OBJECTIVE To investigate the relationship between average interval time of chemotherapy and prognosis in patients with acute leukemia (AL) during intensive treatment. METHODS Data of 92 newly treated adult AL patients who received chemotherapy in The First Hospital of Lanzhou University from January 2010 to June 2019 were analyzed retrospectively. The patients were divided into groups according to the average interval time of chemotherapy during intensive treatment, and its influence on prognosis was analyzed. RESULTS The median interval of chemotherapy during intensive therapy was 38 (20-64) days. According to the average interval of chemotherapy, patients were divided into 4 groups, including < 30 days group, 30-39 days group, 40-49 days group and ≥ 50 days group. The 3-year overall survival (OS) rate of the four groups was (84.9±8.0)%, (73.5±8.7)%, (56.5±11.1)% and (41.8±13.6)%, respectively (P=0.008). The 3-year progression-free survival (PFS) rate of the four groups was (63.6±11.1)%, (52.8±10.2)%, (38.2±10.8)% and (14.0±9.0)%, respectively (P=0.001). After comparison between the 4 groups, it was found that OS and PFS in ≥ 50 days group were significantly shorter than those in < 30 days group (P<0.008). Multivariate analysis showed that risk stratification and average chemotherapy interval ≥ 50 days were the common adverse factors affecting OS and PFS. CONCLUSION The average chemotherapy interval ≥ 50 days during intensive therapy is an independent risk factor affecting the prognosis and survival of patients with AL. When the bone marrow is completely relieved and the peripheral hemogram recovers to an acceptable level, the consolidation therapy should be started as soon as possible. The interval < 30 days can significantly improve the prognosis compared with the interval ≥ 50 days.

目的:探索髓白1号方联合化疗对AML患者骨髓液中Th17细胞的调控作用,为提高AML患者治疗效果与长期生存提供指导.方法:选取2017年4月-2019年8月在武威市人民医院血液科住院的AML患者70例,并以25名健康志愿者纳入对照组;然后AML患者根据治疗方案分为联合治疗组(髓白1号方联合化疗)和非联合治疗组(单纯化疗).采用流式细胞术检测骨髓液中CD3+CD161+IL-17+IFN-γ+T细胞的比例,采用ELISA法检测骨髓液中血管内皮生长因子(VEGF)、白介素17 (IL-17)的浓度.用SPSS 22.0统计软件对数据进行统计学分析.结果:初诊及复发的AML患者CD3+CD161+IL-17+IFN-γ+T细胞的比例、VEGF和IL-17浓度显著高于正常对照组(P＜0.001);而CR及DFS期AML患者的CD3+CD161+IL-17+IFN-γ+T细胞的比例、VEGF和IL-17浓度显著低于初诊及复发的AML患者(P＜0.001),且DFS期AML患者的CD3+CD161+IL-1TIFN-γ+T细胞的比例、VEGF和IL-17浓度与对照组无明显差异(P＞0.05).单纯化疗组AML患者CR期CD3+CD161+IL-1TIFN-γ+T细胞的比例、VEGF和IL-17浓度明显高于对照组(P＜0.05),而用髓白1号方联合化疗组AML患者的上述指标则与对照组无差异;单纯化疗组AML患者CR期CD3+CD161+IL-17+IFN-γ+T细胞的比例、VEGF和IL-17浓度高于联合治疗组AML患者(P＜0.05).联合治疗组的AML患者首次诱导化疗CR率明显高于单纯化疗组患者(P＜0.05),且复发率明显低于单纯化疗组患者(P＜0.05).结论:初诊及复发的AML患者骨髓中Th17细胞的表达水平明显升高,治疗后显著减低.髓白1号方联合化疗治疗AML可明显提高CR率,降低复发率.

OBJECTIVE To explore the regulation effect of myeloid leukemia No.1 Chinese herb medicine prescription combined with chemotherapy on Th17 cells in bone marrow fluid of AML patients, so as to provide guidance for improving AML treatment effect and patients' long-term survival. METHODS Seventy patients with AML who were hospitalized in Department of Hematology, Wuwei People's Hospital from April 2017 to August 2019 were selected and enrolled in AML group, 25 healthy volunteers were selected and enrolled in control group; then according to therapeutic regimen, AML patients were divided into 2 groups: combined therapy group (myeloid leukemia NO.1 Chinese herb medicine prescription combined with chemotherapy) and non-combined therapy group (chemotherapy alone). Flow cytometry was used to detect the ratio of CD3+ CD161+ IL-17+ IFN-γ+ T cells in bone marrow fluid, and ELISA was used to detect the vascular endothelial growth factor (VEGF) and interleukin-17 (IL-17) concentrations in bone marrow fluid. Statistical analysis was performed on the data with SPSS 22.0. RESULTS The ratio of CD3+ CD161+ IL-17+ IFN-γ+ T cells, VEGF and IL-17 concentration in newly diagnosed and relapsed AML patients were significantly higher than those in the normal control group (P<0.001); while those in CR and DFS stage patients were significantly lower than those in newly diagnosed and relapsed patients (P<0.001), and the ratio of CD3+ CD161+ IL-17+ IFN-γ+ T cells, VEGF and IL-17 concentration in DFS patients with AML were not significantly different from those in the control group (P>0.05). The ratio of CD3+ CD161+ IL-17+ IFN-γ+ T cells, VEGF and IL-17 concentration in CR stage of AML patients treated with chemotherapy alone were significantly higher than those in the control group (P<0.05), but there was no difference between combined therapy group and the control group; the ratio of CD3+ CD161+ IL-17+ IFN-γ+ T cells, the concentration of VEGF and IL-17 in CR stage of AML patients treated with chemotherapy alone were higher than those of patients treated with combined therapy regimen (P<0.05). AML patients treated with combined therapy regimen had a significantly higher complete remission rate compared with patients received chemotherapy alone (P<0.05), but the recurrence rate was significantly lower (P<0.05). CONCLUSION Th17 cells expression in bone marrow of newly diagnoses and relapsed AML patients significantly increase, and decrease significantly after treatment. Myeloid leukemia No.1 Chinese herb prescription combined with chemotherapy can significantly increase the CR rate and reduce the RL rate for AML.

OBJECTIVE To detect the level of vascular endothelial growth factor (VEGF) in bone marrow of patients with non-M3 acute leukemia (AL), and estimate its relationship with prognosis. METHODS From January 2016 to December 2019, 114 patients with AL in department of Hematology, Wuwei People's Hospital were selected as study group, and 25 healthy volunteers were enrolled as control group. The concentration of VEGF in bone marrow was detected by ELISA. The patients were divided into high and low concentration group according to the level of VEGF. The overall survival (OS) and event-free survival (EFS) were compared among different groups. RESULTS The level of VEGF in patients with AL was significantly higher than that in the control group. The median OS and EFS in the low concentration group was 34.5 and 32 months, respectively, while, in the high concentration group was 30 and 26 months, respectively. The differences between the two groups were statistically significant (P=0.010). There were significant differences in OS rate (P=0.035) and EFS rate (P=0.026) between low and high concentration group. Multivariate analysis showed that high VEGF concentration was an independent risk factor affecting OS (HR=2.619, 95%CI 1.070-6.406, P=0.035) and EFS (HR=2.221, 95%CI 1.074-4.552, P=0.031) in AL patients. CONCLUSION VEGF highly expresses in the bone marrow of patients with AL at initial diagnosis and relapse, and shows adverse effects on the prognosis.

慢性髓系白血病(chronic myeloid leukemia,CML)是临床常见的恶性骨髓增殖性疾病.研究[1]报道,慢性髓系白血病的发病机制主要与Ph染色体以及BCR ABL融合基因的出现有关.根据患者的临床表现,目前可以将CML的病程分为慢性期、加速期以及急变期.通常患者的急性变是造成死亡的重要原因之一[2].急变期患者骨髓内大量的原始幼稚细胞增生,还可见到大量Ph染色体以外的核型异常,进一步造成慢性髓系白血病患者的细胞分化程度受限,细胞的增殖及抗凋亡能力显著升高.疾病一旦发展到急变期,对患者采取化疗、放疗以及常规靶向治疗的效果均较差.所以,在临床治疗中,通过对患者的急变期分子机制的研究,进而对治疗方案不断优化,对改善患者的预后有积极意义.本文概述老年CML急变期的分子机制、基因机制及酪氨酸激酶抑制剂伊马替尼耐药的研究进展,为临床治疗提供科学依据.

OBJECTIVE Transcriptional factor Gli1 in Hedgehog signal pathway facilitates epithelial mesenchymal transition (EMT) and is associated with invasion or proliferation of multiple tumor cells. The previous study showed the correlation between miR-132 down-regulation and glioma pathogenesis. We investigated the role of miR-132 in mediating Gli1 expression and in affecting proliferation or invasion of glioma cells. PATIENTS AND METHODS Dual luciferase reporter gene assay was used to confirm the targeted regulation between miR-132 and Gli1. Tumor tissues at different pathological grades (grade II, III and IV) were collected from glioma patients, in parallel with brain tissues from contusion surgery. The expression of miR-132 and Gli1 was measured by RT-PCR. Glioma cell line U251 was treated with miR-132 or si-Gli1 followed by measuring the expression of Gli1, E-cadherin, Vimentin and Cyclin D1. In addition, flow cytometry and transwell assay were performed to evaluate cell invasion potency. RESULTS Bioinformatics analysis showed the complementary binding sites between miR-132 and 3'-UTR of Gli1 mRNA. Transfection of miR-132 mimic significantly reduced luciferase activity, indicating the targeted regulatory relationship between miR-132 and Gli1 mRNA. Compared with control group, miR-132 expression was decreased and Gli1 level was elevated in glioma tissues, both of which were correlated with the pathological grade. Transfection of miR-132 mimic or si-Gli1 remarkably suppressed the expression of Gli1, Vimentin or Cyclin D1 in U251 cells, up-regulated E-cadherin expression, suppressed cell proliferation and invasion. CONCLUSIONS Our data indicated that over-expression of miR-132 could inhibit proliferation or invasion of glioma cells via targeted inhibition of Gli1 expression.

CD34 + CD38 − CD58 − cells are leukemia-propagating cells in Philadelphia chromosome-positive acute lymphoblastic leukemia