Predictive Value of Dynamic Peri-Transplantation MRD Assessed By MFC Either Alone or in Combination with Other Variables for Outcomes of Patients with T-Cell Acute Lymphoblastic Leukemia

We performed a retrospective analysis to investigate dynamic peri-hematopoieticstem cell transplantation(HSCT)minimal/measurable residual disease(MRD)on outcomes inpatients with T-cell acute lymphoblastic leukemia(T-ALL).A total of 271 patients were enrolledand classified into three groups:unchanged ncgative MRD pre-and post-HSCT group(group A),post-MRD non-increase group(group B),and post-MRD increase group(group C).The patientsin group B and group C experienced a higher cumulative incidence of relapse(CIR)(42%vs.71%vs.16%,P<0.001)and lower leukemia-free survival(LFS)(46%vs.21%vs.70%,P<0.001)andoverall survival(OS)(50%vs.28%vs.72%,P<0.001)than in group A,but there was no significantdifference in non-relapse mortality(NRM)among three groups(14%vs.12%vs.8%,P=0.752).Multivariate analysis showed that dynamic peri-HSCT MRD was associated with CIR(HR=2.392,95%CI,1.816-3.151,P<0.001),LFS(HR=1.964,95%CI,1.546-2.496,P<0.001)and os(HR=1.731,95%CI,1.348-2.222,P<0.001).We also established a risk scoring system based ondynamic peri-HSCT MRD combined with remission status pre-HSCT and onsct of chronic graft-versus-host disease(GVHD).This risk scoring system could better distinguish ClR(c=0.730)thanthat for pre-HSCT MRD(c=0.562),post-HSCT MRD(c=0.616)and pre-and post-MRD dynamics(c=0.648).Our results confirm the outcome predictive value of dynamic peri-HSCT MRD eitheralone or in combination with other variables for patients with T-ALL.

Geriatric Assessment to Predict Survival and Risk of Serious Adverse Events in Elderly Newly Diagnosed Multiple Myeloma Patients： A Multicenter Study in China

Background： Elderly multiple myeloma （MM） patients often tend to suffer a variety of diseases, so the treatment of choice is very difficult for the elderly myeloma patients. The overall survival （OS） time and side effects with elderly patients are unclear in China. The study tried to find out the role of geriatric assessment in the Chinese elderly MM. Methods： We retrospectively analyzed the data of 628 newly diagnosed patients from six hospitals from June 2011 to June 2013. A geriatric assessment had been performed to assess comorbidities, cognitive, and physical status for these patients. The primary endpoint was to evaluate different physical states of elderly patients with OS time and treatment-related side effects. Results： An additive scoring system （range： 0-5）, based on age, Katz＇s Activity of Daily Living （ADL） and Lawton＇s Instrumental Activity of Daily Living （IADL） 〈5 and Charlson Comorbidity Index （CC1） was developed to identify three groups： fit （score = 0）; intermediate-fitness （score = 1 ）; and fi＇ail （score ≥2）. The 3-year OS was 63% in fit patients, 63% in intermediate-fimess patients, and 49% in frail patients ≥3 hematologic adverse events （AEs） were documented in 45 （35.4%） fit, 34 （34%） intermediate-fitness, and 121 （30.2%） frail patients. The risk of a grade ≥3 hematologic AEs was not significantly increase in intermediate-fitness （hazard ratios [HR]： 0.99, 95% confidence interval [CI]： 0.54 1.47, P = 1.000） and in frail patients （tfR： 1.16, 95% CI： 0.70-1.93, P- 0.558） compared with fit ones. Conclusions： MM occurs earlier in life and being advanced when the diagnosis is made in the mainland of China. The overall survival in fi＇ailty with International Staging System （ISS） ll/lll was the worst in all patients.

Efficacy and Safety of Bortezomib in Multiple Myeloma Patients with Hepatitis B： A Multicenter Retrospective Study

Background： The efficacy and safety evidence of bortezomib in multiple myeloma （MM） patients with hepatitis B is vacant.This study aimed to investigate the efficacy and safety of bortezomib in MM patients with hepatitis B in China.Methods： From 2006 to 2011, 739 newly diagnosed MM patients were screened for serum hepatitis B virus （HBV） biomarkers.HBV-infected patients were followed for HBV reactivation by monitoring of serum alanine transaminase （ALT） and HBV DNA load.The pattern of HBV reactivation in relation to bortezomib was evaluated.Seven hundred thirty-nine MM patients were included in this study.Results： The prevalence of MM patients infected with HBV was 3.4% （n =25）, of which 17 cases were treated with bortezomib.Bortezomib had no significant influence on liver function （ALT before and after treatment： 36.69 ＆#177; 8.90 U/L vs.11.31 ＆#177; 2.74 U/L, P =0.19） and HBV DNA of MM patients with HBV （detectable HBV DNA percentage： 5.9% vs.11.8%, P =0.12）.Conclusions： Bortezomib can be used safely and effectively in MM patients with hepatitis B.HBV prophylaxis and surveillance are recommended during the MM treatment.

Correlation of CD19+CD24hiCD38hl B cells in coronary artery disease with severity of atherosclerosis

To the Editor:Atherosclerosis is a chronic inflammatory disease that involves multiple types of immune cells.Adaptive immunity exerts diverse and profound effects on atherosclerosis.The effector phenotype of lesional T cells may affect lesion growth and stability.Regulatory T cells with anti-inflammatory properties have been reported in atherosclerotic plaques.The targets of suppression of regulatory T cells include naive and effector CD4+and CD8+T cells,dendritic cells,and macrophages.A new subset of B cells,with CD19+CD24h,CD38hl phenotype in humans,is becoming a hot issue in the field of autoimmunity such as systemic lupus erythematosus and arthritis.*11 These regulatory B cells(Bregs)play important roles in immune system by regulating functions of effector and regulatory T cells.Bregs exhibit protective role by attenuating the neointimal formation of atherosclerosis through an interleukin 10(IL-10)mediated mechanism in a experimental study.121 There have been few studies on human Bregs in atherosclerosis disease until now.In this study we aimed to investigate CD 19+CD24hlCD38hl B cells in coronary artery disease(CAD)patients requiring coronary artery bypass graft(CABG)surgery.

Two Secondary Primary Malignancies after Bortezomib Therapy for Multiple Myeloma： A Single-center Experience

Multiple myelorna （MM） is the second most common hematological malignancy. The introduction of novel agents such as thalidomide, bortezomib, and lenalidomide in more recent years has significantly improved the response rate, progression-free survival （PFS）, and overall survival （OS） of MM patients, However, alongside these benefits, a significant increased risk of developing secondary primary malignancies （SPMs） has been observed. Until now, there has not been a relevant large study of Chinese MM patients available to study SPMs, and no secondary malignancy after bortezomib treatment alone has been reported.

Plasmacytoid Dendritic Cells Proliferation Coexisted with Acute Myeloid Leukemia

To the Editor： Plasmacytoid dendritic cells （pDCs） represent a subset of dendritic cells. There are two distinct forms of neoplasms derived from pDCs; the one is blastic plasmacytoid dendritic cell neoplasm （BPDCN） and the other is mature pDCs proliferation coexisted with myeloid tumors. The mature pDCs in myeloid tumor are characterized by a lineage-negative human leukocyte antigen （HLA）-DR^＋ CD56 CD123^＋CDIIc immunophenotype. Here, we describe an 83-year-old man who developed acute ,nyeloid leukemia （AML） transferred from primary myelofibrosis （PMF） coexisted with monoclonal gammopathy of undetermined significance （MGUS） and mature pDCs proliferation; however, the immunophenotype results of bone marrow （BM） showed positive CD56 expression.