High Expression Levels of Long Noncoding RNA Small Nucleolar RNA Host Gene 18 and Semaphorin 5A Indicate Poor Prognosis in Multiple Myeloma.

BACKGROUND: The aim of this study was to detect the expression of long noncoding RNA small nucleolar RNA host gene 18 (SNHG18) andsemaphorin 5A (SEMA5A) genes in multiple myeloma (MM) patients and to explore the correlation of the expression of these genes with the clinical characteristics and prognosis of MM patients. METHODS: Forty-seven newly diagnosed MM, 18 complete remission MM, 13 refractory/relapse MM, and 22 iron deficiency anemia (serving as control) samples were extracted at the Department of Hematology, Second Affiliated Hospital of Xian Jiaotong University between January 2015 and December 2016. The clinical features of the MM patients are summarized. Real-time quantitative PCR was performed to analyze the relative expression levels of the SNHG18 and SEMA5Agenes. The clinical characteristics and overall survival (OS) of the MM patients were statistically analyzed while measuring different levels of SNHG18 and SEMA5Agene expression. At the same time, the correlation between the expression of SNHG18 and SEMA5A was also analyzed. RESULTS: The analysis confirmed that SNHG18 and its possible target gene SEMA5A were both highly expressed in newly diagnosed MM patients. After analyzing the clinical significance of SNHG18 and SEMA5A in MM patients, we found that the expression of SNHG18 and SEMA5A was related to the Durie-Salmon (DS), International Staging System (ISS), and Revised International Staging System (R-ISS) classification systems, and the Mayo Clinic Risk Stratification for Multiple Myeloma (mSMART; p < 0.05). Moreover, we observed a significant difference in OS between the SNHG18/SEMA5A high expression group and the low expression group. We found a positive correlation between SNHG18 and SEMA5A expression (r = 0.709, p < 0.01). Surprisingly, the expected median OS times of both the SNHG18 and SEMA5Ahigh expression groups were significantly decreased, which was in contrast to those of both the SNHG18 and SEMA5Alow expression groups and the single-gene high expression group (p < 0.05). CONCLUSION: High expression of both SNHG18 and SEMA5A is associated with poor prognosis in patients with MM.

Busulfan plus fludarabine compared with busulfan plus cyclophosphamide as a conditioning regimen prior to hematopoietic stem cell transplantation in patients with hematologic neoplasms: a meta-analysis.

OBJECTIVES: The aim of the article is to critically appraise and synthesize available evidence regarding the efficacy and regimen-related toxicity (RRT) of Busulfan plus fludarabine (BuFlu) compared to busulfan plus cyclophosphamide (BuCy) as a conditioning regimen, prior to allogeneic hematopoietic stem cell transplantation (HSCT) in patients with hematologic neoplasms. METHODS: A meta-analysis was attempted on clinical controlled trials (CCTs), randomized or non-randomized controlled trials (RCTs or non-RCTs), comparing BuCy with BuFlu. We did a systematic search of the indexed medical literature using appropriate keywords to identify potentially relevant articles. The primary outcome of interest was efficacy measured by overall survival (OS) and event-free survival (EFS), acute graft-versus-host-disease (aGVHD). Chronic GVHD (extensive) and other toxicity were secondary endpoints. A relative risk or risk ratio (RR) and 95% confidence interval (CI) was calculated for each outcome in the meta-analysis. RESULTS: Nine clinical controlled trials were included, of which 4 tries were RCTs involving 584 patients and the other 5 were non-RCTs involving 571 patients. The cumulative incidences of OS, EFS, acute graft-versus-host disease (aGVHD) were not significantly different between the two regimens. The non-relapse mortality was higher in BuCy but non-significant increment (RR=1.48, 95% CI: [0.97-2.26]). Liver related toxicity was significantly higher with BuCy compared to BuFlu (RR=1.90, 95% CI: [1.00-3.61]). CONCLUSION: Liver related toxicity is significantly lesser with BuFlu, but BuFlu regimen has no significant benefits compared with BuCy in OS, EFS, aGVHD. For all this, the weight of evidence favors BuFlu over BuCy as a first choice-conditioning regimen for patients with hematologic neoplasms, especially for people who have poor liver function.