[Clinical analysis of 500 cases of hematological diseases with oral presentation as the first manifestation].

PURPOSE: To explore the clinical characteristics of hematological diseases with oral presentation as the first manifestation, and to provide basis for early diagnosis of hematological diseases and prevention of missed diagnosis and misdiagnosis. METHODS: The clinical data of 500 patients with hematological diseases who were first diagnosed in department of stomatology in our hospital during the past five years were reviewed, and the diversity and distribution of oral manifestations of patients with hematological diseases were analyzed. RESULTS: Oral manifestations of 500 patients with hematological diseases were mainly oral mucosa and gingival bleeding, gingival hyperplasia, oral mucosal ulcer, oral mucosal infection, oral and maxillofacial mass. Among them, the number of hematological diseases patients first diagnosed in the department of stomatology with the symptoms of oral and maxillofacial mass was the largest, accounting for 19.8%. Blood routine, coagulation mechanism and oral pathological biopsy were very important for preliminary screening and diagnosis of hematological diseases. CONCLUSIONS: Oral manifestations of various hematological diseases may occur at the early stage of the disease. Correct understanding of oral manifestations of the diversity of hematological diseases, combined with blood routine and coagulation mechanism examination, can preliminarily screen hematological diseases. Pathological examination of tumors in patients with oral and maxillofacial masses can be carried out. Diagnosis and differential diagnosis of hematological diseases can be made earlier in clinic, so as to avoid misdiagnosis and missed diagnosis. For patients with hematological diseases first diagnosed in the department of stomatology, the treatment of oral characterization mainly focuses on hematological diseases, supplemented by local symptomatic treatment of oral cavity.

Once-Weekly 1.6 mg/m2 Bortezomib BCD Regimen in Elderly Patients with Newly Diagnosed Multiple Myeloma Who are Unfit for Standard Dose Chemotherapy.

Bortezomib has shown anti-myeloma effects in combination with alkylating agents, but clinical benefits can be limited by neurotoxicity. There is less information on the efficacy and tolerability of once-weekly 1.6 mg/m2 bortezomib combined with cyclophosphamide and dexamethasone (BCD) regimen in elderly patients with newly diagnosed multiple myeloma who are unfit for standard dose chemotherapy. Here, we report our experience of weekly 1.6 mg/m2 intravenous bortezomib in this group of patients. Between March 2010 and February 2015, we treated 34 newly diagnosed elderly patients with the combination of bortezomib 1.6 mg/m2 intravenously on days 1 and 8; cyclophosphamide 200 mg/m2 intravenously on days 1-4; dexamethasone 20 mg intravenously on days 1-4, and 8-11. Among the 34 patients, 14 (41 %) responded with complete response (CR), 6 (18 %) with very good partial response (VGPR) and 10 (29 %) with partial response (PR). The overall response rates were 88 %. After 2 cycles of treatments, the survival of patients who attained a response of VGPR or CR was significantly longer than those with PR or resistance to BCD, for both progression-free survival (PFS) (21.4 vs. 10.6 months, p = 0.002) and overall survival (OS) (23.0 vs. 16.8 months, p = 0.043). The 2-year PFS and OS were 26.5 and 64.7 % respectively in these elderly multiple myeloma patients in our study. Grade 1/2 neuropathy was observed in 20 % of the cycles while grade 3/4 neuropathy was not observed. No patients withdrew due to neuropathy or other side effects. Once-weekly bortezomib at 1.6 mg/m2 BCD regimen is both effective and safe in elderly patients with newly diagnosed multiple myeloma who are unfit for standard dose chemotherapy.

Retrospective Study of Pegaspargase, Gemicitabine, Oxaliplatin and Dexamethasone (Peg-GemOD) as a First-Line Therapy for Advanced-Stage Extranodal NK/T Cell Lymphoma.

This study was conducted to retrospectively investigate the efficacy and safety of pegaspargase, gemicitabine, oxaliplatin and dexamethasone (Peg-GemOD) combination chemotherapy as a first-line therapy for advanced-stage extranodal NK/T cell lymphoma (ENKTL). Eighteen patients with newly diagnosed stage III/IV ENKTL were subjected to 3-6 cycles of Peg-GemOD chemotherapy. After 3 cycles of therapy, the overall response rate was 67 % (12/18) with a complete response rate of 28 % (5/18) and a partial response rate of 39 % (7/18). The median overall survival (OS) and progression-free survival (PFS) time were 10 and 8.5 months respectively. For those responders, the median OS and PFS time were significantly better than those of non-responders (median OS, 15 vs. 10 months; P = 0.001 and median PFS, 15 vs. 7 months; P = 0.001). Furthermore, patients with low plasma EBV-DNA levels after induction chemotherapy had a remarkably longer OS and PFS time. The toxicity of Peg-GemOD regimen was acceptable.

[Clinical study on fludarabine combined with cytarabine regimen in the treatment of patients with refractory and relapsed acute myeloid leukemia].

The aim of study was to evaluate the clinical efficacy and toxicity of fludarabine combined with cytarabine (FA) regimen in the treatment of patients with refractory and/or relapsed acute myeloid leukemia (AML). Nineteen cases with refractory/relapsed AML were treated with FA regimen in which fludarabine phosphate 25 mg/(m(2) x d), d1-5; cytarabine (Ara-C) 2 g/(m(2) x d), d1-5. Another 20 cases were treated with salvage chemotherapy (MAE regimen: mitoxantrone, Ara-C and etoposide or DAE regimen: daunorubicin, Ara-C and etoposide). All patients received at least 2 cycles chemotherapy. The results showed that 9 patients (47%) in FA regimen group achieved complete remission (CR), 8 cases (42%) obtained partial remission (PR), the clinical efficacy was superior to that of the MAE or DAE regimens (p < 0.05). Major toxicity of FA regimen was myelosuppression. Grade IV hematologic toxicity occurred in all patients received FA regimen. Nonhematologic complications consisted of gastrointestinal side effects, mucositis, liver toxicity, which were mild to moderate and could be alleviated with supportive therapy. In conclusion, FA regimen is an effective regimen for treatment of refractory and relapsed AML.

[Progress of study on survivin in diffuse large B-cell lymphoma--review].

Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin's lymphoma (NHL), which is also a significantly heterogeneous disease. Survivin, a unique member of the inhibitor of apoptosis (IAP) family, is overexpressed in various cancers, including some types of lymphoma. It is found that inhibitor of apoptosis protein, survivin, plays an important role in the development and progression of DLBCL. Survivin is able to inhibit the cell apoptosis, and enhances the cell proliferation. Many studies showed that survivin may be considered as an independent unfavorable prognostic index of DLBCL. The poor prognostic cases early are screened in combination of survivin expression with International Prognostic Index (IPI), and improve the outcome of DLBCL. Survivin selectively expressed in tumor tissue, which provide an ideal target for tumor therapy. Modulation of survivin expression or function may provide a novel approach for experimental therapy in patients with DLBCL. In this review, the progress of study on mechanism of survivin protein, the survivin expression in DLBCL, its significance in diagnosis and therapy of DLBCL, and the prospective trend were summarized.

[Correlation of cell cycle alteration to SOCS-1 gene demethylation induced by arsenic trioxide in myeloma cell lines].

BACKGROUND & OBJECTIVE: Recent studies suggest strong therapeutic potentials of arsenic trioxide (As2O3) for multiple myeloma(MM), which may be due to As2O3-induced demethylation of tumor suppressor genes. This study was to explore the correlation of cell cycle alteration to SOCS-1 gene demethylation after As2O3 induction in MM cell lines in vitro. METHODS: MM cell lines U266 and RPMI8226 were used. Cell proliferation and cell cycle of MM cells after the treatment of As2O3 were assessed by MTT assay and flow cytometry, respectively. Methylation status was detected by methylation specific PCR (MSP-PCR), and gene expression of SOCS-1 was measured by real-time PCR in MM cells before and after As2O3 treatment. RESULTS: As2O3 significantly inhibited the growth of U266 and RPMI8226 cells in a dose-dependent manner. The cell cycle of U266 and RPMI8226 were arrested at G0/G1 phase. Compared with the wild type, the percentage of cells was increased at G0-G1 phase, but decreased at S phase after the treatment of As2O3 for 72 h (P < 0.05). The mRNA expression of SOCS-1 gene was significantly increased with hemi-methylation (As2O3, 0.5 micromol/L,72 h) or complete demethylation (As2O3, 1.0 micromol/L or As2O3, 2.0 micromol/L,72 h) of the SOCS-1 gene in comparison with the wide type (P<0.05). CONCLUSIONS: As2O3 could induce cell cycle alteration of MM, which might be related to demethylation and reexpression of SOCS-1 gene in MM cell lines. The study might provide a new approach to elucidate the mechanism of the antitumor effect of As2O3 in MM.

[Arsenic trioxide induces socs-1 gene demethylation in myeloma cell lines].

The aim of this study was to explore the effect of arsenic trioxide (As(2)O(3)) on the methylation status of socs-1 gene in multiple myeloma cell lines U266, RPMI8226. The cell viability was assayed by MTT method. The methylation status of socs-1 gene was detected by methylation specific PCR. The expression of socs-1 gene mRNA was determined with real-time PCR. The cell apoptosis was analyzed by flow cytometry. The results indicated that hypermethylation of CpG island of socs-1 gene was observed without expression of socs-1 in myeloma cell lines U266, RPMI8226. The expression of socs-1 gene mRNA in each myeloma cell line increased significantly after exposure to As(2)O(3) for 72 hours as compared with the cell lines of wild type (p < 0.05). And cell proliferation was significantly inhibited, both early apoptosis and later apoptosis ratios increased in dose-dependent manner. It is concluded that As(2)O(3) may induce socs-1 demethylation and up-regulate the expression of the gene. This study provides a new thought and direction for exploring possible mechanism of cell apoptosis induced by As(2)O(3) and multiple myeloma treatment by As(2)O(3).