14 Hematopoietic System

14 Hematopoietic System

2015231 Clinical observations of lenalidomide combination chemotherapy for relapsing or refractory multiple myeloma.LI Xin（李新），et al.Dept Hematol，Beijing Chaoyang Hosp，Capital Med Univ，Beijing 100043.Natl Med J China 2015；95（10）：745-748.

Objective To explore the clinical efficacies and toxicities of lenalidomide combination chemotherapy in the treatment of relapsing or refractory multiple myeloma （MM）patients.Methods A total of 14 MM patients were recruited to receive lenalidomide combination chemotherapy in Beijing Chaoyang hospital from June 2013 to October 2014.Lenalidomide 25 mg was taken orally daily or every alternate day for 21 days and resting for 7 days.The regiments were RD（lenalidomide and dexamethasone，n=6），RCD（lenalidomide，ifosfamide and dexamethasone，n=4），RDD（lenalidomide，liposomal doxorubicinand dexamethasone，n=1），PRD（ lenalido-mide，velcade and dexamethasone，n=1）and R+ DECP（lenalidomide，cisplatin，etoposide，ifosfamide and dexamethasone，n=2）.Results Among them，two patients died during the first cycle of lenalidomide.Ten patients finished 2 cycles of treatment and 2 patients attained near complete remission or complete remission （nCR/CR），6 partial remission（PR）and 2 stable disease（SD）with an overall response rate（ORR）of 8/10. Ten patients finished 3 cycles of treatment and 3 attained CR，5 PR and 2 SD.Nine patients finished 4 cycles of treatment and 3 attained CR，5 PR and 1 progressive disease（PD）.Six patients finished 5 cycles of treatment and 1 attained CR，3 PR and 2 PD.Three patients finished 6 cycles of treatment and 1 attained CR，1 PR and 1 PD.And the most common adverse reactions were fatigue，loss of appetite and hypocytosis.Six patients died.Conclusion The lenalidomide combination chemotherapy is both efficacious and safe in the treatment of relapsing or refractory MM.

（Authors）

2015232 Study on the molecular mechanisms of a novel large deletion of FⅩⅢA mRNA in a new hereditary factorⅩⅢdeficiency.MA Qiuling（马秋玲），et al.Dept Biochem&Molec Biol，Hainan Med Coll，Haikou 571101.Chin J Hematol 2015；36（2）：131-134.

Objective To investigate the mechanisms of Del-CD11-279 of factorⅩⅢsubunit A mRNA in the pathogenesis of hereditary factorⅩⅢdeficiency.Methods The recombinant plasmids containing pET-22b（+）/FⅩⅢA of normal subject and proband's mother and pET-22b （+）/FⅩⅢA-Del of the proband were constructed and transformed into E.coli BL21.Expressing protein was analyzed by the SDS-PAGE and purified by Ni-NTA resin.Purified proteins were detected by the Western-blot. The activity of purified protein was detected by the incorporation test with EZ-LinkTM5-（Biotinamide）Pentylamine.Results The recombinant plasmids containing pET-22b（+）/FⅩⅢA and pET-22b（+）FⅩⅢA-Del which constructed and identified successfully by enzyme digestion and PCR，were transformed into E.coli BL21 and efficiently expressed by IPTG induction.The molecular weights of expressing proteins were 83 200 and 51 900 by the SDS-PAGE.Expressing proteins were purified by Ni-NTA resin，and were proven to be human FⅩⅢA proteins by Western-blot.Purified protein activity of proband's mother and proband was 95.87%and 0 of the purified FⅩⅢA protein activity from the normal subjects，respectively.Conclusion DelCD11-279 of FⅩⅢA mRNA which encoding a 464 amino acids of inactive FⅩⅢA protein is one of the molecular mechanisms resulting in FⅩⅢdeficiency in the patient.

（Authors）

2015233 Potential relationship and clinical significance of miRNAs and Th17 related cytokines in patients with multiple myeloma.LI Yanjie（李艳杰），et al.Dept Hematol，Affil Hosp，Xuzhou Med Coll，Xuzhou 221002.Chin J Hematol 2015；36（2）：125-130.

Objective To explore the expression and significance of miRNAs and Th17 related cytokines in patients with multiple myeloma（MM）.Methods A total of 27 MM patients and 8 healthy controls were enrolled in this study.The expression of miR-15a/16，miR-34a，miR-194-2-192 cluster and miR-181a/b in bone marrow were detected by real-time quantitative PCR（qRT-PCR）.Enzyme-linked immunosorbent assay（ELISA）was used to determine the levels of Th17 related cytokines interleukin-17（IL-17），IL-21，IL-22，IL-23 and IL-27 in peripheral blood plasma.The role of miRNAs and Th17 related cytokines was analyzed in the development of MM. Results The expression of miR-15a/16，miR-34a，miR-194-2-192 cluster in MM patients were significantly lower than those of the healthy controls，while miR-181a/b were exactly the reverse（P＜0.05）.The levels of IL-17，IL-21 and IL-27 were up-regulated in MM patients compared to healthy controls while IL-22 was down-regulated（P＜0.05）.There was no significant difference of IL-23 between the two groups.The levels of miRNAs and Th17 related cytokines had associated with ISS but not with some clinical parameters（such as gender，age，disease classification）.Higher expression of IL-17，IL-21，IL-23，IL-27， miR-181a/b and lower expression of miR-15a/16，miR-34a，miR-194 and IL-22 were observed in the end stage than the early stage of MM patients（P＜0.05）.There was a significant correlation between miRNAs and Th17 elated cytokines.Conclusion Up-regulated IL-17，IL-21 and IL-27 may potentially down-regulate the expression of several miRNAs in MM patients. Establishment of the relationship may be useful for understanding the pathogenesis of MM and for clinical diagnosis of the disease.

（Authors）

2015234 ALK gene fusion associated non-small cell lung cancer：automated immunostainer detection and clinicopathologic perspectives.SHEN Qin（沈勤），et al.Dept Pathol，Jinling Hosp，South Med Univ，Nanjing 210002.Chin J Pathol 2015；44（3）：164-169.

Objective To explore the automated immunostainer screening anaplastic lymphoma kinase（ALK）gene fusion non-small cell lung cancer（NSCLC）and clinicopathological characteristics of the molecular subtype lung cancers.Methods Five hundred and sixty-six cases of NSCLC were collected over a 16 month period.The test for ALK was performed by Ventana automated immunostainer with anti-ALK D5F3.The histological features，treatment and outcome of patients were assessed.Results Thirty-eight cases（6.75，38/566）of NSCLC showed ALK gene fusion.The frequency of ALK gene fusion was higher in male（7.1%，25/350）than that in female （6.0%，13/216）patients，but not achieving statistical significance（χ2=0.270，P=0.604）.ALK+NSCLC was more significantly frequent in patients≤60 years（9.9%，28/282）than＞60 years（3.5%，10/284）of age.Histologically，the ALK+NSCLCs were mostly adenocarcinoma（81.6%，31/38），among which eighteen cases were solid predominant subtype with mucin production；nine cases were acinar predominant subtype；one case was papillary predominant subtype and three cases were invasive mucinous adenocarcinoma.The ALK+non-adenocarcinoma included three cases of squamous cell carcinoma，three cases of adenosquamous carcinoma and one case of pleomorphic carcinoma.Among the ALK+ NSCLC patients，the number of non/light cigarette smokers（86.8%，33/38）was more than that of heavy smokers.Twenty-nine cases were stagesⅢ andⅣ；twentynine cases showed lymph node metastasis；twenty cases showed metastases mostly to brain and bone；and one case showed EGFR gene mutation coexisting with ALK gene fusion.Twelve of fifteen patients received crizotinib therapy and remained stable.Conclusion NSCLC with ALK gene rearrangement shows distinctive clinical and histological features.Ventana-IHC may be a feasible and valid technique for detection of ALK rearrangement in NSCLC.

（Authors）

2015235 Clinical analysis of newly diagnosed multiple myeloma patients with renal dysfunction.ZHU Wanqiu（朱婉秋），et al.Beijing Chaoyang Hosp，Capital Med Univ，Beijing 100020.Natl Med J China 2015；95（10）：741-744.

Objective To explore the clinical features and prognostic factors of newly diagnosed multiple myeloma patients with renal insufficiency（MM-RI）.Methods The clinical features，survival rates and prognostic factors were retrospectively analyzed for 897 newly diagnosed multiple myeloma（MM）patients at three hospitals from January 1，2010 to June 30，2012.Results Among them，there were 177 cases（19.7%）of MM-RI patients.There were 125 males and 52 females with an average age of 59 years.And 28.2%（50/177）were over 65 years.The types were 17.2%（30/174）of immunoglobulin（Ig）D-λ and 27.6%（48/174）of light chain isotype.And the stages were 94.9%of DS stageⅢ（167/176）and ISS stageⅢ（166/175）.Compared with MM patients with normal renal function（MM-RN），MMRI group had a higher proportion of patients with IgD-λ and light chain isotype，more patients of DS and ISS stageⅢ；elevated bone marrow plasma cells，white blood cells and uric acid；lower hemoglobin and platelet （all P＜0.05）.After a median follow-up period of 24 （2-114）months，the median progression-free survival （PFS）was 28.0 months for MM-RI patients and 29.0 months for MM-RN patients.And the difference was not statistically significant（P=0.457） .The estimated medi-an overall survival（OS）was 44.0 months for MM-RI patients and 59.2 months for MM-RN patients.And the difference was statistically significant（P=0.033）.Logrank univariate analysis showed that age，LDH，β2-MG，first-line treatment with or without bortezomib and previous transplantation or not were independent prognostic factors of MM patients.Conclusion MM-RI and MM-RN patients have different clinical features.Age，LDH，β2-MG，first-line treatment with or without bortezomib and previous transplantation or not are independent prognostic factors for newly diagnosed MM patients.

（Authors）

2015236 Clinical and cytogenetic characteristics of myeloma patients with overall survival less than 24 months.ZHANG Junling（张俊玲），et al.Dept Hematol，PUMC&CAMS，Beijing 100730.Natl Med J China 2015；95（10）：736-740.

Objective To explore the clinical characteristics of multiple myeloma（MM）patients with overall survival （OS）less than 24 months so as to stratify high-risk population.Methods A total of 177 newly diagnosed MM inpatients were recruited from July 2008 to July 2012. Clinical parameters at diagnosis of international staging system（ISS），lactic dehydrogenase（LDH），serum calcium，extramedullary involvement and amyloidosis were collected and cytogenetic abnormalities were detected by fluorescence in situ hybridization（FISH）.Response and death were recorded as endpoints.Otherwise the followup period was over 24 months.Results And 73 patients dying within 24 months were classified into high-risk group while another 104 survivors for over 24 months into control group.Age and gender at baseline were comparable.However，OS of high-risk group was only 8 months while it was not attained during a median follow up of 38 months in control group（P＜0.001）.The most common cause of death was progressive disease in both groups. The pre-treatment percentages of the following parameters were significantly higher in high-risk group，including ISS stageⅢ［76.71%（56/73）vs 50.00%（52/104），P=0.002］，renal dysfunction［47.95%（35/73）vs 31. 73%（33/140），P=0.029］，elevated LDH［20.55%（15/73）vs 7.69%（8/104），P=0.015］and plasma cell leukemia［PCL，5.48%（4/73）vs 0（0/104），P= 0.016］.Conversely，extramedullary involvement，plasmacytoma，amyloidosis and hypercalcemia were similar. Despite comparable chemotherapeutic regimens，the rate of deep response，including complete response（CR）and very good partial response（VGPR），was significant lower in high-risk group than that in control group［12.33% （9/73）vs 53.85%（56/104），P＜0.001］.Overall response rates［ORR，i.e.CR+VGPR+partial response （PR）］were markedly different［38.36%（28/73）vs 86.54%（90/104），P＜0.001］.Univariate analysis of cytogenetic abnormalities indicated a higher proportion of 1q21 amplification in high-risk group［35.62%（26/73）vs 25.15%（22/104），P=0.033］.Multivariate Logistic regression revealed that ISS，LDH and primary response worse than PR independently affected early death （P=0.046，0.005，＜0.001）.Conclusion MM patients with OS less than 24 months have distinct clinical characteristics.And aggressive regimens are needed to improve the outcomes of high-risk population.

（Authors）

2015237 Effect of chronic graft versus host disease on relapse and survival in patients with acute myeloid leukemia.ZHAO Xiaoli（赵小利），et al.Dept Hematol，Chin PLA General Hosp，Beijing 100853.Chin J Hematol 2015；36（2）：116-120.

Objective To explore the influence of relapse and survival by chronic graft versus host disease（cGVHD）in patients with acute myeloid leukemia（AML）after allogeneichematopoieticsstemcelltransplantation（allo-HSCT）.Methods Fifty-five AML patients received allo-HSCT were retrospectively reviewed.Relapse rate and overall survival（OS）were analyzed according to cGVHD. Results cGVHD significantly decreased the relapse rate of AML patients after transplantation within 2 years when compared with those without cGVHD（8.7%vs 38.6%，P=0.019），however，cGVHD had no effect on the long-term relapse rate（22.8%vs 5.9%，P=0.217）. cGVHD had no effect on OS within 2 years（78.3%vs 61.0%，P=0.155） but could decrease the rate of long-term survival（63.7%vs100%，P=0.01）.cGVHD also could reduce the rate of relapse（8.3%vs 46.2%，P=0.044）and enhanced the rate of survival（83.3% vs 47.2%，P=0.045）in patients with high risk AML after allo-HSCT in 2 years，while it had no effect on the relapse rate and OS in patients with low and intermediated risk AML in early and late phase.Moreover，compared with the rate of relapse（38.6%）in patients without cGVHD，the rate of relapse were lower in patients with limited cGVHD and intensive cGVHD（27.3%and 31.3%，respectively）but the long-term survival was significantly lower（53.3%，P=0.001）in those patients with intensive cGVHD after all-HSCT.Conclusion The benefit effect of cGVHD mainly took place within 2 years after allo-HSCT in AML patients especially in those with high risk，while in late phase after allo-HSCT，cGVHD especially intensive cGVHD had an effect on reducing long-term survival.

（Authors）

2015238 Effect of ERK1/2 inhibitor AZD8330 on human Burkitt's lymphoma cell line Raji cells and its mechanism.FENG Ke（冯可），et al.Dept Hematol，AffilCancerHosp， ZhengzhouUniv， Zhengzhou 450008.Chin J Hematol 2015；36（2）：148-152.

Objective To investigate the effect of ERK1/2 inhibitor AZD8330 on human Burkitt's lymphoma cell line Raji cells and its mechanism.Methods Raji cells were treated with different concentrations of AZD8330.CCK-8 was used to detect the cell viability.The apoptosis rate of Raji cells was detected by flow cytometry using Annexin Ⅴ/PI-staining.Real-time PCR was used to assess the expression of Bcl-2，Bcl-x1，caspase-3andVEGF genes.The protein expression level of Bcl-2，Bcl-x1，caspase-3 and p-ERK1/2 was tested with Western blot. Results The cell survival rate decreased to（62.09± 0.86）%，（50.06±1.33）%and（39.13±2.34）5 respectively after cells were treated with AZD8330 at 1.00 μmol/L in vitro for 24 h，48 h and 72 h，and statistically significant differences were observed in groups with different time of treatment（P＜0.05）.Apoptosis of cells treated with AZD8330 at 0.10，1.00，10.00 μmol/L in vitro for 24 h，48 h and 72 h was analyzed，and the statistically significant differences were observed in groups of different time and concentration treatment（P＜0.05）. AZD8330 induced Raji cell apoptosis and upregulated expression of Bcl-2，Bcl-x1，VEFG and decreased the expression of caspase-3 in a dose and time dependent manner，and statistically significant differences were observed in groups of different time and concentration treatment（P＜0.05）.At the same time，the Bcl-2，Bcl-x1 and p-ERK1/2 proteins expression was suppressed obviously，but the expression of caspase-3 protein increased. Conclusion AZD8330 induces cell apoptosis by downregulating the activation of ERK1/2 signal transduction pathway in Burkitt's lymphoma cell line Raji cells in a dose and time dependent manner.

（Authors）

2015239 Effect of ursolic acid on proliferation of T lymphoma cell lines Hut-78 cells and its mechanism. YANG Li（杨力），et al.Dept Hematol，1st Affil Hosp，Soochow Univ，Suzhou 215006.Chin J Hematol 2015；36（2）：153-157.

Objective To investigate the effects of ursolic acid on T cell lymphoma cell lines-Hut-78 cells and its mechanism.Methods Inhibition of Hut-78 cells proliferation by ursolic acid at different concentration（10，20，40 and 80 μmol/L）for different incubation time（4，12，24，48 and 72 h）was examined by MTT method，and early apoptosis by flow cytometry.The protein expressions of p65，p50，p52 and p100，and caspase-8，caspase-3 and caspase-9 were detected by Western blot.VEGF and COX-2 mRNA expressions were measured by reverse transcription polymerase chain reaction（RT-PCR）.Results It was showed that ursolic acid inhibited proliferation of Hut-78 cells（P＜0.05）.Apoptosis of Hut-78 cells was induced by 10，20，40 and 80 μmol/L ursolic acid treatment（P＜0.01）.Likewise，expressions of p65 and p50 proteins were down-regulated by ursolic acid treatment（10，20，40 and 80 μmol/L）（P＜0.01），but there was no significant change in the expression of p52 and p100.Moreover，ursolic acid could up-regulate expression of caspase-8， caspase-3 and caspase-9 protein（P＜0.01）.RT-PCR examination showed that VEGF and COX-2 mRNA expression decreased by ursolic acid treatment.Conclusion Inhibition of Hut-78 cell proliferation may be related to ursolic acid induced apoptosis through h death receptors and mitochondrial pathways. NF-κB classical signal pathway may be one of its mechanisms，and VEGF and cox-2 may also be involved.

（Authors）

2015240 Retrospective efficacy analysis of decitabine bridging allogeneic hematopoietic stem cell transplantation on the treatment of myelodysplastic syndrome.ZHENG Huifei（郑慧菲），et al.Instit Hematol，1st Affil Hosp，Soochow Univ，Suzhou 215006. Chin J Hematol 2015；36（2）：121-124.

Objective To evaluate the efficacy of decitabine （DAC）bridging therapy followed by allogeneic hematopoietic stem cell transplantation（allo-HSCT）in patients with myelodysplastic syndrome（MDS）.Methods The clinical characteristics and curative effect of MDS patients who received allo-HSCT from 2010 July to 2013 December were retrospectively analyzed.Of them，25 MDS patients who received decitabine bridging allo-HSCT were randomly selected（referred to as the bridging group），while at the same time another 33 MDS patients who did not receive decitabine for allo-HSCT in MDS were also randomly selected as control group.The effect of decitabine bridging allo-HSCT on the patients'survival and occurrence of graft versus host disease（GVHD）was analyzed.ResultsWithdecitabinebridgetherapy，64.0%patients（16/25）achieved marrow complete remission before allo-HSCT，while the control group was only 15.1%（5/33，P＜0.05）.Decitabine bridging group of early transplant-related mortality was lower than that of the control group（4.0%vs 18.2%），but the difference was not statistically significant（P=0.106）. Up to follow-up deadline，the mortality of decitabine bridging group was 12.0%，while that of the control group was 30.3%（P＜0.05）.The 2-year OS of decitabine bridging group was 83.0%，while that of the control group was 59.0%（P＜0.05）.Of the 14 patients in decitabine bridging group with aGVHD，7 was gradeⅠ aGVHD，3 gradeⅡand 4 gradeⅢ.Of the 16 patients in control group with aGVHD，7 was gradeⅠaGVHD，8 gradeⅡ and 1 gradeⅢ.Conclusion Decitabine bridging therapy followed by allo-HSCT in the treatment of MDS is safe and effective.

（Authors）

2015241 Analysis of blood cell autophagy distribution in hematologic diseases by transmission electron microscope.DONG Shuxu（董树旭），et al.Instit Hematol&Blood Dis Hosp，CAMS&PUMC，Tianjin 300020.Chin J Hematol 2015；36（2）：144-147.

Objective To investigate the distribution characteristics of blood cells autophagy in hematologic diseases，as well as their possible pathomechanism.Methods Retrospective analysis of electron microscopy specimens of 3 277 patients with hematological diseases were performed. The blood cells autophagy was observed by transmission electron microscopy，and its distribution characteristics were analyzed.The pathomechanism of blood cell autophagy was explored in combination with clinical examination and diagnosis.Results 15 samples were found to have mature granulocytes or nucleated erythrocytes autophagy.Of them，6 cases were myelodysplastic syndrome （MDS），2 acute leukemia，1 in each of aplastic anemia，pure red cell aplastic anemia，thalassemia，iron deficiency anemia，lymphoma，multiple myeloma and polycythemia vera.Among 15 cases，11 cases were found to have mature granulocytes autophagy，4 cases nucleated erythrocytes autophagy.Besides autophagy，apoptosis occurred in 9 cases，cytolysis in 6 cases，megaloblastic change in 5 cases.Conclusion Mature granulocytes or nucleated erythrocytes autophagy occurred more frequently in MDS among hematologic diseases，dyshaematopoiesisincludingapoptosis，cytolysisandmegaloblastic change could induce autophagy function enhancement.

（Authors）

2015242 Gene analysis in a family of hereditary hemorrhagic telangiectasia.YUAN Dong（袁冬），et al.Mudanjian 1st People's Hosp，Mudanjiang 157011. Chin J Hematol 2015；36（2）：

112-115.

Objective To investigate the clinical feature of a familywithhereditaryhemorrhagictelangiectasia （HHT），and to study the mutation of its related genes. Methods Medical histories of the family were analyzed to detect HHT patients according to the diagnostic criteria. ENG and ALK-1 genes of the proband and her two daughters were analyzed.DNA from the three patients' peripheral blood was extracted.The exons 2-10 and their intron-exon boundaries of ALK1 were amplified with PCR，and then the PCR products were sequenced and analyzed to identify the mutation.Results 11 people in 41 family members of 4 generations were diagnosed as HHT.The proband and her two daughters suffered from multiple organ damage，the younger daughter appeared only imaging features instead of corresponding clinical symptoms.A missense mutation at the 1321 bp of cDNA （c.1321G＞A）was detected in the exon 9 of ALK1，which resulted in valine 441 to methionine replacement in ALK-1 protein（p.Va1441Met）.Conclusion A Chinese family with HHT was studied and a missense mutation（c.1321G＞A，p.Va1441Met）of ALK-1 was discovered.This mutation is the genetic basis of the family with HHT and is reported for the first time in China. This research will not only help to further investigate molecular mechanism of pathogenesis of HTT，but also provide evidence and references for the following gene screening and genetic counseling on HTT family members.

（Authors）

2015243 A single-center clinical study of 22 patients with acquired hemophilia.YANG Chunchen（杨春晨），et al.1st Affil Hosp，Soochow Univ，Suzhou 215006.Chin J Hematol 2015；36（2）：107-111.

Objective To investigate the feature of underlying disorders，clinical symptoms，diagnosis and treatment strategies of patients with acquired hemophilia（AH）. Methods The clinical data and laboratory test results of 22 patients with AH from March 2010 to June 2014 were retrospectively analyzed.Results A total of 22 patients with AH were enrolled in our study，including 20 patients diagnosed as acquired hemophilia A（AHA）and 2 as acquired hemophilia B（AHB）.Among the AHA patients，there were 10 males and 10 females with the median age of 37.5（range，2-95）years old.The median activity of FⅧ（FⅧ：C）of the 20 AHA patients was 1.9% （0.5%-39.0%）.Softtissuehematoma （80.0%）and subcutaneous bleeding（75.0%）were the most common clinical symptoms.Two male children were diagnosed as AHB（age 1 and 3 years old，respectively）with mild bleeding symptoms，and the activities of FⅨ（FⅨ：C）were 5.0%and 16.0%，respectively.In addition，an underlying disorder was found in 7 patients （31.8%）.In laboratory testing，all patients had prolonged APTT，normal PT，decreased FⅧ：C or FⅨ：C，positive antibody screening test or antibody titer（2-32 BU），and negative for lupus anticoagulant and anticardiolipin antibody.Nineteen out of 20 patients were treated with blood products to stop acute bleeding episodes.Corticosteroid alone was applied to 7 patients，corticosteroid combined with other immunosuppressive agents to 11 patients，rituximab to 3 patients.Nineteen patients responded well to hemostatic treatment，except 1 patient who died of fatal bleeding.The FⅧ：C of 8 patients increased to a normal level with the median time of 42.5（21-145）days.After treatment，the activity of FⅨ：C of the 2 AHB patients achieved 35%and 24%in 48 and 60 days，respectively.Conclusion Acquired hemophilia is not an uncommon disease in clinical practice，which may occur in people of all ages.AH is a bleeding disorder with heterogeneous characteristics.Compared with adult，the clinical symptoms of children patients were mild，which leads to underdiagnosis.

（Authors）

2015244 A multicenter clinical trial of caffeic acid tablet in treatment of 103 primary immune thrombocytopenia patients.QIN Ping（秦平），et al.Dept Hematol，Qilu Hosp，Shandong Univ，Jinan 250012.Chin J Hematol 2015；36（2）：103-106.

Objective To determine the efficacy and safety of oral caffeic acid（CA）tablet in management of primary immune thrombocytopenia（ITP）.Methods One hundred and three ITP patients with PLT＞10×109/L and no serious bleeding symptoms from three centers were enrolled.According to their platelet count before CA treatment，these patients were divided into group A（PLT＜30×109/L），including 24 females and 27 males with median age 48（18-84）years；and group B（PLT≥30×109/L），including 33 females and 19 males with median age 43（18-83）years.Patients in both groups took CA tablets orally of 300 mg three times per day for 12 consecutive weeks.Combined medicine treatment such as corticosteroids，danazol，TPO and Rituximab，which might increase the platelet count of these patients，were not allowed during CA therapy.Results In group A，the overall response rate was 51.0%（26/51），with 2 patients achieving complete response（CR）and 24 patients achieving response（R）.Of 26 patients achieving response（CR+R），the median platelet count before CA therapy was 20.5（15-28）×109/L，and the median peak platelet count after CA therapy was 63（38-112）× 109/L.The median time to achieve response was 4 （2-10）weeks.Patients with pretreatment PLT＞20× 109/L showed significantly better response than those PLT＜20×109/L（68.0%vs 34.6%，P=0.017）.In group B，the CR rate was 40.4%（21/52）.Frequency of CA-related adverse events was 1.94%（2/103），including mild nausea in 1 case and elevation of liver enzymes in 1 case.Both were grade 1 and transient.Conclusion Caffeic acid was effective in patients with ITP with few and mild adverse effects.

（Authors）

2015245 Effectofimmunoglobulinheavy/light chain detection on the minimal residual disease monitoring in IgG multiple myeloma patients.ZHANG Hui（张慧），et al.Dept Hematol，Changzheng Hosp，2nd Milit Med Univ，Shanghai 200003.Chin J Hematol 2015；36（2）：95-98.

Objective To evaluate the specificity and sensitivity of immunoglobulin heavy/light chain（HLC）and serum free light chain（FLC）level in minimal residual disease monitoring of IgG type multiple myeloma（MM）patients during complete remission（CR）.Methods Immunoglobulin HLC was assessed in 20 IgG myeloma patients by immune turbidimetry using SPAplus Analyzer.The serum level of HLC and FLC was detected at the same time. Combined with those obtained by serum protein electrophoresis（SPE）and immune fixation electrophoresis （IFE），the specificity and sensitivity of HLC in detection of serum immunoglobulin were analyzed.Combined with the clinical efficacy，kappa/lambda ratios of HLC （rHLC）and FLC（rFLC）were compared between the patients and normal controls.Results Among 20 patients，there were 10 male and 10 female，the median age was 56 years（35-70）.There were 6 patients with abnormal rHLC but normal rFLC；3 patients with abnormal rFLC but normal HLC；and 11 patients with both normal rHLC and rFLC.During the mean follow-up time of 18 months，4 of the 6 patients with abnormal rHLC accepted intervention therapies，1 case relapsed in 9 months，the other 2 untreated patients relapsed in 3 months.Among the 3 cases with abnormal rFLC，2 patients are still in remission after intervention therapies，the other untreated patient relapsed in 1.5 months.A-mong the 11 untreated patients with both normal rHLC and rFLC，3 relapsed with the disease free survival time of 3.5 months，5.0 months and 5.5 months respectively.Conclusion The combined detection of HLC and FLC is helpful to assess the curative efficacy and the accuracy of minimal residual disease monitoring，and more effectively evaluate the prognosis of MM patients.Abnormal rHLC and rFLC are correlated with poor prognosis，while early intervention therapies can help to improve disease free survival.

（Authors）

2015246 The relationship between induction chemotherapy cycles and prognosis in patients with acute myeloid leukemia.ZHAO Ting（赵婷），et al.Peking Univ People's Hosp，Beijing 100044.Chin J Hematol 2015；36（2）：89-94.

Objective To explore the relationship between induction chemotherapy cycles to achieve complete remission（CR）and prognosis in patients with acute myeloid leukemia（AML）.Methods From April 2004 to December 2013，397 adult patients with newly diagnosed AML （acute promyelocytic leukemia excluded）received the idarubicin combined with cytarabine（IA）“3+7”regimen as the first induction chemotherapy were enrolled in the study.Therapeutic effect，relapse and survival of these patients were discussed.Patients underwent continuous consolidation chemotherapy，and some eligible patients received allogeneic hematopoietic st em cell trans-plantation（allo-HSCT）in the first complete remission. Results Of 397 patients，347 valuable patients achieved CR after 1-4 cycles induction chemotherapy.The median follow-up was 18.0（2.4-115.4）months in survivors，the cumulative incidence of relapse（CIR），disease-free survival（DFS）and overall survival（OS）at 3 years were 33.0%，58.6%and 67.1%，respectively. Multivariate analysis revealed that unfavorable cytogenetics，more cycles to achieve CR and post-remission treatment without allo-HSCT were independent risk factors affecting DFS and OS.FLT3-ITD mutation positive was another independent risk factor affecting DFS.There was no statistic difference between patients who achieved CR after one cycle（n=255）and two cycles（n=73）treatment in DFS and OS（P＞0.05）.DFS and OS in patients who achieved CR after 3 or 4 cycles（n=19）were significantly lower than the above two groups（P＜0.05）.Multivariate analysis among 183 patients who received consistent chemotherapy showed that achieving CR within 2 cycles was the favorable factor affecting DFS and OS（P=0.001，P=0.035）.Conclusion Achieving CR within 2 cycles of induction chemotherapy was associated with better prognosis among adult CR patients with AML.

（Authors）