Xiaofang Wang

Toll-like receptor 4-induced inflammatory responses contribute to the tumor-associated macrophages formation and infiltration in patients with diffuse large B-cell lymphoma

To evaluate the expression of tumor-associated macrophages (TAMs) and Toll-like receptor 4 (TLR4) in diffuse large B-cell lymphoma (DLBCL) and their correlation with patient clinical characteristics, we detected using immunohistochemistry in 81 specimens of patients with DLBCL. The correlation between protein expression levels and clinical parameters, as well as the association between CD68 and TLR4 were analyzed. The number of CD68 TAMs was closely related to β2-microglobulin (P = .028 and P < .05), whereas there was no significant correlation between the number of CD68 TAMs and other clinical factors. Toll-like receptor 4 was related to tumor size and peripheral blood lymphocyte to monocyte ratio. The Spearman correlation coefficient indicated a significant positive correlation between CD68 TAMs and TLR4 expression (r = 0.240; P = .038, P = .05). These results, on one hand, indicated that TLR4-induced inflammatory responses may affect TAM infiltration and accumulation, and that TAMs and TLR4 may interact to play important roles in DLBCL microenvironment regulating the tumor growth, but, on the other hand demonstrated that both of TAMs and TLR4 had not only one side on DLBCL growth.

The Lymphocyte–Monocyte Ratio and the Platelet–Lymphocyte Ratio at Diagnosis as Independent Prognostic Factors in Primary Gastrointestinal Diffuse Large B Cell Lymphoma

To study the role of the absolute lymphocyte count (ALC), absolute monocyte count (AMC), platelet count (PLT), lymphocyte–monocyte ratio (LMR) and the platelet–lymphocyte ratio (PLR) in the prognosis of primary gastrointestinal diffuse large B cell lymphoma (PGI-DLBCL). We retrospectively analyzed the prognostic value of the ALC, AMC, PLT, LMR, PLR at diagnosis in 173 PGI-DLBCL patients through histopathological examination from March 2009 to February 2015. In total, 173 patients with histopathological diagnosis of PGI-DLBCL in this study, the median age was 51xa0years (range 12–90xa0years), median follow-up time was 44xa0months (range 7–89xa0months). In univariate analysis, age <60xa0years, B symptoms, Lugano stage I–II, low international prognostic index (IPI) or low age-adjusted international prognostic index (aaIPI), normal lactate dehydrogenase (LDH), normal β2-microglobulin (β2m), Hbxa0≥xa011xa0g/dL, ALCxa0≥xa01.5xa0×xa0109/L, AMCxa0≤xa00.50xa0×xa0109/L, LMRxa0≥xa02.5, PLRxa0≤xa0170 were related with superior overall survival (OS) and progression-free survival (PFS) (pxa0≤xa00.05). Multivariate analysis suggested that ALC, LMR, LDH were related with PFS (pxa0≤xa00.05). Similarly, age and LMR were related with OS (pxa0≤xa00.05). The parameters (ALC, AMC, LMR, PLR) may be valuable prognostic factors in PGI-DLBCL patients. LMR, PLR at diagnosis are expected to be independent prognostic factors for PGI-DLBCL patients.

HES1 is an independent prognostic factor for acute myeloid leukemia

HES1 is the target of Notch signaling which is reported to affect cell differentiation and maintain the cells in G0 phase in various tissues including the hematopoietic tissue. HES1 expression appears to be an independent prognostic factor for survival in a heterogeneous group of acute myeloid leukemia (AML) patients. To better assess its significance, we analyzed HES1 expression in a group of non-core binding factor AML patients and correlated its expression with the overall survival and relapse-free survival of AML patients. First, we detected the messenger RNA expression of HES1 in 40 patients with AML by real-time polymerase chain reaction. The top 50% of AML cases with the high HES1 expression were compared with the rest of the AML cohort. Overall survival was calculated from the date of diagnosis until the date of death from any cause or until the date of final follow-up. Relapse-free survival was determined for responders from the time of diagnosis until relapse or death from any cause. We showed that the lower-expression group had a shorter overall survival time and shorter relapse-free survival time compared with those of the high-expression group (37.6±1.6 versus 54.0±1.3 months, 28.6±1.8 months versus 44.8±2.1 months, respectively, P<0.05), and Cox regression showed that HES1 was an independent prognostic factor. In all, we conclude that expression of HES1 is a useful prognostic factor for patients with non-core binding factor AML.

Glomerular infiltration by intravascular large B-cell lymphoma.

A 59-year-old man presented with a 1-month history of lowgrade fever. On examination, he had no hepatosplenomegaly or lymphadenopathy. Routine urine testing showed albuminuria while other laboratory results, including liver function tests and serum lactate dehydrogenase, were normal. Computed tomography (CT) of the neck, chest and abdomen showed a high-density nodular shadow in the right kidney, although F-fluorodeoxyglucose (FDG) positron emission tomography scanning showed that this lesion had no increased FDG uptake. A CT-guided biopsy of the kidney was performed and showed large lymphoma cells infiltrating glomerular capillaries (top). The lymphoma cells were positive for CD20 (bottom), CD45, CD34, CD31 and immunoglobulin (Ig) M and were negative for cytokeratin, IgG, IgA and CD56. Ki67 was expressed by more than 50% of lymphoma cells. Bone marrow aspiration and trephine biopsy showed no infiltration. A diagnosis of glomerular intravascular large B-cell lymphoma (IVLBCL) was made. The patient was treated with two cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone) and complete remission was achieved. Another four cycles of R-CHOP therapy are planned in the future. IVLBCL is a rare disease with a generally poor prognosis. A good response to chemotherapy, as shown in this case, is rare.

Expressions of VEGF and CXCR4 in diffuse large B cell lymphoma and their clinical significances

This study was aimed to investigate the expression levels of CXCR4 and VEGF in serum of patients with DLBCL and their clinical significances. The peripheral blood of 44 patients with newly diagnosed DLBCL and 20 healthy adults as a control group were chosen for study. And the expression levels of CXCR4 and VEGF in serum were detected by ELISA. The results showed that the expressions of VEGF and CXCR4 in DLBCL patients were higher than those in the control group (P < 0.05). The expression of VEGF was positively correlated with the expression of CXCR4 in DLBCL patients, and the correlation coefficient was 0.743 (P < 0.05). The VEGF expression in DLBCL patients was correlated with LDH, immunotyping, the number of extranodal involvements, Ann Arbor staging and ECOG performance score; while the expression of CXCR4 was correlated with LDH, immunotyping, the number of extranodal involvements and Ann Arbor staging. Univariate analysis showed that LDH, extranodal involvements, immunotyping, Ann Arbor staging, CXCR4 and VEGF were associated with OS. Multivariate analysis showed that the immunotyping and CXCR4 expression independently associated with OS. It is concluded that both expression levels of VEGF and CXCR4 are significant higher than those in the control group. CXCR4 expression positively correlates with VEGF expression and displays a prognostic significance for OS. This study suggests that combined targeting VEGF and CXCR4 may become a novel therapeutic strategy for diffuse large B cell lymphoma.

Analysis of clinical characteristics and prognostic factors of primary mediastinal T-cell lymphoblastic lymphoma

Lymphoblastic lymphoma (LBL) comprises 2% to 4% of non-Hodgkin lymphomas cases in adults, of which 85% to 90% of LBL in adults is of T-cell phenotype. This study was aimed to evaluate the clinical characteristics and prognostic factors of patients with mediastinal T-LBL. Based on the retrospective analysis of the clinical data of 35 patients with mediastinal T-LBL during the period from January 1998 to January 2011, the clinical characteristics and prognostic factors of mediastinal T-LBL were summarized. The results showed that the total of 35 patients were identified (male 24 and female 11), with a median age of 19 (5 - 52) years. The majority of patients were in stage III/IV, 16 cases (45.7%) presented bulky mediastinal mass. Intrathoracic effusions (pleural, pericardial) were not uncommon (62.9%). Overall survival rate (OS) and progression-free survival rate (PFS) at 3 years for the entire cohort were 36% and 24%, respectively. OS and PFS at 5 years were 25% and 16.7%, respectively. Anemia at diagnosis were an important, independent predictor of OS (P = 0.048). Bulky mass (P = 0.048), superior vena cava syndrome (P = 0.021), and abnormal PLT count at diagnosis was the independent prognostic factors for PFS (P = 0.021). It is concluded that the patients with primary mediastinal T-LBL are characterized by a low incidence, bad prognosis, and short survival. For patients accompanying with anemia, bulky mass and superior vena cava syndrome, their prognosis is worse.

Analysis of Clinical Characteristics and Prognosis of 46 Elderly Patients with Peripheral T Cell Lymphoma (PTCL)

OBJECTIVEnTo investigate the clinical characteristics and prognostic factors of patients with peripheral T cell lymphoma (PTCL).nnnMETHODSnThe clinical data of 46 elderly PTCL patients admitted in Tianjin Medical University Cancer Hospital from April 2008 to August 2014 were collected, the clinical features, prognostic factors and treatments, as well as followed-up outcome were analyzed retrospectively. Survival analysis was performed by Kaplan-Meier method, and the COX proportional hazard model was used to perform multivariate analysis.nnnRESULTSnThe median survival time was 11 months, and the expected 1-year, 2-year and 3-year overall survival rate (OS) was 50%, 36% and 33%, respectively. Univariate analysis showed that the age, ECOG score, Charlson Comorbidity Index Score, the efficacy and course of chemotherapy were all the prognostic indicators affecting the OS and progression free survival (PFS) in this cohort of elderly patients. Multivariate analysis indicated that ECOG score and course of chemotherapy were the independent prognostic indicators affecting the OS and PFS (P < 0.05).nnnCONCLUSIONnECOG score and course of chemotherapy are of great significance for predicting the prognosis in elderly PTCL patients. The elderly patientss general condition and completion of a certain intensity of chemotherapy are an important measure to prolong survival time in elderly PTCL patients.

Clinical Characteristics and Therapeutic Efficacy Evaluation of 14 Cases of Solitary Myeloid Sarcoma

OBJECTIVEnTo investigate the clinical characteristics, treatment and prognosis of solitary myeloid sarcoma (MS).nnnMETHODSnThe clinical data of 14 solitary MS patients were retrospectively analysed, including their clinical features and treatment, and were evaluated.nnnRESULTSnA total of 14 cases of solitary MS mainly occurred in middle-aged population with the median age 41 years old (17-62 years old). The involved sites were more extensive, including breast, testis, spinal canal, skin, gastrointestinal system, nose and so on. The poorly differentiated cells of small to medium size showed diffuse distribution, relatively consistent morphology and a higher ratio of cytoplasm. The nucleus is in round or oval shape with fine and dense chromatin. Pathological mitosis was easily observed. Expression of MPO, lysozyme, CD43, myeloid-derived cells were positive. Treatment methods included surgery, chemotherapy and stem cell transplantation. Median survival time of 14 patients was 22.5 months; overall survival (OS) was 35.7% (5/14), median disease-free survival reached to 10.4 months on averge (3.5 months to 16 months), and 2-year overall survival (OS) was 50.3%.nnnCONCLUSIONnThe incidence of solitary MS is low, with a tendency progressing to leukemia, the chemotherapy regimen of anthracycline+cytarabine combined with radiotherapy can achieve better clinical efficacy.

Analysis of Clinical Characteristics and Prognostic Factors of 223 Newly Diagnosed Hodgkin's Lymphoma Patients

OBJECTIVEnTo analyze the clinical characteristics and prognostic factors of the newly diagnosed Hodgkins lymphoma (HL) patients.nnnMETHODnThe clinical data of 223 patients with pathologically confirmed and newly diagnosed HL (since January 2001 to December 2012) were collected from Tianjin Medical University Cancer Hospital. The patients route features, laboratory examination results, clinical manifestations and short-term efficacy were analyzed. Furthermore, the Log-rank test and Cox proportional hazard model were applied to analyze the prognosis. All data were analyzed with SPSS software version 1.0 and graphPad Prism 5.nnnRESULTSnAmong the 223 newly diagnosed HL patients, the ratio of male to female was approximately 1.25:1 and the median age was 40 years old (range 3-84 years). The median survival period is 62 months (range 8-189 months). The 5-year overall survival (OS) rate was 92.8% for all 223 HL patients. Multivariate analysis showed that HL originated from mediastinal lymph node region, the extranodal sites were involved, lactate dehydrogenase (LDH) level increased and CR2 was unable to fulfil the CR/CRu which are independent prognostic factors of HL patients (P < 0.05). Therefore, according to the above-mentioned adverse prognostic factors, 223 cases of HL patients were regrouped as low, intermediate and high risk. The HL 5-year OS rate of three groups were 100%, 96.9% and 42.9%, OS in each group was significantly different (P < 0.05).nnnCONCLUSIONnHL displays a high incidence in young male patients but the curative efficacy is optimal and the survival period is long. The HL originated at mediastinal lymph node region, involved extranodal sites, lactate dehydrogenase (LDH) level increased and CR2 is unable to fulfil the CR/CRu which are independent prognostic factors of HL patients. According to the above-mentioned factors for the initial treatment of patients with HL, risk discrimination can predict the prognosis of patients with HL to a certain extent.

[The clinical and pathological characteristics of 14 patients' nodular lymphocyte predominant Hodgkin's lymphoma].

目的 探讨结节性淋巴细胞为主型霍奇金淋巴瘤（NLPHL）患者的临床病理特征及疗效。 方法 收集14例NLPHL患者的临床资料，对其临床病理特征及近、远期疗效进行相关性分析。 结果 14例患者均为初治者，男、女各7例，中位发病年龄38（13～54）岁，中位随访时间为55.5（23～189）个月。发病率占同期霍奇金淋巴瘤（HL）的6.3%（14/223）。免疫组织化学检查结果示14例患者CD20均呈（+）/弱（+），CD30均（−），仅1例患者呈CD15弱（+）。14例患者中13例因自觉浅表淋巴结肿大就诊，所有患者惰性起病，病情进展缓慢。7例患者采用单纯化疗，7例患者采用放、化疗联合治疗。14例患者均有效，其中完全缓解（CR）+未证实的CR（CRu）12例。5年无疾病生存率为85.7%，5年总生存率为100.0%。单纯化疗与放、化疗联合治疗相比，不同的化疗方案相比，其近、远期疗效差异均无统计学意义（P值均>0.05）。 结论 NLPHL患者瘤细胞呈CD20（+）/弱（+），CD30（−），极少数患者呈CD15弱（+）。NLPHL在HL患者中所占比例低，以中青年患者多见，起病缓慢，与经典型HL患者相比疗效较好。OBJECTIVEnTo probe the clinical and pathological characteristics of nodular lymphocyte predominant Hodgkin lymphoma (NLPHL).nnnMETHODSnThe pathologically confirmed 14 cases of NLPHL patients (since January 2001 to December 2012) were collected from Tianjin Medical University Cancer Hospital. The laboratory examinations results, clinical manifestations, short-term and long-term outcomes of these cases were analyzed in this study.nnnRESULTSnThe immunohistochemistry of all cases showed CD20 (+)/weak (+) and CD30 (-), most of them CD15 (-). The morbidity of NLPHL during the same period of Hodgkins lymphoma (HL) was around 6.3%. The median age was 38 (13-54) years old, 92.9% of the patients sought medical advice according to self-feeling of superficial lymph nodes. All patients disease progressed slowly and the sizes of lymph nodes were within 3 cm. Of the 14 patients, 7 patients were treated with chemotherapy and 7 patients chemoradiotherapy. The treatment results showed CR+CRu rate as 85.7% and ORR 100.0%. The rates of 5-year event-free survival (EFS) and overall survival (OS) were 85.7% and 100.0% respectively. Short and long term efficacies between chemotherapy and chemoradiotherapy had no significant differences. Meanwhile, varieties chemotherapy regimens showed no significant effects on short- and long-term efficacies (P>0.05).nnnCONCLUSIONnThe pathologically confirmed 14 cases of NLPHL had the classical and tumorous maxi cell, which showed CD20 (+)/weak (+) and CD30 (-), very few cases showed weak CD15 (+). The incidence of NLPHL was low. The majority of the NLPHL patients were middle-aged and youth. Moreover, the better short- and long-term outcomes over classical HL ones were observed regardless of patients stage.