Objective: The clinical features and prognosis of diffuse large B-cell lymphoma (DLBCL) were analyzed to optimize the treatment. Methods: We retrospectively collected the clinical data of patients with advanced-stage DLBCL from January 2006 to December 2012 in National Cancer Center/Cancer Hospital. The demographic characteristics, clinical stage, histological diagnosis, treatment and prognostic characteristics of these patients were analyzed. Results: A total of 370 patients with median age of 55 years old were recruited in the study. The male-to-female ratio was 1.3∶1. Among the 361 patients who underwent therapy, 280 cases received chemotherapy alone, 65 cases received chemoradiotherapy, and 16 cases received chemotherapy combined with autologous hematopoietic stem cell transplantation (AHSCT). The median follow-up period was 89 months, the 5-year overall survival (OS) rate of the entire cohort was 42.9%. The 5-year OS rate of chemotherapy alone, chemoradiotherapy and chemotherapy combined with AHSCT were 36.8%, 58.5%, 87.5%, respectively. The 5-year OS rate were significantly different between chemoradiotherapy and chemotherapy alone (P=0.001), and between chemotherapy combined with AHSCT and chemoradiotherapy (P=0.040). Univariate analysis showed that the age, Eastern Cooperative Oncology Group performance status (ECOG PS) score, Ann Arbor stage, B symptom, bulky disease, number of extranodal sites, Ki-67 index, lactate dehydrogenase (LDH), β2-microglobulin (β2-MG), international prognostic index (IPI), therapeutic manner and chemotherapy combined with rituximab were significantly associated with the prognosis of advanced DLBCL patients (all P<0.05). Multivariate analysis demonstrated that the age >60 years, Ann Arbor stage IV, with B symptom, with bulky disease, ECOG PS≥1, Ki-67 index > 90%, CD5 expression, up-regulation of serum LDH and β2-MG, and chemotherapy without rituximab were related with the poor prognosis of patients with advanced-stage DLBCL (all P<0.05). Conclusions Chemotherapy combined with rituximab can improve the outcome of patients with advanced-stage DLBCL. The age, stage, B symptom, bulky disease, ECOG PS score, Ki-67 index, CD5 expression, LDH, β2-MG and chemotherapy combined with rituximab are associated with the prognosis of these patients.

Objective To comparison of the effect of tigrine and clopidogrel in PCI in patients with STEMI .Methods 118 cases of routine PCI in patients with acute ST segment elevation myocardial infarction from March 2014 to May 2014 in our hospital were select, according to random number table method to all of the patients were randomly divided into clopidogrel group (group A) and tigrine group(group B), preoperative group A received 300 mg of aspirin combined with 600 mg of clopidogrel for treatment,group B received 300 mg aspirin combined with 180g of tigrolipine for preoperative treatment.Compared the two groups of patients with intraoperative infarct-related artery myocardial infarction thrombolytic test three blood flow and 1.5 hours after ST segment fall, postoperative heart B in the situation, the incidence of dyspnea, adverse cardiac events, bleeding events.Results The incidence of ST segment depression and the incidence of ST segment depression in group B were significantly higher than those in group A (t=12.234,χ2 =7.829,P<0.05).One month after surgery, B group of patients with LVEF value was significantly higher than the A group (t=5.393,P<0.05);there was no significant difference in LVDD between the two groups.The incidence of dyspnea and immediate TIMI grade 3 blood flow in group B were 24.6% and 88.5%, respectively, which were significantly higher than those in group A and 8.8% and 68.4% (χ2 =4.293,χ2 =4.392,P<0.05). The incidence of adverse cardiovascular events was 19.3% in group A, which was significantly higher than that in group B (χ2 =2.193,P<0.05). There was no significant difference in the incidence of bleeding between the two groups.Conclusion The use of STEMI patients underwent PCI surgery ticagrelor treatment, in case of the risk of bleeding can effectively improve the patient's myocardial reperfusion and prognosis does not increase , the increased incidence of immediate thrombolysis in myocardial infarction patients in the three grade .

Objective:Primary gastric diffuse large B-cell lymphoma (PGLBCL) is a highly common subtype of extranodal non-Hodgkin lymphoma. We analyzed the disease's clinical features and prognosis to guide better treatment. Methods:We retrospectively collect-ed data from PGLBCL cases seen from January 1999 to March 2012 in one cancer center. We then analyzed the demographic character-istics, clinical stage, histological diagnosis, complications, treatment, and prognostic characteristics of such patients. Results:A total of 126 patients with median age of 49 years old (range:16-81 years) were included in the study. The male-to-female ratio was 68:58. A to-tal of 96 patients were pathologically diagnosed with pure diffuse large B-cell lymphoma (DLBCL), 27 with mucosa-assouated lymphoid (MALT) component, and 3 with plasmacytoid differentiation. Meanwhile, 90%of the patients were in the early stage of the disease. For the early-stage patients, treatment strategy included surgery+chemotherapy ± radiotherapy for 38 cases, chemoradiotherapy for 39 cases, chemotherapy alone for 37 cases, and surgery alone for 1 case. Under a median follow up of 48 months, the 4-year progres-sion free survival (PFS) and overall ourvival (OS) rate of the whole group were 75.6%and 82.7%, respectively. PFS rates for early and advanced stage patients were 77%and 41.7%(P=0.005), respectively. For the early-stage patients treated with chemotherapy alone, chemoradiotherapy, and surgery with therapy, the PFS rates were 67.3%, 77.8%, and 77.8%(P=0.588), respectively. The patients with international prognostic index (IPI) score of 0, 1, and>1 achieved PFS of 85.4%, 74.4%, and 55.6%(P=0.011), respectively. The PFS rates were 81.2%and 66.1%(P=0.018) for stagesⅠandⅡ, respectively, and 86.6%and 63.3%(P=0.006) for the normal and elevated LDH levels, respectively. The pathological type of pure DLBCL or a MALT component, GCB or non-GCB origin, and age more than 60 years old were not associated with prognosis. Conclusion:The majority of the PGLBCL patients were in the early stage of disease, but the outcome of early-stage disease was favorable. Surgery did not improve outcomes. Univariate analysis demonstrated that IPI score>1, stageⅡdisease, and elevated LDH levels were associated with poor prognosis in the early-stage patient.

OBJECTIVETo analyze the duration of preventive filgrastim administration as support for chemotherapy and its affecting factors.

METHODSSingle institutional data from a phase Ⅱ clinical trial and a phase Ⅲ clinical trial of pegylated filgrastim were combined. In the two randomized cross-over trials, patients with previously untreated cancer received two cycles of chemotherapy of the same regimen. In the study group, the patients received a single subcutaneous injection of 100 μg/kg pegylated filgrastim, and in the control group, they received daily subcutaneous injections of 5 μg/kg filgrastim.

RESULTSIn 53 chemotherapy cycles, the median duration of filgrastim administration was (9.57±2.10)d. 83.0% (44/53) of them received filgrastim for 7-11 days. Patients with baseline absolute neutrophil count of <4×10(9)/L or body mass index less than 22 received a longer filgrastim prophylaxis(P<0.05). RESULTS of multivariate analysis showed that the baseline absolute neutrophil count is associated with the time of filgrastim administration(P=0.019). The most common adverse event of rhG-CSF was skeletal pain, generally mild and no treatment-related death occurred.

CONCLUSIONSThe median duration of filgrastim support for chemotherapy was 10 days. Patients with lower baseline neutrophil count require a longer filgrastim prophylaxis.

TRIAL REGISTRATION: ClinicalTrials.gov identifier, NCT01285219.

Antineoplastic Agents ; adverse effects ; Cross-Over Studies ; Filgrastim ; adverse effects ; therapeutic use ; Hematologic Agents ; adverse effects ; therapeutic use ; Humans ; Induction Chemotherapy ; Injections, Subcutaneous ; Multivariate Analysis ; Neoplasms ; drug therapy ; Neutropenia ; chemically induced ; prevention & control ; Time Factors

Objective To evaluate the safety, efficacy and local control effect of CT- guided radiofrequency ablation (RFA) in treating non-small-cell lung cancer (NSCLC) that is inoperable or the surgical treatment is refused by the patient. Methods Between March 2007 and March 2010 at authors’ hospital, a total of 68 procedures of CT-guided RFA were carried out in 60 patients with early stage NSCLC. The patients included 37 males and 23 females with a mean age of 68.5 years. Pathologically, the lesions included squamous cell carcinoma (n=23, 38.3%), adenocarcinoma (n=31, 51.7%), large cell carcinoma (n=2, 3.3%) and adeno-squamous carcinoma (n=4, 6.7%). The mean diameter of the lesions was 3.8 cm (1.8-6.8 cm). The overall survival rate, cancer-specific survival rate and local progression-free survival rate were evaluated. Results RFA procedure was well tolerated by all patients with an average ablation time of 35 min (18-63 min). The main intraprocedural complication was pneumothorax (n=17, 28.3%). No death occurred during perioperative period. The median local progression-free survival time was 28 months, the median survival time was 32 months, and the one-, 2- and 3-year local progression-free survival rate were 94.6%, 83.1%and 73.6%, respectively. Conclusion For patients with inoperable NSCLC and patients with NSCLC who refuse to receive surgery, CT-guided RFA is a safe and effective treatment. This therapy can significantly improve the local progression-free survival rate.

Objective:To compare the efficacy of a single injection of pegylated filgrastim with daily doses of filgrastim as pro-phylaxis for chemotherapy-induced neutropenia in Chinese cancer patients. Methods:Single-institution data from a phase 2 study and a phase 3 trial on pegylated filgrastim were combined to analyze the efficacy and safety parameters. In the two randomized crossover tri-als, patients with previously untreated cancers received two cycles of chemotherapy with identical regimen. In the study cycle, the pa-tients received a single subcutaneous injection of pegylated filgrastim (100 μg/kg), whereas those in the control cycle received daily subcutaneous injections of filgrastim (5μg/kg). Results:Among the 56 patients enrolled, 53 were evaluable for efficacy. These patients received one cycle with pegylated filgrastim prophylaxis and one cycle with filgrastim support each. Results indicated that 94.3%(50/53) of the cycles with pegylated filgrastim or filgrastim support did not develop grade 4 neutropenia. Moreover, febrile neutropenia did not occur in the cycles. The incidence rates of antibiotic administration were 7.5%(4/53) and 3.8%(2/53) in the pegylated filgrastim and filgrastim cycles, respectively (P=0.678). The median duration of filgrastim administration was 10 days (3-14 days). Generally, the safety profile of pegylated filgrastim is similar to that of filgrastim, including skeletal pain, pain at the injection site, palpitation, fever, and fatigue. Conclusion:A single dose of pegylated filgrastim demonstrated comparable efficacy with 10 consecutive doses of filgras-tim as prophylaxis for chemotherapy-induced neutropenia.

OBJECTIVETo evaluate the efficacy and safety of gemcitabine combined with ifosfamide (GI regimen)in patients with recurrent or metastatic nasopharyngeal carcinoma after failure of platinum-based chemotherapy.

METHODSThe clinical data of 27 nasopharyngeal carcinoma patients, who received GI regimen between April 2005 and March 2014 after failure of prior platinum-based chemotherapy, were retrospectively reviewed,and relevant prognostic factors were explored.

RESULTSAll patients were evaluable for efficacy and toxicity. No patient achieved complete response (CR). Partial response (PR) was achieved in ten patients, stable disease (SD) in thirteen patients, progressive disease (PD) in four patients, with a response rate of 37.0% and an overall disease control rate (PR+SD) of 85.2%. For ten PR patients, the median duration of response was 5.5 months. The median progression-free survival of the whole group was 6.7 months, and the Kaplan-Meier estimate of median overall survival was 17.4 months. The 1-year survival rate was 72.6%. Toxicity was mainly hematological: Grade III or IV anemia, neutropenia and thrombocytopenia were found in 3.7%, 37.0% and 18.5% of all patients, respectively. Univariate and multivariate analyses indicated that dose intensity of gemcitabine was a significant prognostic factor for PFS, whereas salvage treatment after failure of GI regimen was a significant prognostic factor for OS.

CONCLUSIONSGemcitabine and ifosfamide combination is effective and well tolerated by patients with advanced nasopharyngeal carcinoma pretreated with platinum-based chemotherapy. Further clinical study is warranted.

Anemia ; chemically induced ; Antineoplastic Agents ; adverse effects ; therapeutic use ; Antineoplastic Combined Chemotherapy Protocols ; adverse effects ; therapeutic use ; Carcinoma ; Deoxycytidine ; administration & dosage ; adverse effects ; analogs & derivatives ; Disease-Free Survival ; Humans ; Ifosfamide ; administration & dosage ; adverse effects ; Induction Chemotherapy ; Kaplan-Meier Estimate ; Nasopharyngeal Neoplasms ; drug therapy ; mortality ; pathology ; Neutropenia ; chemically induced ; Platinum ; therapeutic use ; Remission Induction ; Salvage Therapy ; Survival Rate ; Thrombocytopenia ; chemically induced ; Treatment Failure

BACKGROUNDThe regimen of cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) is an efficient treatment of non-Hodgkin's lymphoma (NHL). This study aimed to assess the efficacy and toxicity of dose-adjusted CHOP alone or in combination with rituximab (R-CHOP) by examining the stem cell mobilization in NHL patients. Factors affecting the collection of CD34+ cells were also explored.

METHODSOur retrospective study included 39 patients eligible for autologous stem cell transplantation: 14 patients who expressed CD20 and were financially eligible received R-CHOP for autologous peripheral blood stem cell (APBSC) mobilization; the remaining 25 patients received CHOP.

RESULTSThe median CD34+ cell yield was 7.01×10(6) cells/kg body weight (range 1.49-28.39×10(6) cells/kg body weight), with only two patients failing to meet the target CD34+ cell harvest of ≥2.0×10(6) cells/kg body weight. The median number of apheresis procedures per patient was 1 (range 1-3). The APBSC mobilization yield of the CHOP group appeared to be higher than that of the R-CHOP group (P=0.005), whereas the success rate was similar between groups. R-CHOP elevated the complete response (CR) rate in B cell lymphoma patients as compared with CHOP (P=0.01). No significant differences in toxicity or engraftment were observed between the two groups.

CONCLUSIONThe present study demonstrated that dose-adjusted CHOP chemotherapy effectively mobilized APBSCs in NHL patients and that the addition of rituximab to dose-adjusted CHOP chemotherapy elevated the CR rate for patients with B-cell lymphoma.

Antibodies, Monoclonal, Murine-Derived ; Antineoplastic Combined Chemotherapy Protocols ; Cyclophosphamide ; Doxorubicin ; Hematopoietic Stem Cell Mobilization ; Hematopoietic Stem Cell Transplantation ; Humans ; Lymphoma, B-Cell ; Lymphoma, Non-Hodgkin ; Prednisolone ; Prednisone ; Remission Induction ; Retrospective Studies ; Rituximab ; Vincristine

Objective To evaluate the efficacy and safety of gemcitabine combined with ifosfamide (GI regimen) in patients with recurrent or metastatic nasopharyngeal carcinoma after failure of platinum?based chemotherapy. Methods The clinical data of 27 nasopharyngeal carcinoma patients, who received GI regimen between April 2005 and March 2014 after failure of prior platinum?based chemotherapy, were retrospectively reviewed,and relevant prognostic factors were explored. Results All patients were evaluable for efficacy and toxicity. No patient achieved complete response ( CR) . Partial response ( PR) was achieved in ten patients, stable disease ( SD) in thirteen patients, progressive disease ( PD) in four patients, with a response rate of 37.0% and an overall disease control rate (PR+SD) of 85.2%. For ten PR patients, the median duration of response was 5.5 months. The median progression?free survival of the whole group was 6.7 months, and the Kaplan?Meier estimate of median overall survival was 17.4 months. The 1?year survival rate was 72.6%. Toxicity was mainly hematological: Grade Ⅲ or Ⅳ anemia, neutropenia and thrombocytopenia were found in 3.7%, 37.0% and 18.5% of all patients, respectively. Univariate and multivariate analyses indicated that dose intensity of gemcitabine was a significant prognostic factor for PFS, whereas salvage treatment after failure of GI regimen was a significant prognostic factor for OS. Conclusions Gemcitabine and ifosfamide combination is effective and well tolerated by patients with advanced nasopharyngeal carcinoma pretreated with platinum?based chemotherapy. Further clinical study is warranted.