Objective To explore the effectiveness and safety of exchange of cerebrospinal fluid in the treatment of subarachnoid hemorrhage （SAH）. Methods Sixty SAH patients diagnosed by CT and lumbarpuncture were randomly assigned into a control group （n =30, received conventional treatment） and a treatment group （n =30, received exchange of cerebrospinal fluid plus conventional treatment）. The main complications and effectiveness between the two groups were compared. SPSS 10.0 was used for statistical analysis. Results Compared with the control group, complications of persistent headache （ P =0.002 and 0. 007 respectively）, cerebral vasospasm （ P =0. 028 ） and hydrocephalus （ P =0. 038 ） were fewer in the treatment group. No significant difference in the incidence of rehaemorrhagia was found between the two groups （P = 1. 000）. Better effectiveness was observed in the treatment group （RR. 3.00, 95% CI 1. 014 to 8. 880, P = 0. 044 ）. Conclusions Exchange of cerebrospinal fluid plus conventional treatment is more effective than conventional treatment alone in the treatment of SAH.
Interferon regulatory factor 4 (IRF4) is one of the transcription factors in the interferon regulatory factor family. In the normal physiological process, IRF4 protein is a key factor regulating B cell development, such as early B cell development, pre-B cell switch recombination, mature B cell somatic hypermutation, and also a key factor regulating plasma cell differentiation. In addition, in recent years, it has been reported that Irf4 gene abnormalities or abnormal protein expression is closely involved in the occurrence and development of a variety of B cell or plasma cell tumors. This article reviews the physiological role of IRF4 in the differentiation and maturation of B cell or plasma cells, how IRF4 participates in the occurrence and development of B cell or plasma cell tumors, and its potential therapeutic target for B cell or plasma cell tumors.
Objective To compare the efficacy and prognostic impact of distinct second-line treatment strategies in patients with first relapsed or refractory multiple myeloma (RRMM1). Methods We conducted a retrospective cohort study of RRMM1 patients managed by the Myeloma Unit, Department of Hematology, West China Hospital, Sichuan University, between February 2014 and May 2024. Patients were categorized according to the backbone agent of their second-line regimen: daratumumab-based (D-based), bortezomib-based (B-based), pomalidomide-based (P-based), ixazomib-based (I-based), carfilzomib-based (K-based), and salvage autologous stem cell transplantation (ASCT). Pre-specified subgroup analyses were performed based on three key clinical variables: receipt of lenalidomide during initial maintenance therapy, pattern of first relapse (biochemical vs. clinical), and presence or absence of extramedullary disease at relapse. Primary endpoints were second-line progression-free survival (PFS2) and overall survival (OS). Results A total of 257 patients with RRMM1 were included. As of March 31, 2025, with a median follow-up of 61 months, the median progression-free survival from initial treatment to the first relapse or being classified as refractory was 24.0 months [95% confidence interval (CI) (21.7, 26.9) months], and the median PFS2 (mPFS) was 22.0 months [95%CI (18.9, 25.0) months], with no statistically significant difference [hazard ratio (HR)=1.046, 95%CI (0.780, 1.403), P=0.764]; the median OS was 104.0 months [95%CI (93.5, 114.6) months]. Lenalidomide maintenance during frontline therapy conferred a significant OS advantage: median OS was not reached in the lenalidomide-maintained group (n=82) versus 75.0 months in the non-maintained group (n=47) (P=0.006). Although median OS was not reached in the salvage ASCT group (n=9), no statistically significant OS benefit was observed compared with the non-ASCT group (n=248, median OS=102.0 months, P=0.283). Notably, mPFS2 and mOS remained unreached in both the K-based and P-based groups—likely reflecting both superior outcomes and shorter median follow-up (40 months) for the K-based group due to later regulatory approval and real-world adoption. In multivariable Cox regression modeling, pomalidomide use emerged as an independent predictor of prolonged PFS2 [HR=0.421, 95%CI (0.214, 0.829), P=0.012] and demonstrated a strong trend toward improved OS [HR=0.382, 95%CI (0.142, 1.026), P=0.056). Biochemical relapse (n=130) was associated with significantly longer mPFS2 (31.0 vs. 13.0 months, P<0.001) and mOS (110.0 vs. 104.0 months, P=0.030) than clinical relapse (n=91). Similarly, absence of extramedullary disease (n=196) predicted markedly superior mOS compared with extramedullary involvement (n=25) (110.0 vs. 77.0 months, P=0.006). Conclusions In this real-world cohort, second-line regimens incorporating novel agents, including pomalidomide, carfilzomib, and daratumumab, achieve depth and durability of response approaching that observed in newly diagnosed myeloma. Pomalidomide is a robust independent determinant of improved PFS2. Prior lenalidomide maintenance remains a key favorable prognostic factor for long-term mOS. Conversely, patients presenting with clinical relapse and/or extramedullary disease represent a high-risk population for whom current second-line approaches remain suboptimal, highlighting an urgent unmet need for biologically rational, intensified, or investigational strategies.
With the continuous development of new drugs and immunotherapy, the survival period of patient with multiple myeloma (MM) is continuously prolonged, and the disease is becoming chronic. Due to the involvement of multiple systems and numerous complications, the daily nursing for MM faces significant challenges. The doctor-nurse-patient integration model and the whole life cycle health management model for daily nursing of MM are expected to reduce the social burden related to diseases, improve patients’ quality of life, and reduce medical costs. This article provides a review on three aspects of MM doctor-nurse-patient integration, whole life cycle health management, and daily health management involving multiple systems.
Soft tissue plasmacytomas are classified into primary or secondary. Primary soft-tissue plasmacytomas predominantly occur in the head and neck region. When there is no bone marrow involvement, the prognosis is favorable. Genetically, they are primarily characterized by 1q amplification and del(13q). The preferred treatment is local radiotherapy or surgical excision; for extensive lymph node involvement, bortezomib is administered. Secondary soft-tissue plasmacytomas are typically seen in relapsed multiple myeloma, with a shorter survival time. They frequently harbor high-risk mutations such as del(17p) and t(4;14), requiring multi-agent intensive therapy and/or autologous hematopoietic stem cell transplantation. The prognosis of soft-tissue plasmacytomas is influenced by genetic alterations and affected anatomical sites. Future research should focus on targeting drug-resistance mechanisms and establishing diagnostic-therapeutic protocols.
ObjectiveTo evaluate the effect of intravenous immunoglobulin (IVIG) on prognosis of patients with idiopathic systemic capillary leakage syndrome (ISCLS). MethodsCase reports and case series related to IVIG on prognosis of ISCLS were electronically searched from the PubMed, CNKI and WanFang Data databases from inception to December 31, 2021. Two researchers screened literature and extracted the data independently, then, prognostic data were analyzed. ResultsA total of 143 case reports (175 patients) and 5 case series (169 patients) were included. About 75% of patients had monoclonal gamma globulin, most of those were IgG κ type. A total of 40 patients received prophylaxis with IVIG, most of whom received a high dose (2 g/kg) of IVIG per month. The 5-year and 10-year survival rates of ISCLS patients receiving IVIG secondary prevention treatment were 96% and 72%, respectively, significantly better than the rates of 66% and 43% in the group without IVIG. The median number of acute episodes per year was 0 (0-20) in the group receiving secondary prevention with IVIG and 2 (1-16) in the group not receiving IVIG. ConclusionHigh-dose (2g/kg) IVIG can improve the long-term survival of ISCLS patients, but efficacy of IVIG in acute episodes is unclear.