Prolonged and recurrent hypoglycemia induced by trimethoprim-sulfamethoxazole in a Hodgkin lymphoma patient with Pneumocystis carinii pneumonia

To the Editor:A 64-year-old Chinese man(65 kg)with fever and lymphadenopathy was admitted to the hematology department of the Peking University First Hospital.Before admission,he had had intermittent fever for the past 3 months with a body temperature high of 38.5°C.He had no accompanying discomfort and his temperature sometimes dropped to normal without drugs.One month before admission,he found several palpable enlarged cervical lymph nodes.Upon admission,a lymph node biopsy was conducted and the pathological diagnosis showed a nodular sclerosis,a subtype of classical Hodgkin lymphoma.

Efficacy and Safety of Lenalidomide in the Treatment of Multiple Myeloma： A Systematic Review and Meta-analysis of Randomized Controlled Trials

Background：Lenalidomide has emerged as an important treatment for patients with multiple myeloma （MM）.However,its role in the management of MM is still controversial and requires further clarification.The aim of this study was to evaluate efficacy and safety of lenalidomide for MM using a meta-analysis.Methods：We searched the electronic databases including：PubMed,EMBASE and the Cochrane Center Register of Controlled Trials.Seven randomized clinical trials were identified,which included a total of 2357 patients with MM who received lenalidomide-containing,noncontaining lenalidomide regimens or placebo as induction therapy or maintenance therapy.The outcomes included overall response （OR） rate,complete response （CR） rate,3-year progression-free survival （PFS） rate,3-year overall survival （OS） rate,and different types of treatment-related adverse events.We calculated the risk ratios （RRs） as well as their 95％ confidence intervals of these outcomes and pooled the results using RevMan 5.2 software.Results：For patients with previously untreated MM,OR rate and CR rate was significantly higher in lenalidomide-containing group than the control group.For relapsed or refractory MM patients,lenalidomide-containing regimens significantly improved the OR rate,CR rate,3-year PFS rate and 3-year OS rate.With regard to MM patients after autologous stem cell transplantation,lenalidomide maintenance therapy significantly improved 3-year PFS rate but did not result in improved 3-year OS rate.In terms oftoxicities,lenalidomide therapy has a higher rate of Grade 3-4 grade cytopenias,infection,deep-vein thrombosis,and diarrhea.Furthermore,the incidence of second primary malignancies was significantly higher in the lenalidomide group.Conclusions：The lenalidomide-containing regimens as induction therapy clearly increased response rates and improved intervals of survival with acceptable toxicity rates for patients with MM.However,when physicians choose to use the lenalidomide as maintenance therapy,whether the benefits outweigh the risks should be taken into account.

Comparison of outcomes after human leukocyte antigen-matched and haploidentical hematopoietic stem-cell transplantation for multiple myeloma

Background:Allogeneic stem-cell transplantation (SCT) is a well-established immunotherapeutic strategy for multiple myeloma (MM) with a potent and often sustained graft-vs.-myeloma effect.This multicenter investigation aimed to analyze the complications and survival of haploidentical SCT in patients with MM,and compare the main outcomes with matched-related donors (MRDs).Methods:Haploidentical and MRD SCT was identified from a cohort of 97 patients with MM who received a myeloablative transplantation in 13 hospitals from May 2001 to December 2017.A matched-pair analysis was designed.For each haplo recipient,the recipients were randomly selected from the MRD group and were matched according to the following criteria:year of the hematopoietic SCT (±2 years),disease status at transplantation,and the length of follow-up.ults:Seventy cases received MRD and 27 received haploidendcal transplantation.The two groups showed no significant ifferences regarding age,gender,cytogenetic risk,and diagnostic stage.The cumulative incidences of non-relapse mortality (NRM) at1 and 3 years based on donor type were 20.5%(95% confidence interval [CI],10.90-30.10%) and 24.2%(95% CI,13.81-34.59%) for the MRD group and 16.80%(95% CI,1.71-31.89%) and 28.70%(95% CI,8.71-48.69%) for the haplo group,respectively.Cumulative incidence of NRM did not differ significantly between the two groups (x2 =0.031,P =0.861).The cumulative incidences of progression-free survival (PFS) and 1 year and 3 years by type of donors were 59.8 %(95 % CI,48.24-71.36 %) and 45.4 %(95 % CI,33.44-57.36%),and 65.6%(95% CI,47.18-84.02%) and 26.8%(95% CI,7.59-46.01%) for MRD and haploidentical donor,respectively.Cumulative incidence of PFS did not differ significantly between the two groups (x2 =0.182,P =0.670).In multivariate analyses,no statistically significant differences were observed between haploidentical and MRD for relapse,NRM,PFS,and overall survival.There were no statistically differences on main outcomes after haploidentical and MRD.Conclusion:Haploidentical SCT could be performed safely and feasibly for patients with MM in need.

A multicenter retrospective study on the real-world outcomes of autologous vs. allogeneic hematopoietic stem cell transplantation for peripheral T-cell lymphoma in China

Background:There were few studies on real-world data about autologous hematopoietic stem cell transplantation(auto-HSCT)or allogeneic HSCT(allo-HSCT)in peripheral T-cell lymphoma(PTCL).This study aimed to investigate the clinical outcomes of patients who received auto-HSCT or allo-HSCT in China.Methods:From July 2007 to June 2017,a total of 128 patients who received auto-HSCT(n=72)or allo-HSCT(n=56)at eight medical centers across China were included in this study.We retrospectively collected their demographic and clinical data and compared the clinical outcomes between groups.Results:Patients receiving allo-HSCT were more likely to be diagnosed with stage III or IV disease(95%vs.82%,P=0.027),bone marrow involvement(42%vs.15%,P=0.001),chemotherapy-resistant disease(41%vs.8%,P=0.001),and progression disease(32%vs.4%,P<0.001)at transplantation than those receiving auto-HSCT.With a median follow-up of 30(2–143)months,3-year overall survival(OS)and progression-free survival(PFS)in the auto-HSCT group were 70%(48/63)and 59%(42/63),respectively.Three-year OS and PFS for allo-HSCT recipients were 46%(27/54)and 44%(29/54),respectively.There was no difference in relapse rate(34%[17/63]in auto-HSCT vs.29%[15/54]in allo-HSCT,P=0.840).Three-year non-relapse mortality rate in auto-HSCT recipients was 6%(4/63)compared with 27%(14/54)for allo-HSCT recipients(P=0.004).Subanalyses showed that patients with lower prognostic index scores for PTCL(PIT)who received auto-HSCT in an upfront setting had a better outcome than patients with higher PIT scores(3-year OS:85%vs.40%,P=0.003).Patients with complete remission(CR)undergoing auto-HSCT had better survival(3-year OS:88%vs.48%in allo-HSCT,P=0.008).For patients beyond CR,the outcome of patients who received allo-HSCT was similar to that in the atuo-HSCT group(3-year OS:51%vs.46%,P=0.300).Conclusions:Our study provided real-world data about auto-HSCT and allo-HSCT in China.Auto-HSCT seemed to be associated with better survival for patients in good condition(lower PIT score and/or better disease control).For patients possessing unfavorable characteristics,the survival of patients receiving allo-HSCT group was similar to that in the auto-HSCT group.