Jianping Shen

Multi-central Clinical Research into Treating 80 Cases of Chronic Thrombocytopenia with Qi-supplementing and Yin-nourishing Therapy and Western Medicine

OBJECTIVE To probe the effects of qi-supplementing and yin-nourishing therapy (blood-increasing decoction and blood generating powder) on chronic thrombocytopenia. METHODS Two hundred patients with chronic thrombocytopenia were randomly divided into control (n = 100) and test groups (n = 100) with Amino-polypeptide as a basic treatment for both. Test group patients consumed a blood-increasing decoction and blood-generating powder for 1-3 months. Improvements in platelet counts and TCM syndrome were observed. RESULTS One hundred and sixty-four (80 in the test group and 84 in the control group) of 189 total participants were treated for 3 months. The total effective rate in improving TCM syndrome was 95.00% in the test group and 79.76% in the control group (P < 0.05). There was significant difference (P < 0.05) in the accumulated score of TCM syndrome between the two groups treated at different time points. The total effective rate of platelet counts was 86.25% in the test group and 59.52% in the control group (P < 0.05). There was a significant difference in platelet counts before and after treatment in the two groups (P < 0.05). There was no significant differences in platelet count between the two groups treated for 1-2 months; however, a significant difference was found between the two groups after treatment for 3 months (P < 0.05). CONCLUSIONS After a 3-month treatment of chronic thrombocytopenia patients with qi-supplementing and yin-nourishing therapy, TCM syndrome was improved and platelet counts increased with no obvious side effects, and the quality of life of the participants was enhanced with noticeable long-term curative effects.

The combination of thymosin and methylprednisolone for the treatment of a patient with colonic ulcers, subcutaneous nodules, and pleural effusion after dasatinib treatment for chronic myeloid leukemia.

The tyrosine kinase inhibitor (TKI) imatinib is the first-line treatment for chronic myeloid leukemia (CML). However, approximately 30% of patients need a more effective therapy within 5 years of the diagnosis of CML [1]. Dasatinib is a novel multitargeted TKI that is used for the treatment of imatinib-resistant or imatinib-intolerant patients with CML in any phase of the disease [2]. The main side effects of this drug include myelosuppression, pleural effusions, bleeding, rashes, and fatigue [3]. Subcutaneous nodules have not been reported. We report a 71-year-old man with chronic-phase CML who developed colonic ulcers, subcutaneous nodules, and pleural effusion after treatment with dasatinib. CML was diagnosed by bone marrow (BM) biopsy 10 years ago in this man. The disease was controlled initially by combination therapy with interferon-a and hydroxyurea for the first 4 years after diagnosis. Six years ago, he began to be treated with imatinib at a standard dose of 400 mg/day and had a good response to this drug. He developed resistance to imatinib treatment 2 years ago. The daily dose of imatinib was increased to 600 mg for 6 months, but his resistance to imatinib persisted. Afterward, he received nilotinib orally at dose of 600 mg twice daily (b.d.) for 4 months, but this treatment was not effective for this patient. The patient was admitted to the Department of Hematology at the First Hospital Affiliated to Zhejiang Chinese Medical University on 15 December 2007, due to fever. Physical examination showed enlarged splenomegaly that reached the umbilicus, but there was no enlargement of the superficial lymph nodes. Laboratory tests revealed the following: white blood cell count (WBC) 138.16 10/L; hemoglobin (Hb) 73 g/L; platelets (Plt) 676 10/L; myeloblasts 1%; promyelocytes 1%; basophils 30%; eosinophils 9%; Philadelphia (Ph) chromosomeþ; and BCR/ABLþ. A further BM biopsy confirmed that the patient was in the accelerated phase of CML (myeloblasts 12%). After admission, the patient was given dasatinib 70 mg orally b.d. and he soon recovered. His temperature returned to normal, the splenomegaly reduced in size, and the routine blood results normalized. However, 3 weeks after the recommencement of dasatinib treatment, he further developed persistent bright-red bloody stools. There was no evidence of fever, vomiting, abdominal pain, or other symptoms. After emergency treatment with octreotide to establish hemostasis, his gastrointestinal bleeding stopped. One month later, he developed fresh bloody stools again. An emergency colonoscopy revealed whole-colon multiple ulcers and erosions accompanied by bleeding [Figure 1(A)]. Pathological examinations suggested lymphocytic infiltration and other inflammatory lesions, but no evidence of any infiltration by leukemic cells [Figure 1(B)]. His symptoms were alleviated after pentasa treatment at 0.5 g four times daily and calcium folinate coloclysis. In the mean time, the patient gradually developed bilateral multiple scattered subcutaneous nodulated masses on his lower legs; these masses increased progressively and ultimately fused; the patient felt significant bilateral lower limb swelling and pain

Twelve cases of malignant hematopathy treated by combined therapy of hematopoietic stem cell transplantation and Chinese herbal medicine

ObjectiveTo evaluate the effect of hematopoietic stem cell transplantation combined with Chinese erbal medicine in treating malignant hematopathy.MethodsAllo-bone marrow transplantation (allo-BMT) or allo-peripheral blood stem cell transplantation (allo-PBSCT), with conditioning regimen of60Co total body irradiation + Cyclophosphamide (TBI+ Cy) or busulfan + cyclophosphamide (Bu + Cy), was used to treat 4 cases of chronic granulocytic leukemia (CGL, 3 of chronic phase and 1 of accelerating phase) and one case of acute non-lymphocytic leukemia (ANLL). And auto-BMT or auto-PBSCT, with conditioning regimen of myleran + cytosino arabinoside + cyclophosphamide (MAC) or MAC+ VP16, was used to treat 7 cases of hematopathy, including 5 cases of ANLL (3 of CR1 and 2 of CR2) and 2 cases of malignant lymphoma (1 of the first occurrence and 1 of relapse). Chinese herbal medicine was given orally to all the 12 patients after transplantation according to TCM Syndrome Differentiation.ResultsAll patients were successfully engrafted. Within the median follow-up period of 18 (4-70) months, 1 patient (8.3%) died a transplantation-related death, 3 (25.0%) relapsed and 8 (66.7%) survived free of original disease.Conclusion: Auto-BMT or auto-PBSCT inCR1 stage of acute leukemia could reduce the relapse rate, when there was no matched bone marow donor; allo-BMT or allo-PBSCT in chronic stage could result in long-term disease-free survival of patients; Chinese herbal medicine administration in patients of malignant hematopathy after transplantation might reduce the complications and plays certain role in promoting recovery of hematopoietic function.

The regulatory roles of VEGF-Notch signaling pathway on aplastic anemia with kidney deficiency and blood stasis: DENG et al.

Vascular endothelial growth factor (VEGF)‐Notch signaling pathway plays an important role in aplastic anemia (AA). This study aimed to evaluate the regulatory roles of VEGF‐Notch signaling pathway on mesenchymal stem cells (MSCs) isolated from AA patients with kidney deficiency and blood stasis (KB) (AA MSCs).

Successful Treatment of Lung Aspergillus terreus Infection After a Second Hematopoietic Stem Cell Transplant in a Patient With Myelodysplastic Syndrome

A 24-year-old man was diagnosed with myelodysplastic syndrome and received a haploidentical hematopoietic stem cell transplant. The patient experienced graft failure posttransplant. Analysis of specific antibodies revealed that the patient had strongly positive donor-specific antibodies; therefore, we changed the donor to the patients mother and added a single unit of cord blood to perform the second transplant. Corresponding treatments targeting donor-specific antibodies were administered to reverse the graft rejection and to reduce the antibody load. The grafts were implanted successfully, but the patient developed an invasive fungal infection. A lung biopsy was performed, and the pathogen was confirmed to be Aspergillus terreus via gene sequencing and analysis. The combined treatment of micafungin and posaconazole had good efficacy in this case, and this patient now receives close follow-up and receives oral posaconazole for antifungal maintenance treatment.

Effect of Chinese medicine treatment based on pattern identification on cellular immunophenotype of myelodysplastic syndrome

ObjectiveTo observe the influence of treatment based on Chinese medicine pattern identification on cellular immunophenotype of the myelodysplastic syndrome (MDS).MethodsSixty patients with MDS were randomly and equally assigned to the treatment group and the control group using a randomized digital table. Thirty patients in each group included 3 risk levels (low, moderate and high risks) with each level 10 patients according to the international prognostic scoring system. The control group was given conventional therapy which was also used in the treatment group. While the treatment group was given Zuogui Pill (左归丸) and Yougui Pill (右归丸) for low risk patients; Qingwen Baidu Decoction (清瘟败毒饮) and Bazhen Decoction (八珍汤) for moderate risk patients; Gexia Zhuyu Decoction (膈下逐瘀汤) and Qinghao Biejia Decoction (青蒿鳖甲汤) combined with Shiquan Dabu Decoction (十全大补汤) for high risk patients. After the treatment, the differences of overall response rate and immunophenotype (CD13, CD14, CD15, CD33 and CD34) of each group were analyzed.ResultsThe overall response rate of the treatment group was significantly higher than the control group in low risk and moderate risk patients (P=0.029), there was no statistical differences of overall response rate between the treatment group and the control group in high risk patients (P=0.089). The expressions of CD13, CD14, CD33 and CD34 in all three risk levels of the treatment group were obviously decreased after the treatment, while CD15 in all three risk levels of the treatment group was obviously increased after the treatment (P<0.05 or P<0.01). Meanwhile, the difference values of CD13 and CD33 in low risk level of the treatment group, CD33 and CD34 in moderate risk level of the treatment group as well as CD34 and CD15 in high risk level of the treatment group, were all greater than the control groups and they were statistically significant (P<0.05 or P<0.01).ConclusionsIt shows a better therapeutic effect if the MDS patients treated with Chinese medicine pattern identification in addition to conventional therapy. Since the treatment may inhibit the malignant clones and improve the dysmaturity of granulocyte differentiation, it is a feasible option in clinical practice.

Secondary acute myeloid leukemia occurring after successful treatment of acute promyelocytic leukemia

Secondary neoplasm is one of the most devastating complications of cancer therapy. In patients with acute lymphoblastic leukemia (AML), the cumulative risk of secondary neoplasia ranges from 1.2 to 3.3% [1]. Secondary acute myeloid leukemia (sAML) occurs in 10–30% of AML cases [2]. sAML has been documented following the treatment of Hodgkin’s disease, acute lymphoblastic leukemia, and ovarian and breast cancer. The major causes of sAML are alkylating agents, topoisomerase II inhibitors, and radiotherapy used to treat the primary cancers [3–6]. Patients with acute promyelocytic leukemia (APL) treated with regimens that include trans-retinoic acid (ATRA) have typically achieved long-term disease-free survival [7]. However, recent data show an increase in the rate of secondary neoplasms in these patients [8]. Ninety-five patients with APL received arsenic trioxide (ATO) as maintenance therapy at the Department of Hematology, First Hospital Affiliated to Zhejiang Chinese Medical University, China, between 1997 and 2011. Fiftyeight patients were seen in follow-up for a mean of 10 years. During that time, we found one case of sAML that occurred after the complete remission of APL. In 1999, a 57-year-old man was diagnosed via bone marrow biopsy with AML-M3b (Fig. 1a). Chromosomal analysis showed 46,XY,t(15;17) and detected the PML/RARa fusion gene. The immune phenotype showed the following: the ratio of promyelocytic leukemia cells to non-erythroid cells: 56.07%; CD117: 44.5%; CD3: 0.64%; CD7: 5.53%; CD2: 26.90%; CD13: 98.60%; CD33: 96.7%; CD34: 16.6%; CD38: 99%; CD14: 1.08%; CD15: 2.76%; CD11b: 1.32%; HLA-DR: 6.70%; CD19: 3.77%; CD20: 1.04%; CD22: 0.43%; CD10: 0.6%; and CD56: 2.01%. The patient achieved remission after a 1-month course of ATRA 40 mg BID. He then underwent consolidation chemotherapy, which consisted of eight courses of the DA regimen (daunorubicin 60 mg QD on d1-3 ? cytarabine 150 mg QD on d1-7), followed by maintenance chemotherapy (21day course of arsenic trioxide 10 mg QD, once every 2–4 months). The overall course of treatment lasted approximately 3 years. Multiple post-treatment bone marrow biopsies did not detect the PML-RARa fusion gene, which confirmed complete remission. In the following 7 years, he received no further chemotherapy. In September 2010, he experienced pharyngalgia and presented with WBC 2.4 9 10/L, Hb 117 g/L, and platelets 47 9 10/L. Blood coagulation and plasma protamine paracoagulation tests were negative. The results of a bone marrow biopsy showed 53.5% primordial myelocytes that were positive for peroxidase (Fig. 1b). The immunophenotype was as follows: ratio of primordial myelocytes to non-erythroid cells: 52.47%; CD7: 4.97%; CD19: 1.54%; CD64: 52.24%; CD56: 55.69%; CD15: 1.25%; CD117: 95.03%; CD13: 69.8%; CD33: 86.5%; CD34: 92.69%; CD14: 0.03%; CD16: 9.11%; CD11b: 6.98%; HLA-DR: 1.06%; CD71: 29.11%; CD35: 58.74%; CD36: 25.29%; and CD65 s: 7.10%. Tests were negative for bcr1, bcr2, bcr3, and their variant types of PML/RARa fusion genes. Chromosome analysis showed 46,XY,-10, ?mar[1]/69,XXY,-10,-11, ?2mar[4]/46,XY,[10]. FISH was negative for t(15;17). The patient was diagnosed with sAML-M2a. He received one course of the GAA regimen (G-csf 150 lg qd on d0–14, aclacinomycin 20 mg qd on d1-7, cytarabine 20 mg bid on d1–14) and one course of intravenous arsenic J. Chen (&) Z. Zheng J. Shen L. Peng H. Zhuang W. Liu Y. Zhou Department of Hematology, First Hospital Affiliated to Zhejiang Chinese Medical University, YouDian Road 54#, Hangzhou 310006, Zhejiang, China e-mail: jfch1@163.com