Objective:To identify the relevant factors for the first-course remission of acute myeloid leukemia (AML) and to develop a predictive model as well as assess its predictive capability.Methods:Clinical data of 749 patients newly diagnosed with AML admitted to the Department of Hematology, the First Affiliated Hospital, Zhejiang University, School of Medicine from January 1, 2019, to April 30, 2023, were collected and randomly divided into training and validation sets. Multivariate logistic regression analysis was conducted to determine variables associated with complete remission in the first course of induction therapy, and a predictive model was established based on these variables. The receiver operating characteristic (ROC) curve of the predictive model was plotted, and the area under the curve (AUC) was calculated.Results:The indicators predicting the first remission course included peripheral blood white blood cell count during onset, CBF::MYH11 fusion gene, CEBPA bZIP region mutation, myelodysplastic syndrome-related gene mutation, and induction chemotherapy regimen selection as independent factors for the first remission course. The model’s area under the training and validation curves was 0.738 (95% CI: 0.696-0.780) and 0.726 (95% CI: 0.650-0.801), respectively. The Hosmer-Lemeshow test results yielded P-values of 0.993 and 0.335, respectively. Conclusion:In this study, the developed model demonstrates a strong predictive capability for the efficacy of the first course of patients with AML, providing valuable guidance to clinicians in assessing patient prognosis and selecting appropriate treatment strategies.

TAFRO syndrome is an idiopathic systemic inflammatory disease that overlaps with idiopathic multicentric Castleman disease (iMCD). The clinical features of TAFRO syndrome include thrombocytopenia (T), anasarca (A), fever (F), reticulin fibrosis/renal insufficiency (R) and organomegaly (O). The paper reports a special clinical subtype of iMCD—TAFRO syndrome in a patient, manifested as multiple-system involvement including serous effusion (ascites), fever, thrombocytopenia, anemia, multiple lymphadenopathies, pancreatitis and renal insufficiency. Bone marrow biopsy pathology showed active bone marrow hyperplasia. Renal biopsy revealed renal thrombotic microangiopathy, acute renal tubular interstitial injury combined with chronic lesions. Lymph node biopsy demonstrated lymphoproliferative lesions consistent with Castleman disease (hyaline vascular type). Following diagnosis, glucocorticoids, tacrolimus, rituximab and lenalidomide were administered, resulting in significant symptomatic improvement: ascites disappeared, and urinary findings, erythrocyte counts, renal function and hematological indexes normalized. The paper describes the patient's clinical manifestations, diagnosis and treatment process, and prognosis, and reviews relevant literature, to improve clinicians' understanding of this rare disease.

Objective:To identify the relevant factors for the first-course remission of acute myeloid leukemia (AML) and to develop a predictive model as well as assess its predictive capability.Methods:Clinical data of 749 patients newly diagnosed with AML admitted to the Department of Hematology, the First Affiliated Hospital, Zhejiang University, School of Medicine from January 1, 2019, to April 30, 2023, were collected and randomly divided into training and validation sets. Multivariate logistic regression analysis was conducted to determine variables associated with complete remission in the first course of induction therapy, and a predictive model was established based on these variables. The receiver operating characteristic (ROC) curve of the predictive model was plotted, and the area under the curve (AUC) was calculated.Results:The indicators predicting the first remission course included peripheral blood white blood cell count during onset, CBF::MYH11 fusion gene, CEBPA bZIP region mutation, myelodysplastic syndrome-related gene mutation, and induction chemotherapy regimen selection as independent factors for the first remission course. The model’s area under the training and validation curves was 0.738 (95% CI: 0.696-0.780) and 0.726 (95% CI: 0.650-0.801), respectively. The Hosmer-Lemeshow test results yielded P-values of 0.993 and 0.335, respectively. Conclusion:In this study, the developed model demonstrates a strong predictive capability for the efficacy of the first course of patients with AML, providing valuable guidance to clinicians in assessing patient prognosis and selecting appropriate treatment strategies.

TAFRO syndrome is an idiopathic systemic inflammatory disease that overlaps with idiopathic multicentric Castleman disease (iMCD). The clinical features of TAFRO syndrome include thrombocytopenia (T), anasarca (A), fever (F), reticulin fibrosis/renal insufficiency (R) and organomegaly (O). The paper reports a special clinical subtype of iMCD—TAFRO syndrome in a patient, manifested as multiple-system involvement including serous effusion (ascites), fever, thrombocytopenia, anemia, multiple lymphadenopathies, pancreatitis and renal insufficiency. Bone marrow biopsy pathology showed active bone marrow hyperplasia. Renal biopsy revealed renal thrombotic microangiopathy, acute renal tubular interstitial injury combined with chronic lesions. Lymph node biopsy demonstrated lymphoproliferative lesions consistent with Castleman disease (hyaline vascular type). Following diagnosis, glucocorticoids, tacrolimus, rituximab and lenalidomide were administered, resulting in significant symptomatic improvement: ascites disappeared, and urinary findings, erythrocyte counts, renal function and hematological indexes normalized. The paper describes the patient's clinical manifestations, diagnosis and treatment process, and prognosis, and reviews relevant literature, to improve clinicians' understanding of this rare disease.

A CALLG2008 protocol was developed by the Chinese Acute Lymphoblastic Leukemia Cooperative Group for adult acute lymphoblastic leukemia (ALL).We retrospectively analyzed 153 newly diagnosed adult patients with Philadelphia chromosome (Ph)-positive ALL enrolled into imatinib (400 mg/d) plus CALLG2008 regimen between 2009 and 2015.The median age was 40 years (range,18-68 years),with 81 (52.3％) males.The overall hematologic complete remission (CR) rate was 96.7％ after induction.With a median follow-up of 24.2 months,the estimated 3-year overall survival (OS) and event-free survival (EFS) rates were 49.5％ (95％ confidence interval (CI):38.5％-59.5％) and 49.2％ (95％ CI:38.3％-59.2％),respectively.Fifty-eight (36 with haploidentical donor) patients underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) in first CR.Among the patients in CR1 after induction,both the 3-year OS and EFS were significantly better in the allo-HSCT group than in the without allo-HSCT group (73.2％,95％ CI:58.3％-83.5％ vs.22.2％,95％ CI:8.7％-39.6％ and 66.5％,95％ CI:50.7％-78.2％ vs.16.1％,95％ CI:5.1％-32.7％,respectively).Multivariate analysis showed that allo-HSCT and achievement of major molecular response were associated with favorable OS or EFS independently.Interestingly,in the allo-HSCT cohort,the donor type (haploidentical versus matched donors) had no significant impact on EFS or OS.All these results suggested that imatinib plus CALLG2008 was an effective protocol for Ph-positive ALL.Haploidentical donors can also be a reasonable alternative expedient donor pool.

Objective To study the effects of percutaneous liver tumor injection combined with the clinical efficacy of transcatheter hepatic artery chemoembolization in the treatment of advanced liver cancer,and to provide ref-erence for clinical treatment.Methods 22 patients using percutaneous liver tumor injection combined with transcath-eter arterial chemoembolization for treatment were selected,with which 1 month follow-up after discharge.Situation of patients with percutaneous liver tumor injection and transcatheter hepatic artery chemoembolization was analyzed,and the changes of the patients in the following -up of survival time,tumor volume and clinical symptoms were also ana-lyzed.Results Among the patients of postoperative recheck after 6 weeks,6 cases were complete remission,there were partial remission in 8 cases,6 cases of stable,2 cases of progress.Follow up to 2013 December,the patients'sur-vival time was 17-82 months,the average survival time was (55.71 ±13.47)months.After treatment,4 cases of patients'tumor diameter reduced 1 -3cm,18 cases of tumor diameter reduced 3 -5cm,19 cases of liver area pain symptoms for more than half a year of remission,3 cases of liver area pain relief time less than half a year.During the follow -up period,12 patients died of multiple organ failure.Conclusion The development of percutaneous liver tumor injection combined with transcatheter hepatic arterial chemoembolization therapy can delay the development of the disease in patients with advanced HCC,and prolong the survival time.

OBJECTIVETo investigate the expression level of SET gene in patients with acute myeloid leukemia (AML) and evaluate its significance.

METHODSThe expression level of SET gene in 141 de novo AML patients was determined by real time quantitative PCR (RQ-PCR), and its relationship with the clinical features and outcomes of these patients were analyzed.

RESULTSSET gene transcript level was detected in 141 AML patients with the median expression level of 0.86(range 0.02-15.69). AML patients with higher SET gene expression had a higher level of white blood cell (WBC ≥ 100 × 10⁹/L) count than of lower SET gene expression ones (31.0% vs 11.4%, P=0.005). In the 136 patients who received treatment after diagnosis, higher SET gene expression group had lower complete remission rate (50.0%) than of lower expression cohort (73.5%) after two cycles of chemotherapy (P=0.005). Survival analysis showed that patients with higher SET gene expression had significantly shorter overall survival(OS) (10 months vs 22 months, P=0.001) and event-free survival (EFS) (2 months vs 14 months, P=0.005) than of lower SET gene expression ones. Multivariate COX regression analysis showed SET overexpression was an independent prognostic factor for OS. In the patients with the normal karyotype, higher SET expression group also had significantly shorter OS (12 months vs 35 months, P=0.010) and EFS (4 months vs 14 months, P=0.026) than of lower SET expression ones.

CONCLUSIONHigh expression of SET gene was associated with poor prognosis and might be a prognostic molecular marker of AML.

Disease-Free Survival ; Gene Expression Regulation, Neoplastic ; Histone Chaperones ; genetics ; Humans ; Leukemia, Myeloid, Acute ; genetics ; Prognosis ; Remission Induction ; Transcription Factors ; genetics

Aged ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Humans ; Induction Chemotherapy ; Leukemia, Myeloid, Acute ; drug therapy ; Middle Aged

ObjectiveTo investigate the feasibility and efficacy of using the hepatoduodenal ligament tension-reduced operation (tension-reduced operation in short) for iatrogenic bile duct injury where the bile duct was severely defective. MethodsBetween March 2006 and May 2009, the authors treated 6 patients with iatrogenic bile duct injury (Bismuth type Ⅱ : 5 patients and type Ⅲ : 1 patient). A no. 7 black silk thread was used to hold the hilar plate tissues and the seromuscular layer of the bulbous part of the duodenum closer together and knots were tied. This method brought the porta hepatis and the duodenal bulb closer together and the hepatoduodenal ligament was shortened. An end to end anastomosis could then be made between the two broken ends of the defective bile duct without tension. ResultsSix patients suffered from bile duct injury and they recovered fully after the tensionreduced operation. There was no complication on follow-up. ConclusionsThe tension-reduced operation was efficacious in the treatment of iatrogenic bile duct injury. This technique should be popularized and more widely used.

Objective To observe the efficacy of liposomal doxorubicin combined with cyclophosphamide, vincristine and prednisone in the treatment of refractory Non-Hodgkin’s lymphoma.Methods Liposomal doxorubicin (40mg/m2) was given by intravenous drip in the 1st day. Cyclophosphamide (750mg/m2) was given by intravenous injection in the 1st day. Vincristine (2mg) was given by intravenous injection in the 1st day. Prednisone (100mg/m2) was given orally from the 1st to the 5th day. A cycle was repeated every 3 to 4 weeks. Every patient took at least 2 cycles of the regimen.Results A total of 13 patients were assessed in the group. Among them, 7 were completely release (53.8), 4 were partially release (30.67) and 2 remained the same (15.35). The B symptom of 7 patients in the 9 with that disappeared, and that of the other 2 patients was improved obviously. The most common adverse effects were slight gastrointestinal reactions and the grade Ⅲ bone marrow suppression in a few patients. Conclusion The regimen of liposomal doxorubicin combined with cyclophosphamide, vincristine and prednisone is effective in the treatment of refractory Non-Hodgkin’s lymphoma with tolerable toxicity. It may be a salvage chemotherapeutic regimen deserving further study.