| Part1 The analysis of relevant factors to patients with acute myeloid leukemiaBackground and Objective:Acute myeloid leukemia (AML) is a grave threat to human health. However, its pathogeny and pathogenesis are still unclear, and its mortality rate is still very high. In recent years, scientists pay more attention to the relationship between acute myeloid leukemia and environment, which includes living environment, working environment, psychological environment and living habits. In our research, we collect the date about environmental factors from AML patients, including living environment and habits, personal characteristics and so on, and then we define the independent relevant factors to AML, which is helpful for the prevention of AML.Methods:Case-control study method based on Shandong University Affiliated Qilu Hospital is selected. The case group and control group are required to fill in the same epidemiological investigation questionnaire as well as the big five personality research meter.The 102 patients who were defined as AML in hematology department of Qilu Hospital between March 2014 and December 2015 are selected as the case group. And we choose patients with non-hematological and non-malignant diseases from Qilu Hospital at the same time randomly as the control group. The case group and control group are matched by sex and age at the ratio of 3:1.SPSS 17.0 are used to analyze date, and then we screen out the relevant factors to AML. P value<0.1 is considered statistically significant in univariate logistic regression analysis and in multivariate logistic regression analysis, P value <0.05 is considered statistically significant.Results:1. In our research,102 AML patients are selected as case group in total, of which 52 cases are male patients (50.98%) and 50 cases are female patients (49.02%). The maximum age of all cases is 77; The minimum age is 14 and the average age is 43 years old.2. Thirty-four patients with non-hematological and non-malignant diseases from Qilu Hospital are included in the control group. One half of the control patients are male and the other half are female. The maximum age is 76; The minimum age is 15 and the average age is 37.5 years old.3. By univariate logistic regression analysis, we find some relevant factors to AML, including:spinsterhood (P=0.011), hair coloring (P=0.039), passive smoking (P<0.01), keeping pets (P<0.01), chemical factory within the scope of 5Km around the house (P<0.01), using analgesic-antipyretic (P=0.016), using electric blanket (P<0.01), using induction cooker (P<0.01), eating vegetables (5-10 times per week)(P=0.047), drinking tea (2-5 times per week)(P=0.015), eating fruits (less than 2 times per week)(P=0.055), neurotic personality (P<0.01), extroversion personality (P<0.01), conscientiousness personality (P<0.01), agreeableness personality (P=0.027), years of using cellphone (P=0.079), pesticide exposure history (P=0.096).4.Taking the relevant factors mentioned above into multivariate logistic regression analysis and the results are as follows:chemical factory within the scope of 5Km around the house (OR=14.125,95%CI:1.321-151.077), using induction cooker (OR=30.701,95%CI:3.113-302.831), using electric blanket (OR=29.487, 95%CI:3.089-281.480), conscientiousness personality (OR=1.162, 95%CI:1.036-1.302) and pesticide exposure history (OR=6.578, 95%CI:1.075-40.245) are independent risk factors for AML. Drinking tea (2-5 times per week)(OR=0.039,95%CI:0.005-0.322) is an independent protective factor for AML.Conclusion:1. Living environment is related to AML. Chemical factory within the scope of 5Km around the house is an independent risk factor for AML.2. Non-occupational exposure is related to AML. Hair coloring, passive smoking and using telephone can impact AML, but using induction cooker and electric blanket are independent risk factors for AML.3. Occupational exposure has something to do with AML. People with pesticide exposure history are more likely to have AML.4. Personal characteristic is relevant to AML as well. Conscientiousness personality is defined as an independent risk factor for the occurrence of AML.5. Living habits have relationships with AML. Drinking tea (2-5 times per week) is an independent protective factor.Part 2 The prognostic value of BCR-ABL and its reduction rate in chronic myeloid leukemia patients on treatment with TKIsBackground and Objective:Chronic myeloid leukemia (CML) is a disease of haemopoietic stem cells based on BCR-ABL fusion gene. Tyrosine Kinase Inhibitors (TKIs) target and inhibit the BCR-ABL tyrosine kinase, resulting in a high rate of complete cytogenetic and molecular remissions. Early molecular responses have great importance for treatment management. But when to consider failure to therapy and treatment change are undefined. The aim of our research is to define the prognostic value of BCR-ABL transcript level and its reduction rate.Methods:The date of 102 patients with newly diagnosed CML in chronic phase who receive TKIs therapy and are monitored at Qilu Hospital between January 2010 and November 2015 are reviewed. The reduction rates of BCR-ABL are calculated and treatment responses at 6 and 12 months are defined according to the European Leukemia Net (ELN) recommendations.Statistical analysis was performed using the SPSS 17.0 with a significance level of 5%(P< 0.05). The incidences of different groups are compared using chi-square test or Fisher exact test; The non-normal distribution date are analyzed by Wilcoxon rank-sum test; Receiver operating characteristic curve is used to select the best boundary value. Ordinal and binary logistic regression model was developed to identify the independent predict factors.Results:1. Group with a transcript level of>10% at 3 months shows inferior outcomes at 6 months(P<0.001) and 12 months (P=0.036) than the group with≤10%.2. The high risk group with 3-mo reduction rate<0.89 and low risk group with ^ 0.89 had significant differences in treatment responses at 6 months (P <0.001).Similarly, high risk group (3-mo reduction rate<0.966) shows worse responses at 12 months then the low risk group (≥0.966)(P=0.002).3. Group with a 6-mo transcript level of>0.4%shows inferior outcomes at 12 months than the group with≤0.4%(P<0.001).4. The high risk group (6-mo reduction rate<0.991) showed inferior outcomes at 12 months compared to the low risk group (reduction rate≥0.991) (P=0.001).5.3-mo reduction rate≥0.89 and ≥0.966 were independent prognostic indicators of responses at 6 months and 12 months respectively.Conclusion:1. BCR-ABL transcript level is related to early treatment responses of TKIs. 3-mo transcript level≤ 10% can predict treatment responses at 6 and 12 months and 6-mo transcript level≤0.4% is helpful to predict treatment responses at 12 months. But all mentioned above are not independent predictive factors.2. The reduction rate of BCR-ABL is a great predictive factor for early treatment responses of TKIs.3-mo reduction rate≥0.89,≥0.966 are independent predictive factors for treatment responses at 6 and 12 months respectively. |
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