Early T-cell precursor acute lymphoblastic leukemia (ETP-ALL) is a highly aggressive subtype of T-ALL. No standard chemotherapy regimen exists for patients with recurrent/refractory (R/R) ETP-ALL; in these patients, the primary goal of salvage therapy is to achieve remission as a foundation for consolidation and intensification treatments. This study reports cases of two patients with R/R ETP-ALL who underwent salvage therapy of venetoclax combined with the CAG regimen and achieved complete remission in the bone marrow. Flow cytometry results were negative for minimal residual disease. Both patients were bridged to allogeneic hematopoietic stem cell transplantation (HSCT) and in complete remission over a 3-year follow-up period. These cases show that the use of venetoclax combined with the CAG regimen may offer patients with R/R ETP-ALL an opportunity for allogeneic HSCT.
Non-small cell lung cancer (NSCLC) is the leading cause of cancer death, reflecting the need for better understanding the oncogenesis, and developing new diagnostic and therapeutic targets for the malignancy. Emerging evidence suggests that small nucleolar RNAs (snoRNAs) have malfunctioning roles in tumorigenesis. Our recent study demonstrated that small nucleolar RNA 42 (SNORA42) was overexpressed in lung tumors. Here, we investigate the role of SNORA42 in tumorigenesis of NSCLC. We simultaneously assess genomic dosages and expression levels of SNORA42 and its host gene, KIAA0907, in 10 NSCLC cell lines and a human bronchial epithelial cell line. We then determine in vitro functional significance of SNORA42 in lung cancer cell lines through gain- and loss-of-function analyses. We also inoculate cancer cells with SNORA42-siRNA into mice through either tail vein or subcutaneous injection. We finally evaluate expression level of SNORA42 on frozen surgically resected lung tumor tissues of 64 patients with stage I NSCLC by using quantitative reverse transcriptase PCR assay. Genomic amplification and associated high expression of SNORA42 rather than KIAA0907 are frequently observed in lung cancer cells, suggesting that SNORA42 overexpression is activated by its genomic amplification. SNORA42 knockdown in NSCLC cells inhibits in vitro and in vivo tumorigenicity, whereas enforced SNORA42 expression in bronchial epitheliums increases cell growth and colony formation. Such pleiotropy of SNORA42 suppression could be achieved at least partially through increased apoptosis of NSCLC cells in a p53-dependent manner. SNORA42 expression in lung tumor tissue specimens is inversely correlated with survival of NSCLC patients. Therefore, SNORA42 activation could have an oncogenic role in lung tumorigenesis and provide potential diagnostic and therapeutic targets for the malignancy.
The primary objective of phase I oncology studies is to establish the safety profile of a new treatment and determine the maximum tolerated dose (MTD). This is motivated by the development of cytotoxic agents based on the underlying assumption that the higher the dose, the greater the likelihood of efficacy and toxicity. However, evidence from the recent development of cancer immunotherapies that aim to stimulate patients' immune systems to fight cancer challenges this assumption, particularly further escalation after a certain dose level might not necessarily increase the efficacy. Dose escalation study of molecular targeted agents (MTA) often does not only rely on the safety profile. In this paper, we propose a simple and flexible model that uses multivariate Gaussian latent variables to integrate toxicity endpoint and efficacy biomarker. This model can be easily extended to incorporate additional immune biomarkers. By simultaneously considering multiple outcomes, the proposed method is better at identifying the biologically optimal dose, which results in better decision-making. Simulation studies showed that the proposed method has desirable operating characteristics by determining the target dose with an optimal risk-benefit trade-off. We have also implemented our proposed method in a user-friendly R Shiny tool.
The following factors are worthy taking very seriously for preventing hospitalized patient′s fall: scientific and objective assessment,health education for patients,comprehensive hospital administration,combined multiple working,continual summarized and improved experience,overall improvement of nursing processes.It can significantly reduce the incidence of hospitalized patient′s fall,and increase integral quality of nurse teams.
Background: Although laparoscopic liver resection (LLR) has been increasingly popular worldwide, there is lack of predictive model to evaluate the feasibility and safety of LLR. The aim of this study was to establish a scoring system for predicting the possibility of conversion and complication, which could facilitate the patient selection for clinicians and communication with patients and their relatives during the informed consent process. Methods: Consecutively 696 patients between August 1998 and December 2016 underwent LLR were recruited. The entire cohort was divided randomly into development and validation cohorts. The scoring system for conversion and complication were established according to risk factors identified from multiple logistic analysis. Subgroup analysis was performed to assess the clinical application. And the C-index and decision curve analysis (DCA) were conducted to evaluate the discrimination in comparison with other predictive models. Results: Six hundred and ninety-six patients were enrolled eventually. The rate of conversion in the development and validation cohorts was 8.3% and 10.3%, respectively. Compared with 12.6% complication rate in the development cohort, 12.9% was concluded in the validation cohort. Upon on the identified risk factors, the risk stratification model was established and validated. Subsequent subgroup analysis indicated low risk patients presented superior surgical outcomes compared with high risk patients. Besides, the C-index and DCA implied our models had better capacities of predicting conversion and complication in comparison with previous scoring systems. Conclusions: This novel scoring system presents the remarkable capacities of predicting conversion, complication in LLR. And thereby, it could be a useful instrument to facilitate the patient selection for clinicians and communication with patients and their relatives during the informed consent process.
The tumor necrosis factor-alpha-related apoptosis-inducing ligand (TRAIL) and oncolytic viruses have recently been investigated extensively for cancer therapy. However, preclinical and clinical studies have revealed that their clinical application is hampered by either weak anticancer activity or systemic toxicity. We examined whether the weaknesses of the two strategies can be overcome by integrating the TRAIL gene into an oncolytic vector.We constructed a TRAIL-expressing oncolytic adenovector designated as Ad/TRAIL-E1. The expression of both the TRAIL and viral E1A genes is under the control of a synthetic promoter consisting of sequences from the human telomerase reverse transcriptase promoter and a minimal cytomegalovirus early promoter. The transgene expression, apoptosis induction, viral replication, antitumor activity, and toxicity of Ad/TRAIL-E1 were determined in vitro and in vivo in comparison with control vectors.Ad/TRAIL-E1 elicited enhanced viral replication and/or stronger oncolytic effect in vitro in various human cancer cell lines than a TRAIL-expressing, replication-defective adenovector or an oncolytic adenovector-expressing green fluorescent protein. Intralesional administration of Ad/TRAIL-E1 eliminated all s.c. xenograft tumors established from a human non-small cell lung cancer cell line, H1299, on nu/nu nude mice, resulting in long-term, tumor-free survival. Furthermore, we found no treatment-related toxicity.Viral replication and antitumor activity of oncolytic adenovirus can be enhanced by the TRAIL gene and Ad/TRAIL-E1 could become a potent therapeutic agent for cancer therapy.
Delivery of therapeutic genes to disseminated tumor sites has been a major challenge in the field of cancer gene therapy due to lack of an efficient vector delivery system. Among the various vectors currently available, liposomes have shown promise for the systemic delivery of genes to distant sites with minimal toxicity. In this report, we describe an improved extruded DOTAP:cholesterol (DOTAP:Chol) cationic liposome that efficiently delivers therapeutic tumor suppressor genes p53 and FHIT, which are frequently altered in lung cancer, to localized human primary lung cancers and to experimental disseminated metastases. Transgene expression was observed in 25% of tumor cells per tumor in primary tumors and 10% in disseminated tumors. When treated with DOTAP:Chol-p53 and -FHIT complex, significant suppression was observed in both primary (P < 0.02) and metastatic lung tumor growth (P < 0.007). Furthermore, repeated multiple treatments revealed a 2.5-fold increase in gene expression and increased therapeutic efficacy compared to single treatment. Finally, animal survival experiments revealed prolonged survival (median survival time: 76 days, P < 0.001 for H1299; and 96 days, P = 0.04 for A549) when treated with liposome-p53 DNA complex. Our findings may be of importance in the development of treatments for primary and disseminated human lung cancers.
Background: Laparoscopic resection (LAP) for small bowel gastrointestinal stromal tumors (GISTs) is not as common as for stomach. This study aimed to evaluate the safety and efficacy of LAP for small bowel GISTs with systematic review and meta-analysis. Methods: The Web of Science, Cochrane Library, Embase, and PubMed databases before December 2016 were comprehensively searched to retrieve comparative trials of LAP and conventional open resection (OPEN) for GISTs of small bowel with a relevance of review object. These researches reported intraoperative and postoperative clinical course (operation time, blood loss, time to first flatus and oral intake, hospital stay, morbidity, and mortality), oncologic outcomes, and long-term survival status. Results: Six studies involving 391 patients were identified. Compared to OPEN, LAP had associated with a shorter operation time (weighted mean difference [WMD] = −27.97 min, 95% confidence interval [CI]: −49.40–−6.54, P < 0.01); less intraoperative blood loss (WMD = −0.72 ml; 95% CI: −1.30–−0.13, P = 0.02); earlier time to flatus (WMD = −0.83 day; 95% CI: −1.44–−0.22, P < 0.01); earlier time to restart oral intake (WMD = −1.95 days; 95% CI: −3.31–−0.60, P < 0.01); shorter hospital stay (WMD = −3.00 days; 95% CI: −4.87–−1.13, P < 0.01); and a decrease in overall complications (risk ratio = 0.56, 95% CI: 0.33–0.97, P = 0.04). In addition, the tumor recurrence and long-term survival rate showed that there was no significant difference between the two groups of patients. Conclusions: LAP for small bowel GISTs is a safe and feasible procedure with shorter operation time, less blood loss, less overall complications, and quicker recovery. Besides, tumor recurrence and the long-term survival rate are similar to open approach. Because of the limitations of this study, methodologically high-quality studies are needed for certain appraisal.
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