations in one or more genes of the JAK/STAT pathway. Currently, there is no standard treatment for MEITL. Most treatment options include surgical resection and anthracycline-based chemotherapy.

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Effect observation of different collection procedures of blood cell separator on collection of autologous peripheral blood hematopoietic stem cells in children

Ou XU ; Shaoyan HU

Journal of Leukemia & Lymphoma.2021;30(12):744-747. doi:10.3760/cma.j.cn115356-20200725-00186

Objective:To investigate the effect of different collection procedures of COBE Spectra blood cell separator on collection of autologous peripheral blood hematopoietic stem cells in children.Methods:The clinical data of 10 children who were collected autologous peripheral blood hematopoietic stem cells with the monocytes (MNC) or fully automatic peripheral blood stem cells (AutoPBSC) programs of COBE Spectra blood cell separator in the Children's Hospital of Soochow University from July 2018 to January 2020 were retrospectively analyzed, and the children were 3-10 years old with the body weight of 15-31kg. There were 5 cases in MNC group and 5 cases in AutoPBSC group.Results:Autologous peripheral blood hematopoietic stem cells were collected for 25 times, with an average of 2.5 times (1-4 times), 10 times in MNC group and 15 times in AutoPBSC group. The number of stem cells [the median (the range)] before collection was 19.3/μl (3.5-129.0/μl) in MNC group and 9.4/μl (2.2-38.7/μl) in AutoPBSC group. The number of CD34 + cells of single collection was 1.22×10 6/kg (0.18×10 6/kg-6.30×10 6/kg) in MCN group and 0.85×10 6/kg (0.13×10 6/kg-2.64×10 6/kg) in AutoPBSC group. Correlation analysis showed that there was a positive correlation between the number of collected CD34 + cells and the number of stem cells before collection (AutoPBSC group: r=0.921, P < 0.01; MNC group: r=0.833, P=0.003). The collection efficiency was 5.4% (3.4%-11.2%) in MNC group and 10.4% (4.7%-13.9%) in AutoPBSC group, and the difference was statistically significant ( Z=2.163, P = 0.031). Conclusion:The collection effect of children's autologous peripheral blood hematopoietic stem cells with COBE Spectra blood cell separator AutoPBSC program is better than that with MNC program.

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Effects of different treatment regimens before allogeneic-hematopoietic stem cell transplantation on the outcome after transplantation of patients with myelodysplastic syndrome: a meta analysis

Ying LIU ; Panpan LI ; Wenqing WANG ; Huaipeng GUO ; Li LIU

Journal of Leukemia & Lymphoma.2021;30(12):748-755. doi:10.3760/cma.j.cn115356-20210419-00091

Objective:To systematically evaluate effects of different treatment schemes before allogeneic-hematopoietic stem cell transplantation (allo-HSCT) on the long-term relapse and survival of patients with myelodysplastic syndrome (MDS) after transplantation.Methods:The related literatures were searched from databases of Ovid, Cochrane Library, PubMed, Embase, CNKI, VIP, WanFang and CBM from inception to December 2019. And then 2 reviewers independently extracted data, assessed methodological quality and crosschecked on the included literatures. According to the treatment methods, the cases included in the literatures were divided into demethylation drug (decitabine or azacytidine) treatment (demethylation treatment group) and traditional treatment regimen (including chemotherapy and support treatment) (traditional treatment group). RevMan 5.3 software was used to analyze overall survival (OS), recurrence, non-relapse mortality (NRM) and relapse free survival (RFS).Results:Finally, 10 articles were included. The results of meta-analysis showed that in the traditional treatment group, the differences of 3-year OS rate [44.6% (146/327) vs. 35.5%(138/389); OR = 0.93, 95% CI 0.38-2.27, P = 0.87], the recurrence rate [32.4% (106/327) vs. 37.3% (145/389); OR = 1.00, 95% CI 0.49-2.05, P = 0.99], NRM [26.3% (86/327) vs. 27.0% (105/389); OR = 1.05, 95% CI 0.75-1.49, P = 0.77], RFS rate [9.2% (30/327) vs. 12.6% (49/389); OR = 0.74, 95% CI 0.26-2.10, P = 0.57] between the chemotherapy group and the support treatment group were not statistically significant. The differences of 3-year OS rate [40.7% (165/405) vs. 45.9% (290/632); OR = 0.98, 95% CI 0.71-1.36, P = 0.28], recurrence rate [32.6% (132/405) vs. 38.3% (242/632); OR = 1.05, 95% CI 0.79-2.05, P = 0.25], NRM [27.2% (110/405) vs. 24.8% (157/632); OR = 0.81, 95% CI 0.59-1.11, P = 0.68], RFS rate [46.7% (189/405) vs. 42.2 (267/632); OR = 0.84, 95% CI 0.63-1.12, P = 0.85] between demethylation treatment group and traditional treatment group were not statistically significant. There were no significant differences in 3-year OS rate, recurrence rate, NRM and RFS rate between demethylation treatment group and chemotherapy group, demethylation treatment group and support treatment group (all P > 0.05). Conclusion:Different treatment regimens before allo-HSCT have no significant effect on survival or recurrence after transplantation for patients with MDS.

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Application of allogeneic hematopoietic stem cell transplantation in acute lymphoblastic leukemia in the era of targeted therapy

Yingjun CHANG ; Xiangyu ZHAO

Journal of Leukemia & Lymphoma.2022;31(1):11-15. doi:10.3760/cma.j.cn115356-20211217-00297

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is one of the main curable therapies for patients with acute lymphoblastic leukemia (ALL). This article discusses the status of allo-HSCT for ALL as well as how to combine targeted therapy with allo-HSCT to improve outcomes of ALL in the era of targeted therapy based on the data obtained from the 63rd American Society of Hematology (ASH) Annual Meeting.

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Progress in the treatment of relapsed/refractory follicular lymphoma

Zhijuan LIN ; Bing XU

Journal of Leukemia & Lymphoma.2022;31(1):16-19. doi:10.3760/cma.j.cn115356-20211206-00284

Follicular lymphoma (FL) is the most common indolent B-cell lymphoma. Although patients with FL generally have a good prognosis, the treatment of relapsed/refractory FL remains a challenge. The 63rd American Society of Hematology (ASH) Annual Meeting announced the latest updates on relapsed/refractory FL, including the usage of targeted therapy, bio-specific antibodies and chimeric antigen receptor T-cell (CAR-T) therapy. This article provides an overview of the updates in combination with the reports presented at the ASH Annual Meeting.

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