Introduction Immunosuppressive therapy (IST) for acquired hemophilia A (AHA) results in remission within days to months in 60% to 80% of patients. However, little is known regarding the predictors of response. Aim This study aimed to identify the factors that influence response to treatment. Methods The data of 42 patients with AHA from three hospitals were retrospectively analyzed. Results All 42 AHA patients received IST; complete treatment data were available for 34 patients. The response rate was 60% among the 5/34 (14.7%) patients who received steroids alone, 70.8% among the 24/34 (70.6%) patients who received steroids plus cyclophosphamide, and 80% among the 5/34 (14.7%) patients who received steroids plus cyclophosphamide and rituximab. Overall, 29/34 (85.3%) patients achieved CR; 4/34 (13.8%) of them relapsed after a median time of 410 (21–1279) days. Adverse events occurred in 14/34 (41.2%) patients: 13/34 (38.2%) had infections and 1/34 (2.9%) developed pancytopenia. In univariate and multivariate Cox regression analyses, FVIII inhibitor titer ≥20 BU/mL was the only significant prognostic factor affecting time to CR. No variable had significant effect on OS. Conclusion FVIII inhibitory antibody titer ≥20 BU/mL appears to be an important predictor of time to complete response in patients with acquired hemophilia A treated with immunosuppressive therapy.

In this study, the aqueous extract Ziziphora clinopodioides was used to biosynthesis of iron nanoparticles. A green, productive, and environmentally method was developed for the valuable study and the effective preparation of the green-synthesis of iron nanoparticles using aqueous extracts from the leaf of Ziziphora clinopodioides as a result of reducing and stabilizing factor. The simplicity of the synthesis procedures and easy work up are the benefits of the present study. The structural and morphological characterization of green‐synthesized FeNPs was performed by Uv–Vis. and FT-IR spectroscopy, XRD, SEM, and EDX techniques. The SEM images have exhibited an equal and uniform spherical morphology in size of 30.04. We also investigated the anti-hemolytic anemia property of FeNPs in an animal model of hemolytic anemia. In vivo assay, induction of hemolytic anemia was done by phenylhydrazine in mice. FeNPs significantly reduced the weight and volume of liver and spleen and the concentration of pro-inflammatory cytokines and increased the body weight, the anti-inflammatory cytokines concentration, and the total platelet, WBC, neutrophil, lymphocyte, eosinophil, monocyte, and basophil counts, and RBC parameters as compared to the untreated mice. About the biochemical parameters, FeNPs significantly increased GPx, CAT, and SOD in serum, liver, and spleen, and also HDL, total protein, and albumin in serum, and decreased GR in serum, liver, and spleen, and also erythropoietin, ferritin, ferrous, creatinine, urea, LDL, triglyceride, cholesterol, GGT, ALT, AST, and ALP in serum as compared to the anemic mice. DPPH test revealed similar antioxidant potentials for FeNPs and Butylated hydroxytoluene. FeNPs had low cell viability dose-dependently against HUVEC cell line. It appears that FeNPs can be administrated as a hematoprotective and anti-hemolytic anemia drug or supplement for the treatment of hemolytic anemia in the clinical trial.

[This retracts the article DOI: 10.21037/atm-20-4558.].

目的:分析急性髓系白血病(AML)与骨髓增生异常综合征(MDS)患者22种常见基因突变的差异.方法:收集749例AML患者和218例MDS患者的骨髓标本,利用AML/MDS二代测序基因芯片检测22种基因的突变状态.结果:74.4％的AML和MDS患者至少检测到一种基因突变;142(65.1％)例MDS患者中检测到274个基因突变,而577(77.0％)例AML患者中检测到1224个基因突变.与MDS患者相比较,AML患者DNMT3A、IDH1、IDH2、FLT3、KIT、NPM1、NRAS和CEBPA基因的突变率升高(P<0.05),而ASXL1、EZH2、CBL、SRSF2、U2AF1、SF3B1、SETBP1和RUNX1基因突变率降低(P<0.05).两种疾病之间TET2、JAK2、ZRSR2、ETV6、TP53和PHF6基因的突变率差异无统计学意义.年轻患者基因突变率与上类似;而老年患者中DNMT3A、IDH2、FLT3和NPM1基因突变在AML中的发生率高于MDS(P<0.05),U2AF1和SF3B1基因突变在AML中的发生率低于MDS(P<0.05).结论:AML和MDS患者基因突变类型存在差异,不同年龄组AML患者和MDS患者的基因突变谱也不尽相同,DNMT3A、FLT3、NPM1、NRAS和CEBPA等基因突变在AML患者中常见,而ASXL1、U2AF1和RUNX1基因突变在MDS患者中较常见.

OBJECTIVE To analyze the characteristics of gene mutation in adult ALL and its clinical significance. METHODS Clinical data of 134 primary adult ALL patients and DNA sequencing results of 16 kinds of gene mutation were collected. The characteristic of gene mutation and clinical significances were statistically analyzed. RESULTS In 31 cases of 134 ALL cases (23.13%) the gene mutations were detected as follows: 19 cases of 114 B-ALL cases (16.67%), 11 cases of 19 T-ALL cases (57.89%) and 1 case of T/B-ALL. The incidence of T-ALL gene mutation was significantly higher than that of B-ALL (χ2=13.574, P<0.01). Twelve gene mutations were found, and the mutation rates was IL7R, NOTCH1, FLT3, TP53, FBXW7, PAX5, IKZF1, CREBBP, JAK3, JAK1, PHF6 and PTEN from high to low. Among 108 non-transplantable follow-up patients there was no significant difference in 1-year overall survival rate (49.7% vs 67.4%) and median non-recurrence survival time (214 days vs 260 days) between the gene mutation group (23 cases, 21.30%) and the non-mutation group(85 cases, 78.70%). There was a significant difference in 1-year survival rate between NOTCH1 mutation group (4 cases, 3.77%) and non-mutation group (102 cases, 96.23%) (50.0% vs 65.8%,χ2=9.840, P<0.01). CONCLUSION There may be multiple gene mutations in adult ALL patients. IL7R and NOTCH1 are the most common gene mutations and NOTCH1 mutation may indicate poor prognosis. Detection of gene mutations is helpful to understand the pathogenesis of ALL and evaluate the prognosis of adult ALL patients.

Background: Leukemia is characterized by the presence of highly malignant tumors formed in the hematopoietic system. Artesunate (Art), a semi-synthetic derivative of artemisinin, is commonly used as an antimalarial drug and has been proven to possess anticancer potential. Methods: In this study, the effect of Art on the proliferation and stemness of human acute promyelocyte leukemia HL-60 cells and acute myeloid leukemia KG1a cells was investigated. Flow cytometry, colony formation assay, the protein expressive levels of survivin, P21, cleaved caspase 3, Bax, Bcl-2, Ki67 were detected the effect of Art on HL-60 and KG1a cells proliferation and apoptosis. At the same time, cell sphere formation assay and the protein expressive levels of CD44, SOX2, ALDH1 and OCT4 were used to analyze the effects of Art on cancer stem cell-like property in vitro. The orthotopic xenograft mouse models were established by using KG1a cells in BALB/c athymic nude mice. Tumor weigh was detected. The protein levels of survivin and Ki67 were detected by immunohistochemistry assays. Results: Art induced cell apoptosis and inhibited cell proliferation and stemness in a dose-dependent manner. In the meantime, the results exhibited that Art inhibited the growth and stemness of transplanted tumors via the suppression of the MEK/ERK and PI3K/Akt pathway. Conclusions: Our present study provides new insights into the mechanisms of Art's anticancer potential in leukemia.

Objective To investigate the clinical characteristics and prognostic factors in elderly patients with acute myeloid leukemia(AML).Methods Clinical data of 232 patients with acute myelocytic leukemia(AML,except for acute promyelocytic leukemia) admitted in our hospital from January 2012 to December 2015 were retrospectively analyzed.Factors affecting complete remission (CR) were analyzed by using x2 test,and Kaplan-Meier survival analysis was conducted.Univariate and multivariate analysis of prognostic factors were performed by using Log-Rank test and Cox regression model respectively.Results Of 232 patients,195 patients received induction chemotherapy,among whom 8 patients died in early phase,efficacy could not be evaluated in 25 cases,with 162 patients for final statistical study.The CR rate was 37.0％ (60/162) after the first therapy course,and overall CR rate was 54.9％ (89/162).Thirty-seven patients received palliative treatment,among whom 6 patients died in early phase and none achieved CR.Therefore,the 162 patients receiving an induction chemotherapy,whose efficacy can be evaluated,could be clinically analyzed.They were in 60-69 years old (x2 =4.102,P =0.043),with ECOG score≤ 2 (x2 =9.917,P =0.002),NPM1 +FLT3-ITD-(x2 =6.423,P =0.038),favorable karyotypes(x2 =6.033,P =0.049),and related to a higher CR rate.The median overall survival(OS) was 205 days in the 232 patients.Univariate analysis results demonstrated that age(x2 =8.700,P =0.003),white blood cell (WBC) count ≥ 100 × 109/L (x2=4.249,P=0.039),karyotypes(x2=4.807,P=0.028),palliative treatment(x2 =191.221,P=0.000) were influencing factors for the prognosis.Multivariable analysis showed that age(HR =0.464,95％CI:0.245-0.877,P =0.018),karyotypes(HR =3.618,95％CI:1.491-6.728,P =0.003) and whether or not to receive induction chemotherapy (HR =0.076,95 ％ CI:0.030-0.194,P =0.000) were independent influencing factors for OS in elderly patients with AML.Conclusions The prognosis of elderly patients with AML is affected by multiple factors.Age,karyotypes and whether or not to receive induction chemotherapy are independent influencing factors for OS in elderly patients with AML.

Objective To investigate the efficacy and safety of domestic bortezomibˉbased chemotherapy for patients with multiple myeloma (MM). Methods The clinical data of 60 MM patients treated with domestic bortezomibˉbased chemotherapy regimen (the observation group) in the First Affiliated Hospital of Zhengzhou University from April 2018 to October 2018 were retrospectively analyzed, which were compared with 112 MM patients treated with original treatment regimen (the control group) at the same hospital from November 2010 to November 2014. According to the disease stage, the patients were divided into newly diagnosed MM (NDMM) group and relapsed refractory MM (RRMM) group, and efficacy and adverse reactions of domestic bortezomib were evaluated. Results The total response rate (ORR) of the observation group was 71.7% (43/60), severe complete response (sCR) + complete response (CR) rate was 16.7% (10/60), very good partial response (VGPR) rate was 18.3% (11/60), and partial response (PR) rate was 36.7% (22/60). The ORR of NDMM group (45 cases) and RRMM group (15 cases) was 82.2% (37/45) and 40.0% (6/15), respectively, and the difference was statistically significant (χ2＝ 9.877, P < 0.05). There was no significant difference between ISS stage Ⅰ+Ⅱ and stage Ⅲ [ORR: 75.7% (28/37) vs. 65.2% (15/23), respectively; χ2＝0.764, P >0.05]. ORR and CR rates in the NDMM group and RRMM group of the observation group and the control group were not statistically different (all P>0.05). In the treatment of bortezomibˉbased chemotherapy, the common adverse reaction was peripheral neuropathy, mostly belonging to grade 1-2. Other side effects included hematocytopenia, gastrointestinal events and herpes zoster, which could be alleviated or restored to normality after supportive treatments. One patient died of pulmonary infection, respiratory failure and septic shock during the intermittent period of chemotherapy. Conclusion ORR of domestic bortezomibˉbased chemotherapy in treatment of the patients with MM is high, and the incidence of adverse reactions shows no significant increase compared with original drugs.

目的 探讨荧光标记的嗜水气单胞菌溶素变异体(Flaer)试验对于贫血患者PNH克隆筛查的意义.方法 回顾性研究.收集2016年8月至2017年10月期间郑州大学第一附属医院门诊及住院贫血患者共867例,男388例,女479例,中位年龄47岁(8月～89岁).所有患者均接受流式细胞术检测中性粒细胞和单核细胞表面Flaer的表达及红细胞表面CD59的表达,672例患者进行了Ham试验.定量资料组间比较采用Mann-Whitney U秩和检验,配对资料组间比较采用Wilcoxon秩和检验及Mcnemar秩和检验.结果 867例贫血患者中,Flaer试验阳性者87例(10.03％),CD59试验阳性者43例(4.96％).PNH患者中,中性粒细胞[(73.94±28.59)％,(x±s)％]与单核细胞[(76.73±23.64)％]Flaer缺失率均高于CD59试验[(11.15±21.56)％]缺失率(Z=-6.764,P<0.001;Z=-6.618,P<0.001),而中性粒细胞Flaer缺失率与单核细胞Flaer缺失率无明显差异(Z=-0.085,P=0.933).Flaer试验阳性的87例患者中,PNH患者中性粒细胞及单核细胞Flaer缺失率[(76.32±25.74)％,(75.40±25.61)％]均高于非PNH患者[(14.00±24.10)％,(16.74±27.32)％](Z=-6.432,P<0.001;Z=-5.732,P<0.001).结论 Flaer试验用于贫血患者的PNH克隆筛查,对于PNH的诊断及鉴别诊断有重要意义.

OBJECTIVE:To explore the differences of CD146 expression in adult and children's acute B cell lymphoblastic leukemia(B-ALL), and its relation with clinical features, molecular biological and cytogenctic claracteristics.METHODS:The expression of CD146 in bone marrow samples from adult and children's B-ALL patients were detected by flow cytometry (FCM) and the relation of CD146 abnormal high expression with the patients' clinical features, molecular biological and cytogenetical characteristics, as well as other antigens were analyzed.RESULTS:The abnormal high expression rates of CD146 in adult and children's B-ALL patients were 29.17% and 9.09% respectively, showing that the expression rate of CD146 in adult patients was higher than that in children's patients(P<0.05). In adult B-ALL, CD146 was positively related with CD64 and CD117, while in children's B-ALL CD146 was positively related with CD71 and CD58 (P<0.05). After 1 course of standardized chemotherapy, the complete remission rates in adult and children's B-ALL patients with abnormal high expression of CD146 both were low as compared with adult and children's B-ALL without abnormal high expression of CD146 (P<0.05).CONCLUSION:The expression rate of CD146 in adult B-ALL is higher than that in children's B-ALL. The CD146 positively relates with poor prognostic antigens, the CD146 may be one poor prognosis marker.

The aim of this retrospective analysis was to evaluate the antimicrobial resistance, clinical features, and risk factors for septic shock and death of nosocomial E coli bacteremia in adult patients in a single hematological center in China. A retrospective case-control study of 157 adult hematological patients with 168 episodes of E coli bacteremia was initiated from April 2012 to July 2015. Antimicrobial susceptibility as well as antimicrobial co-resistance rates were analyzed. Clinical features and outcomes were also studied. In addition, risk factors for septic shock and death were investigated. Among the 553 positive blood isolates during the study period, the prevalence of E coli was 33.3% and ESBL production strains represented 61.9% of those examined. In all the E coli strains isolated, 85.6% were multidrug-resistance (MDR), 2.4% were extensive drug resistance (XDR), and 6.0% were resistant to carbapenems. More MDR phenotype was noted in ESBL-EC strains (98.6% vs 62.8%, P<.001) and isolates from neutropenic patients (98.6% vs 62.8%, P<.001). In the antimicrobial susceptibility test, carbapenems and amikacin exhibited not only higher in vitro activity against E coli (94.0% and 92.0%, respectively), but lower co-resistance rates to other antibiotics. Carbapenem resistant strains retained full sensitivity to tigecycline and 60% to amikacin. Piperacillin/tazobatam was the third sensitive drug to both ESBL-EC (77.1%) and non-ESBL-EC (86.0%). In our series, 81.6% episodes received appropriate initial antibiotic treatment and no significant decrease in it was found in bacteremia due to ESBL E coli and patients with neutropenia, septic shock. Septic shock was noted in 15.5% patients and the overall 30-day mortality rate was 21.7%. Multivariate analysis revealed that induction chemotherapy (OR 2.126; 95% CI 1.624-11.332; P=.003) and polymicrobial infection (OR 3.628; 95% CI 1.065-21.219; P=. 041) were risk factors for septic shock, whereas male (OR 2.223; 95% CI 1.132-12.022; P <.01) and septic shock (OR 52.359; 95% CI 19.951-292.690; P=. 030) were risk factors for death.In the hematology department, ESBL-producing and MDR are widely prevalent in E coli bacteremia which is still a major life-threatening problem, especially for patients with septic shock. For empirical antimicrobial therapy, combination based on aminoglycoside, especially amikacin, will be helpful to increase the antimicrobial coverage against ESBL-EC while combining tigecycline with aminoglycoside should be considered for seriously carbapenem-resistant infectious patients.

OBJECTIVE:To investigate the expression of N-cadherin in bone marrow leukemic cells derived from acute leukemia patients and its clinical significances.METHODS:A total of 113 patients with acute leukemia were enrolled in this study. Flow cytometry was employed to detect the expression of N-Cadherin in bone marrow leukemic cells from acute leukemia patients and the relationships between the N-cadherin expression and the clinical characteristics of patients with acute leukemia were analyzed.RESULTS:The expression of N-Cadherin in bone marrow leukemic cells deriveted from patients with acute leukemia was variable with 0%-99.7%. For adult AML patients, the positive rate of CD34 in N-cadherin+ group was significantly higher than that in N-cadherin- group(67.39% vs 33.33%)(P=0.013), while the differences of total CR rate and rate of CR after 1 cycle of induction treatment were not significant between these 2 groups(P>0.05). As to ALL patients, N-cadherin+ group had significant lower WBC count (21.31±7.07 vs 51.10±23.69)(P=0.008) and lower percentage of peripheral blood blast (43.22±5.75% vs 66.45±5.65%)(P=0.015). The CR rate after 1 cycle of induction treatment and rate of overall CR were lower and the relapse rate was higher in N-cadherin+ ALL group than those in N-cadherin- ALL group, but the differences were not significant (P>0.05). For childhood ALL, the positive rate of CD33 in N-cadherin+ group was significantly higher than that in N-cadherin- group(47.62% vs 0%)(P=0.012). The relapse rate was higher in N-cadherin+ group than that in N-cadherin- group (30.00% vs 0%)(P=0.115). The median survival time, 3-year overall OS rate and 3-year relapse-free survival rate in N-cadherin- groups of adult AML, non-M3 AML, ALL and chidhood ALL paients were superior to N-cadherin+ groups, but the differences were not significant.CONCLUSION:The expression of N-cadherin in bone marrow leukemic cells relates to some clinical features of patients with acute leukemia and to some extent has inferior effect on survival of patients with acute leukemia.

Objective To investigate the clinical features,efficacy and prognosis factors of acute myeloid leukemia (AML) transformed from myelodysplastic syndrome (MDS).Methods The evolution time,clinical characteristics,subtypes,responses to treatment and the related impact factors of 52 patients with AML transformed from MDS were analyzed retrospectively.Results The median evolution time was 6.75 months.Results of univariate analysis showed age ≥46 years old,male,IPSS-R karyotype of poor prognosis were significant risk factors of leukemia free survival (LFS).Results of multivariate analysis by Cox model showed that age ≥46 years old and IPSS-R karyotype of poor prognosis were independent risk factors for LFS.The subtypes of AML transformed from MDS included M2 (67.31％,35 cases),M5 (11.54 ％,6 cases),M4 (9.62 ％,5 cases),M6 (9.62 ％,5 cases) and M1 (1.92 ％,1 case).17 patients (32.69 ％) developed extramedullary infiltration mainly in liver,spleen,lymph nodes,gingival,alimentary tract and tonsil.White blood cell count and neutrophil count were increased alone with transformation to AML compared with those newly diagnosed MDS.The complete remission rate was only 33.3 ％ (8/24).Conclusions Elderly and IPSS-R karyotype of poor prognosis can increase the risk of MDS evolution to AML,mainly to M2.Extramedullary infiltration was easy to be found in AML transformed from MDS,with low remission rate,high treatment-related mortality and poor prognosis.

多发性骨髓瘤（multiple myeloma，MM）是以骨髓单克隆浆细胞异常增生为特征的恶性肿瘤，发病年龄大多在50～70岁，至今仍不能治愈，目前其主要治疗方法为联合化疗。硼替佐米是一种蛋白酶体抑制剂，在骨髓瘤患者的治疗中发挥持久的疗效。沙利度胺具有抗血管生成和免疫调节作用，在 MM的治疗中取得良好疗效。该研究采用硼替佐米联合地塞米松及沙利度胺治疗 MM，取得一定疗效，报道如下。

Objective Observation the clinical efficacy and adverse reactions of rituximab treatment of chronic primary immune thrombocytopenia in adults.Methods 75 cases of adults-chronic primary immune thrombocytopenia patients of Our hospital in May 2013~ May 2015 were studied. They were randomly divided into observation group and control group. Oral dexamethasone group, the observation group intravenous infusion of rituximab on the basis of the control group, the total efficiency of treatment were compared with the incidence of adverse reactions.Results Observation group total effective rate was 71.4%(25/35), which was higher than 45.7%(16/35), the difference was statistically significant(P<0.05).Adverse reactions observed group was 31.4%(11/35),and the control group was 25.7%(9/35), the difference was not statistically significant(P>0.05).Conclusion Rituximab treatment of chronic primary immune thrombocytopenia in adults can effectively suppress autoantibody production in order to promote an increase in platelet count. The rituximab treatment has high security and should be widely applied.

Objective To observe the effects of arsenic trisulfide on survival of mice bearing acute promyelocytic leukemia( APL)ascites. Methods The animal model of SCID mice with NB4 cell ascites was established. The mice were divided into groups:the mice in the therapeutic group were intraperitoneally administrated with arsenic trisulfide suspension every other day for 3 doses;the mice in the control group were intraperitoneally administrated with 0. 5% methylcellulosis as negative control or adriamycine as positive control. Results The SCID mice grew as-cites after inoculated with NB4 cells and died of APL ascites. The survival times of treated mice in the 100μg·g-1 arsenic trisulfide group were(24. 05 ± 3. 54)days and were(16. 27 ± 2. 34)days in the negative control group(P<0. 05). Conclusion Arsenic trisulfide inhibite the proliferation of NB4 cells in vivo,and increase the survival of mice bearing APL ascites.

OBJECTIVE:To investigate the expression of N-Cadherin in the patients with multiple myeloma (MM) and to explore its clinical significance.METHODS:A total of 64 patients with multiple myeloma were enrolled in this study. The expression of N-Cadherin in bone marrow CD38⁺/CD138⁺ cells from multiple myeloma patients was detected by flow cytometry. The relationship between N-Cadherin expression and clinical prognostic factors was analyzed.RESULTS:Among 64 cases of MM, the expression of N-Cadherin in 17 patients (26.56%) was high (> 20%), while that in 47 cases (73.44%) was low (< 20%); The differences of N-Cadherin expression in disease staging and classification, known prognostic factors, myeloma cell antigen expression and bone damage between patients with high and low N-Cadherin expression were not statistically different; the difference N-Cadherin expression in genetic abnormalities such as D13S319 deletion, RB1 deletion and IGH gene rearrangement between above-methioned two groups was not significant. The 1q21 amplification rate in the group with high expression of N-Cadherin was enhanced significently; the overall survival (OS) times of patients with abnormally high and low expression levels of N-Cadherin were 26.7 months and 55.5 months respectively, and the difference was statistically significant (P < 0.05).CONCLUSION:The high expression of N-Cadherin in multiple myeloma may be one of the indicator for poor prognosis of MM, which may be related with 1q21 amplification.

This study aimed to compare the differences in clinical efficacy and safety of different doses of amphotericin B for treating hematologic malignancies associated with invasive fungal infections (HM-IFI). Fifty cases of HM-IFI were treated with amphotericin B and, according to the dose, the cases were divided into the low-dose (LD) or middle-dose (MD) group. The median treatment time of the MD group was 17 days, while that of the LD group was 30 days (P < 0.05); some patients from the MD group were transferred into the LD group for continuous treatment because they could not tolerate the adverse reactions. The 15-day symptoms and imaging efficiency for the LD and MD groups were 53 and 46%, respectively (P < 0.05), while the efficiency rates of the 2 groups after withdrawal of medication were 58 and 53%, respectively (P > 0.05). Monitoring of the adverse reactions in the LD and MD groups revealed that the respective incidences of chills and fever were 7.2 and 6.9% (P > 0.05); of refractory hypokalemia, 35 and 18% (P < 0.05); of liver dysfunction, 20 and 15% (P < 0.05); and of renal dysfunction, 24 and 19% (P < 0.05). The incidences of adverse reactions were significantly higher in the MD group than in the LD group, and some patients could not tolerate the treatment at this dose. In conclusion, early application of a middle dose of amphotericin B alleviated disease conditions significantly quicker than application of a low dose, and amphotericin B represents a safe, effective, and economical choice for the treatment of HM-IFI.

Objective: The expression of the tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) protein and its regulation by chemotherapeutics were analyzed in primary acute leukemic cells. Materials and Methods: Peripheral blood was collected from 16 patients with acute leukemia on days 0, 1, 3, and 5 of chemotherapy. The mononuclear cells were separated from the peripheral blood, and TRAIL expression was assessed by flow cytometry. The bone marrow mononuclear cells of patients with acute leukemia were separated before chemotherapy and cultured in vitro with VP-16 and/or interferon (IFN). The TRAIL expression level was detected after the cell culture. Results: TRAIL expression in the mononuclear cells of peripheral blood was significantly upregulated on day 1 (p<0.05) and then significantly decreased on day 5 after chemotherapy (p<0.05). Results from the in vitro culture revealed that VP-16 upregulated TRAIL expression in the bone marrow mononuclear cells of patients with acute leukemia, but the binding of VP-16 to IFN did not enhance TRAIL expression as compared with VP-16 alone (p>0.05). onclusion: OA single chemotherapy mechanism for leukemia may suffice to induce TRAIL expression and promote the apoptosis of leukemic cells. Conflict of interest:None declared.