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Pang H, Xu G, Liu H, Zhu X, Zhu X, Wang G, Zhang Y, Yuan T, Ji Z, Gao L, Tan G. Blood-letting therapy combined with Master Tung's Five-tiger Point Scraping (Gua Sha) for patients with hematological malignancy and chemotherapy-induced peripheral neuritis. Am J Transl Res 2023; 15:5304-5313. [PMID: 37692923 PMCID: PMC10492046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/12/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE To investigate the clinical efficacy of Shixuan and Qiduan blood-letting therapy combined with Master Tung's Five-tiger Point (11.27) Scraping for patients with hematological malignancy and peripheral neuritis. METHODS A total of 70 patients with hematological malignancy who were admitted to Langfang TCM Hospital between January 2020 and December 2022 for treating chemotherapy-induced peripheral neuritis were enrolled retrospectively. The patients were divided into a single treatment group that received western nutritional interventions alone, and a combined treatment group that underwent additional Traditional Chinese Medicine (TCM) Shixuan and Qiduan blood-letting therapy, along with Master Tung's Five-tiger Point (11.27) Scraping. Statistical analyses were carried out to compare the clinical efficacy of the two treatment plans in the patients. Scores of sensory disturbance rating (SDR), numeric rating scale (NRS) for pain, nail fold microcirculation (NFM) of the infected extremity, and the quality of life (QoL), as well as the motor nerve conduction velocity (MNCV) and sensory nerve conduction velocity (SNCV) of the median and peroneal nerves of patients in both groups were recorded and compared before and after treatment. The incidence rate of adverse events was compared between the two groups. Furthermore, the clinical outcomes of patients in the two groups were followed up and analyzed for correlated factors using univariate and multivariate analyses. RESULTS The clinical efficacy rate achieved by the combined therapy was 88.57%, significantly higher than 68.57% for patients undergoing single therapy (P=0.041). Moreover, the scores of SDR, pain NRS, QoL, and NFM of the affected extremity, as well as the MNCV and SNCV of patients in the two groups were all improved after treatment, with better improvements in the combined treatment group than in the single treatment group. The incidence rate of adverse events was higher in the single treatment group compared to that of the combined treatment group (17.14% vs. 11.42%) (P=0.466). In addition, during the six-month follow-up period, a total of 27 patients in both groups developed chronic neural disorders. Logistic regression analysis revealed that the MNCV and SNCV of the median and peroneal nerves, together with the duration of chemotherapy, served as independent influencing factors. CONCLUSION Shixuan and Qiduan blood-letting therapy combined with Master Tung's Five-tiger Point (11.27) Scraping could improve the SDR and pain NRS scores, facilitate the recovery of neural functions, and advance the QoL of patients with chemotherapy-induced peripheral neuritis without increasing the risk of adverse reactions.
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Affiliation(s)
- Hongcui Pang
- Department of Hematology, Langfang Hospital of Traditional Chinese MedicineLangfang 065000, Hebei, China
| | - Guanglun Xu
- Department of Rehabilitation, Yantai Penglai Hospital of Traditional Chinese MedicineYantai 265600, Shandong, China
| | - Hua Liu
- Department of Emergency, Yantai Affiliated Hospital of Binzhou Medical UniversityYantai 264100, Shandong, China
| | - Xuehai Zhu
- Langfang Institute of StandardizationLangfang 065000, Hebei, China
| | - Xuewei Zhu
- Department of Radiology, Hebei PetroChina Central HospitalLangfang 065000, Hebei, China
| | - Guannan Wang
- Department of Hematology, Langfang Hospital of Traditional Chinese MedicineLangfang 065000, Hebei, China
| | - Yannan Zhang
- Department of Hematology, Langfang Hospital of Traditional Chinese MedicineLangfang 065000, Hebei, China
| | - Ting Yuan
- Department of Hematology, Tianjin First Central HospitalTianjin 300393, China
| | - Zhifang Ji
- Department of Nursing, Langfang Hospital of Traditional Chinese MedicineLangfnag 065000, Hebei, China
| | - Lishu Gao
- Department of Endocrinology, Tangshan People’s HospitalTangshan 063001, Hebei, China
| | - Guochang Tan
- Department of Tumor Hepatology, Zibo Hospital of Traditional Chinese MedicineZibo 255300, Shandong, China
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Jeon WJ, Dalal S, Moon JH, Joung B, Nguyen M, Castillo D, Hudson J, Park K, Raghavan R, Akhtari M, Patel A. Leukostasis With Isolated Central Nervous System Involvement in Chronic Phase of Chronic Myelogenous Leukemia. J Hematol 2023; 12:187-196. [PMID: 37692864 PMCID: PMC10482607 DOI: 10.14740/jh1150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/11/2023] [Indexed: 09/12/2023] Open
Abstract
Chronic myelogenous leukemia (CML) is a hematologic malignancy with unique significance to the field of hematology and oncology, specifically due to the development of tyrosine kinase inhibitors (TKIs). CML often presents with nonspecific symptoms, and the quality of life in patients with CML has drastically improved as a result of TKIs. However, complications of CML including the risk of transforming into life-threatening blast crises continue to exist. Further, as most patients are asymptomatic in the chronic phase, patients often present with serious complications associated with noncompliance to TKIs. For example, central nervous system (CNS) manifestations of CML have been reported, both as the initial presentation of undiagnosed CML and as known complication of uncontrolled CML. Hyperleukocytosis is a manifestation of uncontrolled CML and leukostasis is a complication, occurring in cases of acute myeloid leukemia (AML). Here we present a rare case of leukostasis in a patient with known CML presenting on computed tomography (CT) as intracranial masses in the chronic phase. Our goal is to discuss this rare case of leukostasis in adult CML and describe its management.
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Affiliation(s)
- Won Jin Jeon
- Department of Internal Medicine, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Suhani Dalal
- Department of Internal Medicine, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Jin Hyun Moon
- Department of Internal Medicine, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Bowon Joung
- Department of Internal Medicine, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Michael Nguyen
- Division of Medical Oncology/Hematology, Department of Internal Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Dani Castillo
- Division of Medical Oncology, City of Hope, Duarte, CA, USA
| | - Jessica Hudson
- Division of Anatomic and Surgical Pathology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Kiwon Park
- Department of Pharmacy, Loma Linda University, Loma Linda, CA, USA
| | - Ravi Raghavan
- Division of Anatomic and Surgical Pathology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Mojtaba Akhtari
- Division of Medical Oncology/Hematology, Department of Internal Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Ami Patel
- Division of Medical Oncology/Hematology, Department of Internal Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA
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Jo S, Yoo JW, Kim S, Lee JW, Im SA, Cho B, Chung NG. Case report: First report of isolated central nervous system lymphoblastic crisis in a child with chronic myeloid leukemia on dasatinib therapy. Front Oncol 2023; 13:1122714. [PMID: 37035148 PMCID: PMC10076740 DOI: 10.3389/fonc.2023.1122714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/09/2023] [Indexed: 04/11/2023] Open
Abstract
Most children with chronic myeloid leukemia (CML) present with the chronic phase (CML-CP) at diagnosis, exhibiting an excellent treatment response to contemporary tyrosine kinase inhibitors (TKIs). However, despite TKI therapy, patients with CML-CP may progress to blastic crisis (BC). CML-BC rarely occurs in extramedullary sites, and isolated central nervous system (CNS) BC is an extremely rare condition. It may with present various neurologic symptoms that necessitates differential diagnosis from other causes such as TKI toxicity. Information on the diagnosis and treatment of this condition is lacking, as are well-established diagnostic criteria. Here, we report a case of isolated CNS lymphoblastic crisis in a child with CML-CP who was treated with dasatinib. The patient, an 8-year-old girl, was admitted owing to visual disturbance and severe headache. We highlight the importance of a CSF study for the differential diagnosis of CNS BC in patients with CML-CP who present with common neurologic symptoms during TKI therapy.
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Affiliation(s)
- Suejung Jo
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Won Yoo
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- *Correspondence: Jae Won Yoo,
| | - Seongkoo Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Wook Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Soo-Ah Im
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Bin Cho
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Nack-Gyun Chung
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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CNS Involvement in a Patient with Chronic Myeloid Leukemia. Case Rep Hematol 2021; 2021:8891376. [PMID: 33777461 PMCID: PMC7972862 DOI: 10.1155/2021/8891376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 11/29/2020] [Accepted: 02/05/2021] [Indexed: 11/29/2022] Open
Abstract
Inspite of medication compliance, some chronic myeloid leukemia (CML) patients will relapse/progress into an accelerated phase or blast crisis. Central nervous system (CNS) involvement is a rare manifestation of such a relapse. Here, we report a case of 23-year-old female who was diagnosed with CML in the accelerated phase and subsequently treated with imatinib. She developed early relapse in her CNS, and her treatment was switched to dasatinib and intrathecal chemotherapy with cytarabine and methotrexate. Her CNS disease went into remission, and she underwent matched unrelated donor (MUD) hematopoietic stem cell transplant (HSCT). We discuss various mechanisms of treatment failure, importance of vigilance for symptoms and signs of treatment failure/relapse, indications for use of different tyrosine kinase inhibitors (TKIs), and management of blast crises in CML.
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Ryu KY, Lee HJ, Woo H, Kang RJ, Han KM, Park H, Lee SM, Lee JY, Jeong YJ, Nam HW, Nam Y, Hoe HS. Dasatinib regulates LPS-induced microglial and astrocytic neuroinflammatory responses by inhibiting AKT/STAT3 signaling. J Neuroinflammation 2019; 16:190. [PMID: 31655606 PMCID: PMC6815018 DOI: 10.1186/s12974-019-1561-x] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 08/19/2019] [Indexed: 12/14/2022] Open
Abstract
Background The FDA-approved small-molecule drug dasatinib is currently used as a treatment for chronic myeloid leukemia (CML). However, the effects of dasatinib on microglial and/or astrocytic neuroinflammatory responses and its mechanism of action have not been studied in detail. Methods BV2 microglial cells, primary astrocytes, or primary microglial cells were treated with dasatinib (100 or 250 nM) or vehicle (1% DMSO) for 30 min or 2 h followed by lipopolysaccharide (LPS; 200 ng/ml or 1 μg/ml) or PBS for 5.5 h. RT-PCR, real-time PCR; immunocytochemistry; subcellular fractionation; and immunohistochemistry were subsequently conducted to determine the effects of dasatinib on LPS-induced neuroinflammation. In addition, wild-type mice were injected with dasatinib (20 mg/kg, intraperitoneally (i.p.) daily for 4 days or 20 mg/kg, orally administered (p.o.) daily for 4 days or 2 weeks) or vehicle (4% DMSO + 30% polyethylene glycol (PEG) + 5% Tween 80), followed by injection with LPS (10 mg/kg, i.p.) or PBS. Then, immunohistochemistry was performed, and plasma IL-6, IL-1β, and TNF-α levels were analyzed by ELISA. Results Dasatinib regulates LPS-induced proinflammatory cytokine and anti-inflammatory cytokine levels in BV2 microglial cells, primary microglial cells, and primary astrocytes. In BV2 microglial cells, dasatinib regulates LPS-induced proinflammatory cytokine levels by regulating TLR4/AKT and/or TLR4/ERK signaling. In addition, intraperitoneal injection and oral administration of dasatinib suppress LPS-induced microglial/astrocyte activation, proinflammatory cytokine levels (including brain and plasma levels), and neutrophil rolling in the brains of wild-type mice. Conclusions Our results suggest that dasatinib modulates LPS-induced microglial and astrocytic activation, proinflammatory cytokine levels, and neutrophil rolling in the brain. Electronic supplementary material The online version of this article (10.1186/s12974-019-1561-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ka-Young Ryu
- Department of Neural Development and Disease, Korea Brain Research Institute (KBRI), 61, Cheomdan-ro, Dong-gu, Daegu, 41068, South Korea
| | - Hyun-Ju Lee
- Department of Neural Development and Disease, Korea Brain Research Institute (KBRI), 61, Cheomdan-ro, Dong-gu, Daegu, 41068, South Korea
| | - Hanwoong Woo
- Department of Neural Development and Disease, Korea Brain Research Institute (KBRI), 61, Cheomdan-ro, Dong-gu, Daegu, 41068, South Korea
| | - Ri-Jin Kang
- Department of Neural Development and Disease, Korea Brain Research Institute (KBRI), 61, Cheomdan-ro, Dong-gu, Daegu, 41068, South Korea
| | - Kyung-Min Han
- Department of Neural Development and Disease, Korea Brain Research Institute (KBRI), 61, Cheomdan-ro, Dong-gu, Daegu, 41068, South Korea.,Department of Brain & Cognitive Sciences, Daegu Gyeongbuk Institute of Science & Technology (DGIST), 333 Techno Jungang-daero, Hyeonpung-myeon, Dalseong-gun, Daegu, 42988, South Korea
| | - HyunHee Park
- Department of Neural Development and Disease, Korea Brain Research Institute (KBRI), 61, Cheomdan-ro, Dong-gu, Daegu, 41068, South Korea
| | - Sang Min Lee
- Department of Neural Development and Disease, Korea Brain Research Institute (KBRI), 61, Cheomdan-ro, Dong-gu, Daegu, 41068, South Korea
| | - Ju-Young Lee
- Department of Neural Development and Disease, Korea Brain Research Institute (KBRI), 61, Cheomdan-ro, Dong-gu, Daegu, 41068, South Korea
| | - Yoo Joo Jeong
- Department of Neural Development and Disease, Korea Brain Research Institute (KBRI), 61, Cheomdan-ro, Dong-gu, Daegu, 41068, South Korea
| | - Hyun-Wook Nam
- Department of Neural Development and Disease, Korea Brain Research Institute (KBRI), 61, Cheomdan-ro, Dong-gu, Daegu, 41068, South Korea
| | - Youngpyo Nam
- Department of Neural Development and Disease, Korea Brain Research Institute (KBRI), 61, Cheomdan-ro, Dong-gu, Daegu, 41068, South Korea.
| | - Hyang-Sook Hoe
- Department of Neural Development and Disease, Korea Brain Research Institute (KBRI), 61, Cheomdan-ro, Dong-gu, Daegu, 41068, South Korea. .,Department of Brain & Cognitive Sciences, Daegu Gyeongbuk Institute of Science & Technology (DGIST), 333 Techno Jungang-daero, Hyeonpung-myeon, Dalseong-gun, Daegu, 42988, South Korea.
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Wambolt SR, Garza J. Another Emergent Cause of Headache. Cureus 2018; 10:e2623. [PMID: 30027015 PMCID: PMC6044492 DOI: 10.7759/cureus.2623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We present a case of a subacute headache related to leukostasis secondary to accelerated chronic myeloid leukemia (CML), which required white blood cell (WBC) reduction in the emergency department. A 28-year-old male presented to the emergency department with a chronic headache found to be secondary to leukostasis from accelerated CML with a white blood cell count of 801,000 and 9% blasts. He had bilateral retinal hemorrhage and a headache associated with elevated intracranial pressure. Hydroxyurea and allopurinol were initiated in the emergency department and the patient was eventually transitioned to a tyrosine kinase inhibitor as outpatient therapy. Headaches are a frequent cause of emergency department visits, and this case illustrates another possible etiology of headache requiring emergent intervention.
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Affiliation(s)
| | - Juan Garza
- Emergency Medicine, UT Health Science Center San Antonio
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Inoue M, Hagihara M, Uchida T, Hua J, Nakajima T, Tajima S, Ota Y. A Rare Monocytic Crisis of Chronic Myelogenous Leukemia Presenting with Unusual Extramedullary Manifestations and an Atypical (14;22)(q24;q11.2) Translocation in the Bone Marrow. Intern Med 2017; 56:3341-3346. [PMID: 29021476 PMCID: PMC5790724 DOI: 10.2169/internalmedicine.8617-16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
A 48-year-old man was admitted due to marked leukocytosis. Bone marrow examinations resulted in a diagnosis of Philadelphia (Ph) chromosome-positive chronic myeloid leukemia. One month later, massive muscle and bone invasion by leukemic cells was detected. After induction chemotherapy, he complained of a headache and visual loss, which was caused by a leukemic infiltration in the central nervous system. After temporary remission in response to chemotherapy, the disease relapsed in the form of an intracranial tumor. The unusual t(14;22)(q24;q11.2) translocation of the Ph-chromosome and the significant increase in monocytes observed might have contributed to the unique and aggressive clinical course.
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MESH Headings
- Blast Crisis/pathology
- Bone Marrow Neoplasms/secondary
- Central Nervous System Neoplasms/secondary
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Male
- Middle Aged
- Monocytes/pathology
- Philadelphia Chromosome
- Translocation, Genetic
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Affiliation(s)
| | | | | | - Jian Hua
- Depatment of Hematology, Eiju General Hospital, Japan
| | | | - Shogo Tajima
- Department of Pathology, Eiju General Hospital, Japan
| | - Yasunori Ota
- Department of Pathology, Teikyo University School of Medicine, Japan
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