To explore the prognostic factors of elderly AML patients, as well as the application and prognostic value of comprehensive geriatric assessment（CGA） in elderly AML patients in China, so as to determine a suitable comprehensive assessment method that can predict survival and guide treatment of patients in Chinese people.Retrospective analysis was performed on the medical records of 84 AML patients aged over 60 years old, and diagnosed in our department from October 2007 to December 2017, and the clinical, pathological and comprehensive evaluation of related prognostic factors was analyzed.The median age of all patients was 70 (60-91) years old, ratio of male to female was 1.9∶1 (55∶29) , the median OS time was 9 (1-125) months, 1 year OS rate was 35.3%, and 5 year OS rate was 12.6%. The age grouping, remission of induction chemotherapy, whether refractory/relapse, WBC count grouping at initial diagnosis, levels of lactate dehydrogenase and creatinine were risk factors for OS. Remission of induction chemotherapy, whether refractory/relapse, WBC count grouping and co-infections at initial diagnosis, levels of lactate dehydrogenase, and ECOG score were the risk factors for DFS. In the assessment of comorbidities, the two score classifications of charlson comorbidity index(CCI) were the risk factor of OS, however,whose effects for DFS were not statistically different. The effects of 3 score classifications of hemaotopoietic cell transplantation comorbidity index (HCT-CI), 4 score classifications of comulative illness kating scale for geriatrics (CIRS-G) and 3 score classifications of CIRS-G on OS and DFS were not statistically different. The impact of the ACA index on OS and DFS was statistically significant in elderly patients. All indexes related with patients self factors and disease-related factors were no independent prognostic factors for OS and DFS, so the judgment of prognosis needs to be comprehensively evaluated.The prognosis and treatment selection of elderly AML patients should be combined with traditional clinical and pathological prognostic factors as well as comprehensive assessment of the elderly patients.84例老年急性髓系白血病患者的临床特点及预后分析.探讨老年AML患者的预后因子，以及老年综合评估在中国老年AML患者中的应用及预后价值，从而确定适合中国人的预测生存并指导治疗选择的老年综合评估方法.回顾性分析2007年10月至2017年12月我科诊断的年龄≥60岁的84例AML患者的病历资料，分析临床、病理以及老年综合评估相关预后因子.所有患者的中位年龄70（60-91）岁，男女比例为：1.9∶1（55∶29），中位OS为 9（1-125）个月，1年OS率为35.3%，5年OS率为12.6% 。年龄分组、第1疗程缓解状态、是否难治复发、初诊白细胞数分组、乳酸脱氢酶和血肌酐水平是影响OS的危险因素；第1疗程缓解状态、是否难治复发、初诊白细胞数分组、乳酸脱氢酶水平、初诊是否合并感染、ECOG评分是影响DFS的危险因素。老年患者合并症的评估，charlson合并症指数（charlson comorbidity index, CCI）2分法是影响OS的危险因素，但对于DFS的影响无统计学差异；而造血细胞移植合并症指数(HCT-CI) 3分法、老年性疾病累积评分量表（CIRS-G）的4分法和3分法对于OS及DFS的影响均无统计学差异；老年患者综合评估的年龄、合并症和白蛋的（ACA）指数对OS、DFS的影响均有统计学意义。患者自身因素相关各指标以及疾病相关因素各指标均不是影响OS和DFS的独立预后因素，故对于预后的判断需进行综合评估.老年AML患者预后的判断以及治疗选择需综合地考虑临床、病理以及老年综合评估各个方面因素.
Topic: 14. Myeloma and other monoclonal gammopathies - Clinical Background: sPCL are found in relapsed/refractory MM (RRMM) with multiple lines of disease progression, The use of BCMA-CART in multiple myeloma has extended survival for many patients, but it is less commonly studied in sPCL. Aims: To assess the efficacy and safety of BCMA-CART in patients with secondary plasma cell leukemia(sPCL), as well as to investigate the consolidation regimen and timing of application in patients who achieved PR after CART. Methods: Patients with sPCL who met the entry criteria were enrolled and treated with BCMA-CART after lymphatic clearance pretreatment regimens, with some patients later receiving allogeneic transplantation(Allo-SCT) for consolidation, to assess the efficacy and safety of this treatment. Results: A total of 8 patients with sPCL were included in our study center from 2020.12 to 2022.11, with a male proportion of 6/8 (75%); 4/8 (50%) patients <45 years old, median age was 48.5 years; 8 patients had DS stage III, with 7/8 (87.5%) in group A; 3/8 (37.5%) were in ISS andR-ISS stage II,5/8 (62.5%) were in ISS and R-ISS stage III; mSMART3.0 stage were all in the high-Risk group, with Double Hit Myeloma accounting for 5/8 (62.5%); only 1 patient with extramedullary lesions; median CPC and range were 22% (6%-77%) respectively; proportion of previous treatment lines 5 (62.5%) and median line 3.5 (1-7); 8/8 (100%) patients were all resistant to lenalidomide, 4/8 (50%) were resistant to pomalidomide, 8/8 (100%) were all resistant to bortezomib, 2/8 (25%) were resistant to carfilzomib, and 8/8 (100%) were all resistant to daratumumab; only 3/8 (37.5%) patients had SCT history.The median and range of peak BCMA-CART amplification was 16 (11-28) days; the best outcome after BCMA-CART was PR in 6 patients, with ORR at 1 and 2 months after CART being 6/ 8 (75%) 4PR,2VGPR.Three of the six patients who achieved remission underwent Allo-SCT for consolidation therapy three months after CART, two patients are still alive with sCR, and one patient relapsed and died one month after consolidation therapy with Allo-SCT; the other three patients did not undergo Allo-SCT and consolidation therapy with CART for financial and medical reasons, and one relapsed and died 6 months after CART, one relapsed and died 1 year and 3 months after CART, and one is still alive. One case died after a one year and 3 months after CART relapse. and one case is still in the VGPR follow-up phase;The median follow-up time was 186.5 days, and the 6-month PFS and OS rates were 62.5% and 60%, respectively. BCMA-CART treated CRS Grade 1 ratio was 4/8(50%), Grade 2 was 2/8(25%), Grade 4 was 2/8(25%); all 8 patients had no ICANS; anemia Grade3 was 8/8(100%), neutropenia Grade2 was 1/8(12.5%), Grade3 was 7/8(87.5%), thrombocytopenia Grade3 was 1/8(12.5), Grade4 was 7/8(87.5%);nausea/vomiting Grade 1 was 4/8 (50%) and Grade 3 was 4/8 (50%); two patients died within one month of returning to CART due to severe pneumonia and gastrointestinal haemorrhage; two patients who died early had up to 70% abnormal peripheral blood plasma cells; and one patient developed pulmonary Aspergillus infection three months after returning to CART. Summary/Conclusion: BCMA-CART therapy can provide short-term relief for patients with sPCL, It is recommended that patients who achieve PR after CART undergo Allo-SCT for consolidation therapy as soon as possible to obtain deep remission and achieve long-term survival.Keywords: Multiple myeloma, Allo-SCT, CAR-T, B-cell maturation antigen
ABSTRACT Objective Currently, chimeric antigen receptor T‐cell (CART) therapy represents a highly effective approach for relapsed/refractory B‐cell lymphomas. However, it also carries treatment‐related risks. Limited data are available on the risks associated with CART therapy in patients with gastrointestinal involvement in B‐cell lymphomas. Therefore, we conducted a retrospective cohort study to address this gap in knowledge. Methods During the period from May 2019 to August 2022, a total of 26 patients recurrent/refractory with recurrent/refractory B‐cell lymphoma involving the gastrointestinal tract enrolled. Pathology confirmed CD19 antigen expression in tumor tissues. The disease status of patients who failed multiple lines of therapy was progressive disease (PD). Before CART cell infusion, patients received an FC regimen (fludarabine and cyclophosphamide) lymphodepletion. Quantitative PCR and flow cytometry were adopted for monitoring CART cell kinetics and function, with a focus on gastrointestinal AEs during treatment. The overall response rate (ORR) of the 26 patients was 61.5% (16/26), while the complete response rate (CR) was 23.1% (6/26). Their median follow‐up time was 22.49 months, while the medians of overall survival (OS) and progression‐free survival (PFS) were 10.88 and 5.47 months, respectively. The 1‐year OS and PFS rates were 45% and 42.3%, respectively. The prevalence of gastrointestinal complications was 21/26 (80.7%), including gastrointestinal hemorrhage in 11/26 (42.3%), emesis and diarrhea in 9/26 (34.6%), as well as intestinal obstruction in 2/26 (7.7%). A total of three patients (3/26, 11.5%) died of gastrointestinal hemorrhage. The gastrointestinal hemorrhage group exhibited markedly lower ORR and inferior OS compared to the non‐hemorrhage group. Conclusion Generally, the CART cell therapy is valid in relapsed/refractory B‐cell lymphoma with gastrointestinal involvement, but gastrointestinal bleeding is a unique risk factor that requires special attention, particularly in patients with high gastrointestinal tumor burden, as it is associated with poor efficacy and survival.
Low-dose methotrexate (LDMTX) has been widely used for many decades in clinical settings, with good safety profiles compared with those of high-dose methotrexate. LDMTX is also used as one of the off-label conservative therapies in treating placenta accreta (PA). Until now, only a few mild adverse drug reactions (ADRs) have been published after short-term use of LDMTX, and no severe cases have been reported.We present a case of a 30-year-old female who developed acute severe oral ulcerative mucositis with degree IV myelosuppression and degree III hepatic injury, after three doses of LDMTX to treat placenta accrete. The symptoms gradually improved after leucovorin rescue and supportive treatments.The present case provides the first severe ADR report for the short-term use of LDMTX for treating PA, indicating that potentially life-threatening complications can also occur when using LDMTX. Early recognition and immediate leucovorin rescue could result in a favourable outcome.
BACKGROUND: ACOT plays an important role in lipid metabolism and recent studies found that ACOT participates in some kinds of tumorigenesis. However, both the role of ACOT and its significance have not been revealed in AML. Therefore, we conduct this study in order to investigate the association be tween AML and ACOT, and hopefully contributed to the management of AML. METHODS: One hundred and fifty-six AML patients were enrolled in our study whose data were derived from the Cancer Genome Atlas database. There were 85 patients who received only chemotherapy and other 71 patients underwent allo-HSCT. RESULTS: Patients in high ACOT7 group had a significant lower EFS and OS, while patients in high versus low expression levels of other types of ACOT showed no significant difference on the outcome. High level of ACOT7 related with poor outcome in both chemotherapy-only group and HSCT group. CONCLUSIONS: High expression level of ACOT7 indicates unfavorable outcome in AML patients. Allo-HSCT could not overcome the unfavorable effect of ACOT7 in these patients.
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