NRS2002 assesses nutritional status of leukemia patients undergoing hematopoietic stem cell transplantation

Objective： To discuss whether nutritional risk screening 2002 （NRS2002） is appropriate for nutritional risk screening for leukemia patients before and after hematopoietic stem cell transplantation （HSCT）, and whether there are risk differences in other conditions, such as age, gender and matching degree; to find the methods and indicators of nutritional risk screening for these patients before and after HSCT, in order to give timely intervention to guarantee the successful completion of the entire transplantation process. Methods： Nutritional risk of 99 leukemia patients was screened with NRS2002 before and after HSCT. The ^（2 test was applied to compare the risk differences between groups such as age, gender and matching degree, while the differences of other enumeration data, such as recent （1-3 months） weight loss, reduced food intake within one week and BMI, were compared by continuity correction. Results： Of the 99 leukemia patients, 22 cases （22.2 %） had nutritional risk before HSCT, while all patients had nutritional risk after ttSCT; there is no significant difference in nutritional risk between male and female, and patients of less than 30 years old, not-full matched, recent （1-3 months） weight loss, reduced food intake within a week or BMI 〈18.5 were more likely to have nutritional risk; and 77 cases （77.8%） had weight loss, among which 49 patients （63.6%） had more than 5% weight loss within one month. Conclusions= This study showed that leukemia patients should receive the nutritional risk screening conventionally before and after HSCT, and NRS2002 was only appropriate for nutritional risk screening before HSCT. More attention should be paid to the patients less than 30 years old or not-full matched. Weight change was one of the important nutritional indicators for patients after HSCT.

Pneumomediastinum, pneumorachis, subcutaneous emphysema: An unusual complication of leukemia in a child

Pneumorrhachis(PR), or epidural emphysema, denotes the presence of air in the spinal epidural space. It can be associated with a variety of etiologies, including trauma; recent iatrogenic manipulations during surgical, anesthesiological and diagnostic interventions;malignancy and its associated therapy. It usually represents an asymptomatic epiphenomenon but also can be symptomatic by itself, as well as by its underlying pathology, and rarely can be fatal. The pathogenesis and etiology of PR are varied and can sometimes be a diagnostic challenge. As such, there are no standard guidelines for the management of symptomatic PR and its treatment is often individualized. Here, we present a case of a 14-year-old boy treated for leukemia who developed this complication and whether chemotherapy related or not, it proved to be fatal for him. To our knowledge, this is the first case in the literature of this complication with acute lymphoblastic leukemia.

Nutritional assessment with different tools in leukemia patients after hematopoietic stem cell transplantation

Objective： Correct nutritional assessment is essential for leukemia patients after hematopoietic stem cell transplantation （HSCT）. This study aimed to investigate the best nutritional assessment method for leukemia patients after HSCT, and find the possible nutritional risk of the patients during the transplantation process in order to intervene in the patients with nutritional risks and undernourished patients timely, so that the entire transplantation process could be successfully completed. Methods： A prospective study was performed in 108 leukemia patients after HSCT, and different nutritional assessment methods, including nutritional risk screening 2002 （NRS2002）, mini nutritional assessment （MNA）, subjective globe assessment （SGA） and malnutritional universal screening tools （MUST）, were used. The associations between nutritional status of these patients and nutritional assessment methods were analyzed. Results： A total of 108 patients completed SGA, and 99 patients completed NRS2002, MNA and MUST. During the treatment process, 85.2% of the patients lost weight, wherein, 50% lost weight greater than 5%, and 42.6% had significantly reduced food intake. For nutritional risk assessment, the positive rates of NRS2002, MNA and MUST were 100%, 74.7% and 63.6%, respectively. There was a significant difference （P〈0.05） among the positive rates of NRS2002, MNA and MUST. In undernutrition assessment, the positive rate of SGA （83.3%） was significantly higher than that of MNA （17.2%） （P〈0.05）, and the incidence rate of nutritional risk among leukemia patients _〈30 years old was greater than that of patients 〉30 years old （P〈0.05）. Conclusions： Patients with leukemia were in poor nutritional status during and after HSCT. The leukemia patients 〈30 years old had a greater incidence rate of nutritional risk. As nutritional risk screening tool, the specificity of NRS2002 is not high, but it can be used for evaluating nutritional deficiencies. MNA is a good nutritional risk screening tool, but not an adequate tool for nutritional assessment. If assessment of undernutrition is necessary, the combination of all these screening tools and clinical laboratory indicators should he applied to improve accuracy.

Pneumomediastinum after acute lymphoblastic leukemia and chemotherapy?

Pneumomediastinum,pneumorachis and subcutaneous emphysema are frequently benign and most commonly result from air escaping from the upper respiratory tract,intrathoracic airways,or gastrointestinal tract.Gas can also be generated by certain infections or reach the mediastinal space from outside air after trauma or surgery.In the article presented by Showkat et al a 14-year-old male patient with acute lymphoblastic leukemia(ALL) under chemotherapy developed pneumomediastinum,pneumorachis and subcutaneous emphysema.In the author's opinion,these complications were caused by ALL or chemotherapy that progressed to severe respiratory failure until the patient finally died in the intensive care unit.I would like to underline some important points,which have been raised following a paper published in the October issue of World Journal of Clinical Cases.

Unusual presentation of Erdheim-Chester disease in a child with acute lymphoblastic leukemia

Erdheim-Chester disease(ECD) is an uncommon, nonfamilial, non-Langerhans cell histiocytosis, which involves skeletal system and soft tissue usually in middle aged and elderly patients. The characteristic radiologic features include bilateral, symmetric cortical osteosclerosis of the diaphyseal and metaphyseal parts of the long bones, or bilateral symmetrically abnormal intense 99 mTechnetium labelling of the metaphyseal-diaphyseal region of the long bones, and computed tomography scan findings of "coated aorta" or "hairy kidneys". ECD in childhood with osteolytic lesion is extremely rare. We describe an unusual case with an expansile lytic bone lesion at presentation in a case of acute lymphoblastic leukemia.

LONG-TERM EFFECT OF HOMOHARRINGTONINE ON CHRONIC GRANULOCYTIC LEUKEMIA

Objective: To observe the long-term effect of homoharringtonine (HHT) on chronic granulocytic leukemia (CGL) and its pharmacological mechanism. Methods: 76 patients with newly diagnosed early chronic phase CGL received treatment of merely 1.5 mg/m2 daily HHT for induction remission and long-term maintenance treatment. The apoptosis rate of bone marrow CD34+ cells induced by HHT was assayed with flow cytometer. Results: 86.8% patients achieved CHR, 13.2% patients PHR and 31.8% patients got cytogenetic response in HHT treatment group, which was longer than 31 (8-54) months in hydroxyurea (HU) group (P<0.05). The effect of apoptosis induction HHT was stronger on CGL-CP patients bone marrow CD34+ cells than on normal person bone marrow CD34+ cells. Conclusion: HHT is a very effective drug for remission induction and long-term maintenance treatment in early chronic phase CGL patients.

Caring in nursing: Investigating the meaning of caring from the perspective of Chinese children living with leukemia

Background:Effective communication between nurse and patient is paramount in establishing the relationship on which patient care is based and influences the quality of nursing care leading to improved health outcomes for patients.It is necessary for nurses to understand children’s perspectives of nurseepatient communication in order to choose appropriate communication skills to promote effective communication and a sweet relationship.Purpose:To explore the communication status of children who were in the early stages of living with leukemia and their perspectives of nurseepatient communication.Method:In-depth interviews were conducted with Chinese children with leukemia using a descriptive qualitative research method,and the data were analyzed using Krippendorf’s content analysis.Results:Twenty-nine children with leukemia were interviewed.Three communication states were identified among children in the first three months of living with leukemia:totally unwilling to communicate,reduced communication with others and increased communication with parents.Nurseepatient communication for children with leukemia formed three themes:content,form and occasion of communication.Conclusions:With a better understanding of children’s communication status and their expectations of communication,nurses can promote effective nurseepatient communication strategies to meet children’s psychological needs and build harmonious relationship.

Coexistence of breakpoint cluster region-Abelson1 rearrangement and Janus kinase 2 V617F mutation in chronic myeloid leukemia: A case report

BACKGROUND The Janus kinase 2(JAK2) V617 F mutation is common in patients with breakpoint cluster region-Abelson1(BCR-ABL1)-negative myeloproliferative neoplasms,including polycythemia vera, essential thrombocythemia and primary myelofibrosis, but is rarely detected in BCR-ABL1-positive chronic myeloid leukemia(CML) patients. Here, we report a CML patient with both a BCR-ABL1 rearrangement and JAK2 V617 F mutation.CASE SUMMARY A 45-year-old Chinese woman was admitted to our department with a history of significant thrombocytosis for 20 d. Color Doppler ultrasound examination showed mild splenomegaly. Bone marrow aspiration revealed a karyotype of 46,XX, t(9;22)(q34;q11.2) in 20/20 metaphases by cytogenetic analysis,rearrangement of BCR-ABL1(32.31%) by fluorescent polymerase chain reaction(PCR) and mutation of JAK2 V617 F(10%) by PCR and Sanger DNA sequencing.The patient was diagnosed with CML and JAK2 V617 F mutation. Following treatment with imatinib for 3 mo, the patient had an optimal response and BCRABL1(IS) was 0.143%, while the mutation rate of JAK2 V617 F rose to 15%.CONCLUSION Emphasis should be placed on the detection of JAK2 mutation when CML is diagnosed to distinguish JAK2 mutation-positive CML and formulate treatment strategies.

Empathetic nursing with mindful cognitive therapy for fatigue,depression,and negative emotions in leukemia patients undergoing long-term chemotherapy

BACKGROUND Leukemia is a broad term for blood cell cancer.Leukemia is divided into acute or chronic,depending on cell differentiation.Leukemia patients are prone to adverse reactions during chemotherapy,such as anxiety,depression,and even suicide,affecting prognosis.As a nursing model developed by three well-known cognitive psychologists,empathetic nursing with mindfulness cognitive therapy(ENMCT)can effectively reduce anxiety and depression and improve the quality of life in patients with chronic disease.AIM To explore the effect of ENMCT on cancer-induced fatigue,hope level,and negative emotions in patients with long-term leukemia chemotherapy.METHODS A total of 103 patients with long-term leukemia chemotherapy diagnosed and treated in our hospital from July 2017 to October 2019 were enrolled and randomly assigned to observation and control groups using the random number table approach.Fifty-one patients in the control group received routine nursing,while 52 patients in the observation group received empathic nursing with mindfulness cognitive therapy.After three months of nursing care,cancerinduced fatigue was measured with the Piper Fatigue Scale(PFS),hope level with the Herth Hope Index(HHI),and negative emotion with the Hamilton Anxiety Scale(HAMA)/Hamilton Depression Scale(HAMD).Self-management(Chinese Strategies Used by People to Promote Health)was also recorded.RESULTS The observation group’s total scores in behavior,cognition,emotion,feeling,and PFS were lower than the control group after the intervention(P<0.05).Keeping close contact with others,the attitude of taking positive actions,the attitude toward reality and future,and the total HHI score were higher in the observation group than the control group(P<0.05).The observation group’s HAMA and HAMD scores were lower than the control group(P<0.05).The observation group’s positive attitude,self-decision,and self-relief scores were greater than the control group(P<0.05).CONCLUSION Empathetic nursing with cognitive mindfulness therapy is beneficial in improving cancer-related fatigue,negative emotions,expectation level,and self-management ability in patients with longterm leukemia chemotherapy.

贵州地区急性淋巴细胞白血病儿童TPMT、NUDT15基因多态性与6-MP耐受性分析

目的观察贵州地区ALL儿童TPMT、NUDT15基因多态性,探讨其与6-MP耐受性的关系。方法收集贵阳市儿童医院血液科住院的贵州地区ALL儿童。Sanger法检测患者NUDT15c.415C>T和TPMT*2、TPMT*3A、TPMT*3B、TPMT*3C基因型。所有ALL儿童均按CCLG-2008方案化疗,每周1次监测血常规及肝肾功能。根据2016新编WHO化疗药物毒性反应分度标准,出现Ⅲ~Ⅳ度与6-MP相关的毒性反应,称为6-MP不耐受(除外感染、其他药物影响)。分析TPMT、NUDT15基因多态性与6-MP不耐受的相关性。结果共纳入患者60例,检测到TPMT突变(中间代谢型)3例(5%),正常代谢型57例(95%)。NUDT15基因CT型12例(20%),TT型1例(1.7%),CC型(野生型)47例(78.3%)。NUDT15基因突变率21.7%(13/60)显著高于TPMT基因突变率5%(3/60),差异有统计学意义(P=0.007)。TPMT突变型3例均发生6-MP不耐受(100%),NUDT15突变型13例中11例发生6-MP不耐受(84.6%)。结论TPMT、NUDT15基因突变与6-MP不耐受相关(P<0.05),联合检测TPMT、NUDT15基因对调整6-MP使用,减少6-MP不良反应提供依据。

Technology-based psychosocial support for adolescent survivors of leukemia:An example intervention for nurse specialists

Technology-based interventions are thought to be one of the innovative alternatives for improving the psychosocial health of adolescent survivors.This article outlines an example of technology-based psychosocial intervention for adolescent survivors of leukemia.This technology-based psychosocial support intervention consists of five separate modules related to personal development,coping skills,and a healthy lifestyle.intervention can be applied to adolescents(aged 12-18 years)who have completed leukemia treatment at least 2 years ago and are disease free.Psychosocial interventions are crucial to improving adolescent survivors’psychosocial well-being in long-term follow-up.It is thought that psychosocial interventions can be effective on survivors’self-efficacy,coping skills,and quality of life,and survivors will be satisfied with the program.Regarding the model of childhood cancer survivorship care,this intervention can be integrated into the follow-up program and guide pediatric oncology nurses in preparing support programs for adolescent survivors.

P53 Regulation of Leukemia Cells with the Blockage of MDM2 by Antisense Oligonucleotides

Summary： The changes of expression and function of MDM2 and P53 by MDM2 specific antisense oligonucleotides were investigated in HL60 cells. Cells were divided into control group, AS group （MDM2 specific antisense oligonucleotides group）, cisplatin group, and combined treatment group. FCM analysis and Western blot and RT-PCR were used to estimate apoptosis and the expression of MDM2 and P53. Our results showed that the transfection of MDM2 specific antisense oligonucleotides obviously inhibited MDM2 expression （P〈0.01） and increased the expression of P53 （P〈0.05）. Apoptosis rate were reduced by MDM2 specific antisense oligonucletides and cisplatin （P〈0.01）. It is concluded that MDM2 specific antisense oligonucletides can inhibit the expression of MDM2, induce the expression of P53 and increase the apoptosis of leukemia cells after chemotherapy.

EFFECTS OF PML AND PML/RMRα ANTISENCE OLIGO-NUCLEOTIDE ON PROMYELOCYTIC LEUKEMIA CELL NB4

Objective: To investigate the effects of anti-PML (promyelocytic leukemia) or anti-PML/RAR( (promyelocytic leukemia/retionic acid receptor() antisense oligonucleotides on cell growth, expression of PML-RAR( mRNA and PML-RAR(/PML protein location of NB4 cell lines. Methods: RT-PCR was used for detecting PML-RAR( mRNA expression, trypan blue exclusion for cell count, methylcellose assay for leukemic colony forming unit detection, immuno- fluorescence for PML-RAR(/PML protein location. Results: Both anti-PML start codon region antisence (STAS) and anti-PML-RAR( fusion region antisence (FUAS) could inhibit cell growth and the formation of acute myelocytic colony forming unit of cells(AML-CFU). Cells become partial differentiated at days 5, being more obvious in FUAS-treated cells than in STAS ones. Down regulation of PML-RAR( mRNA expression occurred at 24 hours in STAS and FUAS-treated cells and maintained for up to 72 hours. Immuno-fluorescence analysis with anti-PML monoclonal antibody showed a remarkable decrease even complete disappearance of microgranules. The residual granules became enlarged as discrete dots (<10 per cell), similar to normal POD structure in some STAS-treated cells at 24 hours. At 72 hours, nearly all the granules disappeared. Similar changes were observed in FUAS-treated cells. Conclusion: Both PML and PML-RAR( antisence oligonucleotides can specially block the expression of PML-RAR( at mRNA and protein levels. PML protein is implicated in the regulations of cell differentiation.

Redistribution of Platelet Membrane Glycoprotein IV and Release of Intracellular α-granule Thrombospondin in Patients with Chronic Myelogenous Leukemia

The redistribution of platelet membrane glycoprotein IV (GPIV) and the release of intracellular Q-granule thrombospondin (TSP) were examined and the inhibition of 5-thromboglobulin (&TG) and platelet factor 4 (PF4) in patients with chronic myelogenous leukemia (CML) was observed and quantitation of β-TG and PF4 in sera was conducted. GPIV in inactive platelet from CML was 36080±17010 molecules/platelet as compared with 13190±4810 from the controls (P<0,01), No abnormality was found in the distribution of platelet membrane GPIb and GPIIb/III.(P>0. 05). The GPIV redistribution on active platelet membrane induced thrombin (1U/ml) from CML and healthy donors was 44320132310 and 228001 12700 molecules/platelet respectively (P<0. 01 ). The difference in the release of intracellular Q-granule TSP between CML and the control group was not found (P>0.05). There was no direct correlation between GPIV expression and TSP binding after platelet activation. The high leveIs of β-TG and PF4 in sera inhibited release of intracellular a-granule TSP in vitro. These results indicate that the abnormality of platelet membrane GPIV is a common marker in CML, therefore the specific increase of platelet GPIV in patients with CML may be a useful tool for the diagnosis and monitoring of the platelet dysfunction. The release of interna1 TSP pools is hindered by either β-TG or PF4 in sera.

NUCLEAR MATRIX PROTEIN IN LEUKEMIA CELLS

Objective: To compare the composition of nuclear matrix proteins (NMP) between leukemia cells and normal bone marrow cells. Methods: NMP was isolated by high-salt extraction and identified in acute and chronic myelogenous leukemia cells as well as in the blast phase of chronic leukemia. On SDS-PAGE, NMPs with molecular myelogenous ferment from what were seen in normal bone marrow cells were present in both acute and chronic myelogenous leukemia. Conclusion: Marked changes of NMP, not only in contents but also in compositions, exist in leukemic cells compared with normal bone marrow cells. NMP may serve as a target of chemotherapeutic drug against leukemia.

Localization and Biodistribution of Conjugate ATG－Dex－DNR in Nude Mice as Models for Human Leukemia

I-labelled anti-thymoglobuline (ATG), 131 I-labelled immunoconjugate ATG-Dex-DNR and 131 I-labelled Ts-MoAb as control antibody, respectively.were injected by intraperitoneal (i. p.) administration into nude mice used as models for human T-cell leukemia. SPECT imaging was performed from day 1 to day 8 following i. p. injection. The results showed that radioimmunoimaging of buman tumor xenografts was clearest day 3 after injection in both of ATG and ATG-Dex-DNR groups, whereas it's not the case in Ts-MoAb group. Nude mice were killed 8th day after injection with antibody or conjugate. The tumor, as well as different dissected normal organs including heart, liver, lungs, kidney, femur and intestine, were harvested, weighed precisely, and radioiodine-counted. T/NT ratios in experimental group was greater than 1. 0 (ranged from 1. 246-7. 865). and in control group they were less than 1. 0 (ranged from 0. 263-0. 757, except for tumor/femur ratio). Our results indicated that ATG and ATG-Dex-DNR had specific affinity to cell line of Tcell leukemia CEM.

Effect of Homoharringtonine on Bone Morrow CD34^+CD7^+ Cells in Chronic Granulocytic Leukemia

Objective： To explore the effect of homoharringtonine （HHT） on bone morrow CD34^＋CD7^＋ cells in chronic granulocytic leukemia （CGL）. Methods： The changes of bone morrow CD34^＋CD7^＋ cells were observed after the treatment of HHT in 23 cases with CGL. The proliferation and apoptosis of CD34^＋CD7^＋ cells treated with HHT in vitro were studied. Results： The proportion of CD34^＋CD7^＋ cells in CGL （0.145±0.021） was higher than that of normal control （0.052±0.013）. The proportion of CD34^＋CD7^＋ cells in patients who got cytogenetic responses to HHT （0.072±0.020） decreased remarkably, but not in those patients who did not got cytogenetic responses to HHT, （0.137±0.023）. the proliferation of CD34^＋ cells was inhibited and the proportion of CD34^＋CD7^＋ cells decreased after cultured with HHT （0.134 in 24 h, 0.126 in 48 h and 0.102 in 72）. The apoptosis rate of CD34^＋CD7^＋ cells was higher than that in CD34^＋CDT cells （35.39%±4.39% versus 24.57%±4.01%, P〈0.05） 72 h after culture with HHT. Conclusion： The proportion of CD34^＋CD7^＋ cells in CGL was higher than that of normal control and HHT may inhibit the proliferation and induce apoptosis of bone marrow CD34^＋CD7^＋ cells.

急性淋巴细胞白血病患儿维持治疗期间6-巯基嘌呤使用剂量与TPMT和NUDT15基因多态性的关系

背景6-巯基嘌呤(6-MP)是急性淋巴细胞白血病(ALL)维持治疗最主要的药物之一,代谢酶基因多态性与药物的骨髓抑制程度有关。目的探讨ALL患儿维持治疗期间6-MP使用剂量与TPMT和NUDT15基因多态性的关系。设计回顾性队列研究。方法纳入2020年1月至2021年12月于郑州大学第一附属医院明确诊断为ALL、经前期化疗骨髓达完全缓解、进入维持治疗阶段且口服6-MP治疗的患儿。口服6-MP前患儿行TPMT和NUDT15基因型检测,分析TPMT、NUDT15不同基因型患儿应用6-MP治疗的使用剂量和骨髓抑制情况。主要结局指标6-MP使用剂量。结果61例维持治疗的ALL患儿纳入本文分析。纳入TPMT基因多态性统计分析的ALL患儿48例(除外NUDT15基因突变13例),野生型45例,突变型3例;纳入NUDT15基因多态性统计分析的ALL患儿58例(除外TPMT基因突变3例),CC型45例,CT型9例,TT型4例。在6-MP维持治疗阶段,TPMT和NUDT15不同基因型患儿的WBC、Hb、PLT计数差异均有统计学意义(均P<0.05)。患儿用药后出现不同程度的中性粒细胞减少,包括TPMT野生型15例,突变型3例;NUDT15基因CC型15例,CT型5例,TT型4例;TPMT和NUDT15不同基因型患儿骨髓抑制情况差异均有统计学意义(均P<0.05)。TPMT和NUDT15不同基因型患儿6-MP使用剂量差异有统计学意义(均P<0.05),TPMT野生型和突变型ALL患儿维持治疗期6-MP使用剂量分别为(40.81±6.02)和(16.25±4.42)mg·m^(-2)·d^(-1);NUDT15基因CC型、CT型和TT型6-MP使用剂量分别为(40.81±6.02)、(34.28±4.53)和(10.00±1.28)mg·m^(-2)·d^(-1)。结论TPMT和NUDT15突变型患儿的骨髓抑制程度均较野生型严重。ALL患儿维持治疗期间6-MP使用剂量与TPMT和NUDT15基因多态性相关。

Juvenile myelo-monocytic leukemia (JMML): No effect of granulocyte monocyte-colony stimulating factor (GM-CSF) on Wilms Tumor gene (<i>WT</i>1) by nested Polymerase Chain Reaction (nPCR) and flow cytometry

This study was to determine whether GM-CSF induced WT1 gene expression and to establish an association with markers of proliferation CD71+CD34+ using nPCR and flow cytometry respectively, in samples obtained from 5 newly diagnosed JMML patients. Overtime (day 0 to day 14) there was an insignificant difference in WT1 gene expression and CD71+CD34+ in JMML samples when compared to peripheral blood of normal volunteers (n = 3). Our study suggests that there is a correlation between WT1 gene expression and cellular proliferation and that GMCSF in vitro does not create a significant difference in JMML samples.

Impact of comorbid subthreshold depressive symptoms on cancerrelated fatigue and complications in adults with leukemia

BACKGROUND Patients not only experience symptoms caused by cancer but also suffer from the accompanying psychological pain.Therefore,these patients do not have high quality of life.According to the World Health Organization,the incidence of leukemia in China in 2020 was 5.1/100000,the mortality rate was 3.3/100000,and the prevalence rate was 16.7/100000.Therefore,it is important to examine the influence of comorbid subthreshold depressive symptoms on leukemia patients.AIM To determine the impact of comorbid subthreshold depressive symptoms on cancer-related fatigue and complications in leukemia patients,thereby providing a basis for early diagnosis and treatment in clinical practice.METHODS A questionnaire survey was conducted among leukemia patients admitted to a tertiary hospital in Xi'an,Shaanxi Province,China,from August 2022 to December 2023.Patients with a score>16 on the Chinese Classification of Mental Disorders(CCMD-3)and a Hamilton Depression Rating Scale score of 8-17 were classified as the subthreshold depressive group(n=95),while 100 leukemia patients admitted during the same period were classified as the control group.Data were collected using Epidata 3.1 software,and comparisons were made between the two groups regarding general clinical data,the Piper Fatigue Scale(PFS),the Pittsburgh Sleep Quality Index(PSQI),the Numeric Rating Scale for pain assessment,laboratory indicators,and the occurrence of complications.RESULTS In this survey,120 leukemia patients with depression were preliminarily screened,95 patients with subthreshold depression were ultimately selected as the subthreshold depression group,and 100 leukemia patients admitted during the same period were enrolled as the normal group.Comparison of basic clinical data between the two groups revealed no significant differences in age,sex,body mass index,cognitive function,or comorbidity with other chronic diseases.However,there were statistically significant differences in the use of radiotherapy and regular exercise between the two groups(P<0.05).Comparisons of scales and laboratory indicators revealed no significant differences in albumin or PSQI scores between the two groups,but there were statistically significant differences in pain scores,PSQI scores,PFS scores,hemoglobin levels,and C-reactive protein levels(P<0.05).Spearman’s correlation analysis indicated that cancer-related fatigue was correlated with age,hemoglobin levels,C-reactive protein levels,pain,and regular exercise among leukemia patients with subthreshold depression.Multivariate regression analysis revealed that advanced age,combined radiotherapy,pain,and low hemoglobin levels were risk factors for cancer-related fatigue in leukemia patients with comorbid subthreshold depression,while regular exercise was a protective factor against cancer-related fatigue.Follow-up comparisons revealed a significantly lower overall incidence of complications in the control group(4%)than in the depressive group(24.21%;P<0.001).CONCLUSION Leukemia patients with comorbid subthreshold depressive symptoms experience more severe cancer-related fatigue and a higher incidence of complications.These findings may be related to advanced age,combined radiotherapy,pain,and low hemoglobin levels,while regular exercise may effectively alleviate symptoms.