Central nervous system leukemia (CNSL) is one of the main causes of recurrence and death in patients with acute leukemia. This study aims to dynamically monitor minimal residual disease (MRD) in cerebrospinal fluid and bone marrow of patients with different types of acute leukemia by flow cytometry (FCM), and to compare the timeliness and consistency of MRD detection between the 2 methods to further explore the application value of monitoring MRD in cerebrospinal fluid.
The aim of the present study was to investigate the value of systemic [18F]fluorodeoxyglucose positron emission tomography (PET)/computed tomography (CT) in the diagnosis and differential diagnosis of aplastic anemia (AA). Systemic PET/CT imaging results of 24 patients diagnosed with AA in The First Affiliated Hospital of Sun Yat-Sen University between May 2011 and August 2014 were retrospectively analyzed and compared with results from healthy individuals and patients with acute leukemia (AL) or myelodysplastic syndrome (MDS) in the same period to summarize the PET/CT characteristics of patients with AA. Systemic PET/CT manifestations of the 24 patients with AA were classified into three types: Normal bone marrow metabolism, hypometabolism and hypometabolism complicated by focal hyperproliferation. Focal hyperproliferation was frequently identified in the vertebral body, breast bones and iliac bones. Bone marrow maximum standardized uptake values (SUV) of AA were associated, to certain extents, with the degree of proliferation and the bone marrow T/B cell ratio. The overall bone marrow SUV of AA were lower compared with those of healthy individuals and AL or patients with MDS, indicating hypometabolism. Considering the T/B cell ratio, systemic PET/CT manifestations of patients with AA are able to predict treatment responses to certain degrees. Systemic PET/CT is highly valuable in the diagnosis and differential diagnosis of AA, and may also indicate treatment responses.
Topic: 14. Myeloma and other monoclonal gammopathies - Clinical Background: Positron emission tomography/computed tomography (PET/CT) can specifically accumulate imaging in tumor tissues.SUVmax is taken from the highest value of FDG uptake in the ROI of the fusion image and represent the metabolism of the target lesion.In our center, we used whole-body 18F-FDG PET/CT to differentiate occult multiple myeloma from pAL, during which we found that affected organs in patients with pAL showed hypermetabolism.In this study, we retrospectively analyzed 18F-FDG PET/CT findings and clinical parameters in 37 newly diagnosed pAL patients in order to investigate the value of 18F-FDG PET/CT for assessing organ involvement in pAL. Aims: To analyze the value of 18F-FDG PET/CT in the evaluation of systemic organ involvement in patients with newly diagnosed primary systemic light chain amyloidosis (pAL). Methods: The clinical data of 37 patients with newly diagnosed pAL admitted to the Department of Hematology of the First Affiliated Hospital, Sun Yat-sen University from October 2013 to June 2021 were retrospectively analyzed. The correlation between 18F-FDG PET/CT assessment and clinical criteria assessment of organ involvement were compared. The relationship between the maximum standardized uptake value (SUVmax), the SUVmax ratio of target organ to mediastinum blood pool (T/Mmax), the SUVmax ratio of target organ to liver blood pool(T/Lmax) and organ biological indicators, disease stage were analyzed. In our study, we focused on the relationship between cardiac biochemical parameters and cardiac FDG uptake. In addition, we analyzed the prognosis value of cardiac FDG uptake. Results: 37 patients with newly diagnosed pAL were included, with a mean age of 59.4±9.6 years. 18F-FDG uptake was observed positive in the heart (29 patients, 78.2%), kidney (16 patients, 43.2%), liver(12 patients, 32.4%), spleen(7 patients, 18.9%), intestine (23 patients, 62.2%), tongue (9 patients, 24.3%), and lung (9 patients, 24.3%). In the heart, liver, spleen and intestine, the positive rate of 18F-FDG PET/CT assessment was significantly higher than the clinical criteria, but 18F-FDG PET/CT assessment for the kidney, lung, tongue, nervous system and bone marrow has limitations. Quantitative analysis (target lesion SUVmax≥2.5) identifies organ involvement at more sites compared with clinical diagnostic criteria. Heart involvement on 18F-FDG PET/CT showed great correlations with the clinical assessment criteria. Patients with N-terminal pro-brain natriuretic peptide (NT-proBNP) ≥1800 pg/ml, interventricular septal (IVS) ≥12 mm, and left ventricular posterior wall (LVPW)≥12 mm showed a higher cardiac SUVmax, T/Mmax, and T/Lmax (p < 0.05). Patients with more advanced Mayo2004 stage, higher troponin T values (TNT), or smaller left ventricular ejection fraction had higher cardiac FDG uptake from a view of a general tendency. Combined cardiac FDG uptake with biochemical parameters could more accurately predict the prognosis of pAL, and are used to identify the patients with terminal stage. Patients with cardiac T/Lmax≥2.6, TNT > 0.035 ng/mL, and NT-proBNP > 332 ng/L had a worse prognosis (P < 0.001), with a median survival time of 6.9 months (See Figure1). Summary/Conclusion: Whole body 18F-FDG PET/CT, as a non-invasive diagnostic method, can comprehensively and intuitively assess systemic organ involvement. 18F-FDG uptake may be used as an indicator to assess organ involvement. Whole body 18F-FDG PET/CT, as a quantitative assessment tool at the organ level, is expected to be used for evaluating organ function accurately, making prediction of disease prognosis, and monitoring organic treatment response.Keywords: AL amyloidosis
Multiple myeloma (MM) is a malignant and incurable neoplasm of plasma cells that accumulate in the bone marrow. Bendamustine, an antitumor agent including double property of alkylating agent and purine analogues, displayed clinical antitumor activity in patients with MM. However, the precise mechanism of action of bendamustine has not been completely elucidated.In this study, we established the cell model of bendamustine-induced MM RPMI8226 cell apoptosis, and used two dimensional differential in-gel electrophoresis (2D-DIGE) proteomics to analyze the bendamustine-induced protein alterations.Our results revealed that compared with control group, bendamustine significantly inhibited the proliferation of RPMI8226 cells in a concentration-dependent and time-dependent manner. Proteomic approach was performed to identify 30 differentially expressed proteins in RPMI8226 cells upon bendamustine treatment, which included 15 up-regulated and 15 down-regulated proteins. Of these, protein disulfide isomerase A3 (PDIA3) and cytokine- induced apoptosis inhibitor 1 (CPIN1), were selected for further studies.These results implicate PDIA3 and CPIN1 as potential molecular targets for drug intervention in MM and thus provide novel insights into the mechanisms of antitumor activity of bendamustine.
Several diagnostic criteria for multiple myeloma are used in clinical practice, and it can be difficult to reach a diagnosis when a patient's clinical presentation is consistent with one criterion but not with another. However, no study to date has compared the superiority of the different diagnostic criteria. The aim of this research is to compare the efficacy of five diagnostic criteria for multiple myeloma and to find the reasons for misdiagnosis of atypical multiple myeloma cases.A total of 227 multiple myeloma cases were retrospectively studied. The clinical data (including plasma cell morphology, flow cytometry, immunofixation electrophoresis, imaging information and clinical manifestations) were scrutinized and the reasons underlying the misdiagnoses analyzed.The Traditional Domestic criteria had the highest misdiagnosis rate due to the high fixed bone marrow plasma cell percentage and serum M-protein thresholds. The WHO criteria and the International Myeloma Working Group 2009 criteria exhibited relatively low misdiagnosis rates due to their lower bone marrow plasma cell percentage thresholds, flexible criteria and detailed end-organ damage descriptions. The 2003 International Myeloma Working Group criteria and the 2011 Chinese Myeloma Working Group criteria exhibited perfect performance, as each focused on monoclonal plasma cell proliferation and not on fixed bone marrow plasma cell percentage and serum M-protein thresholds.The 2003 International Myeloma Working Group criteria and the 2011 Chinese Myeloma Working Group criteria have advantages in diagnosing early or atypical multiple myeloma cases. To avoid misdiagnosing some atypical cases of multiple myeloma, attention should be paid to evidence of monoclonal plasma cell proliferation, and flow cytometry may be a useful tool for discovering monoclonal plasma cell proliferation. Advanced imaging techniques should be used to confirm any suspected or atypical findings on metastatic bone survey.
The purpose of this paper is to develop a method to automatic classify capsule gastroscope image into three categories to prevent high-risk factors for carcinogenesis, such as atrophic gastritis (AG). The purpose of this research work is to develop a deep learning framework based on transfer learning to classify capsule gastroscope image into three categories: normal gastroscopic image, chronic erosive gastritis images, and ulcer gastric image.
The aim of the present study was to verify the potential association between multiple myeloma (MM) and hepatitis B/C virus (HBV/HCV) infection. This retrospective case–control trial included 299 patients with MM and 299 patients with acute leukemia (AL). Age and sex were matched between the two groups. The hepatitis B surface antigen (HBsAg) positivity rate was significantly higher in the MM group (19.4% vs. 12.0% in patients with AL; p = 0.014). The rate of HCV infection did not differ between the two groups. The incidence of cirrhosis was significantly higher in HBsAg+ patients (17.2% vs. 6.2% in HBsAg− patients; p = 0.011). The rate of hepatitis E virus (HEV) infection was also significantly higher in HBsAg+ patients (5.2% vs. 0.4% in HBsAg− patients; p = 0.025). Hepatic damage was much more common in HBsAg+ patients than in HBsAg− patients both prior to (22.4% vs. 8.7%; p = 0.006) and during chemotherapy for MM (67.2% vs. 28.6%; p < 0.001). ISS stage, HBsAg+, the use of bortezomib and thalidomide and autologous stem cell transplant were significant factors for overall survival in univariate analysis. In the Cox regression analysis, ISS stage (p = 0.027), HBsAg+ (p = 0.042) and the use of thalidomide (p = 0.001) showed a significant effect on the OS of these patients. The prevalence of HBV infection is higher in patients with MM than in subjects with other hematological malignancies such as AL. Hepatic injury is more common in patients with MM with HBV infection, particularly during chemotherapeutic treatment. HBsAg positivity may be a prognosis factor in patients with MM in HBV endemic areas.
Abstract RUNX2 is a transcription factor that participates in osteoblast differentiation and chondrocyte maturation and plays an important role in the invasion and metastasis of cancers. With the deepening of research, evidence has indicated the correlation between RUNX2 and bone destruction in cancers. However, the mechanisms underlying its role in multiple myeloma remain unclear. By observing the induction effects of conditioned medium from myeloma cells on preosteoblasts (MC3T3-E1) and preosteoclasts (RAW264.7) and constructing myeloma-bearing mice, we found that RUNX2 promotes bone destruction in multiple myeloma. In vitro, conditioned medium from RUNX2-overexpressing myeloma cells reduced osteoblast activity and increased osteoclast activity. In vivo, RUNX2 expression was positively correlated with bone loss in myeloma-bearing mice. These results suggest that therapeutic inhibition of RUNX2 may protect against bone destruction by maintaining the balance between osteoblast and osteoclast activity in multiple myeloma.
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