Objective:To investigate clinical features, diagnosis, therapy, and prognosis of myelodysplastic/myeloproliferative neoplasms-unclassifiable (MDS/MPN-U) patients with thrombocytopenia, and review relevant literature.Methods:On May 11, 2022, a case of patient admitted to Department of Oncology and Hematology, Chongqing the Fourth People′s Hospital was selected as the research subject. This patient was a 67-year-old male. Clinical data such as medical history, clinical features, laboratory and auxiliary examination results were retrospectively analyzed. The patient was diagnosed and treated according to his clinical manifestations, laboratory and auxiliary examination results. Follow-up of the patient was conducted until August 16, 2022. In addition, literature related to the occurrence of MDS/MPN-U with thrombocytopenia in China National Knowledge Infrastructure database, Wanfang Data Knowledge Service Platform, and PubMed database was searched by key words" myelodysplastic/myeloproliferative neoplasm, unclassifiable" " MDS/MPN-U " " thrombocytopenia" in Chinese and English. Literature related to the diagnosis and treatment of MDS/MPN-U with thrombocytopenia was summarized. Time for literature retrieval was set from established to June 30, 2022. Procedure followed in this study was in line with requirements of the World Medical Association Declaration of Helsinki revised in 2013, and informed consent of clinical research was signed with the patient. Results:① This patient was admitted to our hospital for " abnormal blood cells for 3 months" , and routine blood tests in other hospital repeatedly indicated increased white blood cell count and decreased platelet count, and decreased hemoglobin during the course of the disease. ② Results of blood routine examination after admission showed that white blood cell count (WBC), neutrophil count, eosinophils count, basophils count, monocytes count, red blood cell count, hemoglobin (Hb) value and platelet count were 12.01×10 9/L, 10.84×10 9/L, 0.1×10 9/L, 0.02×10 9/L, 0.31×10 9/L, 4.13×10 12/L, 111 g/L and 9×10 9/L, respectively. Bone marrow cell morphology showed that bone marrow hyperplasia was obviously active, and proportion of blast cells occupied nuclear cells was 1%, granuloid cells was 79%, and erythroid cells was 19.5%; bone marrow smear showed 16 megakaryocytes; there were no obvious developmental abnormalities in the three lines of cells. Bone marrow biopsy showed that the degree of proliferation of nucleated cells in the bone marrow was extremely active (about 85% of the hematopoietic tissue area), immature cells were slightly visible, the ratio of granulocytes to erythrocytes was slightly increased, and megakaryocytes were pathologic hematopoietic, and myelodysplastic/myeloproliferative neoplasms (MDS/MPN) was considered. Bone marrow cell flow cytometric immunophenotyping showed that the the proportion of myeloid blast cells occupied nucleated cells was 0.52%, and cell phenotype was not abnormal. Screening for 25 common fusion genes in myeloid leukemia showed negative results. Bone marrow fluorescence in situ hybridization (FISH) results showed that JAK2, FGFR1, PDGFRA, PDGFRB rearrangement were negative. Chromosome karyotype analysis of bone marrow cells showed normal karyotype. Results of gene mutation of myeloproliferative neoplasms (MPN)-related showed that class Ⅰ mutation ASXL1 p. Gly646trpfster12 (mutation frequency was 41.3%), PHF6 p. Tyr301Ter(mutation frequency was 97.5%). Class Ⅱ mutation CUX1 p. Gln326Ter(mutation frequency was 19.1%). ③ This patient was finally diagnosed with MDS/MPN-U with thrombocytopenia and was given thalidomide orally 100 mg/d for long-term use. Regular blood routine tests were performed outside the hospital. Evaluation of curative effect was a clinical benefit when the platelet count was increased to 41×10 9/L(platelet count was below 20×10 9/L before therapy). By the end of follow-up, the patient was generally in good condition with no active bleeding manifestations. ④ Three literature meeting the requirements of this study included a total of 4 patients of MDS/MPN-U with thrombocytopenia including the patient in this study. All 4 patients were male, and 2 patients had enlarged spleens. All patients had normal karyotypes, and BCR/ ABL fusion gene and JAK2V617F gene mutation were negative. The patients received demethylation, immunomodulators, cytotoxic drug, chemotherapy, and other treatments, but efficacy was poor. One patient received allogeneic hematopoietic stem cell transplantation (allo-HSCT), and the disease was stable after 18 months of follow-up. This patient was effective after treatment of thalidomide. Conclusions:MDS/MPN-U with thrombocytopenia is rare. There are some poor prognostic factors, such as advanced age, increased blasts, and genetic mutations with poor prognosis. At present, there is no unified treatment guideline and expert consensus, and the available treatment options are limited. Immunomodulators and allo-HSCT may be effective.

Objective:To investigate the clinical efficacy of Mannatide in the treatment of primary leukopenia and its impact on the immune function of patients.Methods:80 patients with primary leukopenia admitted to the hospital from January 2009 to October 2012 were randomly divided into treatment group and control group according to the random number table.40 patients in the control group received Diyushengbai tablets,patients in the treatment group were given Mannatide tablets for a course of four weeks,a total of two courses.Results:The effective rate of treatment group was 92.50%,which was significantly better than 75.00%of the control group (P<0.05). The treatment group had rapid effect,only took 6~9 days to see significant improvement in clinical symptoms,while the control group took 15 to 22 days.Tlymphocyte subsets CD3+, CD4+, CD4+/CD8+were also significantly higher (P<0.05) than the control group at the end of treatment.Conclusion:Mannatide can improve immune function in patients with primary leukopenia and elevate peripheral blood leukocytes.

Objective The predictive values of TS and DPD mRNA in advanced gastric cancers treated with S-1.Methods The study population consisted of 24 patients with advanced gastric cancer.All of the patients treated by S-1,TS and DPD mRNA in peripheral blood were measured by the real-time reverse transcription PCR(RT-PCR) method.Results The response rate in the low TS mRNA group(25%),with significant difference(50%) was higher than that in the high TS mRNA group(25%) with significant difference(P<0.05).Patients with low TS mRNA survived longer(8.4 months) than those with high TS mRNA(3.5 months),with significant difference(P<0.05).But there was no statistical difference in the response rates between low DPD mRNA group(42%) and high TS mRNA group(33%),with significant difference(P<0.05).There was no statistical difference(P>0.05) in the statistical survivals between low DPD mRNA group(6.5 months) and high DPD mRNA group(7.2 months).Conclusion The treatment effect of S-1 for advanced gastric cancer was negatively correlated with the status of TS mRNA,and there was no significant correlation between the treatment effect of S-1 and the status of DPD mRNA.