Objective
To observe regular monitoring in patients with chronic myeloid leukemia (CML) who received tyrosine kinase inhibitor (TKI), and to analyze its influencing factors.
Methods
A total of 857 patients with CML in Henan Tumor Hospital from October 2012 to October 2016 were collected. Patients were told to receive regular monitoring after receiving TKI treatment, including blood routine, bone marrow, BCR-ABL fusion gene and chromosomes. All patients were divided into good and poor compliance groups according to regular monitoring. Chi-square test was used to compare ABL kinase domain mutations rate and mortality between two groups. TKI species, level of education, duration from diagnosis to treatment, teaching times, sites of follow-up, convenience of transportation, annual income and gender were recorded respectively, and the factors affecting regular monitoring were analyzed by using single and multiple factor analysis.
Results
There were 390 and 467 patients in good and poor compliance groups respectively. Treatment failure rate was 19.49% (76/390) and 25.91% (121/467) in good and poor compliance groups respectively, the mutation rate was 28.95%(22/76) and 7.44% (9/121) respectively. The difference of ABL kinase domain mutation in patients with treatment failure of both groups was statistically significant (χ 2= 16.287, P < 0.01). The mortality was 0.77% (3/390) in good compliance group, and 2.78% (13/467) in poor compliance group, and the difference was statistically significant (χ 2= 4.543, P= 0.033). The single factors analysis showed that TKI species, level of education, duration from diagnosis to treatment, teaching times, sites of follow-up, convenience of traffic and annual income were related with regular monitoring (all P < 0.05). Multiple-factor analysis showed that inconvenient transportation (β= 1.56, 95% CI 1.74-3.74, P= 0.014), low education level (β= 1.67, 95% CI 0.81-3.12, P= 0.041) and low income (β= 2.87, 95% CI 1.31-4.51, 95% CI 1.74-3.74, P= 0.011) were independent factors for poor compliance in regular monitoring. In the result detection, 56 fusion genes fluctuated.
Conclusions
CML patients who received regular monitoring have a low treatment failure rate and mortality. Inconvenient transportation, low education level and low outcome are independent risk factors for regular monitoring. The single monitoring result can not prompt treatment effect, and thus it needs to review and monitor for many times.
Key words:
Leukemia, myelogenous, chronic; Tyrosine kinase inhibitors; Regular monitoring; Compliance
Objective
To explore the hematology adverse reactions of imatinib mesylate (IM) in the treatment of chronic phase (CP) of chronic myeloid leukemia (CML).
Methods
The clinical data of 435 CML-CP patients treated with IM were analyzed respectively in the Affiliated Cancer Hospital of Zhengzhou University from Jan 2013 to Jan 2015. The hematology adverse reactions were followed up regularly and the incidences in different groups with various factors were compared.
Results
Until the end of follow-up, 74 (17.0 %) patients had hematology adverse reactions. 61 (14.02 %) patients had neutropenia, including 9 (14.75 %) patients who had level Ⅲ-Ⅳ neutropenia. 60 (13.79 %) cases had thrombocytopenia including 11 (18.33 %) patients with level Ⅲ-Ⅳ thrombocytopenia. Anemia occurred in 50 (11.49 %) patients, of whom 5 (10.00 %) cases were grade Ⅲ-Ⅳ anemia. 33 (7.59 %) cases experienced pancytopenia. The incidence of hematology adverse reactions was influenced by nine factors, including the course before treatment, the size of spleen, Sokal scores, the use of interferon, fusion genes, chromosomes, complete cytogenetic response, main molecular reaction and Karnofsky scores (all P 0.05).
Conclusions
During the initial treatment of CML-CP, if patients experienced level Ⅰ-Ⅱ hematology adverse reactions, they can continue to taking IM. However, when level Ⅲ-Ⅳ hematology adverse reactions happened, they need to reduce the dose or stop taking, and one month later, hemocyte will get well. In the long-term treatment of CML, once level Ⅲ-Ⅳ hematology adverse reactions occur, the patients need to receive some related inspections, such as bone marrow morphology and molecular biology detection, to clear the disease stage. When it is necessary, the patients can take the second generation of tyrosine kinase inhibitors.
Key words:
Leukemia, myeloid, chronic; Imatinib mesylate; Hematology adverse reactions
Abstract This study aimed to observe the safety and clinical efficacy of early application of ruxolitinib to prevent acute graft-versus-host disease (aGVHD) after alternative donor transplantation in acute leukemia. There were 57 patients undergoing allo-HSCT at the Affiliated Cancer Hospital of Zhengzhou University from July 2017 to October 2019. They were divided into control(16 patients) and ruxolitinib (41 patients) groups. For aGVHD prophylaxis, the control group received post-transplantation cyclophosphamide, antithymocyte globulin-Fresenius, cyclosporine A, and mycophenolate mofetil, while in the ruxolitinib group, ruxolitinib 5 mg/d in adults or 0.07–0.1 mg/(kg d) in children was administered from the day of neutrophil engraftment to 100 days post-transplantation based on control group. We found 55 patients had successful reconstitution of hematopoiesis; No significant difference was found in cGVHD, hemorrhagic cystitis, pulmonary infection, intestinal infection, Epstein-Barr virus infection, cytomegalovirus infection, relapse, death, and nonrelapse mortality. The incidences of aGVHD (50 vs. 22%, P = 0.046) and grade II–IV aGVHD (42.9 vs. 12.2%, P = 0.013) were significantly higher in the control group than in the ruxolitinib group. No significant differences were observed in overall survival ( P = 0.514), disease-free survival ( P = 0.691), and cumulative platelet transfusion within 100 days post-transplantation between two groups. This suggests early application of ruxolitinib can reduce the incidence and severity of aGVHD and patients are well tolerated.
Biofilm accumulation on the polymethyl methacrylate (PMMA) restorations negatively affect the prognosis of the provisional restorations or the following treatment. This study developed a novel antibacterial PMMA resin containing low concentration of dimethylaminohexadecyl methacrylate (DMAHDM). Four resins were tested: (1) PMMA resin (Control), (2) 1.25% DMAHDM, (3) 2.5% DMAHDM, (4) 5% DMAHDM. Adding 1.25% DMAHDM into the PMMA resin did not influence the mechanical properties, degree of conversion, monomer releasing, and color stability of the specimens (p > 0.05). The incorporation of DMAHDM into PMMA resin could greatly prevent saliva-derived biofilms adhesion compared with the control group (p < 0.05). The metabolism level of saliva-derived biofilms on the 1.25%, 2.5%, and 5% DMAHDM resins were reduced by 20%, 54%, and 62%, respectively. And the mechanism of DMAHDM disturbing the integrity of bacterial cell walls was confirmed by flow cytometric analysis. Adding 1.25% and 2.5% DMAHDM did not compromise cytocompatibility of the modified resin (p > 0.05). Therefore, novel PMMA resin containing low concentration DMAHDM is promising as a future antimicrobial provisional restoration material for preventing microbial-induced complications in clinical settings. Graphical abstract.
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