Doublehit淋巴瘤（double hit lymphoma，DHL）是同时具有MYC和Bcl-2、Bcl-6、Bcl-3或CCNDI基因重排的B细胞淋巴瘤[1-2]、DHL总体发病率较低，病理类型多为灰区淋巴瘤、弥漫大B细胞淋巴瘤（DLBCL）、伯基特淋巴瘤和滤泡淋巴瘤等[3]。DHL呈高度侵袭性，对于现有标准免疫化疗、自体造血干细胞移植（auto．HSCT）反应差，患者多出现早期耐药和复发，预后极差。对于DHL尚无推荐治疗方案[4]。我们收治1例具有MYC和Bcl．2重排的DHL灰区淋巴瘤患者，通过强烈免疫化疗获得完全缓解后以异基因造血干细胞移植（allo—HSCT）作为巩固治疗，报告如下并进行文献复习。
We retrospectively investigated the prognostic factors of acute myeloid leukemia(AML) in 152 Chinese patients with de novo AML who were older than 60 years of age and who received treatment at our hospital.Log-rank test showed that 6 parameters including older age,higher white blood cell(WBC) counts,lactate dehydrogenase(LDH)and bone marrow(BM) blasts at diagnosis,unfavorable risk cytogenetics,and non-mutated CEBPα were significant adverse prognostic factors of overall survival(OS) for elderly AML patients(P = 0.0013,0.0358,0.0132,0.0242,0.0236 and 0.0130,respectively).Moreover,older age and higher LDH were significant adverse predictors for relapse-free survival(RFS)(P = 0.0447 and 0.0470,respectively).Univariate analysis revealed similar results for OS to those of the log-rank test and only higher LDH at diagnosis was a significant adverse predictor for RFS(P = 0.028,HR:1.979,95%CI:1.075-3.644).In multivariate analysis,we identified 2 trends towards independent prognostic factors for OS,including BM blasts at diagnosis(P = 0.057,HR:1.676,95%CI:0.984-2.854)and mutation status of CEBPα(P = 0.064,HR:4.173,95%CI:0.918-18.966).Our data indicated that older age,gender and a previous history of hematologic diseases resulted in lower complete remission rate(P = 0.012,0.051 and 0.086,respectively).We further developed an easy scoring system for predicting prognosis and response to induction therapy in older AML patients.Patients who had lower scores showed significantly longer OS and RFS(P = 0.0006 and 0.1001,respectively) and higher CR rate(P = 0.014).Our research is limited by its retrospective nature and the results from our study need to be further validated by prospective randomized clinical trials.
Background: Serum antinuclear antibodies (ANAs) are positive in some patients with chronic lymphocytic leukemia (CLL), prognostic value of ANAs remains unknown. The aim of this study was to evaluate the role of ANAs as a prognostic factor in CLL. Methods: This study retrospectively analyzed clinical data from 216 newly diagnosed CLL subjects with ANAs test from 2007 to 2017. Multivariate Cox regression analyses were used to screen the independent prognostic factors related to time to first treatment (TTFT), progression free survival (PFS) and overall survival (OS). Receiver operator characteristic curves and area under the curve (AUC) were utilized to assess the predictive accuracy of ANAs together with other independent factors for OS. Results: The incidence of ANAs abnormality at diagnosis was 13.9%. ANAs positivity and TP53 disruption were independent prognostic indicators for OS. The AUC of positive ANAs together with TP53 disruption was 0.766 (95% confidence interval [CI]: 0.697-0.826), which was significantly larger than that of either TP53 disruption (AUC:0.706, 95% CI:0.634-0.772, P=0.034) or positive ANAs (AUC:0.595, 95% CI:0.520-0.668,P<0.001) in OS prediction. Besides, serum positive ANAs as one additional parameter to CLL-international prognostic index (IPI) obtained superior AUCs in predicting CLL OS than CLL-IPI alone. Conclusion: This study identified ANAs as an independent prognostic factor for CLL, and further investigations are needed to validate this finding.
