Association of CDSS score and 60-day mortality in Chinese patients with non-APL acute myeloid leukemia: a retrospective cohort study.

Acute myeloid leukemia (AML) is a heterogeneous hematological malignancy, and is one of the triggers of DIC, the latter is an essential factor in the early death of patients with AML. However, the timely identification of DIC remains a challenge. The Chinese DIC Scoring System (CDSS) is a common consensus widely used in China; but, there are few reports on its application in patients with AML. We undertake this retrospective cohort study to investigate the association between CDSS score and 60-day mortality. CDSS scores were evaluated after admission. The outcome was all-cause 60-day mortality. Multivariate Cox regression analyses were performed to calculate the adjusted hazard ratio (HR) and the corresponding 95% confidence interval (CI). Survival curves were plotted by Kaplan-Meier and log-rank analyses. Subgroup analyses were stratified by relevant effect covariates. A total of 570 consecutive patients with primary AML were included. We found an association between a 39% increase in 60-day mortality and a 1 point increase in CDSS score (HR = 1.39, 95% CI 1.25-1.54), which was associated with a 189% increase in 60-day mortality in CDSS scores ≥ 6 compared with that in the CDSS scores < 6 (HR = 2.89, 95% CI 1.91-4.38). After adjusting for all potential con-founders, a 27% and a 198% increase were observed (HR = 1.27, 95% CI 1.01-1.61; HR = 2.98, 95% CI 1.24-7.19), respectively. There is association between 60-day mortality and CDSS score in patients with AML. These findings may help hematologists in making informed treatment decisions.

Waldenstrom Macroglobulinemia Arising During Maintenance Therapy of Plasma Cell Myeloma.

BACKGROUND: Both plasma cell myeloma (PCM) and Waldenstrom's macroglobulinemia (WM) are mature B-cell neoplasms commonly involving bone marrow and usually related to paraproteinemia. METHODS: Secondary WM in a patient with PCM during maintenance therapy has not been previously reported. We herein report the first case of WM arising during maintenance therapy of PCM. RESULTS: The diagnosis of secondary WM during maintenance therapy of PCM was based on combination of medical history, morphology, flow cytometry, immunofixation electrophoresis, and molecular genetics. CONCLUSIONS: This case highlights the importance of an integrated diagnostic work-up, with an interesting role for morphology and flow immunotyping.

Association between serum albumin and 60-day mortality in Chinese Hakka patients with non-APL acute myeloid leukemia: a retrospective cohort study.

BACKGROUND: Acute myeloid leukemia (AML) is the main type of adult leukemia, and 60-day mortality is a vital clinical problem that doctors have to face at the begin with treatment. Studies on the association between serum albumin and 60-day mortality from AML (non-APL) are limited. METHODS: In this retrospective cohort study, ALB was measured after admission in all patients diagnosed with primary AML from Affiliated Ganzhou Hospital of Nanchang University between January 2013 and May 2021. The outcome was all-cause, 60-day mortality. Multivariable Cox regression analyses were performed to calculate the adjusted hazard ratio (HR) and its corresponding 95% confidence interval (CI). RESULTS: This study included 394 primary AML patients. The overall 60-day mortality was 28.9% (114/394); it was 43.1% (56/130), 27.5% (36/131), and 16.5% (22/133) for ALB quantile1 (Q, < 34.5 g/L), quantile 2 (Q2, 34.5-38.5 g/L), and quantile 3 (Q3, ≥ 38.6 g/L), respectively (P = 0.001). After adjusting for potential confounders, we found an association between a 6% decrease in 60-day mortality rate and a 1 g/L increase in ALB level (HR = 0.94, 95% CI: 0.89-0.99, P = 0.015), which was associated with 38 and 70% decreases in 60-day mortality rates in Q2 (HR = 0.50, 95% CI: 0.30-0.86, P = 0.012) and Q3 (HR = 0.47, 95% CI: 0.2 5-0.90, P = 0.022), respectively, compared with that in Q1. Similar results were obtained after subgrouping based on an ALB level of 35 g/L (HR = 0.55, 95% CI: 0.34-0.88, P = 0.013). CONCLUSIONS: Serum albumin was significantly associated with 60-day mortality of primary AML, which has important clinical significance. Further investigation is warranted.

Megaloblastic Anemia Masked by an Unrecognized Hemoglobinopathy.

BACKGROUND: Deficiency of vitamin B(12) or folate causes megaloblastic anemia (MA). The disease presents with pancytopenia due to the excessive cellular apoptosis of hematopoietic progenitor. MA is characterized by the presence of high mean corpuscular volume in the blood routine test and hyperlobulation nuclei of the granulocytes in the peripheral blood smears, and megaloblasts in the bone marrow. METHODS: We report a rare case, in which megaloblastic anemia was masked by an unrecognized hemoglobinopathy and presented with normocytic anemia and atypical morphological features of bone marrow. RESULTS: The patient was finally diagnosed with coexistence of MA and a-thalassemia minor due to determination of folate deficiency and genetic mutation for a-thalassemia. CONCLUSIONS: The case focuses on the contribution of the peripheral circulating blood smear examination in the diagnosis of anemia.

Plasma Cell Myeloma Mimicking Metastatic Carcinoma with CD138 positivity: a Potential Diagnostic Pitfall.

BACKGROUND: Plasma cell myeloma is a kind of multifocal proliferation of neoplastic plasma cells in bone marrow. Morphology of myeloma plasma cells varies from mature to immature form, plasmablastic, and pleomorphic cells, with the proportion of plasma cells changing from a slight increase to > 90%. Several morphologic variants of PCM have been reported. METHODS: Herein, we present a rare case of PCM with typical morphological features of bone marrow metastatic carcinoma, association with CD138 positivity, and a complex karyotype. RESULTS: The diagnosis of PCM was made based on a combination of the clinical features, morphology, immunofixation electrophoresis, flow cytometry immunophenotyping, and bone marrow biopsy. Overall, the result was in accord with PCM based on the WHO classification. CONCLUSIONS: The case focuses on the wide morphological variants of PCM and highlights the reason why PCM should be taken as a differential diagnosis when one presents with typical morphological feature and common antigens expression of bone marrow metastatic carcinoma.

Association between serum lactate dehydrogenase and 60-day mortality in Chinese Hakka patients with acute myeloid leukemia: A cohort study.

BACKGROUND: There is evidence that a high level of serum lactate dehydrogenase (LDH) is associated with poorer overall survival in acute myeloid leukemia (AML), but its link to 60-day mortality of AML remains unclear. METHODS: All patients newly diagnosed with AML were included in this cohort study. LDH was measured for the first time after admission. Multivariable logistic regression was used to explore the association between serum LDH and 60-day mortality. Interaction and stratified analyses were conducted including age, sex, albumin, glucose, myoglobin, and standard chemotherapy. RESULTS: Three hundred and seventy-one patients ≥15 years of age, who were newly diagnosed with AML, were consecutively selected. The total prevalence of 60-day mortality was 27.2% (101/371), while it was 32.1% (42/131) and higher than in the LDH ≥570U/L compared with the LDH<570U/L, with the prevalence of 24.6% (59/240); however, the difference was not statistically significant. In multivariate regression models, odd ratios and corresponding 95% confidence intervals (CIs) for Log2 and twice limit of normal (ULN) of LDH were 1.46 (1.0, 2.14) and 2.76 (1.24, 6.16), respectively. Interaction analysis revealed no interactive role in the association between LDH concentration and 60-day mortality. CONCLUSIONS: Serum LDH level was associated with 60-day mortality, especially for the patients with LDH ≥570U/L.

Abnormal hemoglobin H band in myelodysplastic syndromes (MDS): A case report.

Myelodysplastic syndrome (MDS) is a group of heterogeneous diseases derived from hematopoietic stem cells characterized by hemolytic anemia and high risk of conversion to acute leukemia. MDS is an age-related disease in which approximately 80% of patients are over 60years of age, male and female. Anemia is the most common clinical condition, and many patients are also associated with infection and bleeding. When the amount of α globin synthesis is insufficient, the remaining ß chain forms tetramer ß4, i.e. HbH. The latter forms a precipitate in red blood cells, leading to hemolytic anemia, called HbH disease, the majority of which is congenital, a small number of patients with myelodysplastic syndrome and acute myeloid leukemia may appear HbH (called acquired HbH disease). We reported a 71years old male patient diagnosed as myelodysplastic syndromes (MDS) in our hospital. The patient has a negative α-thalassemia gene test. The H band is detected by hemoglobin electrophoresis. This article analyzed and discussed this case with MDS, as well reviewed MDS.

[Analysis of CDSS Experimental Indexes in 333 Cases of Newly Diagnosed Acute Leukemia].

OBJECTIVE: To analyze the 5 experimental indexes of CDSS in the patients with acute leukemia (AL) so as to provide the laboratorial basis for the early diagnosis and treatment of the secondary DIC in AL. METHODS: Three hundred and thirty three patients with AL were divided into 7 groups, such as AML-M1-M5, other AML and ALL. The experimental indexes and CDSS scores of all AL groups were compared and analyzed in pairs, meanwhile 100 healthy persons were taken in the control group. Clinical events such as early death in all cases were also analyzed. RESULTS: The highest positive rate of Platelet was 59.76%, among the 5 experimental indexes, followed by D-D (30.93%), and the lowest APTT with only 2.70%. Compared with the control group, the differences of remaining indexes were statistically significant (P＜0.01), except APTT in group AML-M3 and FIB in the other AML groups. The score of laboratory index was (1.50±1.51) in all AL patients, and the positive rate of overt DIC ( score≥4) was 14.11% ( 47 cases). The highest score of CDSS was (3.34 ±1.71) in group AML-M3. The difference in the incidence of early death and cerebral (pulmonary) hemorrhage in DIC patients were statistically significant (P＜0.05 and P＜0.01). CONCLUSION: The application of quantitative integral method of experimental indexes in CDSS is objective and feasible, which is of great significance for early diagnosis and early treatment of acute leukemia complicated with DIC.

A dual-responsive colorimetric and fluorescent chemosensor based on diketopyrrolopyrrole derivative for naked-eye detection of Fe3+ and its practical application.

A novel dual-responsive colorimetric and fluorescent chemosensor L based on diketopyrrolopyrrole derivative for Fe3+ detection was designed and synthesized. In presence of Fe3+, sensor L displayed strong colorimetric response as amaranth to rose pink and significant fluorescence enhancement and chromogenic change, which served as a naked-eye indicator by an obvious color change from purple to red. The binding constant for L-Fe3+ complex was found as 2.4×104 with the lower detection limit of 14.3nM. The sensing mechanism was investigated in detail by fluorescence measurements, IR and 1H NMR spectra. Sensor L for Fe3+ detection also exhibited high anti-interference performance, good reversibility, wide pH response range and instantaneous response time. Furthermore, the sensor L has been used to quantify Fe3+ ions in practical water samples with good recovery.

Chronic inflammation-related DNA damage response: a driving force of gastric cardia carcinogenesis.

Gastric cardia cancer (GCC) is a highly aggressive disease associated with chronic inflammation. To investigate the relationship between DNA damage response (DDR) and chronic inflammation, we collected 100 non-tumor gastric cardia specimens of Chaoshan littoral, a high-risk region for esophageal and gastric cardia cancer. A significantly higher proportion of severe chronic inflammation was found in dysplastic epithelia (80.9%) in comparison with that in non-dysplastic tissues (40.7%) (P<0.001). Immunohistochemical analysis demonstrated that DNA damage response was parallel with the chronic inflammation degrees from normal to severe inflammation (P<0.05). We found that DNA damage response was progressively increased with the progression of precancerous lesions (P<0.05). These findings provide pathological evidence that persistent chronic inflammation-related DNA damage response may be a driving force of gastric cardia carcinogenesis. Based on these findings, DNA damage response in non-malignant tissues may become a promising biomedical marker for predicting malignant transformation in the gastric cardia.