Background Early failure less than 12 months (POD12) of frontline R-CHOP chemo-immunotherapy in very poor outcomes and requires alternative therapy in patients with Diffuse large B-cell lymphoma (DLBCL).Aim We aim to evaluate the association of gene alterations and clinical factors with POD12.Methods The panel included 103 genes that were examined in 26 patients with newly diagnosed DLBCL treated with standard R-CHOP chemo-immunotherapy in the frontline setting therapy using next-generation sequencing. The association of clinical features and gene alterations with early progression was analyzed.Results POD12 group (n=12) was related to poorer OS with a hazard ratio (HR) of 12.13 (95% confidence interval [CI] 2.34-62.78, p=0.0029). Genes mutated in 96.15% of patients (25/26) were grouped into 11 specific pathways, and the POD12 subtype was mostly characterized by mutations in the epigenetic modulation pathway (33.32% of total variation) and apoptosis/cell cycle/autophagy pathway (20.83% of total variation), whereas the no-POD12 subtype is mostly characterized by mutations in the epigenetic modulation pathway (40.66% of total variation). CD79B mutation frequency was significantly increased in the no-POD12 group compared with the POD12 group (50.00% vs 8.33%, p=0.0357). Not achieving complete response (CR) during interim treatment response was found to be significantly associated with the occurrence of POD12 (p=0.0214).Conclusions CD79B wide-type and not achieving CR during interim responses evaluation correlate with POD12. These findings provide a basis for the development of optimal alternative therapies in clinical trials.

BackgroundA novel CT-linac (kilovolt fan-beam CT-linac) has been introduced into total marrow and lymphoid irradiation (TMLI) treatment. Its integrated kilovolt fan-beam CT (kV FBCT) can be used not only for image guidance (IGRT) but also to re-calculate the dose.PurposeThis study reported our clinical routine on performing TMIL treatment on the CT-linac, as well as dose distribution comparison between planned and re-calculated based on IGRT FBCT image sets.Methods11 sets of data from 5 male and 6 female patients who had underwent the TMLI treatment with uRT-linac 506c were selected for this study. The planning target volumes consist of all skeletal bones exclusion of the mandible and lymphatic sanctuary sites. A planned dose of 10 Gy was prescribed to all skeletal bones exclusion of the mandible in two fractions and 12 Gy in two fractions was prescribed to lymphatic sanctuary sites. Each TMLI plan contained two sub-plans, one dynamic IMRT for the upper body and the other VMAT for the lower extremity. Two attempts were made to obtain homogeneous dose in the overlapping region, i.e., applying two plans with different isocenters for the treatment of two fractions, and using a dose gradient matching scheme. The CT scans, including planning CT and IGRT FBCT, were stitched to a whole body CT scan for dose distribution evaluation.ResultsThe average beam-on time of Planupper is 30.6 min, ranging from 24.9 to 37.5 min, and the average beam-on time of Planlower is 6.3 min, ranging from 5.7 to 8.2 min. For the planned dose distribution, the 94.79% of the PTVbone is covered by the prescription dose of 10 Gy (V10), and the 94.68% of the PTVlymph is covered by the prescription dose of 12 Gy (V12). For the re-calculated dose distribution, the 92.17% of the PTVbone is covered by the prescription dose of 10 Gy (V10), and the 90.07% of the PTVlymph is covered by the prescription dose of 12 Gy (V12). The results showed that there is a significant difference (p < 0.05) between planning V10, V12 and delivery V10, V12. There is no significant difference (p > 0.05) between planned dose and re-calculated dose on selected organs, except for right lens (p < 0.05, Dmax). The actual delivered maximum dose of right lens is apparently larger than the planned dose of it.ConclusionTMLI treatment can be performed on the CT-linac with clinical acceptable quality and high efficiency. Evaluation of the recalculated dose on IGRT FBCT suggests the treatment was delivered with adequate target coverage.

Purpose-Immunotherapy has revolutionized cancer therapy, becoming the standard of care for various malignancy treatments. Human immunodeficiency virus (HIV) patients, however, are an underserved group with limited access to clinical trials and cancer therapy. This study was to evaluate the safety and efficacy of programmed cell death 1 (PD - 1) inhibitors in patients with advanced cancer and HIV/acquired immunodeficiency syndrome (AIDS). Methods and Materials-We performed a prospective, open-label, nonrandomized, phase 1 single center study. Patients with advanced cancer and HIV/AIDS received the treatment of PD - 1 inhibitors (camrelizumab, 200 mg, administered intravenously every 3 weeks), along with combination antiretroviral therapy (cART) for HIV. Results-Sixteen participants (12 men and 4 women; median age, 46.5 (29 - 78) years) were enrolled; 1 had non - Hodgkin lymphoma (NHL), and 15 had non - AIDS - defining cancers. Safety was observed over 130 cycles of treatment with camrelizumab. Most treatment-emergent adverse events at least possibly attributed to camrelizumab were grade 1 or 2, including reactive cutaneous capillary endothelial proliferation (RCCEP) (9 participants), hearing loss (1 participant), hypophysitis (1 participant). 3 participants experienced hemorrhage due to poor performance status. HIV was controlled in all participants. Best tumor responses included 3 complete response, 5 partial response, 2 stable disease, and 6 progressive disease. The 2 years progression-free survival (PFS) was 67.0% (95% CI: -0.05, 0.00) and overall survival (OS) was 55.3% (95% CI: -0.05, 0.01) for the 16 patients who had received camrelizumab. Conclusions-This study demonstrates that camrelizumab treatment in patients with advanced cancers and HIV/AIDS was feasible and the clinical outcomes were acceptable.

Abstract Purpose Hematopoietic stem cell transplantation (HSCT) is a curative option for various hematologic malignancies (HM), however, the risk of relapse hampers favorable HSCT outcomes. Augmentation of irradiation to sites of disease is one potential strategy to overcome this risk. This study evaluated the feasibility of radiation dose escalation of total marrow and lymphoid irradiation (TMLI) as part of the conditioning regimen prior to HSCT. Methods and Materials 53 patients (5 acute myelogenous leukemia (AML), 29 acute lymphoblastic leukemia (ALL), 17 non-Hodgkin’s lymphoma (NHL), 2 mixed acute leukemia (MAL)) received conditioning radiation treatment with TMLI 10 Gy (8 Gy to bone marrow (BM), 10 Gy to involved lymphatic sanctuary sites in 2 fractions per day). 36 patients (5 AML, 26 ALL, 2 NHL, 3 MAL) underwent the radiation treatment with TMLI 12 Gy (8 Gy to BM, 12 Gy to involved lymphatic sanctuary sites in 2 fractions per day) before HSCT. Results The median age of patients receiving TMLI 10 Gy and 12 Gy was 24 (4–47) and 27 (8–55) years old, respectively. Median dose of organs at risk (OARs) was down-regulated by 27% − 79% and 11% − 83% of the prescription dose at TMLI 10 Gy and 12 Gy compared to standard total body irradiation (TBI). Grade 1–2 acute toxicities were primarily observed. The 2 years progression-free survival (PFS) was 73.6% at TMLI 10 Gy and 84.8% at TMLI 12 Gy (95% CI: 0.15, 1.33) and, and the 2 years overall survival (OS) was 79.1% and 65.7% respectively (95% CI: 0.28, 2.15). The 2-year relapse rate was 19% and 11%, and the non-relapse mortality was 9% and 22% at TMLI 10 Gy and 12 Gy, respectively. Conclusions This study suggests that the relapse rate and 2 years PFS of HM are considerably improved when TMLI is performed prior to HSCT, which will offer an effective strategy for treating these diseases.

Abstract Background: A novel CT-linac (kilovolt fan-beam CT-linac) has been introduced into total marrow and lymphoid irradiation (TMLI) treatment. Its integrated kilovolt fan-beam CT scanner enables accurate evaluation of the dose distribution difference between plan and delivery, which is crucial for the TMLI treatment improvement for the future. Purpose: This study evaluated the technical feasibility of kilovolt fan-beam CT-linacfor TMLI treatment and investigated the true dose distribution of the delivery. Methods: 11 sets of data from 5 male and 6 female patients who had underwent the TMLI treatment with uRT-linac 506c were selected for this study. The planning target volumes consist of all skeletal bones exclusion of the mandible and lymphatic sanctuary sites. A planned dose of 10Gy was prescribed to all skeletal bones exclusion of the mandible in two fractions and 12Gy in two fractions was prescribed to lymphatic sanctuary sites. Each TMLI plan contained two sub-plans, one dynamic IMRT for the upper body and the other VMAT for the lower extremity. Two attempts were made to obtain homogeneous dose in the overlapping region, i.e., applying two plans with different isocenters for the treatment of two fractions, and using a dose gradient matching scheme. The CT scans, including planning CT and fan-beam CT (obtained during image-guided radiation therapy) were stitched to a whole body CT scan for dose distribution evaluation. Results: Firstly, the kilovolt fan-beam CT-linac can provide the adequate target dose coverage (90% for planning and delivery) and critical organ sparing that satisfied the clinical requirements. Secondly, the beam-on time of kilovolt fan-beam CT-linac is apparently shorter than helical tomotherapy for the TMLI treatment. Thirdly, there exists the dose distribution difference of PTVs between plan and delivery (p<0.05, Wilcoxon signed-rank test), but the PTV coverage of delivery is clinically acceptable (larger than 90%). There is no significant difference (p>0.05) between the dose distribution of the plan and delivery for most organs at risk, except for right len. Fourthly, for the treatment delivery, applying two plans with different isocenters for one patient in two fractions performed better than employing only one plan for one patient in two fractions on PTV coverage for PTVbone, maximum dose for small bowel, heart, and liver. Conclusion: This radiation therapy treatment planning has proved to be effective. This research first exhibited that the dose difference between planning and delivery was evaluated, which is important for treatment evaluation and plan improvement for the future studies.

Objective:To investigate the feasibility, efficacy and adverse reactions of programmed death-1(PD-1) inhibitors in patients with acquired immunodeficiency syndrome (AIDS) complicated with malignant tumor.Methods:From September 2020 to August 2021, patients with AIDS complicated with malignant tumor in Zhongnan Hospital of Wuhan University were enrolled. Data including basic information, laboratory test results, CD4 + T cell count, human immunodeficiency virus (HIV) viral load were collected. Patients were continuously administered intravenously PD-1 monoclonal antibody until disease progression or intolerant toxicity reaction occurred. Adverse reactions during treatment were recorded.And treatment outcomes were assessed once every 12 weeks after treatment. HIV viral load was measured after treatment once a week for four consecutive times, then once four weeks for two consecutive times, and then once every 12 weeks. Results:Ten patients were included in the study, including seven males and three females, three cases of Hodgkin′s lymphoma, two cases of cervical cancer and hepatocellular carcinoma respectively, one case of non-Hodgkin′s lymphoma, non-small cell lung cancer and anal cancer respectively. There were four patients with CD4 + T cell count of 100 to 200 cells/μL and two patients with CD4 + T cell count lower than 100 cells/μL. All patients had completed at least three cycles of treatment with PD-1 monoclonal antibody, HIV viral load remained lower than 20 copies /mL. Three cases achieved complete response and three cases achieved partial response. Adverse reactions were cutaneous capillary endothelial proliferation (CCEP) (seven cases), major bleeding (three cases), and hearing impairment (one case). Conclusions:PD-1 inhibitor has no adverse effect on the continuous suppression of HIV viral load and has an effect on tumor control, so it is a viable choice in AIDS patients complicated with tumor. However, due to its considerable adverse reactions, multidisciplinary cooperation is needed to reduce the risk of complications and deal with serious complications.

Objective:To investigate the epidemic trend and risk change of acquired immunodeficiency syndrome (AIDS) complicated with malignant tumors after combination antiretroviral therapy (cART).Methods:The types of malignant tumors in patients with AIDS at different stages of cART were analyzed among anti-human immunodeficiency virus (HIV)-positive population in Hubei Province screened in National AIDS/HIV prevention and control information system from 1st January, 2004 to 31st December, 2018. The standardized incidence ratios(SIR) of malignant tumors in AIDS patients was analyzed based on the incidence of malignant tumors in the general population in Hubei Province or China in 2013. The changes in risks for development of malignant tumors in AIDS patients at different cART stages from 2004 to 2013 and 2014 to 2018 were compared.Chi-square test was used for statistical analysis.Results:Three hundred and twenty-three out of 22 994 AIDS patients were diagnosed with malignant tumors. Non-Hodgkin lymphoma(NHL) and cervical cancer were most common types in acquired immunodeficiency syndrome-defining cancers (ADC), while liver cancers and lung cancers were the most common types in non-acquired immunodeficiency syndrome-defining cancers (NADC). The overall risk of malignancy in AIDS patients was similar to that in the general population (SIR=1.06, χ2=0.62, P=0.426). However, the risks of Kaposi sarcoma, NHL, Hodgkin lymphoma, cervical cancer, and head and face cancers (excepting nasopharyngeal cancer) in AIDS patients were significantly higher than those in the general population (SIR=834.09, 9.65, 13.33, 5.22 and 2.94, respectively, χ2=11 747.27, 625.54, 56.65, 184.21 and 13.66, respectively, all P<0.01). The risks of lung cancer, colorectal anal cancer, stomach cancer and breast cancer in AIDS patients were significantly lower than those in the general population (SIR=0.33, 0.36, 0.43 and 0.45, respectively, χ2=33.43, 12.84, 9.01 and 7.21, respectively, all P<0.05). The SIR of cervical cancer, liver cancer and colorectal anal cancer from 2014 to 2018 were 4.06, 0.43 and 0.10, respectively, which were significantly lower than those from 2004 to 2013 (7.42, 1.96 and 0.84, respectively). The differences were all statistically significant ( χ2=5.39, 19.52 and 10.86, respectively, all P<0.05). Conclusions:At present, there are no significant differences of the incidences of malignant tumors between AIDS patients and general population, but the tumor types are different. The most common malignant tumors in this region are NHL and cervical cancer, which should be noted that HIV screening among patients with such tumors is conducive to comprehensive treatment to improve the efficacy.

Purpose: Total body irradiation (TBI) has been widely utilized as part of the conditioning regimen for hematopoietic stem cell transplantation (HSCT), but is associated with significant toxicities. Targeted TBI using helical Tomotherapy allows precise and homogeneous tumor coverage and excellent sparing of organs at risk. The purpose of this study was to evaluate the clinical outcomes of a novel hypofractionation strategy for patients receiving total marrow and involved lymphoid irradiation (TMLI) as part of the conditioning regimen before HSCT. Methods and Materials: 61 patients (7 acute myelogenous leukemia (AML), 33 acute lymphoblastic leukemia (ALL), 18 non-Hodgkin's lymphoma (NHL), 3 mixed acute leukemia (MAL)) received conditioning radiation treatment with TMLI (8 Gy to bone marrow, 10 Gy to involved field in 2 fractions per day) in conjunction with chemotherapy before transplantation. Results: The median age of 61 patients with TMLI was 24 (4-54) years. The prescribed dose covered the entire bone and involved target volume, and the dose of organs at risk (OAR) was reduced by 28%-78% of the prescription dose. Grade 1-2 nausea and vomiting occurred in 12 patients and grade 1-2 pain in 6 patients during radiotherapy. Fatigue occurred in 16 patients. 2 patients had diarrhea, enteritis, and 1 patient had fever. None of patient had grade 3-4 non-hematologic adverse reactions. Late (30 days after HSCT) grade 2 toxicities including reversible enteritis occurred in 3 patients. 5 patients developed infectious pneumonia. The 2 years progression-free survival (PFS) was 64.1% (95% CI: 0.16-0.22) and overall survival (OS) was 74.7% (95% CI: 0.19-0.24) for the 61 patients who had received their planned HSCT. The 2-year non-relapse mortality was significantly reduced to 5% in this patient cohort. Conclusions: This study demonstrates that hypo-fractionated TMLI (8 Gy to bone marrow, 10 Gy to involved field in a single day) as a conditioning regimen for lymphoma and acute leukemia was feasible and the clinical outcomes were acceptable. (C) 2020 The Authors. Published by Elsevier B.V. on behalf of European Society for Radiotherapy and Oncology.

The data of patients with HIV/AIDS from Hubei Province during 2004 to 2018 were obtained from the National AIDS Comprehensive Prevention and Control Information System. A total of 22 980 HIV-positive or AIDS patients were followed up for 113 164 person-years and 323 malignant tumors were diagnosed. Non-Hodgkin′s lymphoma (NHL), cervical cancer, liver cancer, lung cancer, and Kaposi sarcoma (KS) accounted for 70.0% (226/323) of all malignant tumors in this population. The average crude incidence and mortality of malignant tumors in HIV-infected patients were 285.43/100 000(269.11/100 000 in males and 325.87/100 000 in females), and 169.67/100 000(184.78/100 000 in males and 132.19/100 000 in females), respectively. The result indicates that the overall cancer incidence and mortality in HIV/AIDS population under widely implementation of combination anti-retroviral therapy (cART) are similar to those in the general population of the region. But the incidence and mortality of AIDS-related tumors such as KS, NHL, HD and cervical cancer are higher than those in general population, and attention should be given to screening of these malignancies in HIV/AIDS population.

目的:异基因造血干细胞移植(allo-HSCT)是治疗难治复发急性白血病的一种有效方法,预处理方案是影响患者生存的重要因素之一,以全身照射(TBI)或全骨髓联合全淋巴照射(TMLI)为基础的预处理方案被应用于接受allo-HSCT的复发难治白血病患者中.然而,由于TBI可导致短期或长期毒性,TBI正逐渐被新发展的TMLI所取代.本研究旨在探讨以TMLI-IDA-CY为预处理的造血干细胞移植对复发难治急性白血病患者的疗效.方法:回顾性评估22例接受以TMLI-IDA-CY为预处理的allo-HSCT的复发难治白血病患者的临床结果.结果:在22例患者中,观察到Ⅰ级恶心或呕吐8例,Ⅰ～Ⅱ级腹泻9例,Ⅰ～Ⅱ级口咽黏膜炎8例.所有患者均未发生Ⅲ～Ⅳ级非血液学不良反应.复发难治急性白血病患者的生存结果是可以接受的(2年总生存率49.3％,累积复发率47.2％,无病生存率47.8％,移植相关死亡率9.1％).+100 d、+365 d完全缓解率分别为77.3％和53.7％.结论:在接受allo-HSCT的复发难治急性白血病患者中使用TMLI这种新放疗手段是安全有效的.

Yongxi Zhang, Song Chen, John Lin, Yingying Wang, Xi-En Gui, Hengning Ke, Di Deng, Jean-Pierre Routy and Qian Cao Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, China; Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China; Department of Biological Repositories, Zhongnan Hospital of Wuhan University, Wuhan, China; Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada; Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, Canada; Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, China; Training Center of AIDS Prevention and Cure of Hubei Province, Zhongnan Hospital of Wuhan University, Wuhan, China; Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China; Division of Hematology, McGill University Health Centre, Montreal, Canada

Isolation of viable circulating tumor cells (CTC) holds the promise for improving screening, early diagnosis, and personalized treatment of lymphoma. In this study, we isolated and characterized spontaneously immortalized B-lymphocyte (SIBC) lines from HIV-infected patients with and without Non-Hodgkin's Lymphoma (AIDS-NHL). A total of 22 SIBC lines was isolated from peripheral blood mononuclear cells (PBMC) of HIV-infected patients with (n = 40) and without (n = 77) clinically detectable NHL, but not from healthy individuals (n = 34). Of these, 8 SIBC lines named HIV-SIBC were generated from HIV-infected patients without AIDS-NHL (10%, 8/77), while 14 SIBCs named AIDS-NHL-SIBC were from 13 of the AIDS-NHL patients (32.5%, 13/40). Among the 14 AIDS-NHL-SIBCs, 12 were derived from AIDS-NHL patients with poor prognoses (survival time less than 1 year). SIBCs displayed markers typical of memory B cells (CD3(-)CD20(+)CD27(+)) with EBV infection. Moreover, AIDS-NHL-SIBCs were representative of CTC as evidenced by monoclonal Ig gene rearrangement, abnormal chromosomal karyotype, and the formation of xenograft tumors, while HIV-SIBCs generated harbored some features of tumor cells, none had the capacity of xenograft tumor formation, suggesting HIV-SIBC present the precursor of CTC. These results indicate that SIBCs is associated with poor prognosis in AIDS-NHL patients and can be isolated from HIV-infected patients with NHL and without NHL. This findings point to the need for further molecular characterization and functional studies of SIBCs, which may prove the value of SIBCs in the diagnosis, prognoses, and screening for NHL among HIV-infected patients.

Background & purpose Helical tomotherapy has been applied to total marrow irradiation (HT-TMI). Our objective was to apply failure mode and effects analysis (FMEA) two times separated by 1 year to evaluate and improve the safety of HT-TMI. Materials and methods A multidisciplinary team was created. FMEA consists of 4 main steps: (1) Creation of a process map; (2) Identification of all potential failure mode (FM) in the process; (3) Evaluation of the occurrence (O), detectability (D) and severity of impact (S) of each FM according to a scoring criteria (1-10), with the subsequent calculation of the risk priority number (RPN=O*D*S) and (4) Identification of the feasible and effective quality control (QC) methods for the highest risks. A second FMEA was performed for the high-risk FMs based on the same risk analysis team in 1 year later. Results A total of 39 subprocesses and 122 FMs were derived. First time RPN ranged from 3 to 264.3. Twenty-five FMs were defined as being high-risk, with the top 5 FMs (first RPN/ second RPN): (1) treatment couch movement failure (264.3/102.8); (2) section plan dose junction error in delivery (236.7/110.4); (3) setup check by megavoltage computed tomography (MVCT) failure (216.8/94.6); (4) patient immobilization error (212.5/90.2) and (5) treatment interruption (204.8/134.2). A total of 20 staff members participated in the study. The second RPN value of the top 5 high-risk FMs were all decreased. Conclusion QC interventions were implemented based on the FMEA results. HT-TMI specific treatment couch tests; the arms immobilization methods and strategy of section plan dose junction in delivery were proved to be effective in the improvement of the safety.

Objective To evaluate the clinical application value of a novel immobilization system in total marrow irradiation ( TMI) with MVCT image. Methods From 2016 to 2017, a retrospective analysis of the setup errors of 22 patients receiving TMI in two groups ( twelve patients were immobilized with the novel immobilization system in group 1, ten patients were immobilized with the combinatorial immobilization devices in group 2) was performed in this study on Zhongnan Hospital of Wuhan University. Two-sample t-test was used to analyze the differences of setup errors and the consistency of setup between two groups. Results In group 1, the setup errors on left-right, superior-inferior, anterior-posterior and rotation directions were ( 1.06±0.79) , ( 1.34±0.66) , ( 2.45±1.48) mm and ( 0.63°±0.65°) for the head and neck position, ( 1.58±1.13) , ( 2.38±1.99) , ( 2.05± 1.68) mm and ( 0.31°± 0.32°) for the chest position, ( 1.67± 1.24) , ( 3.88±2.20) , ( 1.96± 1.32) mm and ( 0.48°± 0.53°) for the pelvis position, and ( 0.95± 0.73) , ( 1.99± 1.35) , ( 3.66±2.13) mm and ( 0.24°±0.31°) for the lower limb, respectively. In group 2, the setup errors were ( 2.59±2.58) , ( 3.28±1.85) , ( 3.71±2.43) mm and ( 1.15°±1.18°) for the head and neck position, ( 4.38±3.69) , ( 5.64±3.78) , ( 2.72± 1.91) mm and ( 1.55°± 0.86°) for the chest position, ( 4.14± 2.97) , ( 6.97±3.68) , ( 2.21±2.26) mm and ( 1.23°±0.74°) for the pelvis position, ( 2.28± 1.15) , ( 5.97± 3.00) , ( 3.44±1.93) mm and ( 1.09°±0.94°) for the lower limb, respectively. The setup errors significantly differed between two groups on the left-right, superior-inferior and rotation directions for all positions ( all P<0.05) . The setup consistency significantly differed between two groups on the left-right, superior-inferior and rotation directions for the chest and pelvis positions ( all P<0.05) . Conclusion The novel immobilization system can significantly improve the setup accuracy and setup consistency, and enhance the precision of treatment for patients.

To report our experience in planning and delivering total marrow irradiation (TMI) and total marrow and lymphatic irradiation (TMLI) in patients with hematologic malignancies.

PURPOSE:The occurrence of neutropenia following chemotherapy makes the management of myelosuppression important. The main objective of this study was to evaluate whether the decrease of peripheral blood monocytes was a potential indicator to predict the occurrence of neutropenia. PATIENTS AND METHODS:We retrospectively reviewed the medical records of 103 chemotherapy patients who underwent neutropenia. A paired sample t-test was used to assess whether the number of days when monocyte initial decrease/are in nadir/final increase was significantly less than that of the neutrophils. The baseline of monocyte percentage and the decrease rate of neutrophil were analyzed by the bivariate correlation (two-tailed). Moreover, the grade of neutropenia and the baseline of monocyte percentage (divided into <5% and ≥5%) were examined by the Chi-square test for correlations. RESULTS:Our study showed that the change trend of monocyte count was the same as that of neutrophil count and that the number of days when monocytes initial decrease/are in nadir/final increase was significantly less than that of neutrophils, respectively. The time of initial decrease in monocyte count was 1.39 days earlier; the nadir in monocyte count occurred 3.81 days earlier, and the final increase in monocyte count was 2.36 days earlier than that in neutrophil count. In addition, there was an inverse correlation between the decrease rate of neutrophil and the baseline of monocyte percentage according to the analysis of bivariate correlation (Pearson correlation = -0.241, P = 0.0142). Unfortunately, there was no significant correlation between the baseline of monocyte percentage and the grade of neutropenia examined with the Chi-square test (P = 0.7401). CONCLUSION:Our study shows the increase or decrease in monocyte count is a significant potential indicator to predict the occurrence of neutropenia, and it is also a predictor to guide the next monitoring time of neutrophil count and the treatment of granulocyte-colony stimulating factor.

Objective:To compare the efficacy of morphine with intravenous injection and subcutaneous injection in the treatment of advanced cancer,and explore the indications of different drug delivery methods for high-dose morphine. Methods: A prospective study was performed,and 46 cases of patients with advanced cancer pain were collected and divided into intravenous group and subcutaneous group according to the administration route. Pain was assessed during the administration,and the analgesic efficiency and the incidence of adverse reactions were observed to compare the efficacy and safety of two different ways to give high-dose morphine. Results:No statisti-cally significant differences were found in the number of outbreaks needed to be rescued,the frequency of morphine-induced drug deliver-y,the efficiency of analgesia after opioid transfer,and the incidence of opioid-related side effects between the groups (P&gt;0.05). The dose of morphine in the subcutaneous group was higher than that of the intravenous group(P&lt;0.05). Conclusion:The continuous ad-ministration of morphine with intravenous injection and subcutaneous injection can quickly,safely and effectively relieve pain. With the same analgesic efficacy,patients can choose appropriate administration route according to the dose of morphine, the influence degree of primary diseases and the individual will.

人文精神以一种非功利性的、以穿越时空的文化积累的形式全面提升人的综合素质,其作用就是为了维护人类尊严与自由,维护人类生存价值与意义.人文情怀是每个个体灵性能力的表现,不同的人在人生的不同阶段有着各自不同的表现方式.在医疗实践中表现为患者的多元化需求和医务人员应该具备的道德情怀.作为安宁疗护工作的践行者,应该敏锐地意识到患者对永恒生命意义与价值的迷失和如何引导患者去追求永恒生命意义与价值,以提高终末期患者的生活质量并可能缓解当前尖锐的医患矛盾.

Objective: To discuss the conversion coefficient of morphine injection with continuous intravenous pump delivery or subcutaneous injection for the patients with advanced cancer pain demanding high dose of opioids.Methods: Using a retrospective survey, the patients with advanced cancer pain demanding high dose of opioids with poor efficacy were divided into 3∶1 group and 2.5∶1 group, and the conversion coefficient of 3∶1 or 2.5∶1 was used for the opioids equivalently conversed to intravenous or subcutaneous injection of morphine.After the conversion, the degree of pain relief, the analgesic efficiency in the conversion process, titration time, daily oral morphine equivalent amount at stable pain, morphine related adverse reactions and the other indicators were studied to evaluate the analgesic effect of morphine injection with different conversion coefficient.Results: There was no statistical significant difference between the two groups in the degree of pain relief, the effective rate of analgesia and the daily oral akministration amount of morphine at sable pain(P>0.05).The adjustment times for morphine in the two groups was (1.57±0.93) and (1.0±0.00), respectively, and the difference was statistically significant (P<0.05).The daily oral administration amount of morphine at stable pain in the two groups respectively was (226.67±69.74) mg and (258.67±101.34) mg;the morphine related adverse reactions were mainly constipation, and there was no significant difference in the incidence (P>0.05).Conclusion: Giving morphine injection to the patients with terminal cancer pain demanding high dose of opioids with poor effect, the use of PCA pump through intravenous or subcutaneous injection can effectively relieve pain.Using the conversion coefficient of 2.5:1 can quickly complete the titration process, and safely achieve the effective analgesia.