Multiple myeloma (MM) is a malignant hematological tumor characterized by the proliferation of monoclonal plasma cells, often accompanied by systemic complications such as bone destruction, renal dysfunction, and hypercoagulability. Plasma D-dimer, as a fibrinolytic marker, may be associated with disease activity. However, there are few reports on the application of plasma D-dimer in evaluating treatment efficacy in MM. This multicenter retrospective study aimed to evaluate the utility of plasma D-dimer levels in predicting treatment response in patients with MM. 160 patients with newly diagnosed MM were enrolled. Blood samples were collected from these patients during their first hospital visit and again after eight cycles of chemotherapy to measure D-dimer levels. This study explores the relationship between plasma D-dimer levels before and after treatment and patient clinical characteristics. Patients showed no statistically different plasma D-dimer levels at initial consultation across treatment-response groups: CR group (0.96 µg/mL [0.67–1.9]), PR group (0.88 µg/mL [0.56–1.39]), SD group (0.68 µg/mL [0.56–0.89]), and PD group (0.91 µg/mL [0.52–1.55]). After chemotherapy, both the absolute change (Dd) and percentage change (Ddp) in D-dimer levels showed significant differences among groups (p < 0.05). The CR and PR groups exhibited significantly greater reductions in D-dimer (Dd: -0.42 and − 0.40 µg/mL; Ddp: -45.2% and − 39.1%) compared to the PD group (Dd: 0.16 µg/mL; Ddp: 18.7%). Patients with overall response (OR) (CR and PR groups) had significantly greater decreases in both Dd and Ddp compared to no-response patients (PD and SD groups) (p < 0.001). Our results suggested that changes in plasma D-dimer levels before and after treatment may provide valuable insights for assessing chemotherapy efficacy in MM.

Hemophagocytic lymphohistiocytosis (HLH) is a rare and fatal disease with a low survival rate. It is important to identify the patients at risk of poor prognosis among HLH patients. In this multicenter and retrospective study, we reviewed 90 newly diagnosed HLH patients treated at the Second Affiliated Hospital of Nanjing Medical University and the First Affiliated Hospital of Anhui Medical University from April 2014 to February 2025. Four pre-treatment clinical characteristics of HLH patients were confirmed to be the independent risk factors: age (hazard ratio (HR) 1.041, 95% confidence interval (CI)1.023-1.059, p < 0.001); splenomegaly (HR 2.112, 95% CI 1.178-3.787, p = 0.012); platelet (PLT) count (HR 0.992, 95% CI 0.984-0.999, p = 0.035); aspartate aminotransferase (AST) (HR 1.002, 95% CI 1.001-1.003, p < 0.001). Subsequently, the patients' prognostic risk scores were calculated based on these four risk factors to stratify patients to high-risk and low-risk groups. Besides, these four factors were included in the final clinical prediction model. Receiver operating characteristic (ROC) curves revealed that this model had a good discrimination with optimism-corrected area under the curve (AUC) values of 0.78 (95% CI: 0.68-0.88) for 30-day mortality and 0.82 (95% CI: 0.74-0.92) for 90-day mortality. The calibration curves aligned with the model predictions and actual observations. The decision curve analysis also confirmed our model's robust predictive power. These results point out that age, splenomegaly, PLT, and AST levels are independent indicators of overall survival in patients with HLH and that the proposed model has a good prognostic value.

OBJECTIVE:To study the role of cytokines and lymphocyte subsets in the diagnosis, prognosis and efficacy evaluation of DLBCL patients, and the effects of Tislelizumab on immune function and cytokines in DLBCL patients.METHODS:Twenty-three patients with newly diagnosed DLBCL were selected as DLBCL group and 34 patients with megaloblastic anemia as the control group. The levels of peripheral blood cytokines IL-2, IL-4, IL-6, IL-10, TNF- α and IFN-γ by ELISA method. The levels of peripheral blood CD3+, CD4+, CD8+ T lymphocytes, B lymphocytes and NK cells， the ratio of CD4+/CD8+ were detected by flow cytometry. The levels of cytokins and lymphocyto subsets in DLBCL patients with different clinical data and different therapeutic effects were compared.RESULTS:The levels of cytokines IL-2, IL-6 and IL-10 in DLBCL group were significantly higher than those in control group, but there was no significant correlation between cytokine levels and age and gender. The higher IPI score, higher Ann Arbor stage, B symptoms, higher β 2-MG, LDH and CRP levels, IL-6 and IL-10 levels were significantly higher, and IL-4 was also significantly higher in patients with high LDH levels. Compared with the ineffective group, the levels of IL-6 and IL-10 were significantly lower and the level of CD4+ T cells and the ratio of CD4+/CD8+ was significantly higher in the effective group before therapy. The levels of IL-6, IL-10 and B lymphocytes in the effective group decreased significantly after therapy compared to those before therapy. After 4 cycles of therapy, the level of IL-2 and the ratio of CD4+/CD8+ in the Tislelizumab group were significantly higher than those in the non-Tislelizumab group, and the level of CD8+ T cells was significantly lower than that in the non-Tislelizumab group(P<0.05). The level of B lymphocytes in both the Tislelizumab group and the non-Tislelizumab group after therapy was significantly lower than that before therapy.CONCLUSION:The expression of cytokines and lymphocyte subsets in peripheral blood of patients with DLBCL is abnormal, which is related to the severity, prognosis and therapeutic effect of the disease. Tislelizumab can improve the immune function of patients with DLBCL by affecting cytokines and lymphocyte subsets and strengthen anti-tumor immunity.

BACKGROUND The Coexistence of myeloid and lymphoid malignancies is rare. Myeloid leukemia occurs more frequently as a secondary event in patients receiving chemotherapy agents for lymphoid malignancies. Synchronous diagnoses of diffuse large B-cell lymphoma (DLBCL), acute myeloid leukemia (AML), and untreated lymphoplasmacytic lymphoma/Waldenström macroglobulinemia (LPL/WM) in the same patient have not been reported. Here we report one such case. CASE SUMMARY An 89-year-old man had a chest wall mass histopathologically diagnosed as DLBCL. The bone marrow and peripheral blood contained two groups of cells. One group of cells fulfilled the criteria of AML, and the other revealed the features of small B lymphocytic proliferative disorder, which we considered LPL/WM. Multiple chromosomal or genetic changes were detected in bone marrow mononuclear cells, including ATM deletion, CCND1 amplification, mutations of MYD88 (L265P) and TP53, WT1 overexpression, and fusion gene of BIRC2-ARAP1, as well as complex chromosomal abnormalities. The patient refused chemotherapy because of old age and died of pneumonia 1 mo after the final diagnosis. CONCLUSION The coexistence of DLBCL, AML, and untreated LPL/WM in the same patient is extremely rare, which probably results from multiple steps of genetic abnormalities. Asymptomatic LPL/WM might have occurred first, then myelodysplastic syndrome-related AML developed, and finally aggressive DLBCL arose. Therefore, medical staff should pay attention to this rare phenomenon to avoid misdiagnoses.

Objective:To improve the understanding of indolent mantle cell lymphoma (MCL).Methods:The data of a patient with indolent leukemic MCL in the Second Affiliated Hospital of Nanjing Medical University in May 2013 were collected. The cell morphology was analyzed by using cell smear, the flow cytometry was used to make immunophenotype analysis, the karyotype analysis was performed by usig cytogenetic technique, and polymerase chain reaction (PCR) was used to make the immunoglobulin gene analysis. At the same time, lymph node pathology and immunohistochemistry were also analyzed. The related articles published were reviewed to sum up the characteristics and the treatment of indolent MCL.Results:The male patient aged 60 years was obviously asymptomatic accompanied with slow disease progression, leukemic manifestation and without lymphadenopathy. He received pathological biopsy because of located lymphadenopathy in 2008. Small cell morphology, Kappa light chain immunophenotype, t(11;14) translocation showed after the cytogenetic examination, clonal immune globulin gene rearrangement and low Ki-67 positive index were identified. In situ MCL was diagnosed by retrospective pathology.Conclusions:Indolent MCL is extremely rare. It is typically asymptomatic with none or minimal nodal involvement, indolent disease course, leukemic phase with mild lymphocytosis, Kappa light chain expression, simple karyotype, classical or small cell morphology of tumor cells and the positive index of Ki-67 <10%. In situ MCL can be seen in pathology examination. IgVH gene mutation positive and SOX11 negative expression are notable in indolent MCL. International prognostic index of MCL is probably not appropriate in the prognostic analysis of leukemic indolent MCL. It is emphasized that initial observation and having therapies only after the disease progression can be suited for indolent MCL.

Rationale: POEMS (polyneuropathy, organomegaly, endocrinopathy, M protein, and skin changes) syndrome is a rare and complicated disease related to multiple organs and systems. Here, we report a case of systemic mastocytosis (SM) that was misdiagnosed as a POEMS syndrome. Patient concerns: A 42-year-old man presented with skin changes, diarrhea, and limb numbness. Diagnoses: Positron emission tomography/computed tomography revealed extravascular volume overload, organomegaly, lymphadenopathy, and bone lesions with mixed lesions of osteosclerosis and osteolysis. Therefore, POEMS syndrome was suspected. Further histopathological and immunohistochemical examination of the bone marrow, lymph nodes, and gastric mucosa suggested a diagnosis of mastocytosis. The c-Kit D816V mutation confirmed the diagnosis of SM. Interventions: The patient received the treatment of pegylated interferon-alpha weekly and glucocorticoid daily. Outcomes: The symptoms relieved significantly. Lessons: There are many similar features between POEMS syndrome and SM, probably leading to misdiagnosis. This study analyzed the different points between them which can provide help for differentiation.

目的:评价短疗程Venetoclax(VEN)联合小剂量阿糖胞苷(ara-C)方案在难治/复发急性髓系白血病(AML)患者中的疗效和安全性.方法:报告8例以短疗程VEN+小剂量ara-C方案联合治疗的难治/复发AML患者.VEN使用剂量为200～400 mg QD 口服,ara-C 10 mg/m2 Q12 h皮下注射,每疗程用药时间10～14 d.结果:8例患者初始治疗后3例达完全缓解,2例达部分缓解,3例评估为未缓解.治疗过程中发现幼稚单核细胞逐渐增多.发生的不良反应主要是3～4级血液学不良反应.结论:短疗程VEN联合小剂量ara-C方案治疗难治/复发AML患者有较好的有效率和安全性,但对急性单核细胞白血病疗效不佳.

Abstract Rationale: Synchronous development of both anaplastic large cell lymphoma (ALCL) and multiple myeloma (MM) in a patient is rare. To our knowledge, until now only one case has been reported. Treatment needs to cover both and is a challenge. Here we reported another case and discussed the diagnosis and treatment. Patient concerns: This is a 63-year old woman who presented with a mass in upper abdominal skin. Positron emission tomography/computed tomography (PET/CT) showed the high metabolism in left abdominal skin and left axillary lymph nodes. Histopathologic and immunohistochemical evaluation identified the cutaneous mass as an ALK-negative ALCL. Bone marrow smear showed increased plasma cells which expressed CD38, CD138, and cLambda concomitantly. The increased monoclonal immunoglobulin IgD λ was detected by immunofixation electrophoresis. Diagnoses: Diagnosis of both ALCL and MM was confirmed. Interventions: The patient successively received 6 cycles of B-CHOD regimen, one cycle of ID regimen, 2 cycles of DHAX regimen, one cycle of L-DA-EPOCH and autologous stem cell transplantation (ASCT). Then lenalidomide was performed as a maintenance therapy. Outcomes: Both ALCL and MM achieved complete remission. Lessons: We reported a very rare case with synchronous development of ALCL and MM, in whom a good therapeutic response to chemotherapies followed by ASCT has been observed.

目的 探讨初诊多发性骨髓瘤(MM)患者血栓弹力图(TEG)特点.方法 选取2015年8月至2019年7月江苏大学附属医院收治的29例初诊MM患者为观察组,28名健康体检者为对照组,进行TEG检测,并以分期、分型分析主要参数.结果 初诊MM患者R值、K值、MA值延长,α角、CI、EPL、LY30变小,与对照组比较,差异均有统计学意义(P＜0.05).与I、II期MM相比,III期MM患者EPL、LY30显著变小,差异有统计学意义(P＜0.05).IgG型MM患者K值较IgA型变小,差异有统计学意义(P＜0.05).结?论 初诊MM患者存在凝血功能异常,随病程进展,高凝倾向可能升高、血栓风险可能增加.