Efficacy observation of lenalidomide in treatment of relapsed/refractory diffuse large B-cell lymphoma / 白血病·淋巴瘤

Objective:To explore the clinical efficacy of lenalidomide combined with second-line immunochemotherapy as a salvage regimen in the treatment of relapsed/refractory diffuse large B-cell lymphoma (DLBCL).Methods:The clinical data of 37 relapsed/refractory DLBCL patients receiving lenalidomide combined with second-line immunochemotherapy as a salvage regimen who had recurrence after autologous hematopoietic stem cell transplantation or who were not eligible for transplantation or had no intention to transplant between January 2016 and December 2020 in the First Affiliated Hospital of University of Science and Technology of China were retrospectively analyzed. Among 37 patients, 6 cases with primary central nervous system (CNS) lymphoma and 3 cases with secondary CNS lymphoma. The short-term efficacy after treatment was evaluated. Kaplan-Meier method was used to analyze the overall survival (OS) and progression-free survival (PFS), and log-rank test was used for subgroup comparison.Results:The median follow-up time of 37 patients was 20.4 months (2.7-37.0 months). At the end of treatment, the overall response rate (ORR) of all patients was 64.9% (24/37), the complete response (CR) rate was 45.9% (17/37), and the median duration of response (DOR) of 24 patients who responded to treatment was 17.7 months (3.6-33.6 months). The median PFS time of all patients was 11.2 months, and the 1-year PFS rate was 48.6% (95% CI 32.5%-64.7%). The median OS time of all patients was not reached, and the 1-year OS was 67.6% (95% CI 52.5%-82.7%). Among 24 responding patients, 17 cases who received lenalidomide maintenance therapy after remission tended to have a better response compared with 7 cases who did not receive lenalidomide maintenance therapy after remission, although there was no significant difference in OS and PFS between both groups (both P > 0.05). Additionally, neutropenia was the most common adverse reaction with an incidence of 81.1% (30/37). Conclusions:Lenalidomide combined with the second-line immunochemotherapy may be an effective salvage therapy for patients with relapsed/refractory DLBCL, especially for patients with CNS involvement. The patients achieving remission after salvage therapy continue to receive lenalidomide maintenance therapy and could have a better prognosis.

Effects of worldwide interventions and vaccination on COVID-19 between waves and countries

Governments worldwide have rapidly deployed non-pharmaceutical interventions (NPIs) to mitigate the COVID-19 pandemic. However, the effect of these individual NPI measures across space and time has yet to be sufficiently assessed, especially with the increase of policy fatigue and the urge for NPI relaxation in the vaccination era. Using the decay ratio in the suppression of COVID-19 infections, we investigated the changing performance of different NPIs across waves from global and regional levels (in 133 countries) to national and subnational (in the United States of America [USA]) scales before the implementation of mass vaccination. The synergistic effectiveness of all NPIs for reducing COVID-19 infections declined along waves, from 95.4% in the first wave to 56.0% in the third wave recently at the global level and similarly from 83.3% to 58.7% at the USA national level, while it had fluctuating performance across waves on regional and subnational scales. Regardless of geographical scale, gathering restrictions and facial coverings played significant roles in epidemic mitigation before the vaccine rollout. Our findings have important implications for continued tailoring and implementation of NPI strategies, together with vaccination, to mitigate future COVID-19 waves, caused by new variants, and other emerging respiratory infectious diseases.

Transmission risk of SARS-CoV-2 on airplanes and high-speed trains

Modern transportation plays a key role in the long-distance and rapid spread of SARS-CoV-2. However, little is known about the transmission risk of SARS-CoV-2 on confined vehicles, such as airplanes and trains. Based on the itinerary and epidemiological data of COVID-19 cases and close contacts among 9,265 airline passengers on 291 airplanes and 29,335 passengers on 830 high-speed trains in China from December 20, 2019 to March 17, 2020, we estimated that the upper bound of overall attack rate of COVID-19 among passengers was 0.60% (95% confidence interval: 0.43%-0.84%) for airplanes and 0.35% (0.28%-0.44%) for trains departing from Wuhan before its lockdown, respectively. The reproduction number during travel ranged from 0.12 to 0.19 on airplanes and from 0.07 to 0.12 on trains, with the risk varying by seat distance from the index case and joint travel time, but the difference in risk was not significant between the types of aircraft and train. Overall, the risk of SARS-CoV-2 transmission on planes and high-speed trains with high efficiency air filtration devices was relatively low. Our findings improve understanding of COVID-19 spread during travel and may inform response efforts, such as lifting travel restrictions, and resuming transportation in the pandemic.

Relationship between dynamic changes of Epstein-Barr virus and efficacy of lymphoma / 白血病·淋巴瘤

Objective To observe the relationship between the dynamic changes of Epstein-Barr virus (EBV) and the clinical efficacy of lymphoma. Methods The retrospective study was performed on 51 lymphoma patients with EBV-positive in Anhui Provincial Cancer Hospital from September 2015 to August 2017. The treatment effect of lymphoma was evaluated by the changes of EBV DNA, lactic dehydrogenase (LDH) and lymph nodes. Results Among the 51 lymphoma patients, EBV DNA elevated in 18 patients when the LDH was elevated, 23 cases presented with EBV DNA decrease and the LDH also decreased. EBV DNA decreased in 2 patients when the LDH was elevated. Eight patients were elevated when LDH was reduced. The quantification of EBV DNA and LDH had high consistency (κ = 0.609, P= 0.000). Among the 51 lymphoma patients, 20 patients with elevated EBV DNA were elevated with lymph nodeen largement, the lymph nodes in 22 cases with EBV DNA decrease were also decreased. EBV DNA decreased in 3 patients when the lymph nodes were enlarged. Six patients were elevated when lymph nodes were reduced. The quantification of EBV and lymph nodes had high consistency (κ = 0.648, P= 0.000). Patients with elevated EBV DNA during the course of treatment showed an increase in the mean value of LDH, and the patients with reduced EBV DNA during treatment also had lower average LDH. LDH levels were positively correlated with EBV DNA in patients with EBV-positive lymphoma (r= 0.627, P= 0.000). Conclusion Dynamic detection of EBV DNA and LDH can be used as the evaluation index of therapeutic effect and follow-up in patients with EBV-positive lymphoma.

Downscaling research of spatial distribution of incidence of hand foot and mouth disease based on area-to-area Poisson Kriging method / 中华流行病学杂志

Objective To understand the spatial distribution of incidence of hand foot and mouth disease (HFMD) at scale of township and provide evidence for the better prevention and control of HFMD and allocation of medical resources.Methods The incidence data of HFMD in 108 counties (district) in Shandong province in 2010 were collected.Downscaling interpolation was conducted by using area-to-area Poisson Kriging method.The interpolation results were visualized by using geographic information system (GIS).The county (district) incidence was interpolated into township incidence to get the distribution of spatial distribution of incidence of township.Results In the downscaling interpolation,the range of the fitting semi-variance equation was 20.38 km.Within the range,the incidence had correlation with each other.The fitting function of scatter diagram of estimated and actual incidence of HFMD at country level was y=1.053 1x,R2=0.99.The incidences at different scale were consistent.Conclusions The incidence of HFMD had spatial autocorrelation within 20.38 km.When HFMD occurs in one place,it is necessary to strengthen the surveillance and allocation of medical resource in the surrounding area within 20.38 km.Area to area Poisson Kriging method based downscaling research can be used in spatial visualization of HFMD incidence.

Downscaling research of spatial distribution of incidence of hand foot and mouth disease based on area-to-area Poisson Kriging method / 中华流行病学杂志

Objective To understand the spatial distribution of incidence of hand foot and mouth disease (HFMD) at scale of township and provide evidence for the better prevention and control of HFMD and allocation of medical resources.Methods The incidence data of HFMD in 108 counties (district) in Shandong province in 2010 were collected.Downscaling interpolation was conducted by using area-to-area Poisson Kriging method.The interpolation results were visualized by using geographic information system (GIS).The county (district) incidence was interpolated into township incidence to get the distribution of spatial distribution of incidence of township.Results In the downscaling interpolation,the range of the fitting semi-variance equation was 20.38 km.Within the range,the incidence had correlation with each other.The fitting function of scatter diagram of estimated and actual incidence of HFMD at country level was y=1.053 1x,R2=0.99.The incidences at different scale were consistent.Conclusions The incidence of HFMD had spatial autocorrelation within 20.38 km.When HFMD occurs in one place,it is necessary to strengthen the surveillance and allocation of medical resource in the surrounding area within 20.38 km.Area to area Poisson Kriging method based downscaling research can be used in spatial visualization of HFMD incidence.