[Significance of Thl7/Treg Ratio in aGVHD Occurence after Allo-HSCT].

OBJECTIVE: To explore the relationship between Th17 and Treg levels and aGVHD occurence in patients after allo-HSCT. METHODS: Thirty-nine patients received allo-HSCT were divided into 2 groups: aGVHD group(17 cases) and non-aGVHD group (22 cases). For aGVHD group, the peripheral blood was collected before aGVHD occurence, in occurence and after aGVHD improvement; for non-aGVHD group, the peripheral blood was collected after 1, 2 and 3 months of transplantation. In addition, 16 healthy donors were used as controls, their peripheral blood was collected before mobilization. The Th17 and Treg counts as well as Th17/Treg ratio were detected by flow cytometry. RESULTS: Among patients with aGVHD after transplantation, the Th17 count increased, and the Treg count decreased, the Th17/Treg ratio increased before aGVHD occurence, as compared with the patients without aGVHD(P<0.05); but after aGVHD occurence, the Th17 count decreased, Treg count increated, and the Th17/Treg ratio decreased as compared with that before aGVHD occurence (P<0.05). After aGVHD was improved, the Th17/Treg ratio decreased as compared with level before aGVHD occurence (P<0.05). After aGVHD was improved, the Th17/Treg ratio was no statistical different from healthy donors (P>0.05). Among patients without aGVHD after transplantation, the Th17/Treg ratio at 2 and 3 months after transplantation was no statistical different from that of healthy donos(P>0.05). CONCLUSION: The Th17 and Treg levels recoverel showly after transplantation, but the Th17/Treg ratio recoveres after 2 months in the patients after transplantation. The Th17 cells may initiate aGVHD; when aGVHD happened, the Treg level increases, which may regulate the aGVHD ontcome through inhibiting the Th17 cells. The detection of Th17/Treg ratio after transplantation can predict the occurence and outcome of aGVHD.

Sorafenib in liver function impaired advanced hepatocellular carcinoma.

OBJECTIVE: To explore the efficacy and safty of sorafenib in Child-Pugh class B to class C hepatocellular carcinoma (HCC). METHODS: In this three-center open-label study from November 2011 to May 2013, we randomly assigned 189 patients with advanced Child-Pugh class B or C HCC patients into two groups, one group with 95 patient to receive sorafenib (400 mg a time, twice a day) and the other group with 94 patients to receive best supportive care. The primary end points were progression-free survival and overall survival. RESULTS: The median progression-free survival was 2.2 months and 1.9 months in the sorafenib group and best supportive care group respectively (Hazard ratio in the sorafenib group, 0.55; 95% confidence interval, 0.40-0.75; P=0.002). The median overall survival was 4.0 months and 3.5 months in the sorafenib group and best supportive care group respectively (Hazard ratio in the sorafenib group, 0.48; 95% confidence interval, 0.35-0.68; P<0.001). The main adverse effect of sorafenib was rash and acne of the skin (in 51.7% patients). The incidences of severe rash, diarrhea, and dry skin were 5.6%, 5.6%, and 2.2% in the sorafenib group. One patient reached partial response in the sorafenib group. CONCLUSIONS: Sorafenib is safe in patients with liver function impaired advanced HCC. It is effective in terms of progression-free survival and overall survival compared with best supportive care. Liver functions are the important predictive factors.