Consolidation therapy with autologous stem cell transplantation after remission of induction chemotherapy prolongs the survival of patients with peripheral T-cell lymphoma.

Background: There was little evidence of autologous stem cell transplantation (ASCT) as consolidation therapy after remission of induction for patients with Peripheral T-cell lymphoma (PTCL). In this study, we conducted a comparative analysis of real-world survival outcomes between consolidation therapy and observation in patients with PTCL. Methods: A total of 92 patients with peripheral T-cell lymphoma (PTCL) who were admitted to the Department of Hematology, Huadong Hospital Affiliated with Fudan University from January 2013 to April 2019 were divided into two groups based on whether they were treated with high-dose therapy (HDT) followed by autologous hematopoietic stem cell transplantation (ASCT): ASCT as consolidation therapy (n=30) and observation (n=62). Clinical characteristics, treatment patterns, and survival outcomes were analyzed between the two groups. Univariate and Cox multivariate regression analyses were also performed to detect prognostic factors of survival. Results: With a median follow-up time of 41 months, the median overall survival (OS) of peripheral T-cell lymphoma patients treated with ASCT was not reached; the median progression-free survival (PFS) was 77.0 months, which was much higher than that of patients without ASCT (p<0.003 for OS, p=0.015 for PFS). Subgroup analysis found that patients with high risks benefited more from ASCT. Combination with hemophagocytic lymphohistiocytosis (HLH) (p<0.001), clinical stage more than III (p=0.014), IPI score above 3 (p=0.049), and bone marrow involvement (p=0.010) were the independent prognostic factors significantly associated with worse OS and PFS. Additionally, pegylated liposomal doxorubicin (PLD)-containing chemotherapy regimen could bring a higher overall response rate (ORR) and prolong the survival of patients with PTCL who underwent ASCT. Conclusion: ASCT may improve the long-term survival of patients with PTCL as consolidation therapy after achieving complete or partial remission of induction treatment, particularly for those with high risks. The chemotherapy regimen containing pegylated liposomal doxorubicin may induce deeper remission than traditional doxorubicin in PTCL. It is crucial to identify the specific groups most likely to benefit from upfront ASCT.

Maintenance regimen of GM-CSF with rituximab and lenalidomide improves survival in high-risk B-cell lymphoma by modulating natural killer cells.

BACKGROUND: The treatment of high-risk B-cell lymphoma (BCL) remains a challenge, especially in the elderly. METHODS: A total of 83 patients (median age 65 years), who have achieved a complete response after induction therapy, were divided into two groups: R2 + GM-CSF regimen (lenalidomide, rituximab, granulocyte-macrophage colony-stimulating factor [GM-CSF]) as maintenance therapy (n = 39) and observation (n = 44). The efficacy of the R2 + GM-CSF regimen as maintenance in patient with high-risk BCL was analyzed and compared with observation. RESULTS: The number of natural killer cells in patients increased after R2 + GM-CSF regimen administration (0.131 × 109 /L vs. 0.061 × 109 /L, p = 0.0244). Patients receiving the R2 + GM-CSF regimen as maintenance therapy had longer remission (duration of response: 18.9 vs. 11.3 months, p = 0.001), and longer progression-free survival (not reached (NR) vs. 31.7 months, p = 0.037), and overall survival (OS) (NR vs. NR, p = 0.015). The R2 + GM-CSF regimen was safe and well tolerated. High international prognostic index score (p = 0.012), and high tumor burden (p = 0.005) appeared to be independent prognostic factors for worse PFS. CONCLUSIONS: The maintenance therapy of R2 + GM-CSF regimen may improve survival in high-risk BCL patients, which might be modulated by amplification of natural killer cells. The efficacy of the R2 + GM-CSF maintenance regimen has to be further validated in prospective random clinical trials.

The impact of death attitudes on death education needs among medical and nursing students.

BACKGROUND: Medical and nursing students will play an essential role in delivering palliative care in the future. Death education is important in preparing them for future palliative care, however, little is known about students education needs and how death attitudes affect such needs in Mainland China. OBJECTIVES: The purpose of this survey was to investigate the death education needs of medical and nursing students and to evaluate the impact of death attitudes on death education needs. DESIGN: Multi-center, cross-sectional survey. SETTINGS: Fourteen medical and nursing colleges & universities in Hunan, Sichuan, Liaoning, Guangdong, Shandong, and Shanxi provinces in China. PARTICIPANTS: The sample included 1044 medical and nursing students from six provinces. METHODS: In this multi-center cross-sectional study, all data were collected through an online questionnaire that included demographic information and questions on death-related experiences. In addition, the Death Attitude Profile-Revised and the Death Education Needs Scale were used to evaluate students' death attitudes and death education needs , respectively. RESULTS: The students had a mean death education needs score of 38.85 ± 7.25 (range: 10-50), yet only 20.9 % of them had received palliative care-related training. Being female (B:3.869, 95 % CI:2.849-4.889), fear of death (B:0.119, 95 % CI:0.005-0.232), and neutral acceptance (B:0.787, 95 % CI:0.638-0.936) were associated with higher death education needs, while death avoidance (B: -0.226, 95 % CI: -0.368 ~ -0.083), approach acceptance (B: -0.126, 95 % CI: -0.215 ~ -0.036), and escape acceptance (B: -0.198, 95 % CI: -0.322 ~ -0.073) were associated with lower death education needs. CONCLUSIONS: The high level of death education needs and low training rate in palliative care among medical and nursing students in mainland China indicates a gap that needs to be addressed. Students' death education needs were affected by gender and death attitudes, which provides implications for the future development of palliative care training models.

Clinical characteristics and prognostic factors of lymphoma patients initially presenting with fever of unknown origin.

BACKGROUND: Lymphoma has been identified as the most common cause of non-infectious fever of unknown origin (FUO). However, clinical characteristics and prognostic factors in lymphoma patients with FUO are lacking. METHODS: From January 1, 2013 to December 31, 2019, our center enrolled 185 patients who initially presented with FUO but were later diagnosed with lymphoma in Huadong Hospital of Fudan University. The FUO and matched non-FUO groups were compared in terms of clinical symptoms, laboratory examinations, overall survival (OS), and progression-free survival (PFS). The prognostic factors of OS and PFS in patients with FUO were assessed by Cox analyses. RESULTS: In the FUO group (180 in total), B cell non-Hodgkin's lymphoma (B-NHL) cases were 88 (48.9%), T cell non-Hodgkin's lymphoma (T-NHL) was 60 (33.3%), NK/T cell lymphoma (NK/T-CL) was 24 (13.3%), and Hodgkin's lymphoma (HL) was 8 (4.4%). During the hospitalization, the maximum body temperature of the FUO group diagnosed with B-NHL, T-NHL, or NK/T-CL was statistically higher than that of the non-FUO group (P < 0.05). The differences in OS between the FUO and non-FUO groups were significant for HL (P = 0.006), B-NHL (P = 0.007), and T-NHL (P = 0.013). In the multivariate analyses, the log10 serum ferritin was an independent risk factor for all-cause death in patients with FUO (hazard ratio, 9.578; 95% confidence interval, 1.382-66.365; P = 0.022). CONCLUSION: We found that the subtypes of lymphoma initially presenting with FUO were mostly B-NHL and T-NHL. The detection of ferritin levels during the hospital stay may help predict the long-term survival rate in patients with FUO.

18F-fluorodeoxyglucose positron emission tomography-based prediction for splenectomy in patients with suspected splenic lymphoma.

BACKGROUND: Diagnostic splenectomy is often performed on patients with suspected splenic lymphoma. However, unnecessary splenectomy entails more harm than benefit for patients. Therefore, a preliminary screening method for patients with suspected splenic lymphoma that has high sensitivity and specificity is urgently needed. METHODS: From the pathology database at Huadong and Huashan Hospital, we retrospectively identified 60 patients of suspected splenic lymphoma who underwent fluorodeoxyglucose (FDG)-positron emission tomography (PET) before receiving a splenectomy and did not show any increase in FDG uptake except in the spleen. We compared the indicators of PET-CT, such as the maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and the SUVmax of 18F-FDG uptake ratios between the spleen/liver, spleen/bone marrow, and liver/bone marrow. RESULTS: No significant differences were detected in SUVmax, TLG, MTV, or the SUVmax ratio of the liver/bone marrow between the lymphoma and benign groups. However, the SUVmax ratios of the spleen/liver and spleen/bone marrow were significantly higher in the lymphoma group than in the benign group (P=0.001; P=0.001). Receiver operating characteristic (ROC) curve analysis determined a spleen/liver SUVmax ratio of >2.42 and a spleen/bone marrow SUVmax ratio of >1.45 to be the indications for requiring a diagnostic splenectomy for lymphoma. Parallel testing increased the specificity and sensitivity of the test. CONCLUSIONS: Patients whose PET-CT results are inconclusive regarding the need for splenectomy may benefit from our prediction model. Future large-scale prospective clinical trials are required to verify these findings.

Survival Benefit and Efficiency of Low Dose Decitabine With CEG Regimen Compared to Decitabine Alone in the Elderly MDS - A Multicenter, Retrospective Study.

BACKGROUND: Decitabine are used in the treatment of myelodysplastic syndrome (MDS), but none trials reported overall survival improvement. METHODS: High-risk MDS and MDS transformed AML (sAML) patients (IPSS-R > 4.5, age above 60 years) in 6 medical centers of China were treated and compared a new regimen (decitabine with CEG) consisted of low dose decitabine (15 mg/m2, days 1-3), low dose etoposide (30 mg/m2, days 4,6,8,10,12), cytarabine (10 mg/m2 per day, days 4-12) and granulocyte colony-stimulating factor (G-CSF, 5ug/kg, adjusted by patients' WBC level, 12 hours prior to decitabine administration) with decitabine alone. The endpoints were death and disease progression. RESULTS: The baseline characteristics of these 2 groups were equivalent and none patients received prior chemotherapy. The treatment response rate (P= .048) and progression free survival (PFS, P = .030) all demonstrated significant improvement compared with decitabine alone. Decitabine with CEG regimen had attained a CR rate of 45.7%, a median OS of 36 (19-53) months and a median PFS of 34 (16.7-51.3) months in high-risk MDS patients, a CR rate of 40% in sAML. While decitabine alone only attained a median OS of 26 (24.5-27.5) months and a CR rate of 18.2% as well as a median progression free survival of 20 (17.6-22.4) months in MDS patients. Treatment response to CR or PR and TP53 mutation were 2 prognostic factor for OS and PFS in decitabine with CEG regimen. CONCLUSION: Decitabine with CEG regimen showed some promising advantage in elderly, high-risk MDS.

[Comparison of the Curative Efficacy of Elderly Patients with High-Risk MDS and MDS-Transformed AML between Decitabine Combined with Low-Dose CEG Regimen and Decitabine Combined with Low-Dose CAG Regimen].

OBJECTIVE: To evaluate the efficacy of decitabine combined with low-dose CEG regimen (DCEG) and decitabine combined with low-dose CAG regimen (DCAG) in the treatment of elderly patients with MDS and MDS-transformed acute myeloid leukemia (AML). METHODS: A prospective study was conducted in 7 medical centers, 45 patients with MDS (≥ 60 years old) and MDS-transformed AML from October 2016 to January 2019 were enrolled, with the median age of 68.5 years old. The risk stratification of patients was poor or very poor, according to IPSS-R score. The treament results of decitabine combined with CEG and decitabine combined with CAG were compared. RESULTS: The comparison of the two regiem showed that the DCEG regimen had advantages on total effective rate (ORR, 86.4% vs 47.8%, respectively), overall survival time (OS) (10.0 months vs 6.0 months, respectively) and progression-free survival time (PFS) (9.0 months vs 3.0 months, respectively). About 50% of MDS patients treated by DCEG regimen achieved PR or CR, with a median OS of 31 months. Multivariate analysis showed that patients with PR or CR after induction therapy and DCEG regimen had longer survival time (31months). The incidence of bone marrow suppression, infection and treatment-related mortality rate were similar between the two groups. CONCLUSION: Decitabine combined with CEG regimen could improve the survival of patients with high-risk MDS and MDS-transformed AML. The conclusion of the reaserch needs to be validated by a larger prospective randomized clinical trial.

Efficiency and Tolerability of Induction and Consolidation Therapy with Arsenic Trioxide/Bortezomib/Ascorbic Acid/Dexamethasone (ABCD) Regimen Compared to Bortezomib/Dexamethasone (BD) Regimen in Newly Diagnosed Myeloma Patients.

PURPOSE: This study was aimed at comparing the efficacy and tolerability of an arsenic trioxide/bortezomib/ascorbic acid/dexamethasone (ABCD) regimen with efficacy and tolerability of a bortezomib/dexamethasone (BD) regimen in patients with newly diagnosed myeloma. PATIENTS AND METHODS: Fifty-seven and sixty-four patients were treated with the ABCD and BD regimens, respectively. Eligible and agreeable patients received autologous hematopoietic stem cell transplantation followed by consolidation. RESULTS: The response rates (above VGPR) were 74.1% and 32.8% in the ABCD- and BD-treated groups, respectively (P = 0.000). Compared to BD regimen, ABCD regimen significantly improved PFS (P = 0.026) and OS (P = 0.000) in newly diagnosed patients. Patients with a high tumor burden, low or standard risk, and without auto-HSCT seemed to especially benefit compared to the same group with BD regimen. ABCD also showed better tolerability with lower bone marrow suppression (P = 0.026). Furthermore, complete response or near CR after induction therapy was a good prognostic factor for ABCD-associated OS and PFS. CONCLUSION: ABCD is an effective and tolerable regimen compared with BD regimen in newly diagnosed myeloma patients. ABCD regimen could be an economical, effective, and tolerable choice in low- and standard-risk patients.

Administration of amifostine in the stage of remission induction can benefit the patients with hematological malignancy in autologous stem cell transplantation: a retrospective study.

BACKGROUND: To investigate whether the administration of amifostine in the stage of remission induction can benefit patients with hematological malignancy in autologous stem cell transplantation (ASCT). METHODS: Two historical groups of patients who received prophylactic amifostine in the stage of remission induction and ASCT (group A, n=95) or amifostine in ASCT only (group B, n=73) were included. The chemotherapy-associated side effects in peripheral blood stem cell (PBSC) mobilization, total average monocyte per kilogram in stem cells collections, hematologic toxicity and engraftment kinetics, non-hematologic toxicity, therapeutic response after ASCT were compared between the two groups. RESULTS: For PBSCs mobilization, the rate of fever in group A was significantly higher (24/95 vs. 2/73; P=0.0001), but the incidence of emesis was significantly lower (8/95 vs. 27/73; P=0.0001) compared with group B. For collected PBSCs, the average total mononuclear cells per kilogram in group A were 7.031×108/kg, while it was 4.624×108/kg in group B (P=0.0001). The median duration of neutropenia was 8.62 days in group A, which was significantly shorter than that of group B by almost 2 days (10.51 days, P=0.038). The incidence of oral mucositis was 8.4% in group A and 32% in group B (P=0.0002). No significant differences of therapeutic response were observed between the two groups. CONCLUSIONS: Prophylactic amifostine can reduce mucositis, improve monocytes collection and promote hematopoietic recovery in ASCT.

A Rare Morphology Resembling APL with t (11;12) (p15;q13) in Acute Myeloid Leukemia: Case Report and Literature Review.

BACKGROUND: To investigate the clinical features of and therapeutic options for a rare morphology resembling APL with t (11;12) (p15;q13) in acute myeloid leukemia. METHODS: One case of APL-like acute leukemia with a t (11;12) (p15;q13) translocation is reported and related literature is retrospectively reviewed. RESULTS: A rare acute myeloid leukemia with a t (11;12) (p15;q13) translocation was diagnosed by morphology, immunophenotyping, chromosome analysis, and fusion gene detection, without finding a classical t (15;17) (q24.1;q21.1) translocation and the PML-RARa fusion gene. The patient responded poorly to differentiation induction therapy with all-trans retinoic acid (ATRA) and arsenic trioxide (ATO). In the three previous cases re-ported, poor results were obtained with ATRA and/or ATO therapy. CONCLUSIONS: We reported a rare meaningful AML patient with t (11;12) (p15;q13). Standard AML regimens may be preferred. These APL-like leukemias may benefit from hematopoietic stem cell transplantation treatment. Further investigation involving more cases is needed to determine the role of t (11;12) (p15;q13) in AML and to find better therapy choices.

Akt2 mediates glucocorticoid resistance in lymphoid malignancies through FoxO3a/Bim axis and serves as a direct target for resistance reversal.

Glucocorticoids (GCs) are widely used drugs in the treatment of lymphoid malignancies; resistance of GCs in lymphocytes confers poor prognosis and the mechanisms are poorly understood. Here, we found T-acute lymphoblastic leukemia (T-ALL) cells acquire resistance to dexamethasone (DEX)-mediated killing through abnormal activation of Akt, resulting in inhibition of the FoxO3a/Bim pathway. The resistant state was reported to be associated with increased glycolysis, NOTCH1 activating mutations and activated PI3K/ serum GS regulated kinases (SGK) pathway. Use of aforementioned pathway inhibitors blocked FoxO3a-phosphorylation and partially improved DEX-mediated killing of GC-resistant T-ALL cells, further revealing the essential role of the FoxO3a/Bim pathway in the development of GC resistance. Inhibition of Akt is most effective at restoring sensitivity to DEX of GC-resistant lymphocytes in vitro and in vivo, but shows significant hepatotoxicity in vivo. A significantly elevated expression of Akt2 not Akt1 in intrinsically, secondarily GC-resistant lymphocytes and relapsed/refractory ALL patients implicates a more specific target for GC resistance. Mechanistically, Akt2 has a stronger binding capacity with FoxO3a compared to Akt1, and acts as a direct and major negative regulator of FoxO3a activity driving GC resistance. Pharmacologic inhibition of Akt2 more effectively restores sensitivity to GCs than inhibition of Akt1 in vitro, shows higher synergistic effect acting with DEX, and reverses GC resistance in GC-resistant T- or B- lymphoid tumors in vivo with reduced liver toxicity. In summary, these results suggest that Akt2 might serve as a more direct and specific kinase mediating GC resistance through FoxO3a/Bim signaling pathway, and Akt2 inhibition may be explored as a promising target for treating GC-resistant hematopoietic malignancies.

Timing Determination of Invasive Fungal Infection Prophylaxis According to Immune Function in HSCT Patients.

Patients who receive a hematopoietic stem cell transplantation (HSCT) exhibit an immune defect after recovering from neutropenia. The current guidelines do not recommend fungal prophylaxis in these patients, except for grades III to IV GVHD in HSCT. Thus, the timing for the initiation and cessation of IFI prophylaxis in immune-compromised patients remains a challenging endeavor. We retrospectively analyzed patients who received auto or allo-HSCT and monitored their immune function after recovering from neutropenia by measuring the levels of IgG, IgA, IgM, as well as the number of T, B, NK cells. We found that the level of IgG and NK cell count exhibited a significant difference with the incidence of IFI by logistic regression (p = 0.000 vs. 0.000, respectively) and conditional logistic regression (p = 0.009 vs. p = 0.002). The initiation of IFI prophylaxis was determined to be IgG < 7 mg/mL and NK cell count < 6.5 × 104/mL by an receiver operating characteristic curve separately. Tests in parallel increased the test sensitivity and specificity. Thus, the optimal timing for initiating prophylaxis in patients after HSCT could be IgG < 7 mg/mL or NK cell count < 6.5 × 104/mL. Future large-scale prospective clinical trials are required to verify these findings. Patients who are immuno-compromised after auto or allo-HSCT may benefit from a lower fungi infection incidence with immune surveillance and proper fungal prophylaxis.

[Application of miR-182 for Determination of Glucocorticoid-Resistant Patients with Lymphoid Malignancy].

OBJECTIVE: To validate the clinical relationship between miR-182 and glucocorticoid-resistance in patients with lymphoid malignancy. METHODS: Real-time quantitative PCR(qRT-PCR) was employed to detect the expression of miR-182 in lymphoma patients (68 cases, the specimens indluded bone marrow of 20 cases, and plasma of 48 cases), multiple myeloma patients (24 cases, the specimens included bone marrow of 14 cases and plasma of 10 cases), ALL patients (3 cases, specimen was plasma of 3 cases) and non-lymphotic system disorder patients (18 cases, specimens included bone marrow of 8 cases and plasma of 10 cases). RESULTS: The expression of miR-182 in refractory lymphoblastic tumor patients was significantly higher than that in initial treatment group (P<0.05); the expression of miR-182 in initial treatment patients was not significantly different from the controls. The expression level of miR-182 in plasma of lymphoid malignancy patient significantly correlated with their used dosage of corticosteroids (P<0.05). When the expression level of miR-182 in bone marrow cells was 10.09, its sensitivity and specificity for diagnosis were 100% and 88.2% respectively; when the expression level of miR-182 in plasma was 1.393, its sensitivity and specificity for diagnosis of glucocorticoid resistance of lymphoblastic tumor cells were 90.9% and 51.3% respectively. CONCLUSION: The expression of miR-182 in lymphoblastic tumor with glucocorticoid resistance is significantly up-regulated, suggesting that the glucocorticoid resistance of lymphoblastic tumor is related with the over-expression of miR-182. The miR-182 is expected as a new biomarker for the diagnosis of glucocorticoid resistant lymphoblastic tumor.

Synergistic Cytotoxicity of Lenalidomide and Dexamethasone in Mantle Cell Lymphoma via Cereblon-dependent Targeting of the IL-6/STAT3/PI3K Axis.

At our center, relapsed mantle cell lymphoma (MCL) can be treated with maintenance therapy composed of consecutive low-dose lenalidomide and short-term, high-dose dexamethasone (LD regimen), which achieves good responses (longer overall survival and progression-free survival) and low toxicity. Cereblon is probably targeted by both lenalidomide and dexamethasone, which leads to synergistic cytotoxicity in MCL by inhibiting the interleukin-6/signal transducer and activator of transcription 3 (IL-6/STAT3), phosphatidylinositol 3-kinase (PI3K)/AKT and AKT2/Forkhead box O3 (FOXO3A)/BCL2-like 11 (BIM) pathways. The two drugs synergistically inhibit the same pathways, but through different sites. Cereblon was found expressed in most of the MCL tissues (91.3% positivity). Moreover, cereblon expression is positively correlated with LD regimen sensitivity: long-term lenalidomide exposure downregulates cereblon and induces multi-drug resistance against lenalidomide, dexamethasone, cytarabine, cisplatin, and methotrexate in vitro. Removal of lenalidomide resensitizes lenalidomide-resistant MCL cells to lenalidomide and dexamethasone. Our work suggests that rotating the LD regimen with other regimens would improve MCL maintenance therapy.

Predictive value of F-18 FDG PET/CT quantization parameters for progression-free survival in patients with diffuse large B-cell lymphoma.

OBJECTIVES: To evaluate the predictive significance of F-18 FDG PET/CT quantization parameters for progression-free survival (PFS) in patients with diffuse large B cell lymphoma (DLBCL) before chemotherapy. METHODS: We conducted a retrospective study involving 60 patients with DLBCL between January 2010 and August 2014 who had undergone F-18 FDG PET/CT scan prior to treatment. Maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and number of enlarged lymph nodes (>2 cm) were measured. The primary outcome measure was PFS. Spearman rank correlation analysis, univariate and multivariate Cox regression models, receiver operating characteristic (ROC) analysis, and Kaplan-Meir survival curves were used. RESULTS: Spearman analysis determined that the MTV and TLG values were positively related to Ann Arbor stage, National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI) score, and lactate dehydrogenase (LDH) level. The number of enlarged lymph nodes was positively related only to LDH level. The SUVmax value and clinical characteristics were not related. Univariate Cox regression determined that the MTV and TLG values, number of enlarged lymph nodes, and NCCN-IPI score were predictive factors. Multivariate Cox regression determined that the MTV and TLG values and number of enlarged lymph nodes predicted PFS independently of the NCCN-IPI score. The SUVmax value was not predictive of PFS. According to the cut-off determined from ROC analysis, lower MTV and TLG values were highly predictive of favorable PFS. CONCLUSIONS: In contrast to SUVmax, the MTV and TLG may be significant prognostic markers for PFS in DLBCL.

Predictive value of F-18 FDG PET/CT quantization parameters in diffuse large B cell lymphoma: a meta-analysis with 702 participants.

F-18 fluorodeoxyglucose (FDG) positron emission tomography/computerized tomography (PET/CT) is considered to be the most beneficial imaging method for staging patients with lymphoma. Whether maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) acquired from F-18 FDG PET/CT are predictors of prognosis of diffuse large B cell lymphoma (DLBCL) is controversial, with some studies concluding that it is and others concluding the opposite. Therefore, a systematic review was performed to explore the relationship of F-18 FDG PET/CT quantization parameters with the prognosis of DLBCL. Seven trials with a total of 703 DLBCL patients were included for analysis. Hazard ratios (HRs) for progression-free survival (PFS) and overall survival (OS), and odds ratios (ORs) for 3-year PFS and OS were pooled using the STATA package. Combined results suggested a strong link between the high SUVmax, MTV and TLG values and the poor 3-year PFS with ORs of 2.59, 3.69 and 2.29, respectively. Similarly, high MTV and TLG values unfavorably influenced the 3-year OS with ORs of 5.40 and 2.19, respectively. The pooled results also showed that high SUVmax and MTV were negative predictors of PFS with HRs of 1.61 (p = 0.038) and 2.18 (p = 0.000), respectively. The TLG value was not predictive of PFS. And for OS, only high MTV was a strong predictor of poor prognosis in DLBCL with HR 2.99 (p = 0.000). Our results suggested that SUVmax and MTV may be significant prognostic markers for PFS and MTV may be the only predictor for OS in DLBCL.

Comparison between decitabine and azacitidine for the treatment of myelodysplastic syndrome: a meta-analysis with 1,392 participants.

The hypomethylating agents decitabine and azacitidine have been found to improve the outcome of patients with myelodysplastic syndrome (MDS); however, the clinical choice between them is controversial. Therefore, this meta-analysis was performed to compare the efficacy, toxicity, and survival advantage of decitabine and azacitidine in patients with MDS. Eleven trials with a total of 1392 patients with MDS (decitabine, n = 768; azacitidine, n = 624) were included for analysis. The pooled estimates of partial response, hematologic improvement, and overall response rates for azacitidine were significantly higher than for decitabine. There were no differences between these 2 drugs regarding complete response, red blood cell transfusion-independent rates, and grade 3 or 4 hematologic toxicity. When compared with best supportive care, azacitidine significantly improved overall survival (hazard ratio [HR], 0.69; 95% CI, 0.54-0.87) and time to acute myeloid leukemia transformation (HR, 0.51; 95% CI, 0.35-0.74). But these benefits were not found with decitabine. Among patients with higher risk (International Prognostic Scoring System value of 3) or older than 75 years, treatment with azacitidine was a favorable factor, whereas decitabine showed no advantage. Therefore, with higher overall response rates and better survival benefits, azacitidine is recommended as the first-line hypomethylating agent for MDS, especially in elderly patients or those with high risk.

The effect of TLX3 expression on the prognosis of pediatric T cell acute lymphocytic leukemia--a systematic review.

Whether TLX3 is a predictor of prognosis of pediatric T cell acute lymphocytic leukemia (T-ALL) is controversial, with some studies concluding that it is and others concluding the opposite. Therefore, a systematic review was performed to explore the relationship of TLX3 expression with the prognosis of pediatric T-ALL. The PubMed database, The Cochrane Library, conference proceedings, EMBASE databases, and references of published trials and review articles were searched. Two reviewers independently assessed the quality of the trials and extracted data. Hazard ratios (HRs) for disease-free survival (DFS) and odds ratios (OR) for 5-year DFS were pooled using the STATA package. Ultimately, six trials involving 515 patients with pediatric T-ALL were analyzed. The pooled HR (1.07 [0.32, 3.56], p = 0.91) for DFS and OR (1.30 [0.52, 3.27], p = 0.57) for 5-year DFS showed that the TLX3-positive group showed no statistically significant difference with the TLX3-negative group. Our results suggested that TLX3 expression is not an indicator for the prognosis of pediatric T-ALL.