Serum Levels of Zinc,Copper and Ferritin in Patients with Salivary Gland Tumors

Background: Variation in serum levels of trace elements including zinc, copper and ferritin has been reported incancer patients. The aim of this study was to evaluate these trace elements in the patients’ sera with benign and malignantsalivary gland tumors (SGTs) and compare them with normal individuals. Methods: In this cross-sectional study, 60patients with SGTs including 16 pleomorphic adenoma and 44 malignant SGTs, as well as 28 healthy controls, wereenrolled. Serum levels of zinc, copper and ferritin were determined by atomic absorption and ELISA methods. Datawere analyzed using one way ANOVA, Chi-square, Kruskal-Wallis and Mann- Whitney tests. Results: The meanconcentration of zinc, copper, ferritin was1.5± 2 ppm, 1.2± 0.5 ppm, and 96.7± 65.7 ng/ml in PA, 1.5± 1.4,1.3± 0.4,and 111.2± 112 in malignant SGTs, and1.1±0.3, 1.2± 0.23 and 124±135.8 in normal control groups. There was nostatistically significant difference between the patients and control groups, and between benign and malignant SGTs(P>0.05). Conclusion: The serum levels of trace elements in SGTs were not different from normal individuals. Theresults might have been affected by some interventional factors. Therefore, designing cohort complementary studiesmight result in obtaining more accurate data.     

高危骨髓增生异常综合征的治疗

骨髓增生异常综合征（MDS）是一类造血干细胞恶性克隆性疾病,其治疗主要集中在表观遗传学治疗、化疗、干细胞移植以及新药方面,现将各种治疗方法进行综述。     

Immunological Findings in Patients with Myelodysplastic Syndrome

Activation of monocytes and granulocytes in vitro by cytokines, in vivo administration of cytokines, as well as in vivo cytokine production due to infectious and inflammatory diseases causes changes of the surface expression density of certain membrane molecules. In recent studies we attempted to determine the feasibility of using flow cytometric immunophenotyping as a tool to develop a sensitive parameter for detecting infections at an early stage of disease when clinical parameters are still negative. Since infections are an important factor determining the clinical course of myelodysplastic syndromes (MDS), early detection of infection might be beneficial for these immunocompromised patients. We indeed found activation-associated immunophenotypic changes of cell surface antigens on monocytes and granulocytes of clinically infection free MDS patients suggesting enhanced immune activity in these patients, most likely due to latent or beginning infections. In particular, analyses of the expression density of receptors for IgG (Fc-γRs), complement receptors, and certain activation-associated surface molecules such as the CD67 and the M5 molecule seem to be of clinical relevance. We will also discuss findings concerning changes of cytokine levels and functional alterations of immunologic parameters in MDS patients.     

Chromosomal Abnormalities in Myelodysplastic Syndrome Patients in Upper Northern Thailand

Objective: Chromosome detection is important in the diagnosis and prognosis of Myelodysplastic syndrome (MDS) patients. About 50% of MDS patients have chromosomal abnormalities. Moreover, chromosome 5 and 7 are common genetic abnormalities in MDS patients and use to identify prognosis risk group and the proper treatment in MDS patients. The objective of this study was to evaluate chromosomal abnormalities and clinical features of MDS patients in upper northern Thailand. Methods: Fifty bone marrow (BM) specimens were examined by conventional cytogenetic (CC) technique and fluorescence in situ hybridization (FISH) technique for detected chromosome 5 and 7 abnormalities. The clinical features were comparison between MDS patients with chromosomal abnormalities and those with normal karyotype. Results: Chromosomal abnormalities were detected in 8/50 MDS patients by CC and 17/50 cases by FISH technique. When the CC and FISH techniques were combined, chromosomal abnormalities increased to 21/50 cases.  Abnormalities of isolated chromosome 5 were found in 13 cases and were associated with lower level of percentage blast of BM (p = 0.003) and higher level of hemoglobin (p = 0.019). Moreover, abnormalities of chromosome 7 were found in 3 cases, 1 case of isolated del(7q) and 2 cases of -7 and del(7q) with complex abnormalities. These three cases were associated with higher level of percentage blast of BM (p = 0.010). Conclusion: This study showed the frequency and pattern of chromosomal abnormalities of MDS patients in upper northern Thailand were different from other populations. MDS with isolated chromosome 5 abnormalities had clinical characteristics corresponding with patients in good prognosis risk group. However, MDS patients with chromosome 7 and complex abnormalities showed higher percentage blast of BM which high risk to progression to acute myeloid leukemia (AML). Combined CC and FISH techniques detect chromosomal abnormalities with greater frequency than when either technique is used alone.     

DNA甲基转移酶基因在MDS患者中的表达及其临床意义

研究DNA甲基转移酶（DNA methyltransferase,DNMT）基因在骨髓增生异常综合征（MDS）患者中的表达及其与抑癌基因p15INK4B甲基化状态的相关性,并进一步探讨其与临床预后的关系。方法：采用SYBR Green I实时定量逆转录聚合酶链反应（Real-time RT-PCR）方法对48例初治MDS患者和20例正常人骨髓进行DNMT1、DNMT3A、DNMT3B mRNA水平检测;采用甲基化特异性PCR（MSP-PCR）方法检测48例初治MDS患者和20例正常人p15INK4B基因的甲基化状态。结果：低危组MDS患者3种DNMTs mRNA与正常对照组相比,表达水平差异均无统计学意义（P>0.05）;高危组MDS患者3种DNMTs mRNA表达显著高于低危组和正常对照组（P均<0.01）;MDS患者DNMTs mRNA表达水平与p15INK4B基因甲基化程度呈正相关。12例高危MDS患者接受了地西他滨治疗,另外15例高危MDS患者接受了IA/DA联合化疗,地西他滨组疗效与联合化疗组比较差异无统计学意义（P>0.05）。结论：DNMTs基因的异常高表达,导致细胞周期调控相关的p15INK4B等抑癌基因启动子CpG岛过甲基化失活,在MDS患者由低危向高危转变乃至进展为急性髓系白血病（AML）过程中,起着至关重要的作用,DNMTs mRNA表达水平可以作为一种判断MDS预后的指标。     

Clinical and Biological Effects of Erythropoietin treatment of Myelodysplastic Syndrome

To evaluate its clinical efficacy as well as its biologic safety, human recombinant Erythropoietin (rh-Epo) was given to 19 patients with myelodysplastic syndromes (MDS) in an open non-randomized study. Among the seventeen evaluable patients only two showed an apparent hematologic response to rh-Epo treatment. In these patients hemoglobin levels increased from a mean pretreatment value of 8.5 and 8.4g/dl up to 11.7 and 11.3 g/dl respectively and remained relatively stable for several weeks. In one of these patients the transfusion requirement decreased from 4 to 1.5 units per month whereas the other had no transfusion requirement during the whole period of rh-Epo treatment. Interestingly, when the responding patients, after a “wash-out” period of at least ten weeks, received an additional course of rh-Epo results were less impressive. Before treatment the serum level of endogenous Epo was 18 and llOmU/ml in the two responding patients, whereas a mean value of 532 mU/ml (range 17-2797 mU/ml) was observed in non responders. The treatment of MDS patients with rh-Epo was clinically well tolerated since no relavent side effects were registered. Moreover, no evidence of harmful cytogenetic changes nor activation of myeloid growth factor genes, as determined by Northern blot analysis of GM-CSF and G-CSF gene expression, could be related to rh-Epo treatment. Overall, it appears that administration of rh-Epo is well tolerated but the therapeutic effects appear to be restricted to a minority of patients and a limited period of time.     

The Frequency of SF3B1 Mutations in Thai Patients with Myelodysplastic Syndrome

Genetic mutations in genes encoding critical component of RNA splicing machinery including SF3B1 are frequentlyidentified and recognized as the pathogenesis in the development of myelodysplatic syndrome (MDS). In this study,PCR sequencings specific for SF3B1 exon 13, 14, 15, and 16 were performed to analyse genomic DNA isolated frombone marrow samples of 72 newly diagnosed MDS patients. We found that 10 of 72 (14%) patients harbor SF3B1missense mutations including E622D (1/72), R625C/G (2/72), H662Q (1/72), K666T (1/72), K700E (4/72) and G740E(1/72), respectively. Mutations were predominantly located on exon 14 and 15 of SF3B1 coding sequence. Interestingly,patients with SF3B1 mutations exhibited higher platelet counts (195×109/L VS. 140×109/L, p-value = 0.025) as well aslower hemoglobin levels (81 g/L VS. 92 g/L, p-value = 0.009) and associated with ring sideroblast phenotype (p-value< 0.001) when compared with patients without the SF3B1 mutation. In summary, we reported the frequency of SF3B1mutations in Thai patients with different subtypes of MDS. SF3B1 mutations were predominantly occurred in MDS-RSand considered as favourable prognosis value. This study further highlighted the clinical important of SF3B1 mutationsanalysis for the classification of MDS.     

Neutrophil to Lymphocyte Ratio - Not an Independent Prognostic Factor in Patients with the Myelodysplastic Syndrome

Purpose: Neutrophil-to-lymphocyte ratio (NLR) was evaluated as a potential prognostic factor in patientswith myelodysplastic syndrome (MDS). Materials and Methods: Between December 2009 and April 2014, 14female (35%) and 26 male (65%) MDS patients who were followed up in our hematology clinic were included inthe study for NLR during diagnosis. Division was into two groups according to the NLR, and the correlation withmortality was evaluated. The prognostic significance of NLR regarding treatment outcome was also evaluatedwith adjustment for known confounding risk factors. Results: The mortality rate of the patient group was55%, and median survival was 18 months. There was no significant correlation between mortality and NLR ata median value of 1.8 (p=0.75). Thrombocytopenia was observed to increase mortality (p=0.027), and there wasa significant correlation between mortality and pancytopenia (p=0.017). Conclusions: This first study of NLRand mortality did not show any significant correlation . In centres with limited access to genetic evaluation forthe presence of pancytopenia and/or thrombocytopenia at the time of diagnosis, a platelet level less than 50×109/lmay be poor prognostic markers in MDS patients.     

肺癌患者血清铜和铁蛋白测定分析

 目的: 探讨癌症病人血清铜和血清铁蛋白之间的相互关系, 方法: 分别用原子吸收分光度计火焰法和放射免疫分析法测定了27例肺癌和45名正常人的血清铜和血清铁蛋白水平并作统计学分析。结果: 肺癌组的血清铜水平和铁蛋白水平均比对照组增加而且均有非常显著意义(P<0.01)。相关关系分析结果显示：人体血清铜与血清铁蛋白两者相互有高度的正相关关系(P<0.005)。鉴于血清铜绝大部分是以本质为亚铁氧化酶的铜蓝蛋白形式存在, 能促进铁的吸收, 而铁蛋白是机体对铁起贮存作用的蛋白质, 结论: 肺癌患者血清铁蛋白水平异常升高是铜蓝蛋白水平增高所致。     

Autoimmune Phenomena in Patients with Myelodysplastic Syndromes

Autoimmune syndromes are common in patients with myelodysplastic syndromes (MDS). Clinical manifestations include an acute systemic vasculitic syndrome (characterized by skin vasculitis, fever, arthritis and sometimes associated with pulmonary infiltrates and peripheral edema), chronic autoimmune disorders, including chronic cutaneous vasculitis, polyneuropathy, inflammatory bowel disease and glomerulonephritis, and classical connective tissue disorders, most notably relapsing polychondritis. Asymptomatic immunologic abnormalities are also common and include hypergammaglobulinemia and a positive FANA. Autoimmune syndromes may be the primary cause of death in some patients with MDS. However, these syndromes frequently respond to immunosuppressive agents and occasional dramatic hematologic responses to steroid therapy are seen. We review the incidence, nature, course and response to therapy of these manifestations and discuss potential pathogenic mechanisms.     

A Pilot Trial of Lirilumab With or Without Azacitidine for Patients With Myelodysplastic Syndrome

Background

Enhancement of natural killer cell activity by blocking interactions between killer immunoglobulin (Ig)-like receptors (KIRs) and human leukocyte antigen-C (HLA-C) molecules can improve outcomes in myeloid malignancies. Lirilumab is a human IgG4 monoclonal antibody that blocks KIR/HLA-C interaction. We designed a study to evaluate the safety and efficacy of lirilumab as a single agent and in combination with azacitidine in patients with myelodysplastic syndrome (MDS).

Association of Somatic Gene Mutations with Risk of Transformation into Acute Myeloid Leukemia in Patients with Myelodysplastic Syndrome: A Systematic Review and Meta-Analysis

Objectives: we aim to conduct a systematic review and meta-analysis in population of adult MDS patients to elucidate the role of these genes in AML transformation risk. Materials and Methods: The protocol for this systematic review and meta-analysis was registered in the international prospective register of systematic reviews (PROSPERO) with ID number of CRD42020218581. Systematic literature search was conducted by all authors up to October 2021 on: (1) PubMed, (2) EBSCOhost, (3) Scopus, (4) JSTOR, and (5) grey literatures. Hand-searching for relevant articles was also conducted. The following keywords with their synonyms and combinations using Boolean operators were applied to all database: “myelodysplastic syndrome”, SRSF2”, “SF3B1”, “U2AF1”, “ASXL1”, “DNMT3A”, “TET2”, “IDH1”, “IDH2”, “RUNX1”, “acute myeloid leukemia progression”, and “leukemia free survival”. Outcome was measured using hazard ratio (HR). Results: We identified 14 articles to be used for this systematic review and meta-analysis. There was no statistically significant difference in AML transformation risk between U2AF1 mutant and U2AF1 wildtype MDS patients (HR: 1.41; 95% CI: 0.95–2.07, p=0.08, I2=0%). Pooled HR showed that patients with SRSF2 mutation had higher risk of AML transformation (HR 2.62; 95% CI: 1.54-4.45; p= .0004; I2= 55%). The pooled HR for SF3B1 was 0.48 (95% CI: 0.22–1.06, p=0.07, I2=55%). Mutations of TET2, ASXL1, and EZH2 were not associated with AML transformation. Meanwhile, DNMT3A mutations were associated with AML transformation with pooled HR of 2.73 (95% CI: 1.43-5.21; p= 0.08; I2: 67%). The pooled HR for IDH genes was smaller (HR: 2.92; 95%CI: 1.21-7.06; p=0.02; I2:65%). Patients with RUNX1 mutation were associated with AML transformation (HR: 1.85; 95%CI: 1.11-3.09; p=0.02; I2:38%). Conclusion: Based from our analyses, MDS patients with mutations of SRSF2, DNMT3A, IDH, and RUNX1 have higher hazard ratio for AML transformation.     

消化道肿瘤患者血清锌,铜水平及铜／锌比值的临床观察

本文应用ICP-光谱法对50例消化道肿瘤病人的血清锌、铜及铜/锌比值作了对照性观察、结果表明肿瘤病人的血清锌低于对照组、血清钢及铜/锌比值高于对照、差异非常显著(P<0.001、P<0.005)。有远位转移组与无转移组相比;静脉营养组与进食组相比,血清锌、铜及铜/锌比值差异不显著(P>0.05～0.10)。因此,认为血清锌低、铜及铜/锌比值增高是本组肿瘤病人的特征,可作为肿瘤监测的一个指标,但是,不能作为判断预后的依据。     

Intravenous Bolus Topotecan in Patients with Myelodysplastic Syndrome

We treated 16 patients with myelodysplastic syndromes with 24 courses of bolus topotecan. Patients received topotecan as a daily 15 minute infusion for 5 days at 3 dose levels (4.0 mg/m²/d, 2.0 mg/m²/d or 2.5 mg/m²/d). There was one complete response and one partial response (overall response rate 12%). Toxicity included myelosuppression, diarrhea, ileus and mucositis. There were 3 treatment-related deaths. The results of this schedule of topotecan appeared to be inferior to that reported with infusional topotecan in patients with MDS.     

Managing Iron Overload in Patients with Myelodysplastic Syndromes with Oral Deferasirox Therapy

Patients with myelodysplastic syndromes (MDS) often require chronic RBC transfusions, which can lead to iron overload. Without adequate management, this may cause progressive damage to hepatic, endocrine, and cardiac organs, significantly affecting overall survival. Recent retrospective analyses have suggested that iron chelation provides a survival advantage in iron‐overloaded patients with MDS who are given chelation therapy compared with those who are not. Nonetheless, it is evident that iron overload in many patients with MDS is not adequately managed. Clinical evaluation of the once‐daily, oral iron chelator deferasirox in MDS populations has indicated that it provides dose‐dependent reductions in body iron burden and is generally well tolerated, with a manageable safety profile in adult and pediatric patients. The most common treatment‐related adverse events (AEs) included transient, mild‐to‐moderate gastrointestinal disturbances and skin rash, which rarely required drug discontinuation and resolved spontaneously in most cases. Adequate management of AEs and practical approaches such as patient education and counseling are necessary to ensure that patients remain compliant with therapy. Regular monitoring of serum ferritin levels is key to identifying patients who require iron chelation therapy, and to ensure maintenance of iron levels below the critical level of 1,000 μg/l. The flexible dosing regimen of deferasirox allows dose adjustments to be made in response to trends in serum ferritin, to changes in a patient's transfusional iron intake, and to the objectives of treatment, allowing the full benefit of transfusion therapy without the risks associated with iron overload.     

Clinical Outcomes of Decitabine Treatment for Patients With Lower-Risk Myelodysplastic Syndrome on the Basis of the International Prognostic Scoring System

IntroductionDecitabine has shown clinical benefits in patients with intermediate (INT)-2 or high-risk myelodysplastic syndrome (MDS), determined according to the International Prognostic Scoring System (IPSS), but the benefits have not been well demonstrated in patients with lower-risk (IPSS low or INT-1) disease. Recently, it was proposed that the prognosis for patients with IPSS lower-risk disease is heterogeneous, with a substantial proportion of these patients having poor survival.Patients and MethodsThis study included patients with IPSS lower-risk MDS from the DRAMA (An Observational Study for Dacogen Long-Term Treatment in Patients With Myelodysplastic Syndrome; NCT01400633) and DIVA (A Study for Dacogen Treatment in Patients With Myelodysplastic Syndrome; NCT01041846) studies, which were prospective observational studies on the efficacy and safety of decitabine treatment in patients with MDS. Using the Lower-Risk Prognostic Scoring System [LR-PSS], we classified IPSS lower-risk MDS. Patients in each LR-PSS category were divided according to overall response (OR) to decitabine treatment, and survival outcomes were compared.ResultsOne hundred sixteen patients were enrolled: LR-PSS category 1 (n = 12; 10.3%), category 2 (n = 56; 48.3%), and category 3 (n = 48; 41.4%). Survival outcomes differed among the 3 categories (P = .046). The overall survival according to OR showed a significant difference in total patients (P = .008) and category 3 patients (P = .003). We analyzed predictive factors for OR, but no variable was found to significantly affect OR.ConclusionDecitabine treatment showed a survival benefit in the higher-risk group of IPSS lower-risk MDS patients who responded to treatment, and classification using the LR-PSS category was helpful for this subgroup, indicating that decitabine treatment might alter the natural course of disease in these patients.     

骨髓增生异常综合征DNA甲基化及其治疗机制的进展

骨髓增生异常综合征（myelodysp lasticsyndrome,MDS）仍为血液病学较难攻克的一大主题。近年由于DNA甲基化研究的进展及DNA去甲基化药物的开发、使用,为MDS的治疗提供了更多可能的靶点。全文就近年DNA甲基化及去甲基化治疗相关机制的研究进展作一介绍。     

Favorable Outcomes With Tumor Burden Reduction Following Administration of Hypomethylating Agents Before Allogeneic Hematopoietic Cell Transplantation in Patients With Higher Risk Myelodysplastic Syndrome

IntroductionThe clinical significance of tumor burden reduction following administration of hypomethylating agents (HMAs) for transplant-eligible patients with higher risk myelodysplastic syndrome (MDS) was evaluated.Patients and MethodsData of 79 transplant-eligible patients (< 65 years) diagnosed with higher-risk MDS between July 2002 and March 2013 were retrospectively analyzed. Among 79 patients, 30 (38%) underwent allogeneic hematopoietic cell transplantation (HCT group), and 49 (62%) were treated with HMA alone (non-HCT group).ResultsThe median follow-up duration was 732 days (range, 28-1952 days), and the 3-year overall survival (OS) rate of all patients was 30.6%. In the HCT group, early HCT showed a better 3-year OS rate than late HCT (67.1% vs. 25.7%; P = .035). In multivariate analysis, time/performance of allogenic transplant (no HCT vs. early HCT, hazard ratio, 0.18; 95% confidence interval, 0.04-0.81; P = .026) and follow-up higher risk International Prognostic Scoring System (hazard ratio, 6.22; 95% confidence interval, 2.09-18.51; P = .001) were significantly correlated with OS.ConclusionTo predict the clinical outcomes of patients with higher risk MDS, the optimal time for tumor burden evaluation is prior to follow-up rather than at the time of initial diagnosis. Patients with lower International Prognostic Scoring System risk groups after HMA treatment or early HCT had favorable OS.