IntroductionCarbapenem-resistant Enterobacteriaceae (CRE) infections pose a significant threat to hematological patients, contributing to high mortality rates. This retrospective study evaluated the incidence, risk factors, and patient outcomes associated with active CRE surveillance in the hematology department.MethodsThe study identified 23,832 hematological patients between 2019 and 2021. Propensity score matching was used to align underlying diseases and admission times in a 1:1:1 ratio across three groups: detected CRE, undetected CRE, and non-active CRE surveillance. The positivity rate of active CRE surveillance was 2.1% (141/6,735), with an incidence of 4.8% (85/1,789) among patients who underwent active CRE surveillance.ResultsThe distribution of the 141 isolates was as follows: Klebsiella pneumoniae (66.7%), Escherichia coli (22.6%), and others (10.7%). Independent risk factors associated with a positive result for active CRE surveillance included hematopoietic stem cell transplantation, hospital length of stay (LOS) ≥ 18 days, use of central venous catheters, steroid treatment within the past 3 months, antibiotic exposure (ß-lactam/ß-lactamase inhibitor, Echinocandins) within the last month, perianal skin ulceration within the previous 3 days, albumin < 33.4 g/L, and neutropenia lasting ≥ 7 days. In the detected CRE group, 26.5% of patients developed a CRE infection. Cox regression analysis identified diarrhea within 3 days prior to active CRE surveillance and interleukin-6 levels ≥ 39.35 pg./mL within 24 h of CRE surveillance as independent predictors of 90-day mortality. Klebsiella pneumoniae and Escherichia coli were the predominant pathogens identified in active CRE surveillance.DiscussionThe incidence of CRE infection was notably higher in the detected CRE group. Our study provides real-world evidence on the role of active CRE surveillance in survival outcomes, especially in regions like China, where CRE infections are highly prevalent. The findings suggest that active CRE surveillance could serve as an early indicator of 90-day mortality in hematology patients and should be considered for routine implementation in this population.

HLA-C*07:1089 differs from HLA-C*07:02:01:01 by one nucleotide in exon 3.

HLA-C*07:1089 differs from HLA-C*07:02:01:01 by one nucleotide in exon 3.

Cytomegalovirus reactivation (CMVr) and bloodstream infections (BSI) are the most common infectious complications in patients after allogeneic haematopoietic stem cell transplantation (allo-HSCT). Both are associated with great high morbidity whilst the BSI is the leading cause of mortality. This retrospective study evaluated the incidence of CMVr and BSI, identified associated risk factors, assessed their impact on survival in allo-HSCT recipients during the first 100 days after transplantation. The study comprised 500 allo-HSCT recipients who were CMV DNA-negative and CMV IgG-positive before allo-HSCT. Amongst them, 400 developed CMVr and 75 experienced BSI within 100 days after allo-HSCT. Multivariate regression revealed that graft failure and acute graft-versus-host disease were significant risk factors for poor prognosis, whereas CMVr or BSI alone were not. Amongst all 500 patients, 56 (14%) developed both CMVr and BSI in the 100 days after HSCT, showing significantly reduced 6-month overall survival (p = 0.003) and long-term survival (p = 0.002). Specifically, in the initial post-transplant phase (within 60 days), BSI significantly elevate mortality risk, However, patients who survive BSI during this critical period subsequently experience a lower mortality risk. Nevertheless, the presence of CMVr in patients with BSI considerably diminishes their long-term survival prospects. This study provides real-world data on the impact of CMVr and BSI following transplantation on survival, particularly in regions such as China, where the prevalence of CMV IgG-positivity is high. The findings underscore the necessity for devising and executing focused prevention and early management strategies for CMVr and BSI to enhance outcomes for allo-HSCT recipients.

Purpose Most patients with acute lymphoblastic leukemia (ALL) are treated with chemotherapy as primary care. Although the treatment response is usually positive, resistance and relapse often occur via unknown mechanisms. The purpose of this study was to identify factors associated with chemotherapy resistance in ALL. Here, we present clinical and experimental evidence that overexpression of nucleolin (NCL), a multifunctional nucleolar protein, is linked to drug resistance in ALL. Methods NCL mRNA and protein levels were compared between cell lines and patient samples using qRT-PCR and immunoblotting. NCL mRNA levels were compared between patients of different disease stages from our clinic patients’ specimens and publicly available ALL patient datasets. Cells and patient-derived xenograft mouse experiments were performed to assess the effect of NCL inhibition on ALL chemotherapy effectiveness. Results Analysis of patient specimens, and publicly available RNA-sequencing datasets revealed a strong correlation between the abundance of NCL and disease relapse or poor survival in B-ALL. Altering NCL expression results in changes in drug sensitivity in ALL cell lines. High levels of NCL upregulated components of the ATP-binding cassette transporters via activation of the ERK pathway, resulting in a decrease in drug accumulation inside the cells. Targeting NCL with AS1411, an NCL-binding oligonucleotide aptamer, significantly increased the sensitivity of ALL cell lines and cells/patient-derived ALL xenograft mice to chemotherapeutic drugs and prolonged mouse survival. Conclusion Our results highlight NCL as a prognostic marker in B-ALL and a potential therapeutic target to combat chemotherapy resistance in ALL.

This study aimed to assess the efficacy and safety of hypomethylating agent (HMA)-based regimens in the treatment of older adult patients with acute myeloid leukaemia (AML), unfit for standard induction chemotherapy. Treatment outcomes and prognostic factors of 140 older adult patients with AML who were unfit for intensive chemotherapy and were treated with HMA-based therapies were retrospectively analysed. The median age of the group was 70 years, and poor-risk cytogenetics and secondary/treatment-related AML (s/t-AML) accounted for 45.6% and 34.3% of these patients, respectively. The overall response rate was 48.6%, and 40.1% for patients who achieved complete remission (CR) or CR with incomplete blood count recovery. The median overall survival (OS) was 10.4 months, and the 1-, 2-, and 5-year OS rates were 42.6%, 19.9%, and 4.9%, respectively. Early mortality accounted for 4.3% of all cases, and infection occurred in 87.1% of all patients during induction therapy. Patients who received HMA and low-dose chemotherapy presented with significantly superior response and long-term survival rates compared to those who received HMA alone. They also showed comparable outcomes to those treated with the azacitidine plus venetoclax protocol. Low-dose chemotherapy in combination with decitabine or azacitidine showed a similar response rate and prognosis. Age ≥ 75years and a white blood cell (WBC) count ≥ 10 × 109 cells/L were identified as independent adverse prognostic factors for OS, while poor-risk cytogenetics, percentage of bone marrow blasts, and s/tAML had no significant impact on OS when patients were treated with HMA-based regimens. In conclusion, HMA combined with low-dose chemotherapy was effective and safe in older adults with AML who were unfit for intensive chemotherapy, and no difference was observed between decitabine and azacitidine.

Purpose This single-centre study aimed to determine the clinicopathological characteristics and prognosis for patients with co-existing FL and DLBCL components (FL/DLBCL). Methods We retrospectively analysed the clinical characteristics and prognosis of patients diagnosed with FL/DLBCL (n = 56) and with pure FL (n = 260) or de novo DLBCL (n = 812) (controls) between January 2013 and December 2021. Results The median age of patients with FL/DLBCL was 52 years. The amount of the DLBCL component ranged from 5 to 95%. Among the 56 FL/DLBCL cases analysed, 67.9% were of germinal centre B-cell (GCB) origin, 26.8% non-GCB origin, and 5.3% were unclassified. The clinical features of patients with FL/DLBCL were intermediate, falling between those of FL and DLBCL. Propensity-score matching was performed for patients with similar baseline characteristics who were receiving the rituximab plus cyclophosphamide, doxorubicin or epirubicin, vindesine, and prednisone (R-CHOP) regimen. Patients with FL/DLBCL showed inferior outcomes compared to those with FL, with a lower complete remission (CR) rate, progression-free survival (PFS), and overall survival (OS). Bone marrow involvement and B symptoms were identified as independent adverse prognostic factors for PFS among patients with FL/DLBCL. Patients with FL/DLBCL presented a lower CR rate and PFS but similar OS to those with DLBCL when receiving the R-CHOP regimen. Conclusion Patients with FL/DLBCL showed inferior treatment response and survival than those with pure FL and had a lower CR rate and PFS, but similar OS to those with DLBCL in the rituximab era.

目的 对于中性粒细胞缺乏(粒缺)伴持续性发热住院患者,在前期对比国产与原研卡泊芬净经验性抗真菌治疗的药代动力学试验的基础上,进一步评价国产卡泊芬净的疗效和安全性.方法 本研究为前瞻性、多中心、开放临床试验(ClinicalTrials.gov注册号NCT03857399).纳入粒缺伴持续性发热住院患者,在卡泊芬净经验性治疗结束后,对全部患者进行国产卡泊芬净的疗效和安全性评估.结果 共入组32例,纳入全分析集(FAS)32例,符合方案集(PPS)30例.FAS和PPS中,国产卡泊芬净的临床有效率分别为71.88％(23/32)和76.67％(23/30),疗程分别为(13.22±5.80)d和(13.70±5.62)d.治疗结束0～2 d内,退热率分别为78.13％(25/32)和80％(24/30)、中性粒细胞绝对值计数(ANC)﹥0.5×109/L的占比分别为75％(24/32)和76.67％(23/30).治疗结束后28 d内的生存率分别为81.25％(26/32)和83.33％(25/30).国产卡泊芬净的耐受性较好,不良事件多为1～2级,大多与其无关,均未导致用药减少或停药,药物相关不良事件发生率3.1％(1/32),为1例肝功能异常.无药物相关的严重不良事件发生.结论 国产卡泊芬净经验性治疗粒缺伴持续性发热患者获得了良好的临床疗效和安全性.

The characteristics and survival of 218 patients with extranodal natural killer/T-cell lymphoma (ENKTCL) were analyzed in this retrospective study. The median progression-free survival (PFS) and overall survival (OS) were 10.9 months and 50.5 months, respectively. Sequential chemoradiotherapy achieved a 74.5% overall response rate (ORR) and a 30.9% 5-year PFS rate in patients with localized stage. Asparaginase-containing protocols demonstrated superior prognosis in advanced cases, with a median FPS at 5.7 months, compared to 1.9 months without asparaginase. Initial treatment with P-GEMOX regimens showed superior ORR and PFS compared to the SMILE regimen, with lower toxicities. Hematopoietic stem cell transplantation (HSCT) improved the PFS and OS of refractory or relapsed (R/R) cases. PD-1/PD-L1 antibody could achieve a median PFS at 4.0 months and a median OS at 14.6 months in R/R patients for whom salvage therapies failed. High-risk PINK-E score was the only independent adverse prognostic factor for PFS and OS.

This study was designed to analyze the clinical characteristics and prognostic value of c-MYC and BCL-2 proteins expression in patients with primary central nervous system diffuse large B-cell lymphoma (PCNS-DLBCL).82 patients newly diagnosed with PCNS-DLBCL, from January 2008 to November 2018, were enrolled in this study. Clinical characteristics, immunohistochemical features, laboratory examinations, and treatment outcome were analyzed among these patients.Among these 82 cases, 45 were males (54.9%) and 37 were females (45.1%). Age ranged from 16 to 78 years old, and 29 patients (35.4%) were elder than 60 years old, with median age at 57 years old. According to Hans classification, 25 were accounted for origin of germinal center B-cell (GCB) subtype (30.5%) and 49 were accounted for non-GCB subtype (59.8%), respectively. Eight patients were unclassified due to lack of detailed pathological results. The median survival of these 82 patients was 30 months, and 1-year, 3-year, and 5-year overall survival (OS) rate was 59.7%, 44.6%, and 34.1%, respectively. Patients treated with sequential HD-MTX based chemotherapies showed a superior prognosis than those without. In combination with rituximab, the outcome was further improved. The median OS was 55 months in HD-MTX + R group, 27 months in HD-MTX group, and 9 months in other groups, respectively. Univariate analysis identified age ≥60, ECOG score ≥ 2 points, and overexpression of BCL-2 protein (≥85%) were adverse prognostic factors for OS. Co-expression of c-MYC (≥40%) and BCL-2 (≥50%) proteins was associated with poor ECOG score, high Ki-67 expression, and trended towards an inferior outcome. Gender, lesion location, number of lesions, lactic dehydrogenase (LDH), cell of origin, BCL-6 protein expression, expression of c-MYC protein alone and Ki-67 ≥85% had no significant impact on OS.In patients with PCNS-DLBCL, age ≥60 years old, ECOG score ≥2 points, and overexpression of BCL-2 protein (≥85%) were associated with a poor survival. HD-MTX based chemotherapies in combination with rituximab could improve the prognosis.

Burkitt’s lymphoma (BL) is a rare and aggressive type of B-cell lymphoma that constitutes only 1% to 2% of all adult lymphoma cases worldwide. BL is treated with short, intensive combination chemotherapy regimens. The aim of the present study was to analyse the effects and benefits of rituximab in adult BL patients without human immunodeficiency virus. Meta-analysis demonstrated that the addition of rituximab with the hyper-CVAD (composed of hyperfractionated cyclophosphamide, vincristine, doxorubicin, dexamethasone, high-dose methotrexate, and cytarabine) and CODOX-M-IVAC (composed of cyclophosphamide, vincristine, doxorubicin, and high-dose methotrexate alternating with ifosfamide, etoposide, and high-dose cytarabine, along with intrathecal methotrexate and cytarabine) regimens have better outcomes. This pooled study of 455 patients showed a complete response (83.9% vs. 71.8%), while 807 patients demonstrated a higher survival rate (76.1% vs. 54.7%). In comparison with previous studies, our data revealed a complete response range of 66.6% to 94.4%, with an overall survival rate of 70% to 89%. However, some patients developed infection and neutropenia, which was believed to be associated with chemotherapy.

Abstract Backgroun d Patients with relapse and/or chemo-refractory (R/R) diffuse large B cell lymphoma (DLBCL) are often fail to conventional therapy and suffer dismal prognosis. Recently CD19-targeted immunotherapy using chimeric antigen receptor (CAR)-modified T cells (CART cells) has produced the most promising clinical outcomes in patients with R/R B-cell leukemia and lymphoma, including R/R DLBCL, with overall response rate (ORR) at 50%-80%. However, a part of R/R DLBCL patients, who had restricted durability of clinical response after CD19-specific CART (CD19-CART) cell therapy were at the risks of disease progression. Considering the majority of the existing studies generally used a single infusion of CART cells, with a limited remission duration in which 20%-40% R/R DLBCL patients lost response within 6 months, the purpose of this study is to investigate whether repeat infusions could raise therapeutic response and extend its persistence, and thus improve the clinical outcomes in R/R DLBCL patients. Herein, we conducted a clinical trial (ClinicalTrials.gov Identifier: NCT03391726) to evaluate the efficacy and safety of repeat infusion of CD19-CART cells to patients with R/R DLBCL. Methods Following chemotherapy consisting of cyclophosphamide and fludarabine for lymphodepletion, the enrolled R/R DLBCL patients received an infusion of CD19-CART cells at a dose of 0.7-6×106 cells/kg. The CD19-CART cells were generated by modifying autologous T cells with a lentiviral vector encoding a CAR comprising a murine derived anti-CD19 scFv, 4-1BB and CD3ζ domains. Four of eight (50.0%) patients were given a repeat infusion of CART cells at 3 to 10 months after the initial infusion. R esults From June 2017 to July 2018, eight patients (median age, 52 years; range, 27-70 years) with R/R DLBCLs that were relapsed or resistant to primary or salvage chemotherapy or local radiotherapy, or fail to other clinical trial were enrolled (5 cases of DLBCL; 1 case of DLBCL with central nervous system infiltration;1 case of primary central nervous system lymphoma (PCNSL); 1 case of primary mediastinal large B cell lymphoma (PMBL)). Patients were evaluated for efficacy and safety at four weeks after initial infusion. 1/8(12.5%) patients reached complete remission (CR), 5/8(62.5%) patients had a partial remission (PR), while 2/8(25.0%) patients had stable disease (SD). The ORR (CR and PR) was 75.0% (6 of 8). With a median follow-up of 8.5 months, among 4 patients who had received a second infusion of the CART cells, 1 patient with RR DLBC remained in CR, 1 patient with primary refractory DLBCL remained in PR with constant improvement in symptom and iconography, 1 patient with primary refractory DLBCL had SD after initial infusion and reached PR after a second infusion, and 1 patient with PCNSL remained in SD. Of the 4 patients receiving single infusion of CART cells, 2 patients with primary refractory DLBCL remained in PR, 1 patient with RR DLBCL with CNSL infiltration was SD and 1 patient with refractory PMBL developed to progress disease after reaching PR and finally died. Overall survival (OS) and progression free survival (PFS) rates at 12 months were 87.5 % and 87.5 %, respectively. The most common adverse events of grade 3 or higher during the treatments were neutropenia and anaemia (in 87.5% and 25% of the patients, respectively). Grade 1 cytokine release syndrome (CRS) was observed in 5/8 (62.5%) patients. Neither CRS of > grade 2 nor neurologic events occurred in any patients. No prolonged B cell aplasia and hypogammaglobinemia was observed in repeat infusion patients. Conclusion Patients with R/R DLBCL who were treated CD19-CART cells had promising clinical responses with a safety profile. A repeat infusion of CD19-CART cells may lead to prolonged persistence, and sustained responses without elevated side effect. The tendency of improved OS by repeat infusion need to be further evaluated in more patients. Figure. Figure. Disclosures No relevant conflicts of interest to declare.

Abstract Background Hemorrhagic cystitis (HC) is one of the serious complications of allogeneic hematopoietic stem cell transplants (allo-HSCT), with the potential to cause significant morbidity. However, the underlying mechanism of HC is not yet clear. Objective To explore the reciprocal interaction between immune reconstitution and HC after allo-HSCT. Methods 101 patients undergoing allo-HSCT in our department during July, 2014 to April, 2017 were analyzed. JC virus(JCV), BK virus (BKV), cytomegalovirus (CMV) by quantitative real-time PCR were performed on all blood or urine samples post-HSCT. Non-specific T and B cell immune reconstitution were assessed by the expression of CD3, CD4, CD8, CD56, CD10, CD19, CD20 and CD22 with multiparametric flow cytometry, and specific T cell phenotype and cytokine production were determined by the expression of CD3, CD4, CD8, CD69, IL-2, IFN-gamma and TNF-alpha on PBMCs after the stimulation with one of four BKV peptides (tAg,Tag,VP-1,VP-2,VP-3). Results 62 out of total 101 patients were male and 39 were female. The median age was 27 years (range, 1-54). 85 patients were diagnosed as malignancy hematologic disease (AML=44, ALL=26, MDS=4, CML=6, NHL=5), while 16 were non-malignancy hematologic disease (SAA = 14, fanconi=1, thalassemia=1). Through the cox regression analysis, the hazard ratio (HR) of HC (95% confidence interval) for BKV viruria was 4.866 (1.908-12.406), with a P-value of 0.001. Those with primary malignance disease also had higher odds of developing HC, with an HR of 5.101. Both of them were independent risk factors in multivariate analysis. There was no significant difference on the expression of CD3, CD4, CD8 and CD56 representative the non-specific T cell immune reconstitution between BK+ and BK- group, but the non-specific B cell immune reconstitution stained with CD19+, CD20+, CD22+ was significant delayed in BK+ group. Moreover, the specific T cell immune reconstitution performed in 6 cases were significant delayed in BK+ group as well compared to that in BK- group. Conclusion HC is correlated to BKV viruria and primary malignance disease in allo-HSCT. Poor specific immune reconstitution post-HSCT increased the risk of BK virus reactivation, and BK virus infection delayed the immune reconstitution after transplantation vise versa. Disclosures No relevant conflicts of interest to declare.

The aim of the study was to determine the clinical significance of EBV DNA in the peripheral blood mononuclear cells (PBMCs) from the patients with non-Hodgkin lymphoma (NHL). Newly diagnosed patients with NHL were enrolled in the study (n = 328), and clinical data retrospectively analyzed. EBV DNA was detectable in 34.8% of patients, and the positivity rate was 51.6% for T/NK cell subtype and 24.3% for B cell subtype (p<. 001). In diffuse large B cell lymphoma (DLBCL), extranodal NK/T-cell lymphoma, nasal type (ENKTL), peripheral T-cell lymphoma not otherwise classified (PTCLNOS), or angioimmunoblastic T cell lymphoma (AITL), positive EBV DNA before treatment was associated with more risk factors with prognostic significance, including older age, advanced stage, extranodal involvement, bone marrow infiltration, elevated LDH, and B symptoms, and with poor prognosis.

Background: Minimal residual disease (MRD) quantification prior to allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a powerful predictor for post-transplant outcome. Thus, new strategies with modified transplantation procedures are needed to reverse the outcomes of that remain MRD-positive despite multiple induction attempts. OBJECTIVE: To determine the prognostic relevance of MRD status in patients with acute lymphoblastic leukemia (ALL), especially those with Philadelphia chromosome-positive ALL (Ph+ ALL), receiving the conditioning regimen of FA5-Bucy, registered on http:// ClinicalTrials.gov (NCT02328950). METHODS: We retrospectively reviewed our HSCT experience using FA5-Bucy, i.e., 5-day salvage chemotherapy (Fludarabine/Ara-C) and conditioning (Busulfan/ Cyclophosphamide) for patients with ALL. A total of 48 consecutive patients from 2013 to 2016 are analyzed. 11 out of 48 (7 males and 4 females) were diagnosed with Ph+ ALL with the induction treatments including a tyrosine kinase inhibitor (TKI). Median age was 30 years (range, 8-52 years). Among whom four (36.4%) achieved complete remission(CR)at transplantation, Six (54.5%) with detectable residual P190 BCR-ABL positive leukaemic cells, while 1 (9.1%) not in the status of remission with 39.5% blasts in the bone marrow (BM). The other 37 cases were Ph-negative (Ph-) ALL, with the median age of 21 years (range, 2-61 years). Among whom 25 (67.6%) patients were in CR, 6 (16.2%) MRD-positive and 6 (16.2%) with 23.5%-98% BM blasts. The MRD status was monitored by four-color FCM in Ph- group, and by RT-PCR to detect the chimeric bcr-abl mRNA transcript in Ph+ group. Patients were transplanted either from an HLA-identical sibling or haplo-identical related donors. The GVHD prophylaxis consisted of ATG, CsA, MMF and short-term MTX. None of these patients had severe infection or organ failure before HSCT. RESULTS: All patients achieved successful engraftment and full donor chimerism. Patients with Ph+ ALL seems have a better outcome than that with Ph- ALL (3-year OS of 54.5% vs 37.8%, P=0.245). With a median follow-up of 666 (83-1276) days, the 1y-OS and 1y-DFS were 72.7%, 3y-OS and 3y-DFS were 54.5% in Ph+ group, respectively, and non-relapse mortality and relapse incidence were 18.2% and 10%. MRD monitoring is an important tool for relapse prediction in Ph- ALL patients (3-year OS and DFS of MRD-positive vs MRD-negative =16.7% vs 56%, P=0.021).However, the profile of OS and DFS was similar in Ph+ patients with bcr-abl positive to that with bcr-abl negative (3-year OS and DFS of bcr-abl positive vs bcr-abl negative= 57.1% vs 50%, P=0.744). Severe acute-GvHD (aGVHD) occurred in 3/11 patients. Few patients experienced mild-to-moderate toxicity, and main causes of death were aGVHD. CONCLUSION: We concluded that allo-HSCT with the sequential tumor-ablative conditioning of FA5-Bucy offers great benefits for the patients with Ph+ ALL, with the potentially capability of reducing or overcoming the negative impacts of MRD. Thus creates exciting transplant opportunities for patients not in remission to be cured. Download : Download high-res image (144KB) Download : Download full-size image Disclosures No relevant conflicts of interest to declare.

The prognosis of elderly patients with acute myeloid leukemia (AML) is poor, and the recommendation of standard-dose or low-intensity induction regimen for these patients remains controversial. We retrospectively analyzed treatment outcome and prognostic factors of elderly AML patients who had received either standard-dose or low-intensity induction regimens.Two hundred forty-eight elderly AML patients with good Eastern Cooperative Oncology Group performance status (ECOG PS ≤ 2) received one of three regimens for induction in this study: standard-dose cytarabine plus idarubicin (IA; n = 144) or daunorubicin (DA; n = 42); low-intensity cytarabine, aclarubicin, and granulocyte colony-stimulating factor (G-CSF) (CAG; n = 62).After first induction treatment cycle, the overall complete remission (CR) rate was 42.7%. Patients in IA group had a higher CR rate than in DA or CAG group (49.3%, 35.7%, and 32.3%, respectively; P = 0.046). The 1-year, 3-year, and 5-year overall survival (OS) rates were 42.2%, 18.9%, and 13.5% for these 248 patients, with median survival of 9.2 months. Long-term survival of IA group was better than DA or CAG group. The 1-year, 3-year, and 5-year OS rates of IA group were 45.9%, 23.5%, and 19.4%, respectively, as compared to 39.8%, 8.3%, and estimated 2.4% in DA group, and 34.9%, 15.9%, and 6.3% in CAG group, respectively. Early induction mortality and 2-year relapse rates showed no difference among 3 groups. Univariate analysis and multivariate analysis identified lactic dehydrogenase (LDH) more than two times of upper normal limit at diagnosis and nonremission after first induction cycle as adverse prognostic factors for OS. A simple and valid scoring model was constructed for risk stratification and prediction of long-term survival of elderly AML patients.Standard-dose IA regimen could improve the prognosis of elderly AML patients with good performance status compared with standard-dose DA or low-intensity CAG regimen. All prognostic factors and risk assessment should be considered to ensure that each patient receives the suitable individualized treatment.

CALLG2008 Protocol is sequential chemotherapy for adult acute lymphoblastic leukemia (ALL) established by Collaborative Group of adults acute lymphoblastic leukemia. It is emphasized that comprehensive treatment of adult ALL according to risk stratification is rather important. This study was purposed to evaluate the therapeutic efficacy of CALLG2008 for adult ALL. The clinical data of adult ALL patients of ≥ 14 years old diagnosed and treated by CALLG2008 Protocol were collected from May 1, 2009 to December 31, 2011 in Fujian Medical University Union Hospital, and the efficacy was analyzed. The results showed that 31 out of 33 cases of ALL achieved CR, the CR rate was up to 93.9%, the PR rate was 3.1%, and the total response rate was 97%. There were no uncontrolled severe toxicities, and no early deaths were observed. The overall survival (OS) at 1 year was only 66.7%,the relapse rate was 43.8% and the 1-year mortality was 33.3 %. This may be related with no-enough compliance, no-enough economical support and short follow-up time of the patients. The risk factor analysis showed that WBC level in newly diagnosed patients may influence the OS and relapse-free survival (RFS) of ALL. It is concluded that CALLG2008 protocol applied to adult ALL has a high remission quality and low mortality rate during the induction. The disease free survival (DFS) needs to be observed longer. It is essential to carry out MRD monitoring to determine the early recurrence and improving the long-term efficacy.