[Clinical Analysis of Elderly Patients with AML/High-Risk MDS].

OBJECTIVE: To analyze the clinical features of acute myeloid leukemia (AML)/high-risk myelodysplastic syndrome (MDS) patients aged over 60 years old. METHODS: The clinical data of 61 elderly newly diagnosed patients with AML and high-risk MDS who submitted to the Department of Hematology/Oncology of the First Affiliated Hospital of Tsinghua University from January 2009 to April 16, 2021 were retrospectively analyzed. These patients were divided into chemotherapy group (45 cases) and supportive treatment group (16 cases). The overall survival (OS) was analyzed by Kaplan-Meier method, and the prognostic factors of survival were analyzed by multivariate Cox regression. RESULTS: After 2 cycles of induction chemotherapy, the complete remission (CR) rate was 37.8% (17/45), and overall response rate was 62.2% (28/45) in the chemotherapy group. The median OS in the chemotherapy group and supportive treatment group was 11.3 (0.07-43) and 1.6 (0.33-7.72) months, respectively (P<0.001). The median OS in patients who reached CR or did not reach after 1 cycle of induction chemotherapy was 19.8 (10-30.63) and 8.17 (0.07-43) months, respectively (P<0.05), while after 2 cycles was 22.7 (4.2-43) and 7.26 (0.07-26) months, respectively (P<0.001). Univariate analysis showed that age > 80 years old, CCI score > 2, PS score > 2 and supportive treatment were the adverse prognostic factors for OS. Further multivariate analysis suggested that chemotherapy was the only independent prognostic factor for OS (HR=0.140, 95%CI: 0.048-0.409, P<0.001). In the chemotherapy group, univariate analysis showed that CCI score > 2 and failure to reach CR after induction chemotherapy were poor prognostic factors. Multivariate analysis showed that CCI score > 2 (HR=0.139, 95%CI: 0.050-0.384, P<0.001) and failure to achieve CR after induction chemotherapy (HR=0.103, 95%CI: 0.041-0.259, P<0.001) were the adverse prognostic factors for OS. The patients were tolerant to side-effect of chemotherapy. CONCLUSION: Appropriate chemotherapy can prolong the survival of elderly patients with AML and high-risk MDS.

Chinese expert consensus on the nursing management of the totally implantable venous access device.

The totally implantable venous access device (TIVAD) has been widely used in clinical nursing work in China. The use of TIVAD has significantly improved the safety of venous access and reduced the pain caused by a repeated puncture; however, it may also bring with it varying degrees of complications associated with the long-term insertion of TIVAD and the maintenance quality of the venous access. Standard maintenance of the venous access for TIVAD is very important for reducing complications and improving the efficacy and patient's quality of life. This consensus briefly describes the fundamental knowledge and operating procedures of TIVAD while focusing on the evaluation and management of perioperative nursing, the observation and treatment of complications, the operation methods, and precautions for maintenance of venous access, as well as health education. This agreement seeks to standardize the nursing care of TIVAD patients in China.

[Survival Analysis of 148 Patients with Primary Diffuse Large B Cell Lymphoma].

OBJECTIVE: To investigate the clinical outcome of the patients with primary diffuse large B-cell lymphoma（DLBCL）. METHODS: Clinical data of 148 patients with DLBCL in our hospital and cancer hospital from March 2006 to April 2016 were retrospectively analyzed. Kaplan-Meier analysis was used to estimate progression-free survival（PFS）and overall survival（OS）. RESULTS: 5-year OS and PFS rates were 85% and 69%，respectively. The survival analysis showed that 5-year OS rate of R-CHOP group was significantly higher than that of CHOP alone group（89% vs. 70%，P<0.05）. In univariate analysis，several clinical factors，such as older age（>60 years），poor ECOG score（≥2），advanced stage（Ⅲ-Ⅳ），higher IPI score（≥3），CHOP alone and absence of radiotherapy related with poor survival rate. Furthermore，multivariate analysis showed that age>60 year significantly related with the worse OS. CONCLUSION: Age >60 year is an important independent prognostic factor to predict worse OS or PFS.

[Clinical Analysis of Priming Regimen for Treatment of Acute Myeloid Leukemia (Non-APL) Patients Aged over 70 Years].

OBJECTIVE: To explore the therapeutic efficacy for patients aged over 70 years with acute myeloid leukemia(non-APL). METHODS: Clinical data of 19 acute myeloid leukemia patients aged over 70 years admitted in our hospital from March 2006 to April 2016 years were analyzed retrospectively. Among them 15 patients received priming regimen and 4 patients received best supportive treatment. The overall survival time between patients with priming regimen and patients with best supportine treatment was compared by Kaplan-Meier analysis. The prognostic factors were evaluated by using multivariate analysis. Out of the 19 patients, 9 were males and 10 were females, with median age of 75 years (70-84). RESULTS: After 2 cycles of induction chemotherapy, the complete response rate was (7/15)46.6% and overall response rate was (11/15) 73%. Significant longer median survival time was observed in priming regimen group, compared with that in best supportive treatment group (11 months vs 2 months)(χ2=17.077, P<0.001). The patients were well tolerant to side-effect of chemotherapy. Multivariate analysis showed that only receiving induction chemotherapy or not was the independent prognostic factor of the survival time(P<0.05), while the sex, age, ECOG index, CD34, HLA-DR, WBC count and ratio of blast cells in bone marrow were factor affecting the prognosis. CONCLUSION: The priming regimen may be practicable and effective for the treatment of patients with acute myeloid leukemia aged over 70 years (non-APL) and prolong the survival time of these patients.