Objective To investigate the association between MDM2 gene promoter SNP 309 polymorphism and leukemia susceptibility. Methods Such databases as Ovid, EBSCO, PubMed, CNKI, CBM, VIP and WanFang Data were searched to collect the case-control studies published from January 1990 to June 2012. According to the inclusion and exclusion criteria, the studies were screened, the data were extracted, and the methodological quality of the included studies was evaluated. Then meta-analysis was conducted using RevMan 5.0 and Stata 10.0 software, the pooled odds ratio (ORs) with 95% confidence interval (CI) were calculated, and the sensitivity and publication bias were evaluated at the same time. Results A total of 9 studies within 8 articles were included, which involved 1 821 cases and 5 642 controls. The results of meta-analysis showed that, the susceptibility of leukemia was increased in the G allele carriers compared with the T allele carriers (OR=1.26, 95%CI 1.08 to 1.46, P=0.003), and the leukemia risk was higher in the GG genotype populations compared with the TT genotype populations (OR=1.46, 95%CI 1.02 to 2.10, P=0.04). Among Asians with recessive models, the leukemia risk was higher in the homozygous GG genotype compared with both the heterozygous GT genotype and the homozygous TT genotype (OR=2.00, 95%CI 1.37 to 2.92, P=0.000 3). There was no obvious publication bias. Conclusion MDM2 gene promoter SNP 309 polymorphism is associated with the susceptibility of leukemia, and the G allele is likely to be the risk factor for leukemia.
Objective To systematically review the effectiveness and safety of arsenic trioxide (ATO) versus retinoic acid for patients with acute promyelocytic leukemia (APL). Methods Such databases as PubMed, The Cochrane Library (Issue 12, 2012), CNKI, WanFang Data and VIP were electronically and comprehensively searched from inception to December 2012, for randomized controlled trials (RCTs) on the effectiveness and safety of ATO versus retinoic acid for patients with APL. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality. Then, meta-analysis was performed using RevMan 5.0.2 software. Results Eight RCTs involving 586 cases of APL patients. The results of meta-analysis showed that, ATO and all-trans-retinoic (ATRA) were not statistically different in CR rates (OR=0.85, 95%CI 0.54 to 1.35, P=0.50), CR time (OR=–8.14, 95%CI –16.42 to 0.13, P=0.05), recurrence rates (OR=0.14, 95%CI 0.02 to 1.21, P=0.07), early mortality (OR=0.82, 95%CI 0.32 to 2.06, P=0.67), and five-year total survival rates (OR=1.19, 95%CI 0.54 to 2.60, P=0.66). ATO had lower incidences of adverse reaction such as hyperleukocytosis syndrome (OR=0.32, 95%CI 0.18 to 0.58, P=0.000 1) and retinoic acid syndrome (OR=0.05, 95%CI 0.02 to 0.14, Plt;0.000 01). Conclusion ATO and ATRA are alike in CR rates, CR time, recurrence rates, early mortality, and five-year total survival rates, but ATO causes less adverse reaction. Due to the limited quantity and quality of the included studies, ATO should be applied with caution according to patients’ conditions in clinic.
Objective To search evidence in the treatment of Philadelphia chromosome （Ph）-positive acute lymphocytic leukemia （ALL） for guiding chnical practice. Methods We searched MEDLINE （February, 1970～July, 2005 ） and SUMSEAILCH （till July, 2005 ）to identify systematic reviews（SIL）, randomized controlled trials（RCTs） and controlled clinical trials （CCTs） in the treatment of Ph-positive ALL. Results One RCT and 8 CCTs were identified. The results showed that Ph-positive ALL had a very poor prognosis . Chemotherapy and bone marrow transplantation （BMT） were the two main ways to treat the disease. Outcome of conventional chemotherapy treatment for adults with the disease was poor. Outcome of treatment with hyper-CVAD and imatinib mesylate was better and BMT was the only way which could potentially cure the disease. Conclusions Treatment of Ph-positive ALL with hyper-CVAD and imatinib mesylate may induce higher remission rate and disease free survival rate. BMT is the best way to cure the disease.
Objective To assess the clinical effectiveness and safety of inductive treatment with arsenic trioxide （As203） for acute promyelocytic leukemia （APL）. Methods Randomized controlled trials （RCTs） were identified from MEDLINE （1966 -July, 2005 ）, EMBASE （1984 -July, 2005 ）, The Cochrane Library （ Issue 3, 2005） and CBM- disc （1978 -July, 2005）. The references of eligible studies were handsearched. RCTs of As203 treating for APL were included. Data were evaluated and extracted by two reviewers independently with designed extraction form. RevMan 4. 2.7 software was used for data analysis. Results Six RCTs involving 323 patients were included. Two studies reported that there was no statistical difference between As2O3 group and all-transretinoic acid （ATRA） group in mortality for patients with APL or APL patients with complications of desseminated intiavascular coagulation or cerebra hemorrhage. The pooled result of 4 studies showed that there was no statistical difference with RR 0.98, 95 % CI 0.86 to 1.12 in complete remission （CR） rates between the two groups. The result of one study showed that the CR rate of patients with intravenous injection of As203 in 2 divided dosages with longer injection duration was higher with RR 1.31, 95% CI 0.86 to 1.12 compared with those with a single intravenous injection. Adverse effects in As2O3 group were less than ATRA group. Conclusions Inductive treatment with As2O3 for acute promyelocytic leukeuia has similar mortality and CR with less adverse effects compared with ATRA. More trials of high quality are required.
目的 增加对治疗相关性继发白血病的认识。 方法 报道非霍奇金淋巴瘤治疗后2年继发急性髓细胞白血病M6型1例，结合文献讨论治疗相关性白血病的发病机制、治疗、预后。 结果 1例73岁非霍奇金淋巴瘤患者接受R（Rituxmab，利妥昔单抗）－CHOP环磷酰胺+多柔比星+长春新碱+泼尼松方案规律化学治疗。治疗结束24+个月后，经骨髓涂片及细胞免疫分型诊断为急性髓细胞白血病M6型，染色体检查为：44～48，XY，del（5）（q12q33），-8，-10，der（12）t（4；12）（q11-q12；p13），其一般情况急剧恶化并死亡。 结论 治疗相关性白血病的发生可能与烷化剂等化疗药物使用和免疫受损等有关，利妥昔单抗导致第二肿瘤的发生暂时不能除外。治疗相关性白血病常伴有复杂染色体核型，其病情发展迅速，治疗效果差，生存期明显缩短。Objective To improve the understanding of secondary therapy-related leukemia. Methods The clinical data of one patient with non-Hodgkin lymphoma which transformed into acute myeloid leukemia M6 2 years after chemotherapy were studied. We discussed the pathogenesis, treatment and prognosis of therapy-related leukemia with literature review. Results A 73-year-old patient diagnosed to have non-Hodgkin’s lymphoma accepted R-CHOP chemotherapy.Two years after the treatment, the disease finally developed into acute myeloid leukemia M6 confirmed by cytogenetics, bone marrow morphology and flowcytometry analysis. The chromosome analysis demonstrated complex karyotypes as 44-48, XY, del (5) (q12q33), -8, -10, der (12) t (4; 12) (q11-q12; p13). His general status deteriorated rapidly and soon after the patient died. Conclusions Occurrence of therapy-related leukemia may be due to the administration of alkylating agents, topoisomerase inhibitors and damage of immune function. Therapy-related leukemia often occurs with complex karyotypes and progresses rapidly with poor treatment response.
【摘要】 目的 了解住院白血病患者的社会支持状况。 方法 采用相关“社会支持评定量表”，调查分析2010年8-11月80例住院白血病患者的社会支持状况。 结果 白血病患者获得的社会支持为（42.34±7.04）分，支持度较高，与常模（34.56±3.74）分比较差异有统计学意义（Plt;0.01），无配偶及医疗自费患者所获得的社会支持相对较低。 结论 医护人员在临床中应注意拓宽住院白血病患者的社会支持渠道，帮助患者保持较高的社会支持水平，从而促进康复，提高生活质量。【Abstract】 Objective To explore the social support condition of the inpatients with leukemia. Methods According to “Social Support Assessment Inventory”, the social support conditions of 80 patients with leukemia who were hospitalized between August and November, 2010 were analyzed. Results The total score of social support was 42.34±7.04 in inpatients with leukemia, and 34.56±3.74 in normal controls; the difference was significant (Plt;0.01). The patients who remained single or had no medical insurance obtained less social support. Conclusions Nurses should help patients with leukemia keep in a moderate high level of social support to promote the recovery of patients and improve their quality of life.
目的：了解左旋门冬酰胺酶（L-ASP）对儿童急性淋巴细胞白血病凝血功能变化的影响。方法：观察86例患儿在诱导缓解后治疗期间，L-ASP使用前后活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白原(FIB)、抗凝血酶Ⅲ(AT-Ⅲ)、D-二聚体变化情况。结果：与用药前比,用药结束后一天的PT、APTT、TT均显著延长(P＜0.01);FIB、AT-Ⅲ显著降低(P＜0.01),D-二聚体显著升高(P＜0.01);用药结束后1周时PT、APTT、TT、D-二聚体较用药前差异无显著性,FIB、AT-Ⅲ虽有回升,但仍低于正常(P＜0.01)。结论：L-ASP可引起ALL患儿凝血功能异常，尤其对FIB、AT-Ⅲ影响明显，应引起临床高度重视。Ｌ-Ａｓｐ主要影响蛋白质的合成而引起蛋白质成份的凝血因子减少,从而引起凝血功能障碍,且对纤维蛋白原的合成影响更为显著。
ObjectiveTo investigate the relationship between the expressions of B-cell-specific monoclonal leukemia virus insert site 1 (Bmi1) and human telomerase reverse transcriptase (hTERT) genes and the proliferative capacity of stem cells. MethodsCord blood CD34+ cells were cultured in IMDM medium containing fetal bovine serum, stem cell growth factor, thrombopoietin, and Fms-like tyrosine kinase 3 ligand during a 28-day ex vivo expansion process, while the expansion fold, specific growth rate, and the colony-forming efficiency were monitored. Then the Bmi1 and hTERT mRNA expressions in CD34+ cells were detected by fluorescence quantitative PCR, and the relations between the expressions and the cell proliferative capacity were analyzed. ResultsCD34+ cells expanded (20.1 ± 3.5) folds during the 28-day culture, while the proportion declined from 95.5% ± 2.6% before culture to 2.1% ± 0.4%. Both the specific growth rate and colony-forming efficiency of CD34+ cells declined significantly after 7 days, while the expression levels of Bmi1 and hTERT mRNA in CD34+ cells reached top at 7 days and declined gradually thereafter. ConclusionThe expressions of Bmi1 and hTERT genes may have a close relation to the proliferative capacity of CD34+ cells.