BACKGROUND Colorectal cancer represents a major global health burden, with neoadjuvant chemoradiotherapy as standard treatment for locally advanced rectal cancer, although preoperative magnetic resonance imaging (MRI) staging shows only moderate accuracy. A substantial proportion of patients staged as cT1-2N0 on MRI are subsequently upstaged after surgery, thereby missing neoadjuvant treatment and risking worse oncologic outcomes. AIM To develop a machine learning model that integrates multiomics profiles to improve the accuracy of neoadjuvant chemoradiotherapy decision-making in rectal cancer patients whose baseline MRI indicates cT1-2N0 disease. METHODS This multicenter cohort study consecutively enrolled patients who underwent pre-operative MRI and curative rectal cancer surgery at three institutions between January 2013 and December 2024. Participants were randomly allocated to training, internal validation and external validation sets. A pre-defined set of 2260 radiomic features was extracted from T2-weighted and diffusion-weighted images and fused with baseline clinical, hematological and pathological variables. Ten independent machine learning classifiers were constructed and compared with both physician decisions and imaging-only radiomic models. Model performance was evaluated with receiver operating characteristic analysis, calibration plots, decision curve analysis and confusion matrices. RESULTS A total of 1320 consecutive patients with clinically staged cT1-2N0 rectal cancer who underwent curative intent surgery were retrospectively enrolled from three tertiary centers: (1) Center 1 (n = 1009); (2) Center 2 (n = 246); and (3) Center 3 (n = 65). We developed a Clinical, Hematologic, Oncopathologic, and Radiomic Decision (CHORD) model, an XGBoost-based machine learning classifier that integrates seven preoperative MRI radiomic features with 16 clinical, hematologic, and pathologic variables via a CART regression tree algorithm in patients with cT1-2N0 rectal cancer. Externally validated, the CHORD model delivered an area under the curve of 0.927 and an F1-score of 0.825, attesting to its consistent and robust performance across independent cohorts. CONCLUSION Our study demonstrated that the CHORD model exhibits satisfactory performance in identifying cT1-2N0 rectal cancer patients who require neoadjuvant chemoradiotherapy by integrating preoperative multi-omics data, offering critical insights into reducing the omission rate of neoadjuvant therapy and enhancing the accuracy of preoperative radiological staging.

OBJECTIVES:Currently, there is limited understanding regarding the prognostic significance of time to progression (TTP) after first remission in multiple myeloma (MM). METHODS:We conducted a retrospective analysis of clinical data from 209 patients with MM. These patients were categorized into ≤ 6 months, ≤ 12 months, ≤ 24 months, > 24 months, 6-12 months, and 12-24 months subgroups based on TTP. RESULTS:Patients in ≤ 12 months group exhibited shorter median overall survival (OS) and OS-1 compared to those in ≤ 24 months group (61.73 vs 96.10 months, P = 0.02; 54.00 vs 74.17 months, P = 0.048). ≤ 6 months group exhibited shorter median OS and OS-1 compared to 6-12 months group (33.63 vs 79.60 months, P = 0.022; 19.93 vs 65.17 months, P = 0.015). Patients in 6-12 months group had shorter median OS and OS-1 compared to those in 12-24 months group (79.60 vs 100.43 months, P < 0.001; 65.17 vs 77.17 months, P = 0.012).No significant difference in OS was observed between patients in 12-24 months and > 24 months groups. For patients who experienced progression within 12 or 24 months after remission, undergoing autologous hematopoietic stem cell transplantation (ASCT) after progression conferred a median OS and OS-2 advantage over receiving post-progression chemotherapy. Multivariable analysis confirmed that TTP was an independent predictor for OS in patients with MM. CONCLUSION:Patients with MM who experience earlier disease progression within 12 months after remission have a worse prognosis, and post-progression ASCT can improve their survival outcomes.

Objectives: Controlling Nutritional Status (CONUT) Score is an effective tool for the assessment of malnutrition and proved to be associated with survival of Diffuse large B-cell lymphoma (DLBCL) patients. We investigated the impact of CONUT score on specific subgroups of DLBCL patients, including age and International prognostic Index (IPI) risk groups. Methods: Data of 287 newly diagnosed DLBCL in the Third Affiliated Hospital of Soochow University were retrospectively collected. Baseline CONUT score, clinical data and survival information were recorded. Results: With the standard cut-off value of 4 points, 88 (30.7%) patients were clarified as malnourished. During a median follow-up of 34 months, malnourished patients exhibited significant reduction in both progression-free survival (PFS) and overall survival (OS). The 3-year PFS rates for malnourished and well-nourished patients were 51.4% and 70.9% (p = 0.001), while the 3-year OS rates were 62.4% and 84.0% (p < 0.001). Malnutrition was demonstrated an independent predictor of OS in DLBCL patients (HR 2.220, 95% CI 1.307-3.772, p = 0.003). It could effectively identify patients with inferior OS in both low/intermediate-low risk and intermediate-high/high risk IPI groups. In the group of elderly patients aged over 60 years, malnutrition was independently associated with OS (HR 2.182, 95% CI 1.178-4.040, p = 0.024), but not PFS (HR 1.709, 95% CI 1.016-2.875, p = 0.070) after adjustment using the Benjamini-Hochberg procedure. Conversely, for younger patients, malnutrition did not demonstrate an independent impact on either PFS or OS. Conclusion: Malnutrition evaluated by CONUT score was an independent predictor for the outcome of DLBCL patients, which is exclusively caused by its effect on elderly patients.

Tumor metabolic heterogeneity (MH) assessed by 18-fluorine fluorodeoxyglucose positron emission tomography computed tomography (18F-FDG PET/CT) is established as a marker of drug resistance in solid tumors. Its prognostic significance in diffuse large B-cell lymphoma (DLBCL) remains inadequately explored. This study aims to investigate the prognostic value of tumor MH assessed by 18F-FDG PET/CT in DLBCL. This study retrospectively included 297 patients diagnosed with DLBCL at the Third Affiliated Hospital of Soochow University from August 2012 to December 2022. We evaluated tumor MH using the area under the curve of cumulative standardized uptake value-volume histogram (AUC-CSH). In addition to obtaining conventional PET metabolic metrics, including maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), total metabolic tumor volume (TMTV), and total lesion glycolysis (TLG), we also collected baseline clinical data. This study developed a survival prediction model based on Cox regression analysis and compared its prognostic performance with the National Comprehensive Cancer Network-International prognostic index (NCCN-IPI). We evaluated the model’s calibration, discrimination, and clinical utility, and conducted an internal validation. Multivariable Cox regression analysis indicated age (hazard ratio [HR], HR,1.62, 95

Abstract Background 18F-FDG PET/CT provides precise information about dissemination of lymphoma lesions. Dmax, defined as distance between the two lesions that were farthest apart by PET/CT, was found to be a promising predictor of Diffuse large B-cell lymphoma (DLBCL) outcome in a small size of clinical trial data. We analyzed the impact of Dmax on the outcome of a large real-world DLBCL cohort. Methods Data of newly diagnosed DLBCL at the Third Affiliated Hospital of Soochow University were retrospectively collected. Baseline Dmax, clinical data and survival information were recorded. A metabolic parameter, metabolic bulk volume (MBV), was also measured to verify the independent impact of Dmax. Results Optimal cut-off values for Dmax and MBV were 45.34 cm and 21.65 cm3. With a median follow-up of 32 months, Dmax significantly impacted progression-free survival (PFS) and overall survival (OS) in 253 DLBCL patients. For Dmaxlow and Dmaxhigh groups, estimated 3-year OS were 87.0% and 53.8% (p < 0.001), while 3-year PFS were 77.3% and 37.3% (p < 0.001). And for MBVlow and MBVhighgroups, 3-year OS were 84.5% and 58.8% (p < 0.001), and 3-year PFS were 68.7% and 50.4% (p = 0.003). Multivariate analysis identified Dmax and Eastern Cooperative Oncology Group performance status (ECOG PS) independently associated with PFS and OS, while MBV only independently associated with OS. A Dmax revised prognostic index (DRPI) combining Dmax and ECOG PS identified an ultra-risk DLBCL population with 3-year PFS of 31.7% and 3-year OS of 38.5%. The area under the curve (AUC) showed that this model performed better than International prognostic Index (IPI). Conclusion Dmax is a new and promising indicator to investigate dissemination of lymphoma lesions associated with the outcome of DLBCL. It significantly contributes to stratification of patients with disparate outcomes. Trial registration This research has been retrospectively registered in the Ethics Committee institutional of the Third Affiliated Hospital of Soochow University, and the registration number was approval No. 155 (approved date: 31 May 2022).

目的 探讨益生菌辅助治疗对非霍奇金淋巴瘤患者肠道微生态失衡、T淋巴细胞亚群及食欲调节因子的影响.方法 前瞻性选择2022年6月至12月来常州市第一人民医院诊治的非霍奇金淋巴瘤患者120例,根据随机数字表法将患者分为对照组(n=60)与观察组(n=60).对照组行CHOP方案化疗,观察组在对照组基础上给予双歧杆菌四联活菌片,两组治疗疗程相同.比较两组的临床疗效,对比两组治疗前后的肠道微生态失衡情况、T淋巴细胞亚群水平、ghrelin及leptin水平,对比两组患者治疗期间的不良反应发生情况.结果 观察组的缓解率为81.67％,明显高于对照组(61.67％),差异有统计学意义(P＜0.05).治疗后,观察组的肠球菌、肠杆菌、梭杆菌、拟杆菌水平低于对照组,双歧杆菌、乳杆菌高于对照组,差异均有统计学意义(P＜0.05).治疗后,观察组肠道微生态失衡比例为8.33％低于对照组(33.33％),差异有统计学意义(P＜0.05).治疗后,观察组的CD4+、CD4+/CD8+明显高于对照组,CD8+明显低于对照组,差异均有统计学意义(P＜0.05).治疗后,观察组的ghrelin水平高于对照组,leptin水平低于对照组,差异均有统计学意义(P＜0.05).治疗后,观察组的恶心呕吐、血红蛋白降低、周围神经症状比例明显低于对照组,差异均有统计学意义(P＜0.05);两组的白细胞降低、肝损害、血小板降低比例比较,差异均无统计学意义(P＞0.05).结论 益生菌辅助治疗可改善非霍奇金淋巴瘤患者的肠道微生态失衡、T淋巴细胞亚群及食欲调节因子,降低不良反应发生率.

获得性凝血因子ⅩⅢ(FⅩⅢ)缺乏罕见,可发生于消耗过多、合成减少或免疫抑制介导.该病多见于老年群体,临床出血症状重,可出现反复自发性出血,治疗困难,死亡率接近50％,常规凝血检查无异常,极易漏诊和误诊.本文报道1例获得性FⅩⅢ缺乏症伴深静脉血栓形成患者,诊断过程曲折,经免疫抑制治疗取得成功.通过病例分析及文献复习,为临床出凝血障碍疾病诊治提供临床诊疗思路.

Diffuse large B cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma, and the prognosis of the disease varied. This research aims to investigate the impact of serum lipid level on the outcome of DLBCL patients and their interaction with rituximab (RTX). Data of newly diagnosed DLBCL in the third affiliated hospital of Soochow University were retrospectively collected. Baseline serum lipid levels, clinical data, and survival information were simultaneously recorded. Data of healthy controls were collected with age matching. Serum lipid levels significantly differed for the patients. All were transformed into categorical variables for the analysis of survival. During a median follow-up of 58 months, 32.8

Background Nearly all anti-PD-1 antibodies are of the IgG4 isotype which may possess residual crystallizable fragment (Fc) gamma receptor (FcγR) effector functions and are also associated with immune tolerance and escape due to instability of the CH3 domain and Fc-Fc interaction. Penpulimab is a novel IgG1 anti-PD-1 antibody that has a good stability and reduced host cell protein residue. Penpulimab was engineered to eliminate Fc-mediated effector function that compromises anti-tumor immune cell function. Penpulimab also showed numerous contacts with N58 glycosylation on the BC loop of PD-1 which may contribute to slower binding off-rate. In this trial, we examined the efficacy and safety of penpulimab in patients (pts) with R/R cHL. Here we report results from up to 30 months follow-up. Methods AK105-201 (NCT03722147) is a multicenter, single-arm, open-label study of penpulimab in R/R cHL. Adult pts (≥18 years of age) received penpulimab 200 mg once biweekly until progression or unacceptable toxicities. Eligible pts had prior autologous stem cell transplant (ASCT) or at least 2 lines of prior chemotherapy. The primary endpoint was ORR based on the Lugano 2014 criteria as assessed by an independent review committee (IRC). Key secondary endpoints included complete response (CR) rate, progression-free survival (PFS), overall survival (OS), treatment-related adverse events (TRAEs) and immune-related adverse events (irAEs). Results A total of 94 patients were enrolled. As of the data cutoff date (Dec 31, 2021), the median follow-up was 29.5 months. Median number of treatment cycles was 26.1 (range 2–36). 85 patients meted the definition of primary efficacy population-IRC. Efficacy data is presented in (table 1). TRAEs (with unlikely related events included) occurred in 98.9% of pts (≥ G3 in 28.7% [27/94], treatment discontinuation in 6.4% [6/94]). Treatment related serious adverse event (SAEs) occurred in 12.8%. Most frequent TRAEs were hypothyroidism (33.0%), upper respiratory tract infection (26.6%), fever (24.5%), and ALT elevations (24.5%). Grade ≥3 TRAEs reported in ≥3 pts were platelet count decreased (3.2%), hyperlipemia (3.2%), rash (3.2%). In addition, 52 (55.3%) patients experienced an irAEs. The most frequent irAE was hypothyroidism (51.1%), and 4 (4.3%) patients developed grade 3 irAEs. No grade 4 or 5 irAEs were reported. No new safety signals were observed. Conclusions Penpulimab was well tolerated, with a good safety profile in long-term use in R/R cHL pts. It demonstrated promising therapeutic activity and continued PFS and OS benefit. Trial Registration NCT03722147 Ethics Approval The study was approved by relevant ethic committees and institutional review boards. Consent Written informed consent was obtained from the patient for publication of this abstract and any accompanying images. A copy of the written consent is available for review by the Editor of this journal.

OBJECTIVE:To investigate the efficacy and safety of bendamustine combined with gemcitabine, vinorelbine，glucocorticoids (BeGEV)±X regimen in treatment of patients with relapsed/refractory non-Hodgkin lymphoma.METHODS:A total of 18 relapsed/ refractory non-Hodgkin lymphoma patients at the age of 18 years or older hospitalized in the First People's Hospital of Changzhou from March 2020 to March 2021 were selected. They received two or more cycles of BeGEV±X regimen. X could be anti-CD20 monoclonal antibody, PD-1-blocking antibodies, lenalidomide, BTK inhibitor, Bcl-2 inhibitor and so on according to patients' disease feature. The clinical efficacy and adverse effects were observed.RESULTS:In total, 18 patients completed two or more cycles of BeGEV±X regimen, including 14 with diffuse large B-cell lymphoma, one with low-grade follicular lymphoma, one with follicular lymphoma grade 3b, one with angioimmunoblastic T-cell lymphoma and one with peripheral T-cell lymphoma, not otherwise specified. 11 patients were male. The median age of the patients was 64 years old. 17 patients had modified Ann Arbor stage Ⅲ/Ⅳ disease. 13 patients had high- intermediate risk or high risk IPI score, while 15 patients had high-intermediate high risk or high risk NCCN-IPI score. 14 cases had extranodal sites of disease. And 6 cases had bulky disease. 12 patients experienced refractory disease, while 8 patients had received 3 line or more prior treatment. After two or three cycles of chemotherapy, the complete response rate was 6/18, the partial response rate was 3/18, and the objective response rate was 9/18. From the beginning of salvage chemotherapy to the end of follow-up, the median progression-free survival time was 130 days, and the median overall survival was 152 days. The most common grade 3 to 4 adverse events were hematologic toxicities, infection and febrile neutropenia.CONCLUSION:BeGEV±X is an effective salvage regimen in treatment of patients with relapsed/refractory non-Hodgkin lymphoma, while adverse events such as hematologic toxicities and infection should be closely monitored.

Background:Nearly all anti-PD-1 antibodies are of the IgG4 isotype, and thus possess residual FcR effector functions. Such anti-PD-1 antibodies are also associated with immune tolerance and escape due to instability of the CH3 domain and Fc-Fc interaction. In this trial, we examined the efficacy and safety of penpulimab, a novel IgG1 anti-PD-1 antibody that does not bind to the Fc receptor, in patients with refractory or relapsed classical Hodgkin lymphoma (R/R cHL).Methods:Adult patients (≥18 years of age) with R/R cHL received 200 mg penpulimab once biweekly until disease progression or unacceptable toxicities for a maximum of 24 months. The primary endpoint was objective response rate (ORR) based on the Independent Radiology Review Committee per Lugano 2014 criteria. Secondary endpoints included progression-free survival (PFS), overall survival (OS), treatment-related adverse events (TRAEs) and immune-related adverse events (irAEs).Results:A total of 94 patients were enrolled. The median follow-up was 15.8 months. The ORR was 89.4% (95% CI 80.8%, 95.0%) in the full analysis set (85 patients). Forty (47.1%) patients achieved complete remission, 36 (42.4%) patients achieved partial remission. The 12-month PFS rate was 72.1% (95% CI 60.5%, 80.8%) and the 18-month OS rate was 100%. Totally 97.9% (92/94) of patients experienced at least one TRAE. The rate of grade 3 and above TRAEs was 26.6% (25/94). In addition, 51 (54.3%) patients experienced an irAE, and 4 (4.3%) patients developed grade 3 or above irAEs. No irAE-related death occurred.Conclusions:Penpulimab was effective and safe in patients with R/R cHL.

Background: Although pre-treatment paroxysmal nocturnal hemoglobinuria (PNH) clone has been reported in a fraction of aplastic anemia (AA) for a long time, its predictive value on response to immunosuppressive therapy (IST) remained debatable. Therefore, we conducted a meta-analysis to elaborate this issue. Methods: The identified articles were retrieved from five English databases PubMed, EMBASE, Web of Science, Medline, the Cochrane Library, and four Chinese databases Weipu, Wangfang, China National Knowledge Infrastructure (CNKI), and SinoMed. We extracted odds ratios (ORs) and the corresponding 95% confidential intervals (CIs) for response to IST in AA patients with pre-treatment PNH clone versus those without from the available studies. Results: Twelve studies covering 1787 patients were included this meta-analysis. The pooled ORs indicated that the pre-treatment PNH clone had no impact on 3-month response (pooled OR: 1.323, 95% CI: 0.260-6.735, p = 0.736), 6-month response (OR: 1.668, 95% CI: 0.802-3.470, p = 0.171), and overall response (OR: 2.220, 95% CI: 0.870-5.665, p = 0.095), including overall response in pediatric patients (OR: 1.919, 95% CI: 0.378-9.738, p = 0.432). However, pre-treatment PNH clone had a favorable impact on 12-month response (OR: 2.725, 95% CI: 1.525-4.870, p = 0.001). Conclusion: Pre-treatment PNH clone is associated with favorable 12-month response to IST in AA, the underlying mechanism needs further exploring.

Background Penpulimab is a humanized IgG1 mAb that blocks PD-1 binding to PD-L1. Penpulimab was engineered to eliminate Fc?R binding and ADCC/ADCP completely, as compared to majority of marketed IgG4 PD-1 antibodies with ADCC/ADCP activity. ADCC/ADCP effects can induce T-cell apoptosis and clearance and then compromise anti-tumor activity. The removal of Fc?R binding eliminates Fc receptor mediated immune-cell recruitment and activation and could potentially reduce immune-related adverse reactions. Penpulimab demonstrated a slower PD-1 antigen binding off-rate than marketed PD-1 antibodies, which result in better cellular activity and higher receptor occupancy. Penpulimab also showed numerous contacts with N58 glycosylation on the BC loop of PD-1 which could be an advantage to facilitate interaction of PD-1 antibody and may contribute to slower binding off-rate. These structural differentiations offer more robust biological effect and enhance anti-tumor activity of penpulimab. Methods AK105-201 (NCT03722147) is a multicenter, single-arm, open-label study of penpulimab in R/R cHL. All pts received penpulimab 200 mg q2w until progression or unacceptable toxicity. Eligible pts had R/R cHL after ASCT, or at least 2 lines of prior chemotherapy. The primary endpoint was ORR based on the Lugano 2014 criteria as assessed by an independent review committee (IRC). Key secondary endpoints included CR rate, DCR, PFS, duration of response (DoR), safety, and tolerability. Results As of 10 January, 2020, the median follow-up was 6.3 months (range, 3.5 to 17.0). The anti-tumor activity of penpulimab in the 73 pts evaluable for efficacy (defined as pts who had an opportunity to be followed for at least 16 weeks) is shown in the table 1. At data cutoff, 91.8% of responders remained ongoing and still on treatment. Treatment-related adverse events (TRAEs) occurred in 93.6% of pts (G3 in 13.8% [13/94], no G4 or G5, treatment discontinuation in 2.1% [2/94]). Treatment-related SAEs occurred in 3.2%. Most frequent TRAEs (≥15%) were fever (24.5%), hypothyroidism (21.3%), upper respiratory tract infection (18.1%), and ALT elevations (17.0%). Grade ≥3 TRAEs reported in ≥2 pts were platelet count decreased (2.1%). Immune-related AEs were reported in 42.6% of pts (G3 in 2.1%: psoriasis [n=1], IgA nephropathy [n=1]). Conclusions Penpulimab was shown to be highly active resulting in a high CR rate in pts with R/R cHL. With longer follow-up, CR rate for penpulimab in R/R cHL could be further increased. Penpulimab demonstrated notably lower rates of SAE, TRAE leading to discontinuation, and Grade Grade ≥3 immune-related AEs in pts with R/R cHL. Trial Registration NCT03722147

Anthracycline chemotherapy is commonly used in the treatment of diffuse large B-cell lymphoma (DLBCL). Treatment-related cardiotoxicity (TRC) is defined as when the patient is identified to have one of the following clinical manifestations: Symptomatic heart failure, cardiac death, arrhythmia, infarction, a decrease in left ventricular ejection fraction (LVEF) of >15% from baseline or a decrease in LVEF of >10 to <50%. TRC may induce severe cardiac failure or cardiac arrhythmia as the main cause of death. The present study aimed to investigate the prognostic value of the summed rest score (SRS) in gated myocardial perfusion imaging (G-MPI) for the early detection of TRC caused by anthracycline chemotherapy in patients with DLBCL. A total of 36 DLBCL patients were enrolled in the present study, and a series of parameters were compared at baseline and after chemotherapy. According to the occurrence of TRC during the observation period, the patients were divided into two groups, and parameters associated with cardiac function were compared. The SRS in G-MPI and the corrected QT interval in the electrocardiogram were significantly different before and after chemotherapy (P=0.012 and P=0.015, respectively). By comparing parameters associated with cardiac function between the TRC group (n=22) and the no-TRC group (n=14), it was found that only SRS was significantly different (P=0.012). Multivariate logistic regression analysis showed that the SRS level was the only independent predicator for TRC (P=0.018; HR, 6.053; 95% CI, 1.364-26.869). Receiver operating characteristic curve analysis identified an optimal SRS cutoff of >1 for predicting TRC after anthracycline chemotherapy (P<0.001). Overall, the G-MPI SRS level was an early indicator for TRC surveillance in patients with DLBCL after anthracycline chemotherapy. The application of G-MPI SRS in clinical practice may contribute to early treatment and a subsequent decrease in mortality caused by such cardiovascular complications.

Objective To evaluate the left ventricular systolic synchrony and investigate the early diagnostic value of left ventricular systolic dyssynchrony on cardiotoxicity caused by anthracyclines in pa-tients with diffuse large B-cell lymphoma ( DLBCL) . Methods Thirty-two patients ( 22 males, 10 females, age:22-73(54.4±14.2) years) from June 2016 to January 2019 with confirmed DLBCL and normal gated myocardial perfusion imaging (GMPI) before anthracyclines chemotherapy were enrolled prospectively. GMPI was performed after 6 cycles or more of chemotherapy. Changes of myocardial markers, electrocardiogram (ECG) indicators, left ventricular function indicators including left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume ( LVEDV) , left ventricular end-systolic volume ( LVESV) , peak filling rate ( PFR) , summed motion score ( SMS) and summed thickening score ( STS) as well as left ventricular systolic synchrony indicators including phase bandwidth ( BW) , phase standard deviation ( SD) and entropy before and after anthracyclines chemotherapy were analyzed. Paired t test, Wilcoxon signed rank test and χ2 test were used for data analysis. Results Compared with pre-chemotherapy, the left ventricular systolic synchrony indicators were significantly higher than those before chemotherapy (BW: (42.81±11.37)° vs (29.28±8. 68)°;SD:(11.65±4.64)° vs (8.79±3.14)°;entropy:(39.84±5.51)％ vs (36.19±5.94)％;t values: -9.132 to-3.173, all P<0.05) . There were no significant differences in other indicators ( t values:-1.161 to 1.750, z values:-1.633 to-0.096, all P>0.05). Of 32 patients, 13 patients (40.62％) had left ventricular systolic dyssynchrony, and the rate of chemotherapy-induced left ventricular systolic dyssynchro-ny was significantly higher than that of left ventricular dysfunction (15.62％, 5/32;χ2=4.947, P=0.025). All 5 patients with left ventricular dysfunction caused by chemotherapy had left ventricular systolic dyssyn-chrony. The LVEF of the chemotherapy-induced left ventricular systolic dyssynchrony group was significantly lower than that of the left ventricular systolic synchronization group ((54.54±9.25)％ vs (66.79±7.65)％;t=4.087, P<0.01) . Conclusion Left ventricular systolic dyssynchrony can be appeared in DLBCL patients after chemotherapy and is significantly earlier than left ventricular dysfunction, which can be an early indi-cator of cardiotoxicity caused by anthracycline chemotherapy.

Objective To observe the alteration and clinical significances of blood coagulation indicators in patients with lymphoplasmacytic lymphoma (LPL). Methods Twenty patients who were newly diagnosed LPL in the First People's Hospital of Changzhou from January 2008 to October 2017 and twenty healthy controls were studied. The patients were treated by chemotherapy, plasma exchange, supplement of coagulation factor or other supportive therapy. The parameters of prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), thrombin time (TT), D-dimer (D-D), and platelet count (Plt) were detected in LPL group and healthy controls. Results The levels of PT and APTT in LPL group were dramatically higher than those in control group [(12.9±1.2) s vs. (11.6±0.9) s, (41.7±9.8) s vs. (24.7±2.9) s], and the level of Plt in LPL group was lower than that in control group [112×109/L (3×109/L - 379×109/L) vs. 210×109/L (170×109/L - 271×109/L)], and the differences were statistically significant (all P< 0.05). There were no significant differences in FIB, TT and D-D levels between LPL group and control group (all P ＞0.05). There were no statistical differences in PT, APTT, FIB, TT, D-D and Plt levels among LPL patients with different types of immunoglobins (all P ＞ 0.05). After treatment, all the coagulation abnormalities got relieved and no patient died of hemorrhage or thrombosis. Conclusions The LPL patients have coagulation disorders and hypercoagulability, and this is independent of the type of immunoglobulin. Clinical attention should be paid to monitoring coagulation indicators to prevent the occurrence of adverse reactions.

Objective To investigate the ef ect of Simvastatin (SV) combined with Phorbol-12-myristate-13-acetate (PMA) on the proliferation ,dif erentiation,apoptosis and WT1/hDMP1 gene expression profiles of human monocytic leukemia cellline SHI-1. Methods SHI-1 cells were incubated with Simvastatin and PMA solely or in combination,cells of dif erent groups were col ected after incubation for further detection.M'IT method was used to assay the growth inhibition rate and cytoflowmetry was used to detect the early stage apoptosis ratio and cellnecrosis ratio.Real-time quantitative reverse transcriptase polymerase chain reaction(RT-PCR) was used to detect the WT1/hDMP1 gene expression levels. Results Treated with 15μmol/LSV and 10μmol/LSV in each, with the SHI-1 cells growth, the cellinhibition rates gradual y increased( =24.61, =0.000), and AnnexinV expression levels( =5.69, =0.018), however the WT1 expression levels gradual y decreased ( =12.20, =0.008),paral eled with hDMP1 expression levels increased in reverse ( =23.81, =0.000),furthermore the SHI-1 cells treated with Combination of 15μmol/LSV with 5ng/L PMA displayed obvious interaction for cellgrowth inhibition and Annexin V expression were found. Conclusion Simvastatin in vitro inhibited SHI-1 cellproliferation, induced celldifferentiation and promoted cellapotosis, as wel as decreased the WT1 expression and increased hDMP1 expression dose-dependently, indicating that simvastatin has the synergistic anti-monocytic potency in vitro.

Acute promyelocytic leukemia (APL) is currently considered to be a highly curable disease. However, early death (ED) remains a major cause of treatment failure in APL. The purpose of this study was to retrospectively review the morphological, immunophenotypic and molecular characteristics of 26 patients with APL resulting in ED. It was observed that elevated white blood cell (WBC) counts, lower fibrinogen concentrations, morphological variant M3v, CD34+ and the short form (S- or bcr3 form) of the PML-RARα transcript were significantly associated with ED, mainly due to cerebral hemorrhage. Admission on weekends or holidays without immediate diagnosis or prompt administration of treatment for APL resulted in intracranial bleeding and was the major cause of ED. Therefore, it is recommended that APL and coagulopathy management treatments are promptly initiated only upon morphological and clinical suspicion of APL on admission, in order to reduce the risk of severe bleeding and lower the rate of ED.

目的 探讨微小RNA-181b(miR-181b)在急性髓性白血病(AML)中的表达特点及预后意义.方法 采用实时定量逆转录-聚合酶链反应(RT-PCR)检测158例初诊AML患者及20例健康供者骨髓单个核细胞中miR-181b的表达水平.同时采用基因组DNA-PCR结合测序方法检测158例AML患者核磷蛋白1(NPM1)基因第12号外显子突变和fms样酪氨酸激酶3(FLT3)基因内部串联重复(ITD)突变(FLT3-ITD).结果 AML中miR-181b表达水平较正常对照组显著升高(Z =-2.386,P=0.017),各FAB亚型中M1、M5及M6型miR-181b表达水平较对照组明显升高(P＜0.05).miR-181b高表达与低血红蛋白、高乳酸脱氢酶及NPMI野生型有关.miR-181b高表达完全缓解率较低(x2 =7.717,P=0.005)、总生存期较短(P＜0.05).结论 miR-181b在AML某些亚型中高表达,miR-181b高表达是AML患者不利的预后因素.