BackgroundCirrhosis always goes with profound immunity compromise, and makes those patients easily be the target of pneumonia. Cirrhotic patients with pneumonia have a dramatically increased mortality. To recognize the risk factors of mortality and to optimize stratification are critical for improving survival rate.MethodsTwo hundred and three cirrhotic patients with pneumonia at a tertiary care hospital were included in this retrospective study. Demographical, clinical and laboratory parameters, severity models and prognosis were recorded. Multivariate Cox regression analysis was used to identify independent predictors of 30-day and 90-day mortality. Area under receiver operating characteristics curves (AUROC) was used to compare the predictive value of different prognostic scoring systems.ResultsPatients with nosocomial acquired or community acquired pneumonia indicated similar prognosis after 30- and 90-day follow-up. However, patients triggered acute-on-chronic liver failure (ACLF) highly increased mortality (46.4% vs 4.5% for 30-day, 69.6% vs 11.2% for 90-day). Age, inappropriate empirical antibiotic therapy (HR: 2.326 p = 0.018 for 30-day and HR: 3.126 p < 0.001 for 90-day), bacteremia (HR: 3.037 p = 0.002 for 30-day and HR: 2.651 p = 0.001 for 90-day), white blood cell count (WBC) (HR: 1.452 p < 0.001 for 30-day and HR: 1.551 p < 0.001 for 90-day) and total bilirubin (HR: 1.059 p = 0.002 for 90-day) were independent factors for mortality in current study. Chronic liver failure–sequential organ failure assessment (CLIF-SOFA) displayed highest AUROC (0.89 and 0.90, 95% CI: 0.83–0.95 and 0.85–0.95 for 30-day and 90-day respectively) in current study.ConclusionsThis study found age, bacteremia, WBC, total bilirubin and inappropriate empirical antibiotic therapy were independently associated with increased mortality. Pneumonia triggered ACLF remarkably increased mortality. CLIF-SOFA was more accurate in predicting mortality than other five prognostic models (model for end-stage liver disease (MELD), MELD-Na, quick sequential organ failure assessment (qSOFA), pneumonia severity index (PSI), Child-Turcotte-Pugh (CTP) score).Electronic supplementary materialThe online version of this article (10.1186/s12931-018-0934-5) contains supplementary material, which is available to authorized users.
ObjectiveTo evaluate the efficacy and safety of standard or low-dose chemotherapy followed by HLA-mismatched allogeneic T-cell infusion (allo-TLI) for the treatment of elderly patients with acute myeloid leukemia (AML) and patients with intermediate-2 to high-risk myelodysplastic syndrome (MDS).MethodsWe carried out a prospective, multicenter, single-arm clinical trial. Totally of 25 patients were enrolled, including 17 AML patients and 8 MDS patients. Each patient received four courses of non-ablative chemotherapy, with HLA-mismatched donor CD3+ allo-TLI 24 h after each course. AML patients received chemotherapy with decitabine, idarubicin, and cytarabine, and MDS patients received decitabine, cytarabine, aclarubicin, and granulocyte colony-stimulating factor.ResultsA total of 79 procedures were performed. The overall response rates of the AML and MDS patients were 94% and 75% and the 1-year overall survival rates were 88% (61–97%) and 60% (13–88%), respectively. The overall 60-day treatment-related mortality was 8%. Compared with a historical control cohort that received idarubicin plus cytarabine (3 + 7), the study group showed significantly better overall response (94% vs. 50%, P=0.002) and overall survival rates (the 1-year OS rate was 88% vs. 27%, P=0.014). Post-TLI cytokine-release syndrome (CRS) occurred after 79% of allo-TLI operations, and 96% of CRS reactions were grade 1.ConclusionElderly AML patients and intermediate-2 to high-risk MDS patients are usually insensitive to or cannot tolerate regular chemotherapies, and may not have the opportunity to undergo allogeneic stem cell transplantation. Our study showed that non-ablative chemotherapy followed by HLA-mismatched allo-TLI is safe and effective, and may thus be used as a first-line treatment for these patients.Clinical Trial Registrationhttps://www.chictr.org.cn/showproj.aspx?proj=20112.
Objective: Between October 2010 to May 2014, 59 patients who diagnosed as FLT3-ITD positive aAML were analyzed. All the patients were signed informed consents to agree to provide their clinical information to this study. Informed consents were approved by Ethics Committee. Peripheral white cell count at diagnose; complete remission (CR) rate; the percentage of progressing to refractory leukemia and the response to allogenic stem cell transplantation (allo-SCT) were analyzed. Better therapeutic strategy was explored. Methods: Diagnosis was made according to the French-American-British classification system or World Health Organization diagnostic classification criteria. FLT3-ITD mutation was detected by polymerase chain reaction (PCR) and gel electrophoresis. Refractory leukemia is defined as fail to achieve CR after two courses of conventional chemotherapy, or with a short (<6–12 months) CR1 duration, or patients who have relapsed at least twice. Results: 59 patients were diagnosed as Flt3-ITD mutation positive aAML in our centre during the last 44months, including 30 males and 29 females, with an average age at 42.2y. Flt-ITD mutation can be detected in 1/59 of M0 (1.7%); 6/59 of M1 (10.1%); 20/59 of M2 (33.8%); 9/59 of M3 (15.2%); 5/59 of M4 (8.5%); 14/59 of M5 (23.7) and 1/59 of M6 (1.7%). 23.7% (14/59) patients had high white blood cell counts (>100*10E9/L) at diagnose. After induction chemotherapy, 50% (27/54) cases achieved CR. 53.4% (23/43, 16 cases were lost follow-up) patients met the criteria of refractory leukemia. 12 patients received allo-SCT, including 8 refractory leukemia cases. The average time from diagnose to transplantation is 6.5 months (3 to 12 months). 1 patient relapsed at 3 months after allo-SCT who was diagnosed refractory leukemia before allo-SCT, all other 11 cases remained CR with the longest follow-up time at 26 months (3 to 26 months). For the left 15 refractory leukemia cases who did not received allo-SCT, the 1-year OS rate for the 12 cases is 50% (6/12), but the 1-year EFS rate is 0 (0/12) (3 cases were lost follow-up). Conclusion: FLT3-ITD mutation was reported to be detected in around 30% of aAML. Flt3-ITD mutation is an independent high-risk factor for aAML. Based on retrospective data from 59 cases in our centre, FLT3-ITD mutation positive aAML patients can be characterized as high white blood cell count at diagnose, lower CR rate and higher refractory leukemia percent. allo-SCT can achieve persistent remission in part of patients, even in refractory leukemia patients. Our study also implied that the CR1 is the ideal stage for FLT3-ITD mutation positive aAML patient to receive allo-SCT. Disclosures No relevant conflicts of interest to declare.
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