BACKGROUND Colorectal cancer is a common digestive malignancy,and chemotherapy remains a cornerstone of treatment.Myelosuppression,a frequent hematologic toxicity,poses significant clinical challenges.However,no inter...BACKGROUND Colorectal cancer is a common digestive malignancy,and chemotherapy remains a cornerstone of treatment.Myelosuppression,a frequent hematologic toxicity,poses significant clinical challenges.However,no interpretable machine learning-based nomogram exists to predict chemotherapy-induced myelosuppression in colorectal cancer patients.This study aimed to develop and validate an inter-pretable clinic-machine learning nomogram integrating clinical predictors with multiple algorithms via a feature mapping algorithm.The model provides accurate risk estimation and clinical interpretability,supporting individualized prevention strategies and optimizing decision-making in patients receiving first-line chemotherapy.AIM To develop and validate an interpretable clinic-machine learning nomogram predicting chemotherapy-induced myelosuppression in colorectal cancer.METHODS This retrospective study enrolled 855 colorectal cancer patients receiving first-line chemotherapy.Data were split into training(n=612),validation(n=153),and testing(n=90)cohorts.Ten predictors were identified through least absolute shrinkage and selection operator,decision tree,random forest,and expert con-sensus.Ten machine learning algorithms were applied,with performance assessed by area under the receiver operating characteristic curve(AUC),area under the precision-recall curve(AUPRC),calibration,and decision curves.The optimal model was integrated into a clinic-machine learning nomogram via the feature mapping algorithm,which was internally validated for predictive accuracy and clinical utility.(AUPRC),calibration,and decision curves.The optimal model was integrated into a clinic-machine learning nomogram via the feature mapping algorithm,which was internally validated for predictive accuracy and clinical utility.RESULTS A total of 855 colorectal cancer patients were enrolled,with 765 cases(April 2020 to December 2023)used for model training and validation,and 90 cases(January 2024 to July 2024)for internal testing.Baseline clinical features did not differ significantly between training and validation cohorts(P>0.05).Ten predictors were identified through integrated feature selection and expert consensus,including age,body surface area,body mass index,tumor position,albumin,carcinoembryonic antigen,carbohydrate antigen(CA)19-9,CA125,chemotherapy regimen,and chemotherapy cycles.Among ten machine learning algorithms,extreme gradient boosting achieved the best validation performance(AUC=0.97,AUPRC=0.92,sensitivity=0.79,specificity=0.92,accuracy=0.88).Logistic regression confirmed extra trees and random forest as independent predictors,which were incorporated into a clinic-machine learning nomogram.The clinic-machine learning nomogram demonstrated superior discrimination(AUC=0.96,AUPRC=0.93,accuracy=0.90,specificity=0.95),good calibration,and greater net clinical benefit across a wide probability range(10%-90%).Internal testing further confirmed its robustness and generalizability(AUC=0.95).CONCLUSION The clinic-machine learning nomogram accurately predicts chemotherapy-induced myelosuppression in colorectal cancer,providing interpretability and clinical utility to support individualized risk assessment and treatment decision-making.展开更多
Background:Non-small cell lung cancer(NSCLC)patients with leptomeningeal metastasis(LM)have a very poor prognosis.Intrathecal pemetrexed(IP)has shown moderate efficacy in treating patients with NSCLC-LM.Myelosuppressi...Background:Non-small cell lung cancer(NSCLC)patients with leptomeningeal metastasis(LM)have a very poor prognosis.Intrathecal pemetrexed(IP)has shown moderate efficacy in treating patients with NSCLC-LM.Myelosuppression is the most common adverse effect following IP administration.Despite this trend,the specific risk factors contributing to IP-related myelosuppression remain unclear.Methods:This study conducted a retrospective analysis of lung adenocarcinoma(LUAD)patients with LM who received IP treatment at the Second Affiliated Hospital of Nanchang University from April 2017 to April 2024.Risk factors for myelosuppression were identified through univariate and multivariate logistic regression analyses.Non-linear relationships and determined the inflection points were subsequently determined using smooth curve fitting and threshold effect analysis.Results:A total of 95 patients were identified,among whom 64(68.42%)experienced myelosuppression,with 43(45.26%)cases classified as severe myelosuppression.Leukopenia emerged as the most prevalent form of myelosuppression.Age was established as an independent risk factor for both myelosuppression and its severe form.A nonlinear relationship between age and severe myelosuppression was observed.The risk of developing severe myelosuppression increased significantly with age,beyond the turning point of 58 years old(OR 1.28,95%CI 1.08–1.52;p 0.0042).Conclusions:Advanced age is=associated with the occurrence of myelosuppression and severe myelosuppression.The probability of developing severe myelosuppression increases significantly in individuals aged 58 years or older.展开更多
Objective:To assess the effectiveness and safety of the Fuzheng Buxue Dietary Therapy(FBDT)for mitigating myelosuppression caused by chemotherapy containing platinum agents.Methods:In this non-randomized concurrent co...Objective:To assess the effectiveness and safety of the Fuzheng Buxue Dietary Therapy(FBDT)for mitigating myelosuppression caused by chemotherapy containing platinum agents.Methods:In this non-randomized concurrent controlled trial,70 chemotherapy patients were evenly divided into two groups:the FBDT group and a standard care control group.The control group adhered to the standard oncological treatment protocol.Meanwhile,the FBDT group,in addition to the standard regimen,took an additional 300ml of the formula daily with lunch,beginning one week prior to chemotherapy and lasting for two weeks.The study conducted a comprehensive comparative analysis of peripheral blood counts,Traditional Chinese Medicine(TCM)symptom scores,Karnofsky Performance Status(KPS)scores,and the incidence of adverse reactions among patients from both groups.Outcomes:A total of 64 patients completed the study,with 32 in each group.FBDT group exhibited a significantly higher white blood cells recovery level one and three weeks after the chemotherapy compared to control group(3.23±0.68 vs 2.76±0.75(×10^(9)/L);3.92±1.07 vs 3.44±0.91(×10^(9)/L);P<0.05).Furthermore,three weeks after the start of chemotherapy,FBDT group had higher platelet recovery levels than the control group(164.25±54.38 vs 124.81±47.88(×10^(9)/L),P<0.05).Additionally,the TCM syndrome scores in FBDT group were lower(P<0.05),and the KPS scores were significantly higher in FBDT group(P<0.05).No serious adverse events were observed in two groups.Conclusion:FBDT is effective and safe in reducing myelosuppression caused by platinum chemotherapy.Future study should involve larger,multicenter trials to better understand dose-response and overall therapeutic value of FBDT.展开更多
Paeonia lactiflora root(baishao in Chinese) is a commonly used herb in traditional Chinese medicines(TCM). Two isomers, paeoniflorin(PF) and albiflorin(AF), are isolated from P. lactiflora. The present study aimed to ...Paeonia lactiflora root(baishao in Chinese) is a commonly used herb in traditional Chinese medicines(TCM). Two isomers, paeoniflorin(PF) and albiflorin(AF), are isolated from P. lactiflora. The present study aimed to investigate the protective effects of PF and AF on myelosuppression induced by chemotherapy in mice and to explore the underlying mechanisms. The mouse myelosuppression model was established by intraperitoneal(i.p.) injection of cyclophosphamide(CP, 200 mg×kg^(–1)). The blood cell counts were performed. The thymus index and spleen index were also determined and bone morrow histological examination was performed. The levels of tumor necrosis factor-α(TNF-α) in serum and colony-stimulating factor(G-CSF) in plasma were measured by Enzyme-Linked Immunosorbent Assays(ELISA) and the serum levels of interleukin-3(IL-3), granulocyte-macrophagecolony- stimulatingfactor(GM-CSF), and interleukin-6(IL-6) were measured by radioimmunoassay(RIA). The levels of m RNA expression protein of IL-3, GM-CSF and G-CSF in spleen and bone marrow cells were determined respectively. PF and AF significantly increased the white blood cell(WBC) counts and reversed the atrophy of thymus. They also increased the serum levels of GM-CSF and IL-3 and the plasma level of G-CSF and reduced the level of TNF-α in serum.. PF enhanced the m RNA level of IL-3 and AF enhanced the m RNA levels of GM-CSF and G-CSF in the spleen. PF and AF both increased the protein levels of GM-CSF and G-CSF in bone marrow cells. In conclusion, our results demonstrated that PF and AF promoted the recovery of bone marrow hemopoietic function in the mouse myelosuppression model.展开更多
Objective: To compare effect of different formulation of Dang-Gui-Bu-Xu-Tang(DCBXT) on myelosuppression mouse. Methods: HPLC was used to measure active ingredients of two DCBXT formulations. Hemopoesic function of bon...Objective: To compare effect of different formulation of Dang-Gui-Bu-Xu-Tang(DCBXT) on myelosuppression mouse. Methods: HPLC was used to measure active ingredients of two DCBXT formulations. Hemopoesic function of bone marrow was measured by hemopoietic progenitor cell culture and peipheral blood count. And hemopoietic factors in bone marrow were tested by ELISA. Results: The content level of astragaloside A in granule formulation was higher than that in decoction and the content ratio of active ingredient was close to 5 : 1. Two DGBXD formulations could significantly improve amount of peripheral blood cells, and bone marrow cells of bone marrow suppression mice (P < 0.05). DGBXD granule formulation significantly increased the colony quantity of all progenitor cell lines and amount of G(2)/M and S phase cells (P < 0.05). It also significantly decreased amount of G(0)/G(1) phase cells in the bone marrow and was more effective (P < 0.05). Conclusions: DGBXT decoction and the granule formulation all can improve the hematopoietic function of bone marrow suppression mouse. They can improve quantities of peripheral blood and nucleated bone marrow cells, and yield of the hematopoietic stem/progenitor cells in vitro colony; balance the expression of cytokine (EPO, TPO and GM-CSF) in bone marrow microenvirement. They can also facilitate hematopoietic stem/progenitor cells to enter the cell cycle. And the effect of granule formulation is more satisfactory.展开更多
Objective The influential factors of chemotherapy-induced myelosuppression in esophageal cancer in central China are unclear.This study aimed to investigate the effect of commonly used chemotherapy regimens on the inc...Objective The influential factors of chemotherapy-induced myelosuppression in esophageal cancer in central China are unclear.This study aimed to investigate the effect of commonly used chemotherapy regimens on the incidence of myelosuppression in clinical treatment of esophageal cancer.Methods In this retrospective study,624 patients with esophageal cancer who received six different chemotherapy regimens between 2013 and 2020 at our institute were included.Chemotherapy consisted of lobaplatin,5-fluorouracil(5-F),lobaplatin and 5-F,nedaplatin,nedaplatin and paclitaxel(PTX),cisplatin and PTX.Multivariable logistic regression analysis was used to explore the risk of myelosuppression among the six different chemotherapy regimens.Results Compared with lobaplatin group,the incidence of myelosuppression in patients treated with chemotherapy regimens of lobaplatin and 5-F,nedaplatin,nedaplatin and PTX and cisplatin and PTX were significantly ameliorated.The dose of lobaplatin was significantly reduced(P=0.007)when lobaplatin was combined with 5-F,and the combination could significantly reduce the risk of myelosuppression(P=0.022).Furthermore,chemotherapeutic regimens,the dose of platinum,hemoglobin and uric acid levels,age,sex,total bilirubin and immune-enhancing drugs were found to be strong predictors of developing myelosuppression.Conclusion Targeted preventive interventions that enhance immune function,reduce uric acid levels and choose combined medication during chemotherapy should be implemented for high-risk patients to reduce the occurrence of myelosuppression.In addition,the dose of lobaplatin should be adjusted when combined with other chemotherapy drugs to reduce the incidence of myelosuppression.展开更多
OBJECTIVE:To explore the inhibitory effect of Zishenshengxue capsule(ZSC) on myelosuppression in mice induced by cyclophosphamide.METHODS:Kunming mice were randomly assigned into a control group,myelosuppression group...OBJECTIVE:To explore the inhibitory effect of Zishenshengxue capsule(ZSC) on myelosuppression in mice induced by cyclophosphamide.METHODS:Kunming mice were randomly assigned into a control group,myelosuppression group,or groups for mice with myelosuppression receiving high dose ZSC,middle dose ZSC,low dose ZSC or Yixuesheng.Myelosuppression was induced by peritoneal injection of cyclophosphamide.ZSC and cyclophosphamide were administered simultaneously.The numbers of peripheral blood cells and bone marrow karyocytes were counted.Cell proliferation activity and colony formation of granulocyte-monocyte series hemopoietic progenitor cells(C-GMs) and cell cycle were detected.RESULTS:The numbers of white blood cells in the middle and high dose ZSC groups were significantly increased at the 12th and 13th day(P<0.01) and bone marrow karyocytes and cell proliferation activity increased in the high dose ZSC group(P<0.01) compared with the myelosuppression group.C-GMs of middle and high dose ZSC groups significantly increased(P<0.01).The percentage of G 1 phase in the high dose ZSC group decreased(P< 0.01) and the percentage of S and G 2 phase increased(P<0.01).CONCLUSION:ZSC increased the numbers of peripheral white blood cells,bone marrow karyocytes and C-GMs.ZSC also increased cell proliferation activity and removed the G 1 phase block.Thus,ZSC could reduce myelosuppression in mice induced by cyclophosphamide.展开更多
Colchicine has been widely used as an anti-gout medication over the past decades.However,it is less commonly used due to its narrow therapeutic range,meaning that its lethal dose is close to its therapeutic dose.The l...Colchicine has been widely used as an anti-gout medication over the past decades.However,it is less commonly used due to its narrow therapeutic range,meaning that its lethal dose is close to its therapeutic dose.The lethal dose of colchicine is considered to be 0.8 mg/kg.As chronic colchicine poisoning has multiple manifestations,it poses a challenge in the clinician’s differential diagnosis.Historically,the drug was important in treating gout;however,clinical studies are currently underway regarding the use of colchicine in patients with coronavirus disease 2019 as well as its use in coronary artery disease,making this drug more important in clinical practice.CASE SUMMARY A 61-year-old male with a history of gout and chronic colchicine intake was admitted to our Emergency Department due to numbness and weakness of the lower limbs.The patient reported a history of colchicine intake for 23 years.After thorough examination,he was diagnosed with colchicine poisoning,manifesting as neuromyopathy,multiple gastric ulcers and myelosuppression.We advised him to stop taking colchicine and drinking alcohol.We also provided a prescription of lansoprazole and mecobalamin,and then asked him to return to the clinic for re-examination.The patient was followed up for 3-mo during which time his gout symptoms were controlled to the point where he was asymptomatic.CONCLUSION Colchicine overdose can mimic the clinical manifestations of several conditions.Physicians easily pay attention to the disease while ignoring the cause of the disease.Thus,the patient’s medication history should never be ignored.展开更多
Objective:To evaluate the effect of acupuncture on myelosuppression after chemotherapy and summarize its acupoint selection strategy.Methods:After a systematic search,an acupoint database on myelosuppression after che...Objective:To evaluate the effect of acupuncture on myelosuppression after chemotherapy and summarize its acupoint selection strategy.Methods:After a systematic search,an acupoint database on myelosuppression after chemotherapy was constructed.A meta-analysis was conducted to assess the efficacy of acupuncture.On this basis,association analysis and cluster analysis were performed to explore the distribution of acupoints in SPSS Modeler18.0 and SPSS 22.0.Results:40 studies with 2988 patients were included.The white blood cell count,platelet count,red blood cell count,and hemoglobin were significantly higher in patients receiving acupuncture versus convention therapy exclusively.The two groups,however,did not differ in neutrophils count.Most acupoints,mainly distributed in the limbs and the back,were from the bladder meridian,the stomach meridian,and the spleen meridian.The lower sea and transport points were the most preferred specific points,in which ST36 and SP6 ranked highest in use.ST36-RN6,SP6-SP10,and ST36-SP10 turned out to be the most significant correlations in association rule mining.In cluster analysis,LI4-RN12,ST36-RN4-RN6 were grouped for their high similarity.Conclusion:For patients with myelosuppression after chemotherapy,acupuncture significantly inhibited the decline in blood cell components(white blood cell count,platelet count,red blood cell count,and hemoglobin)except for neutrophils.As the central combination of acupuncture prescriptions for this population,ST36-SP6-RN6-SP10-RN4 presented promising prospects and deserved more exploration for clinical use.展开更多
Objective:To observe the effects of moxibustion on the hematopoietic function in mice with aplastic anemia(AA)induced by bone marrow(BM)suppression,and to investigate the intervention effects of moxibustion on AA from...Objective:To observe the effects of moxibustion on the hematopoietic function in mice with aplastic anemia(AA)induced by bone marrow(BM)suppression,and to investigate the intervention effects of moxibustion on AA from the perspective of intestinal bacteria.Methods:A total of 24 C57BL/6 J male mice were randomly and evenly divided into control,model and moxibustion groups.The myelosuppression-induced AA model was established by cyclophosphamide(CTX)and cyclosporine(Cs)intraperitoneal injection.Mice in the moxibustion group were intervened in mild moxibustion at unilateral“Zusanli(ST36)”acupoint for 15 min per day,and the sides were switched the next day.The intervention of mild moxibustion lasted 60 days consecutively.The red blood cell(RBC),white blood cell(WBC),platelet(PLT)counts and haemoglobin(Hb)concentration levels of mice in each group were detected by peripheral blood cells count staining,and the BM hematopoietic cells and hematopoietic structures were observed by BM smear Wright-Giemsa staining and HE staining.16SrDNA sequencing was used to analyze the gut bacterial species abundance and diversity in mice from each group.Results:After all the intervention,compared to the control group,the model group had lower levels of RBC,WBC,PLT counts and Hb concentration in peripheral blood(P<0.05)and fewer hematopoietic cells and hematopoietic structures;compared to the model group,moxibustion group had higher levels of RBC,WBC,PLT counts and Hb concentration in peripheral blood(P<0.05),and more BM hematopoietic cells and hematopoietic structures.Gut flora showed that moxibustion increased the species richness and diversity of intestinal bacteria in mice;compared with the control group,the relative abundance of Faecalibaculum and Anaeroplasmataceae in the model group was higher(P<0.05);whereas,the relative abundance of Faecalibaculum and Anaeroplasmataceae in the moxibustion group was lower(P<0.05)when compared with the model group.In addition,Faecalibaculum was significantly correlated with RBC,WBC,PLT count and Hb concentration(P<0.05).Conclusion:Moxibustion can improved BM histology,restored hematopoietic cells function,and increased peripheral blood cells count and Hb concentration in AA mice.The mechanism may be related to the fact that moxibustion regulates the abundance of specific intestinal bacteria to maintain the stability of the flora structure.展开更多
Objective To assess the effectiveness of Chinese herbal medicine(CHM)combined with adjuvant chemotherapy on myelosuppression for colorectal cancer(CRC)patients using network meta-analysis(NMA).Methods Literature searc...Objective To assess the effectiveness of Chinese herbal medicine(CHM)combined with adjuvant chemotherapy on myelosuppression for colorectal cancer(CRC)patients using network meta-analysis(NMA).Methods Literature searches in both international(PubMed,Embase,Web of Science,and Cochrane Library)and Chinese(China Science and Technology Journal Database,Wanfang Data,China National Knowledge Infrastructure)databases for relevant randomized controlled trials(RCTs)were conducted from inception until October 10,2022.We included RCTs of patients who received CHM combined with chemotherapy,including FOLFOX,XELOX,FOLFIRI,and other relevant regimens in the CHM treatment group.The outcomes included the incidence of myelosuppression,leukopenia,hemoglobin reduction,and thrombocytopenia.Two reviewers independently screened the databases,extracted the data,and assessed the risk of bias and credibility of evidence.RevMan 5.4.1 software and STATA 14.0 were used to perform the NMA.Results A total of 31 RCTs were included,published from 2008 to 2021 in Chinese.Among these,2,314 participants comparing the following 9 CHMs were identified:Shengbai Recipe(SBR),Bazhen Decoction(BZD),Jianpi Jiedu Recipe(JJR),Jianpi Recipe(JR),Compound Cantharis Capsule(CCC),Zaofan Pill(ZFP),Guilu Erxian Gel(GL),Buzhong Tiaogan Decoction(BZ),and Qiamagu Capsule(QM).The results of NMA found an indirect comparison.Based on the surface under the cumulative ranking curve(SUCRA),the ZFP+chemotherapy group had the lowest incidence of myelosuppression,with an odds ratio(OR)of 0.08[95%confidence interval(CI):0.01,0.76],whereas the GL+chemotherapy group had the lowest incidence of leukopenia,hemoglobin reduction,and thrombocytopenia,with an OR of 5.25(95%CI:2.41,11.43),4.66(95%CI:2.23,9.72),and 0.27(95%CI:0.13,0.54),respectively.Moreover,BZD+chemotherapy could alleviate leukopenia,hemoglobin reduction,and thrombocytopenia(P<0.01).Pairwise comparison showed that there was no difference in the efficacy among the 8 CHMs+chemotherapy group.The comparison and adjustment funnel plot indicated that small-study effect had no impact on these outcomes.Conclusions This NMA provided evidence to support that patients with CRC benefit from receiving different combination of CHM chemotherapies.Among these,GL plus chemotherapy and BZD plus chemotherapy were the more effective for myelosuppression in patients;however,as the qualtiy of evidence is insufficient,further research is needed.(PROSPERO, No. CRD42022369025.展开更多
Background and Objectives:To evaluate the potential benefits of Bacteroides fragilis 839(BF839),a nextgeneration probiotics,in reducing myelosuppression and gastrointestinal toxicity associated with chemotherapy in br...Background and Objectives:To evaluate the potential benefits of Bacteroides fragilis 839(BF839),a nextgeneration probiotics,in reducing myelosuppression and gastrointestinal toxicity associated with chemotherapy in breast cancer patient.Methods and Study Design:40 women with early breast cancer were randomly assigned to the BF839(n=20)or placebo(n=20)during the administration of adjuvant chemotherapy(4 cycles of epirubicin 100mg/m^(2) and cyclophosphamide 600mg/m^(2)).Myelosuppression and gastrointestinal adverse effects were monitored in both groups.Results:Throughout the four treatment cycles,the percentage of patients experiencing myelosuppression was 42.5%in the BF839 group,significantly lower than the 66.3%observed in the control group(p=0.003).Two patients in the BF839 group and three patients in the placebo group received recombinant human granulocyte colony-stimulating factor(rhG-CSF)due to leukopenia/neutropenia.When considering an ITT analysis,which included all patients regardless of rhG-CSF treatment,the BF839 group exhibited less reduction from baseline in white blood cells(-0.31±1.19 vs-1.15±0.77,p=0.012)and neutrophils(0.06±1.00 vs-0.84±0.85,p=0.004)compared to the placebo group.The difference became even more significant when excluding the patients who received rhG-CSF injections.Throughout the four treatment cycles,compared to the placebo group,the BF839 group had significantly lower rates of 3-4 grade nausea(35.0%vs 71.3%,p=0.001),vomiting(20.0%vs 45.0%,p=0.001),and diarrhea(15.0%vs 30.0%,p=0.023).Conclusions:These findings suggest that BF839 has the potential to effectively mitigate myelosuppression and gastrointestinal toxicity associated with chemotherapy in breast cancer patients.展开更多
Objective: To observe the clinical efficacy of grain-sized moxibustion in treating chemotherapy-induced myelosuppression for non-small cell lung cancer (NSCLC) and its effect on quality of life (QOL). Methods: Eighty ...Objective: To observe the clinical efficacy of grain-sized moxibustion in treating chemotherapy-induced myelosuppression for non-small cell lung cancer (NSCLC) and its effect on quality of life (QOL). Methods: Eighty NSCLC patients admitted to the Inpatient Department of Zhejiang Cancer Hospital between September 2016 and March 2018 were recruited and divided into an observation group and a control group by random number method, with 40 cases in each group. The two groups both received chemotherapy with paclitaxel plus cisplatin (TP regimen). The control group received oral administration of leucogen tablets starting from the first day of chemotherapy, 20 mg each time, three times a day, for consecutive 14 d;the observation group was additionally given grain-sized moxibustion, once a day, five days per week at a two-day interval, until the fourteenth day. The myelosuppression severity was observed and compared between the two groups prior to chemotherapy, at the 3rd, 7th and 14th days of chemotherapy;the QOL in the two groups was evaluated before chemotherapy, at the 14th and 21st days of chemotherapy. Results: Regarding myelosuppression, the peripheral blood indicators increased significantly at the 3rd day of chemotherapy in both groups (P<0.05 or P<0.01);at the 7th and 14th days of chemotherapy, the peripheral blood indicators presented a decreasing tendency in the two groups, but the level in the observation group was still significantly higher than that before chemotherapy (P<0.01);at the 3rd, 7th and 14th days of chemotherapy, the peripheral blood indicators in the observation group were higher than those in the control group (P<0.05 or P<0.01);the occurrence rate of myelosuppression in the observation group was significantly lower than that in the control group (P<0.01). The QOL score in the observation group was markedly higher than that in the control group at the 14th and 21st days of chemotherapy (both P<0.05). Conclusion: Grain-sized moxibustion can effectively improve myelosuppression after chemotherapy for NSCLC, reducing its occurrence and enhancing the patient's QOL.展开更多
Objective To explore the protective effects of tannins in Sanguisorba Radix （TSR） on myelosuppression mice induced by cyclophosphamide （CTX）. Methods TSR was ig given at the dose of 20 mg/kg for 10 d after ip admi...Objective To explore the protective effects of tannins in Sanguisorba Radix （TSR） on myelosuppression mice induced by cyclophosphamide （CTX）. Methods TSR was ig given at the dose of 20 mg/kg for 10 d after ip administration of CTX （200 mg/kg）. Results TSR could significantly increase the numbers of white blood ceils, red blood cells, and platelets of myelosuppression in mice. And it could accelerate bone marrow haemopoietic stem/progenitor cells （HSPCs） in myelosuppression mice and enhance cell proliferation by promoting cell cycles from G0/G1 phase to access into S and G2/M phases, then the reduced number of HSPCs induced by CTX was reversed. Moreover, TSR could increase the mRNA and protein expression levels of O（6）-methylguanine- DNA methyltransferase （MGMT） in HSPCs of myelosuppression mice. Concision TSR has a protective function against CTX-induced myelosuppression. The mechanism might be related to protecting hematopoietic stem cells of bone marrow, stimulating hematopoiesis recovery, as well as preventing the apoptosis of hematopoietic stem cells induced by CTX.展开更多
Objective： To study the efficacy and safety of Shuanghuang Shengbai Granule（双黄升白颗粒, SSG）, a traditional Chinese herbal medicine, on myelosuppression of cancer patients caused by chemotherapy. Methods： A tota...Objective： To study the efficacy and safety of Shuanghuang Shengbai Granule（双黄升白颗粒, SSG）, a traditional Chinese herbal medicine, on myelosuppression of cancer patients caused by chemotherapy. Methods： A total of 330 patients were randomly assigned to the treatment group（220 cases, analysed 209 cases） and the control group（110 cases, analysed 102 cases） with a 2：1 ratio by envelope method. The patients in the treatment group at the first day of chemotherapy started to take SSG for 14 days, while the patients in the control group took Leucogon Tablets. The changes of the blood routine, clinical symptoms and immune function in both groups were observed for safety and efficacy evaluation. Results： At the 7th day of chemotherapy, the white blood cells（WBCs） level in the treatment group was significantly higher than that in the control group（P〈0.05）. After treatment, the WBCs rate in the normal range accounted for 50.2% in the treatment group, the myelosuppression of WBCs and neutrophil were mainly grade Ⅰ, while 8.1% and 5.7% of patients emerged grade Ⅲ and grade Ⅳ myelosuppression, respectively. The incidence of myelosuppression of the treatment group was significantly lower than that of the control group（P〈0.05）. The total effective rate of Chinese medicine syndrome in the treatment group was significantly higher than that in the control group（84.2% vs. 72.5%, P〈0.05）. The immune cell levels in both groups were maintained in the normal range. Compared with that before treatment, the levels of CD3~＋ and CD4~＋ cells were significantly increased in the treatment group after treatment（P〈0.05）. The discrepancy of CD3~＋ and CD4~＋ cell activity before and after treatment in both groups were significantly different（P〈0.05）. No obvious adverse event occurred in both groups. Conclusion： SSG had a protection effect on bone marrow suppression, and alleviated the clinical symptoms together with clinical safety.展开更多
BACKGROUND Aplastic anemia(AA)presents a significant clinical challenge as a life-threatening condition due to failure to produce essential blood cells,with the current the-rapeutic options being notably limited.AIM T...BACKGROUND Aplastic anemia(AA)presents a significant clinical challenge as a life-threatening condition due to failure to produce essential blood cells,with the current the-rapeutic options being notably limited.AIM To assess the therapeutic potential of ginsenoside Rg1 on AA,specifically its protective effects,while elucidating the mechanism at play.METHODS We employed a model of myelosuppression induced by cyclophosphamide(CTX)in C57 mice,followed by administration of ginsenoside Rg1 over 13 d.The invest-igation included examining the bone marrow,thymus and spleen for pathological changes via hematoxylin-eosin staining.Moreover,orbital blood of mice was collected for blood routine examinations.Flow cytometry was employed to identify the impact of ginsenoside Rg1 on cell apoptosis and cycle in the bone marrow of AA mice.Additionally,the study further evaluated cytokine levels with enzyme-linked immunosorbent assay and analyzed the expression of key proteins in the MAPK signaling pathway via western blot.RESULTS Administration of CTX led to significant damage to the bone marrow’s structural integrity and a reduction in hematopoietic cells,establishing a model of AA.Ginsenoside Rg1 successfully reversed hematopoietic dysfunction in AA mice.In comparison to the AA group,ginsenoside Rg1 provided relief by reducing the induction of cell apoptosis and inflammation factors caused by CTX.Furthermore,it helped alleviate the blockade in the cell cycle.Treatment with ginsenoside Rg1 significantly alleviated myelosuppression in mice by inhibiting the MAPK signaling pathway.CONCLUSION This study suggested that ginsenoside Rg1 addresses AA by alleviating myelosuppression,primarily through modulating the MAPK signaling pathway,which paves the way for a novel therapeutic strategy in treating AA,highlighting the potential of ginsenoside Rg1 as a beneficial intervention.展开更多
Background:The disease burden,treatment patterns,and financial costs associated with chemotherapy-induced myelosuppression(CIM)in Chinese patients with extensive-stage small cell lung cancer(ES-SCLC)remain poorly char...Background:The disease burden,treatment patterns,and financial costs associated with chemotherapy-induced myelosuppression(CIM)in Chinese patients with extensive-stage small cell lung cancer(ES-SCLC)remain poorly characterized,particularly in terms of real-world evidence derived from large populations.This study aimed to describe the incidence,treatment patterns,costs,and healthcare resource utilization(HCRU)in Chinese patients with ES-SCLC who develop CIM.Methods:Adults diagnosed with ES-SCLC who started etoposide—platinum(EP)chemotherapy for the first time between January 1,2018 and December 31,2022 were retrospectively identifiedin the Chinese National Cancer Information Database.Baseline demographic and clinical data were collected.Information on CIM-related events,treatment,costs,and HCRU during EP chemotherapy and during follow-up was assessed.Costs and HCRU were compared among patients with grade 3-4 CIM,grade 12 CIM,and no CIM using the KruskalWallis test.Results:In total,7505 patients with ES-SCLC(mean age 61.2 years;17.7%[1332/7505]female;body mass index 23.2±3.3 kg/m^(2))were enrolled.After initiation of EP-based chemotherapy,6901 patients(92.0%)experienced at least one CIM-related event.At least one grade 34 CIM event occurred in 1883 patients(25.1%)and consisted of single-lineage(neutropenia[n=609,8.1%],thrombocytopenia[n=85,1.1%],anemia[n=797,10.6%]),twolineage(n=318,4.2%),and three-lineage(n=74,1.0%)events.Patients receiving immune checkpoint inhibitors(ICIs)plus EP(n=1674)had a significantly higher incidence of at least one CIM during the ICI combination therapy(87.8%[1469/1674]vs.82.8%[4827/5831];χ^(2)=23.43,P<0.0001)and grade 34 CIM(25.7%[430/1674]vs.20.6%[1201/5831];χ^(2)=19.51,P<0.0001)compared to those receiving other EP-basedtherapies duringEP chemotherapy(n=5831).Rates of use of granulocyte colony-stimulating factor,thrombopoietin,interleukin-11,erythropoiesis-stimulating agents,and blood transfusion were 81.1%(n=6087),9.2%(n=691),12.4%(n=927),9.0%(n=678),and 12.1%(n=907),respectively.HCRU and total costs per patient were higher for those with grade 3-4 CIM than for those without CIM or grade 1-2 CIM,and significant differences in the total cost were observed across groups(H=195.54,P<0.0001).Conclusion:Despite the availability of supportive care for CIM in patients with ES-SCLC in China,a considerable clinical and financial burden persists.Strategies that protect bone marrow from progressing to high-grade myelosuppression could reduce the burden on patients and healthcare organizations.展开更多
The cellular basis of bone marrow （BM） tissue development and regeneration is mediated through hematopoietic stem cells （HSCs） and mesenchymal stem cells （MSCs）. Local interplays between hematopoietic cells and ...The cellular basis of bone marrow （BM） tissue development and regeneration is mediated through hematopoietic stem cells （HSCs） and mesenchymal stem cells （MSCs）. Local interplays between hematopoietic cells and BM stromal cells （BMSCs） determine the reconstitution of hematopoiesis after myelosuppression. Here we review the BM local signals in control of BM regeneration after insults. Hematopoietic growth factors （HGFs） and cytokines produced by BMSCs are primary factors in regulation ofBM hematopoiesis. Morphogens which are critical to early embryo development in multiple species have been added to the family of HSCs regulators, including families of Wnt proteins, Notch ligands, BMPs, and Hedgehogs. Global gene expression analysis of HSCs and BMSCs has begun to reveal signature groups of genes for both cell types. More importantly, analysis of global gene expression coupled with biochemical and biological studies of local signals during BM regeneration have strongly suggested that HGFs and cytokines may not be the primary local regulators for BM recovery, rather chemokines （SDF- 1, FGF-4） and angiogenic growth factors （VEGF-A, Ang- 1） play instructive roles in BM reconstitution after myelosuppression. A new direction of management of BM toxicity is emerging from the identification of BM regenerative regulators.展开更多
AIM: To evaluate the efficacy of Myelophil, an extract containing Astragali Radix and Salviae Radix, for reducing complications induced by 5-fluorouracil (5-FU) in a gastrointestinal cancer model. METHODS: We injected...AIM: To evaluate the efficacy of Myelophil, an extract containing Astragali Radix and Salviae Radix, for reducing complications induced by 5-fluorouracil (5-FU) in a gastrointestinal cancer model. METHODS: We injected 5-FU into mice and then administered Myelophil to examine the ability of the drug to treat the side effects of 5-FU in mice. Peripheral blood counts, histological examinations, and colony-forming assays of bone marrow were conducted, followed by swimming tests and assessment of survival times. RESULTS: Myelophil restored red and white blood cells and platelets in blood, and recovered cell density in bone marrow to levels comparable to those observed within the control group. In addition, Myelophil significantly increased colony-forming unit granulocyte-macrophage (CFU-GM) and CFU-erythroid (CFU-E) compared to the control group. We confirmed that interleukin-3 gene expression was upregulated by Myelophil in spleen cells. Myelophil administration also doubled the survival rate of mice that were severely myelosuppressed as a result of 5-FU injection at a lethal dose of 70%. Finally, the swimming performance of mice significantly improved as a result of Myelophil treatment. CONCLUSION: These results provide experimentalevidence in support of clinical applications of Myelophil to minimize 5-FU-induced myelosuppression and improve general post-chemotherapy health.展开更多
基金Supported by the Beijing Municipal Natural Science Foundation,No.7252262High Level Chinese Medical Hospital Promotion Project,No.HLCMHPP2023085+2 种基金National Natural Science Foundation of China,No.82174463National Administration of Traditional Chinese Medicine,No.ZYYCXTD-C-C202205China Academy of Chinese Medical Sciences,No.CI2021A01804 and No.2022S469.
文摘BACKGROUND Colorectal cancer is a common digestive malignancy,and chemotherapy remains a cornerstone of treatment.Myelosuppression,a frequent hematologic toxicity,poses significant clinical challenges.However,no interpretable machine learning-based nomogram exists to predict chemotherapy-induced myelosuppression in colorectal cancer patients.This study aimed to develop and validate an inter-pretable clinic-machine learning nomogram integrating clinical predictors with multiple algorithms via a feature mapping algorithm.The model provides accurate risk estimation and clinical interpretability,supporting individualized prevention strategies and optimizing decision-making in patients receiving first-line chemotherapy.AIM To develop and validate an interpretable clinic-machine learning nomogram predicting chemotherapy-induced myelosuppression in colorectal cancer.METHODS This retrospective study enrolled 855 colorectal cancer patients receiving first-line chemotherapy.Data were split into training(n=612),validation(n=153),and testing(n=90)cohorts.Ten predictors were identified through least absolute shrinkage and selection operator,decision tree,random forest,and expert con-sensus.Ten machine learning algorithms were applied,with performance assessed by area under the receiver operating characteristic curve(AUC),area under the precision-recall curve(AUPRC),calibration,and decision curves.The optimal model was integrated into a clinic-machine learning nomogram via the feature mapping algorithm,which was internally validated for predictive accuracy and clinical utility.(AUPRC),calibration,and decision curves.The optimal model was integrated into a clinic-machine learning nomogram via the feature mapping algorithm,which was internally validated for predictive accuracy and clinical utility.RESULTS A total of 855 colorectal cancer patients were enrolled,with 765 cases(April 2020 to December 2023)used for model training and validation,and 90 cases(January 2024 to July 2024)for internal testing.Baseline clinical features did not differ significantly between training and validation cohorts(P>0.05).Ten predictors were identified through integrated feature selection and expert consensus,including age,body surface area,body mass index,tumor position,albumin,carcinoembryonic antigen,carbohydrate antigen(CA)19-9,CA125,chemotherapy regimen,and chemotherapy cycles.Among ten machine learning algorithms,extreme gradient boosting achieved the best validation performance(AUC=0.97,AUPRC=0.92,sensitivity=0.79,specificity=0.92,accuracy=0.88).Logistic regression confirmed extra trees and random forest as independent predictors,which were incorporated into a clinic-machine learning nomogram.The clinic-machine learning nomogram demonstrated superior discrimination(AUC=0.96,AUPRC=0.93,accuracy=0.90,specificity=0.95),good calibration,and greater net clinical benefit across a wide probability range(10%-90%).Internal testing further confirmed its robustness and generalizability(AUC=0.95).CONCLUSION The clinic-machine learning nomogram accurately predicts chemotherapy-induced myelosuppression in colorectal cancer,providing interpretability and clinical utility to support individualized risk assessment and treatment decision-making.
基金funded by the National Natural Science Foundation of China(grant number 82360629,awarded to ZZM)the Jiangxi Provincial Health Department Project(grant number 202410026,awarded to ZZM,202510363,awarded to HYQ).
文摘Background:Non-small cell lung cancer(NSCLC)patients with leptomeningeal metastasis(LM)have a very poor prognosis.Intrathecal pemetrexed(IP)has shown moderate efficacy in treating patients with NSCLC-LM.Myelosuppression is the most common adverse effect following IP administration.Despite this trend,the specific risk factors contributing to IP-related myelosuppression remain unclear.Methods:This study conducted a retrospective analysis of lung adenocarcinoma(LUAD)patients with LM who received IP treatment at the Second Affiliated Hospital of Nanchang University from April 2017 to April 2024.Risk factors for myelosuppression were identified through univariate and multivariate logistic regression analyses.Non-linear relationships and determined the inflection points were subsequently determined using smooth curve fitting and threshold effect analysis.Results:A total of 95 patients were identified,among whom 64(68.42%)experienced myelosuppression,with 43(45.26%)cases classified as severe myelosuppression.Leukopenia emerged as the most prevalent form of myelosuppression.Age was established as an independent risk factor for both myelosuppression and its severe form.A nonlinear relationship between age and severe myelosuppression was observed.The risk of developing severe myelosuppression increased significantly with age,beyond the turning point of 58 years old(OR 1.28,95%CI 1.08–1.52;p 0.0042).Conclusions:Advanced age is=associated with the occurrence of myelosuppression and severe myelosuppression.The probability of developing severe myelosuppression increases significantly in individuals aged 58 years or older.
基金supported by National Natural Science Foundation of China(82205237)Matching Project for the Youth Fund of the National Natural Science Foundation at Nanjing University of Chinese Medicine(XPT82205237)Jiangsu Provincial Department of Health Medical Science Research Project(Z2021065).
文摘Objective:To assess the effectiveness and safety of the Fuzheng Buxue Dietary Therapy(FBDT)for mitigating myelosuppression caused by chemotherapy containing platinum agents.Methods:In this non-randomized concurrent controlled trial,70 chemotherapy patients were evenly divided into two groups:the FBDT group and a standard care control group.The control group adhered to the standard oncological treatment protocol.Meanwhile,the FBDT group,in addition to the standard regimen,took an additional 300ml of the formula daily with lunch,beginning one week prior to chemotherapy and lasting for two weeks.The study conducted a comprehensive comparative analysis of peripheral blood counts,Traditional Chinese Medicine(TCM)symptom scores,Karnofsky Performance Status(KPS)scores,and the incidence of adverse reactions among patients from both groups.Outcomes:A total of 64 patients completed the study,with 32 in each group.FBDT group exhibited a significantly higher white blood cells recovery level one and three weeks after the chemotherapy compared to control group(3.23±0.68 vs 2.76±0.75(×10^(9)/L);3.92±1.07 vs 3.44±0.91(×10^(9)/L);P<0.05).Furthermore,three weeks after the start of chemotherapy,FBDT group had higher platelet recovery levels than the control group(164.25±54.38 vs 124.81±47.88(×10^(9)/L),P<0.05).Additionally,the TCM syndrome scores in FBDT group were lower(P<0.05),and the KPS scores were significantly higher in FBDT group(P<0.05).No serious adverse events were observed in two groups.Conclusion:FBDT is effective and safe in reducing myelosuppression caused by platinum chemotherapy.Future study should involve larger,multicenter trials to better understand dose-response and overall therapeutic value of FBDT.
基金supported by the National Nature Science Foundation of China(Nos.81473370,81173569)
文摘Paeonia lactiflora root(baishao in Chinese) is a commonly used herb in traditional Chinese medicines(TCM). Two isomers, paeoniflorin(PF) and albiflorin(AF), are isolated from P. lactiflora. The present study aimed to investigate the protective effects of PF and AF on myelosuppression induced by chemotherapy in mice and to explore the underlying mechanisms. The mouse myelosuppression model was established by intraperitoneal(i.p.) injection of cyclophosphamide(CP, 200 mg×kg^(–1)). The blood cell counts were performed. The thymus index and spleen index were also determined and bone morrow histological examination was performed. The levels of tumor necrosis factor-α(TNF-α) in serum and colony-stimulating factor(G-CSF) in plasma were measured by Enzyme-Linked Immunosorbent Assays(ELISA) and the serum levels of interleukin-3(IL-3), granulocyte-macrophagecolony- stimulatingfactor(GM-CSF), and interleukin-6(IL-6) were measured by radioimmunoassay(RIA). The levels of m RNA expression protein of IL-3, GM-CSF and G-CSF in spleen and bone marrow cells were determined respectively. PF and AF significantly increased the white blood cell(WBC) counts and reversed the atrophy of thymus. They also increased the serum levels of GM-CSF and IL-3 and the plasma level of G-CSF and reduced the level of TNF-α in serum.. PF enhanced the m RNA level of IL-3 and AF enhanced the m RNA levels of GM-CSF and G-CSF in the spleen. PF and AF both increased the protein levels of GM-CSF and G-CSF in bone marrow cells. In conclusion, our results demonstrated that PF and AF promoted the recovery of bone marrow hemopoietic function in the mouse myelosuppression model.
基金the Sanjiu Modern Medicine Ltd.for providing fund and DGBXT granule formula
文摘Objective: To compare effect of different formulation of Dang-Gui-Bu-Xu-Tang(DCBXT) on myelosuppression mouse. Methods: HPLC was used to measure active ingredients of two DCBXT formulations. Hemopoesic function of bone marrow was measured by hemopoietic progenitor cell culture and peipheral blood count. And hemopoietic factors in bone marrow were tested by ELISA. Results: The content level of astragaloside A in granule formulation was higher than that in decoction and the content ratio of active ingredient was close to 5 : 1. Two DGBXD formulations could significantly improve amount of peripheral blood cells, and bone marrow cells of bone marrow suppression mice (P < 0.05). DGBXD granule formulation significantly increased the colony quantity of all progenitor cell lines and amount of G(2)/M and S phase cells (P < 0.05). It also significantly decreased amount of G(0)/G(1) phase cells in the bone marrow and was more effective (P < 0.05). Conclusions: DGBXT decoction and the granule formulation all can improve the hematopoietic function of bone marrow suppression mouse. They can improve quantities of peripheral blood and nucleated bone marrow cells, and yield of the hematopoietic stem/progenitor cells in vitro colony; balance the expression of cytokine (EPO, TPO and GM-CSF) in bone marrow microenvirement. They can also facilitate hematopoietic stem/progenitor cells to enter the cell cycle. And the effect of granule formulation is more satisfactory.
基金the National Key R&D Programmes(NKPs)of China(No.2017YFC0909900).
文摘Objective The influential factors of chemotherapy-induced myelosuppression in esophageal cancer in central China are unclear.This study aimed to investigate the effect of commonly used chemotherapy regimens on the incidence of myelosuppression in clinical treatment of esophageal cancer.Methods In this retrospective study,624 patients with esophageal cancer who received six different chemotherapy regimens between 2013 and 2020 at our institute were included.Chemotherapy consisted of lobaplatin,5-fluorouracil(5-F),lobaplatin and 5-F,nedaplatin,nedaplatin and paclitaxel(PTX),cisplatin and PTX.Multivariable logistic regression analysis was used to explore the risk of myelosuppression among the six different chemotherapy regimens.Results Compared with lobaplatin group,the incidence of myelosuppression in patients treated with chemotherapy regimens of lobaplatin and 5-F,nedaplatin,nedaplatin and PTX and cisplatin and PTX were significantly ameliorated.The dose of lobaplatin was significantly reduced(P=0.007)when lobaplatin was combined with 5-F,and the combination could significantly reduce the risk of myelosuppression(P=0.022).Furthermore,chemotherapeutic regimens,the dose of platinum,hemoglobin and uric acid levels,age,sex,total bilirubin and immune-enhancing drugs were found to be strong predictors of developing myelosuppression.Conclusion Targeted preventive interventions that enhance immune function,reduce uric acid levels and choose combined medication during chemotherapy should be implemented for high-risk patients to reduce the occurrence of myelosuppression.In addition,the dose of lobaplatin should be adjusted when combined with other chemotherapy drugs to reduce the incidence of myelosuppression.
基金Supported by Heilongjiang Science and Technology Program (No. 2004 G0076-00)
文摘OBJECTIVE:To explore the inhibitory effect of Zishenshengxue capsule(ZSC) on myelosuppression in mice induced by cyclophosphamide.METHODS:Kunming mice were randomly assigned into a control group,myelosuppression group,or groups for mice with myelosuppression receiving high dose ZSC,middle dose ZSC,low dose ZSC or Yixuesheng.Myelosuppression was induced by peritoneal injection of cyclophosphamide.ZSC and cyclophosphamide were administered simultaneously.The numbers of peripheral blood cells and bone marrow karyocytes were counted.Cell proliferation activity and colony formation of granulocyte-monocyte series hemopoietic progenitor cells(C-GMs) and cell cycle were detected.RESULTS:The numbers of white blood cells in the middle and high dose ZSC groups were significantly increased at the 12th and 13th day(P<0.01) and bone marrow karyocytes and cell proliferation activity increased in the high dose ZSC group(P<0.01) compared with the myelosuppression group.C-GMs of middle and high dose ZSC groups significantly increased(P<0.01).The percentage of G 1 phase in the high dose ZSC group decreased(P< 0.01) and the percentage of S and G 2 phase increased(P<0.01).CONCLUSION:ZSC increased the numbers of peripheral white blood cells,bone marrow karyocytes and C-GMs.ZSC also increased cell proliferation activity and removed the G 1 phase block.Thus,ZSC could reduce myelosuppression in mice induced by cyclophosphamide.
文摘Colchicine has been widely used as an anti-gout medication over the past decades.However,it is less commonly used due to its narrow therapeutic range,meaning that its lethal dose is close to its therapeutic dose.The lethal dose of colchicine is considered to be 0.8 mg/kg.As chronic colchicine poisoning has multiple manifestations,it poses a challenge in the clinician’s differential diagnosis.Historically,the drug was important in treating gout;however,clinical studies are currently underway regarding the use of colchicine in patients with coronavirus disease 2019 as well as its use in coronary artery disease,making this drug more important in clinical practice.CASE SUMMARY A 61-year-old male with a history of gout and chronic colchicine intake was admitted to our Emergency Department due to numbness and weakness of the lower limbs.The patient reported a history of colchicine intake for 23 years.After thorough examination,he was diagnosed with colchicine poisoning,manifesting as neuromyopathy,multiple gastric ulcers and myelosuppression.We advised him to stop taking colchicine and drinking alcohol.We also provided a prescription of lansoprazole and mecobalamin,and then asked him to return to the clinic for re-examination.The patient was followed up for 3-mo during which time his gout symptoms were controlled to the point where he was asymptomatic.CONCLUSION Colchicine overdose can mimic the clinical manifestations of several conditions.Physicians easily pay attention to the disease while ignoring the cause of the disease.Thus,the patient’s medication history should never be ignored.
基金supported by the Natural Science Foundation of China(Grant Nos.81703839,81874411).
文摘Objective:To evaluate the effect of acupuncture on myelosuppression after chemotherapy and summarize its acupoint selection strategy.Methods:After a systematic search,an acupoint database on myelosuppression after chemotherapy was constructed.A meta-analysis was conducted to assess the efficacy of acupuncture.On this basis,association analysis and cluster analysis were performed to explore the distribution of acupoints in SPSS Modeler18.0 and SPSS 22.0.Results:40 studies with 2988 patients were included.The white blood cell count,platelet count,red blood cell count,and hemoglobin were significantly higher in patients receiving acupuncture versus convention therapy exclusively.The two groups,however,did not differ in neutrophils count.Most acupoints,mainly distributed in the limbs and the back,were from the bladder meridian,the stomach meridian,and the spleen meridian.The lower sea and transport points were the most preferred specific points,in which ST36 and SP6 ranked highest in use.ST36-RN6,SP6-SP10,and ST36-SP10 turned out to be the most significant correlations in association rule mining.In cluster analysis,LI4-RN12,ST36-RN4-RN6 were grouped for their high similarity.Conclusion:For patients with myelosuppression after chemotherapy,acupuncture significantly inhibited the decline in blood cell components(white blood cell count,platelet count,red blood cell count,and hemoglobin)except for neutrophils.As the central combination of acupuncture prescriptions for this population,ST36-SP6-RN6-SP10-RN4 presented promising prospects and deserved more exploration for clinical use.
基金Supported by the State Administration of Traditional Chinese Medicine high-level key disciplines construction project:zyyzdxk-2023068Three-year Action Plan for Shanghai TCM Development and Inheritance Program:ZY(2021-2023)-0302。
文摘Objective:To observe the effects of moxibustion on the hematopoietic function in mice with aplastic anemia(AA)induced by bone marrow(BM)suppression,and to investigate the intervention effects of moxibustion on AA from the perspective of intestinal bacteria.Methods:A total of 24 C57BL/6 J male mice were randomly and evenly divided into control,model and moxibustion groups.The myelosuppression-induced AA model was established by cyclophosphamide(CTX)and cyclosporine(Cs)intraperitoneal injection.Mice in the moxibustion group were intervened in mild moxibustion at unilateral“Zusanli(ST36)”acupoint for 15 min per day,and the sides were switched the next day.The intervention of mild moxibustion lasted 60 days consecutively.The red blood cell(RBC),white blood cell(WBC),platelet(PLT)counts and haemoglobin(Hb)concentration levels of mice in each group were detected by peripheral blood cells count staining,and the BM hematopoietic cells and hematopoietic structures were observed by BM smear Wright-Giemsa staining and HE staining.16SrDNA sequencing was used to analyze the gut bacterial species abundance and diversity in mice from each group.Results:After all the intervention,compared to the control group,the model group had lower levels of RBC,WBC,PLT counts and Hb concentration in peripheral blood(P<0.05)and fewer hematopoietic cells and hematopoietic structures;compared to the model group,moxibustion group had higher levels of RBC,WBC,PLT counts and Hb concentration in peripheral blood(P<0.05),and more BM hematopoietic cells and hematopoietic structures.Gut flora showed that moxibustion increased the species richness and diversity of intestinal bacteria in mice;compared with the control group,the relative abundance of Faecalibaculum and Anaeroplasmataceae in the model group was higher(P<0.05);whereas,the relative abundance of Faecalibaculum and Anaeroplasmataceae in the moxibustion group was lower(P<0.05)when compared with the model group.In addition,Faecalibaculum was significantly correlated with RBC,WBC,PLT count and Hb concentration(P<0.05).Conclusion:Moxibustion can improved BM histology,restored hematopoietic cells function,and increased peripheral blood cells count and Hb concentration in AA mice.The mechanism may be related to the fact that moxibustion regulates the abundance of specific intestinal bacteria to maintain the stability of the flora structure.
基金Supported by Project of Qihuang Scholar(No.010120006)the National Natural Science Foundation of China(No.82174461)the Capital Health Development Scientific Research Project(No.2022-1-41-71)。
文摘Objective To assess the effectiveness of Chinese herbal medicine(CHM)combined with adjuvant chemotherapy on myelosuppression for colorectal cancer(CRC)patients using network meta-analysis(NMA).Methods Literature searches in both international(PubMed,Embase,Web of Science,and Cochrane Library)and Chinese(China Science and Technology Journal Database,Wanfang Data,China National Knowledge Infrastructure)databases for relevant randomized controlled trials(RCTs)were conducted from inception until October 10,2022.We included RCTs of patients who received CHM combined with chemotherapy,including FOLFOX,XELOX,FOLFIRI,and other relevant regimens in the CHM treatment group.The outcomes included the incidence of myelosuppression,leukopenia,hemoglobin reduction,and thrombocytopenia.Two reviewers independently screened the databases,extracted the data,and assessed the risk of bias and credibility of evidence.RevMan 5.4.1 software and STATA 14.0 were used to perform the NMA.Results A total of 31 RCTs were included,published from 2008 to 2021 in Chinese.Among these,2,314 participants comparing the following 9 CHMs were identified:Shengbai Recipe(SBR),Bazhen Decoction(BZD),Jianpi Jiedu Recipe(JJR),Jianpi Recipe(JR),Compound Cantharis Capsule(CCC),Zaofan Pill(ZFP),Guilu Erxian Gel(GL),Buzhong Tiaogan Decoction(BZ),and Qiamagu Capsule(QM).The results of NMA found an indirect comparison.Based on the surface under the cumulative ranking curve(SUCRA),the ZFP+chemotherapy group had the lowest incidence of myelosuppression,with an odds ratio(OR)of 0.08[95%confidence interval(CI):0.01,0.76],whereas the GL+chemotherapy group had the lowest incidence of leukopenia,hemoglobin reduction,and thrombocytopenia,with an OR of 5.25(95%CI:2.41,11.43),4.66(95%CI:2.23,9.72),and 0.27(95%CI:0.13,0.54),respectively.Moreover,BZD+chemotherapy could alleviate leukopenia,hemoglobin reduction,and thrombocytopenia(P<0.01).Pairwise comparison showed that there was no difference in the efficacy among the 8 CHMs+chemotherapy group.The comparison and adjustment funnel plot indicated that small-study effect had no impact on these outcomes.Conclusions This NMA provided evidence to support that patients with CRC benefit from receiving different combination of CHM chemotherapies.Among these,GL plus chemotherapy and BZD plus chemotherapy were the more effective for myelosuppression in patients;however,as the qualtiy of evidence is insufficient,further research is needed.(PROSPERO, No. CRD42022369025.
文摘Background and Objectives:To evaluate the potential benefits of Bacteroides fragilis 839(BF839),a nextgeneration probiotics,in reducing myelosuppression and gastrointestinal toxicity associated with chemotherapy in breast cancer patient.Methods and Study Design:40 women with early breast cancer were randomly assigned to the BF839(n=20)or placebo(n=20)during the administration of adjuvant chemotherapy(4 cycles of epirubicin 100mg/m^(2) and cyclophosphamide 600mg/m^(2)).Myelosuppression and gastrointestinal adverse effects were monitored in both groups.Results:Throughout the four treatment cycles,the percentage of patients experiencing myelosuppression was 42.5%in the BF839 group,significantly lower than the 66.3%observed in the control group(p=0.003).Two patients in the BF839 group and three patients in the placebo group received recombinant human granulocyte colony-stimulating factor(rhG-CSF)due to leukopenia/neutropenia.When considering an ITT analysis,which included all patients regardless of rhG-CSF treatment,the BF839 group exhibited less reduction from baseline in white blood cells(-0.31±1.19 vs-1.15±0.77,p=0.012)and neutrophils(0.06±1.00 vs-0.84±0.85,p=0.004)compared to the placebo group.The difference became even more significant when excluding the patients who received rhG-CSF injections.Throughout the four treatment cycles,compared to the placebo group,the BF839 group had significantly lower rates of 3-4 grade nausea(35.0%vs 71.3%,p=0.001),vomiting(20.0%vs 45.0%,p=0.001),and diarrhea(15.0%vs 30.0%,p=0.023).Conclusions:These findings suggest that BF839 has the potential to effectively mitigate myelosuppression and gastrointestinal toxicity associated with chemotherapy in breast cancer patients.
文摘Objective: To observe the clinical efficacy of grain-sized moxibustion in treating chemotherapy-induced myelosuppression for non-small cell lung cancer (NSCLC) and its effect on quality of life (QOL). Methods: Eighty NSCLC patients admitted to the Inpatient Department of Zhejiang Cancer Hospital between September 2016 and March 2018 were recruited and divided into an observation group and a control group by random number method, with 40 cases in each group. The two groups both received chemotherapy with paclitaxel plus cisplatin (TP regimen). The control group received oral administration of leucogen tablets starting from the first day of chemotherapy, 20 mg each time, three times a day, for consecutive 14 d;the observation group was additionally given grain-sized moxibustion, once a day, five days per week at a two-day interval, until the fourteenth day. The myelosuppression severity was observed and compared between the two groups prior to chemotherapy, at the 3rd, 7th and 14th days of chemotherapy;the QOL in the two groups was evaluated before chemotherapy, at the 14th and 21st days of chemotherapy. Results: Regarding myelosuppression, the peripheral blood indicators increased significantly at the 3rd day of chemotherapy in both groups (P<0.05 or P<0.01);at the 7th and 14th days of chemotherapy, the peripheral blood indicators presented a decreasing tendency in the two groups, but the level in the observation group was still significantly higher than that before chemotherapy (P<0.01);at the 3rd, 7th and 14th days of chemotherapy, the peripheral blood indicators in the observation group were higher than those in the control group (P<0.05 or P<0.01);the occurrence rate of myelosuppression in the observation group was significantly lower than that in the control group (P<0.01). The QOL score in the observation group was markedly higher than that in the control group at the 14th and 21st days of chemotherapy (both P<0.05). Conclusion: Grain-sized moxibustion can effectively improve myelosuppression after chemotherapy for NSCLC, reducing its occurrence and enhancing the patient's QOL.
基金Natural Science Fundation of China(No.81373976)Major and special project of National science and technology(No.2013ZX09103002-013)
文摘Objective To explore the protective effects of tannins in Sanguisorba Radix （TSR） on myelosuppression mice induced by cyclophosphamide （CTX）. Methods TSR was ig given at the dose of 20 mg/kg for 10 d after ip administration of CTX （200 mg/kg）. Results TSR could significantly increase the numbers of white blood ceils, red blood cells, and platelets of myelosuppression in mice. And it could accelerate bone marrow haemopoietic stem/progenitor cells （HSPCs） in myelosuppression mice and enhance cell proliferation by promoting cell cycles from G0/G1 phase to access into S and G2/M phases, then the reduced number of HSPCs induced by CTX was reversed. Moreover, TSR could increase the mRNA and protein expression levels of O（6）-methylguanine- DNA methyltransferase （MGMT） in HSPCs of myelosuppression mice. Concision TSR has a protective function against CTX-induced myelosuppression. The mechanism might be related to protecting hematopoietic stem cells of bone marrow, stimulating hematopoiesis recovery, as well as preventing the apoptosis of hematopoietic stem cells induced by CTX.
基金Supported by National Natural Science Foundation of China(No.81202670)Project of Longhua Medical Team Shanghai,China(No.LYTD-18)
文摘Objective： To study the efficacy and safety of Shuanghuang Shengbai Granule（双黄升白颗粒, SSG）, a traditional Chinese herbal medicine, on myelosuppression of cancer patients caused by chemotherapy. Methods： A total of 330 patients were randomly assigned to the treatment group（220 cases, analysed 209 cases） and the control group（110 cases, analysed 102 cases） with a 2：1 ratio by envelope method. The patients in the treatment group at the first day of chemotherapy started to take SSG for 14 days, while the patients in the control group took Leucogon Tablets. The changes of the blood routine, clinical symptoms and immune function in both groups were observed for safety and efficacy evaluation. Results： At the 7th day of chemotherapy, the white blood cells（WBCs） level in the treatment group was significantly higher than that in the control group（P〈0.05）. After treatment, the WBCs rate in the normal range accounted for 50.2% in the treatment group, the myelosuppression of WBCs and neutrophil were mainly grade Ⅰ, while 8.1% and 5.7% of patients emerged grade Ⅲ and grade Ⅳ myelosuppression, respectively. The incidence of myelosuppression of the treatment group was significantly lower than that of the control group（P〈0.05）. The total effective rate of Chinese medicine syndrome in the treatment group was significantly higher than that in the control group（84.2% vs. 72.5%, P〈0.05）. The immune cell levels in both groups were maintained in the normal range. Compared with that before treatment, the levels of CD3~＋ and CD4~＋ cells were significantly increased in the treatment group after treatment（P〈0.05）. The discrepancy of CD3~＋ and CD4~＋ cell activity before and after treatment in both groups were significantly different（P〈0.05）. No obvious adverse event occurred in both groups. Conclusion： SSG had a protection effect on bone marrow suppression, and alleviated the clinical symptoms together with clinical safety.
基金Supported by Hangzhou Municipal Bureau of Science and Technology,No.2021WJCY366.
文摘BACKGROUND Aplastic anemia(AA)presents a significant clinical challenge as a life-threatening condition due to failure to produce essential blood cells,with the current the-rapeutic options being notably limited.AIM To assess the therapeutic potential of ginsenoside Rg1 on AA,specifically its protective effects,while elucidating the mechanism at play.METHODS We employed a model of myelosuppression induced by cyclophosphamide(CTX)in C57 mice,followed by administration of ginsenoside Rg1 over 13 d.The invest-igation included examining the bone marrow,thymus and spleen for pathological changes via hematoxylin-eosin staining.Moreover,orbital blood of mice was collected for blood routine examinations.Flow cytometry was employed to identify the impact of ginsenoside Rg1 on cell apoptosis and cycle in the bone marrow of AA mice.Additionally,the study further evaluated cytokine levels with enzyme-linked immunosorbent assay and analyzed the expression of key proteins in the MAPK signaling pathway via western blot.RESULTS Administration of CTX led to significant damage to the bone marrow’s structural integrity and a reduction in hematopoietic cells,establishing a model of AA.Ginsenoside Rg1 successfully reversed hematopoietic dysfunction in AA mice.In comparison to the AA group,ginsenoside Rg1 provided relief by reducing the induction of cell apoptosis and inflammation factors caused by CTX.Furthermore,it helped alleviate the blockade in the cell cycle.Treatment with ginsenoside Rg1 significantly alleviated myelosuppression in mice by inhibiting the MAPK signaling pathway.CONCLUSION This study suggested that ginsenoside Rg1 addresses AA by alleviating myelosuppression,primarily through modulating the MAPK signaling pathway,which paves the way for a novel therapeutic strategy in treating AA,highlighting the potential of ginsenoside Rg1 as a beneficial intervention.
基金funded by the National Key Reseach&Development Program of China(No.2022YFC2505000)the Chinese Academy of Medical Sciences(CAMS)Innovation Fund for Medical Sciences(No.CIFMS 2022-I2M-1-O09)+2 种基金the National Natural Science Foundation of China(NSFC)Special Program(No.82241229)the Y&M Cultivation Project of Cancer Hospital Chinese Academy of Medical Sciences(No.CICAMS-MOY&M-202402)Simcere Zaiming Pharmaceutical Co.,Ltd.
文摘Background:The disease burden,treatment patterns,and financial costs associated with chemotherapy-induced myelosuppression(CIM)in Chinese patients with extensive-stage small cell lung cancer(ES-SCLC)remain poorly characterized,particularly in terms of real-world evidence derived from large populations.This study aimed to describe the incidence,treatment patterns,costs,and healthcare resource utilization(HCRU)in Chinese patients with ES-SCLC who develop CIM.Methods:Adults diagnosed with ES-SCLC who started etoposide—platinum(EP)chemotherapy for the first time between January 1,2018 and December 31,2022 were retrospectively identifiedin the Chinese National Cancer Information Database.Baseline demographic and clinical data were collected.Information on CIM-related events,treatment,costs,and HCRU during EP chemotherapy and during follow-up was assessed.Costs and HCRU were compared among patients with grade 3-4 CIM,grade 12 CIM,and no CIM using the KruskalWallis test.Results:In total,7505 patients with ES-SCLC(mean age 61.2 years;17.7%[1332/7505]female;body mass index 23.2±3.3 kg/m^(2))were enrolled.After initiation of EP-based chemotherapy,6901 patients(92.0%)experienced at least one CIM-related event.At least one grade 34 CIM event occurred in 1883 patients(25.1%)and consisted of single-lineage(neutropenia[n=609,8.1%],thrombocytopenia[n=85,1.1%],anemia[n=797,10.6%]),twolineage(n=318,4.2%),and three-lineage(n=74,1.0%)events.Patients receiving immune checkpoint inhibitors(ICIs)plus EP(n=1674)had a significantly higher incidence of at least one CIM during the ICI combination therapy(87.8%[1469/1674]vs.82.8%[4827/5831];χ^(2)=23.43,P<0.0001)and grade 34 CIM(25.7%[430/1674]vs.20.6%[1201/5831];χ^(2)=19.51,P<0.0001)compared to those receiving other EP-basedtherapies duringEP chemotherapy(n=5831).Rates of use of granulocyte colony-stimulating factor,thrombopoietin,interleukin-11,erythropoiesis-stimulating agents,and blood transfusion were 81.1%(n=6087),9.2%(n=691),12.4%(n=927),9.0%(n=678),and 12.1%(n=907),respectively.HCRU and total costs per patient were higher for those with grade 3-4 CIM than for those without CIM or grade 1-2 CIM,and significant differences in the total cost were observed across groups(H=195.54,P<0.0001).Conclusion:Despite the availability of supportive care for CIM in patients with ES-SCLC in China,a considerable clinical and financial burden persists.Strategies that protect bone marrow from progressing to high-grade myelosuppression could reduce the burden on patients and healthcare organizations.
文摘The cellular basis of bone marrow （BM） tissue development and regeneration is mediated through hematopoietic stem cells （HSCs） and mesenchymal stem cells （MSCs）. Local interplays between hematopoietic cells and BM stromal cells （BMSCs） determine the reconstitution of hematopoiesis after myelosuppression. Here we review the BM local signals in control of BM regeneration after insults. Hematopoietic growth factors （HGFs） and cytokines produced by BMSCs are primary factors in regulation ofBM hematopoiesis. Morphogens which are critical to early embryo development in multiple species have been added to the family of HSCs regulators, including families of Wnt proteins, Notch ligands, BMPs, and Hedgehogs. Global gene expression analysis of HSCs and BMSCs has begun to reveal signature groups of genes for both cell types. More importantly, analysis of global gene expression coupled with biochemical and biological studies of local signals during BM regeneration have strongly suggested that HGFs and cytokines may not be the primary local regulators for BM recovery, rather chemokines （SDF- 1, FGF-4） and angiogenic growth factors （VEGF-A, Ang- 1） play instructive roles in BM reconstitution after myelosuppression. A new direction of management of BM toxicity is emerging from the identification of BM regenerative regulators.
基金The Oriental Medicine R&D Project, B050018 Ministry of Health and Welfare, Korea
文摘AIM: To evaluate the efficacy of Myelophil, an extract containing Astragali Radix and Salviae Radix, for reducing complications induced by 5-fluorouracil (5-FU) in a gastrointestinal cancer model. METHODS: We injected 5-FU into mice and then administered Myelophil to examine the ability of the drug to treat the side effects of 5-FU in mice. Peripheral blood counts, histological examinations, and colony-forming assays of bone marrow were conducted, followed by swimming tests and assessment of survival times. RESULTS: Myelophil restored red and white blood cells and platelets in blood, and recovered cell density in bone marrow to levels comparable to those observed within the control group. In addition, Myelophil significantly increased colony-forming unit granulocyte-macrophage (CFU-GM) and CFU-erythroid (CFU-E) compared to the control group. We confirmed that interleukin-3 gene expression was upregulated by Myelophil in spleen cells. Myelophil administration also doubled the survival rate of mice that were severely myelosuppressed as a result of 5-FU injection at a lethal dose of 70%. Finally, the swimming performance of mice significantly improved as a result of Myelophil treatment. CONCLUSION: These results provide experimentalevidence in support of clinical applications of Myelophil to minimize 5-FU-induced myelosuppression and improve general post-chemotherapy health.
