Leukemia research最新文献

{"title":"Multiple myeloma and infections in the era of novel treatment modalities","authors":"Mobil Akhmedov ,&nbsp;Pervin Zeynalova ,&nbsp;Alexander Fedenko","doi":"10.1016/j.leukres.2024.107544","DOIUrl":"10.1016/j.leukres.2024.107544","url":null,"abstract":"<div><p>Infections are major cause of morbidity and mortality in patients with multiple myeloma. Current treatment landscape of newly-diagnosed multiple myeloma includes different classes of drugs, such as proteasome inhibitors, immunomodulatory drugs, and monoclonal antibodies, all of which are characterized by specific risk and pattern of infectious complications. Additionally, autologous and allogeneic hematopoietic cell transplantation, widely used in the treatment of multiple myeloma, are complex procedures, carrying a significant risk of complications, and mainly infections. Finally, novel treatment modalities such as bispecific T-cell engagers and chimeric antigen receptor T-lymphocytes have been changing the paradigm of myeloma treatment in relapsed-refractory setting. These agents due to unique mechanism of action carry distinct pattern of infectious complications. In this review, an attempt has been made to summarize the incidence, risk factors, and patterns of infections during different stages of myeloma treatment including novel treatment modalities, and to provide evidence underlying the current concept of infectious disease prophylaxis in this category of patients.</p></div>","PeriodicalId":18051,"journal":{"name":"Leukemia research","volume":"143 ","pages":"Article 107544"},"PeriodicalIF":2.1,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141534758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combining the novel FLT3 and MERTK dual inhibitor MRX-2843 with venetoclax results in promising antileukemic activity against FLT3-ITD AML","authors":"Shuangshuang Wu ,&nbsp;Fangbing Liu ,&nbsp;Yuqing Gai ,&nbsp;Jenna Carter ,&nbsp;Holly Edwards ,&nbsp;Maik Hüttemann ,&nbsp;Guan Wang ,&nbsp;Chunhuai Li ,&nbsp;Jeffrey W. Taub ,&nbsp;Yue Wang ,&nbsp;Yubin Ge","doi":"10.1016/j.leukres.2024.107547","DOIUrl":"10.1016/j.leukres.2024.107547","url":null,"abstract":"<div><p><em>FMS-like tyrosine kinase 3</em> (<em>FLT3</em>) mutations occur in approximately one third of acute myeloid leukemia (AML) patients. <em>FLT3</em>-Internal tandem duplication (<em>FLT3</em>-ITD) mutations are the most common <em>FLT3</em> mutations and are associated with a poor prognosis. Gilteritinib is a FLT3 inhibitor that is US FDA approved for treating adult patients with relapsed/refractory AML and a <em>FLT3</em> mutation. While gilteritinib monotherapy has improved patient outcome, few patients achieve durable responses. Combining gilteritinib with venetoclax (VEN) appears to make further improvements, though early results suggest that patients with prior exposure to VEN fair much worse than those without prior exposure. MRX-2843 is a promising inhibitor of FLT3 and MERTK. We recently demonstrated that MRX-2843 is equally potent as gilteritinib in <em>FLT3</em>-ITD AML cell lines <em>in vitro</em> and primary patient samples <em>ex vivo</em>. In this study, we investigated the combination of VEN and MRX-2843 against <em>FLT3</em>-ITD AML cells. We found that VEN synergistically enhances cell death induced by MRX-2843 in <em>FLT3</em>-mutated AML cell lines and primary patient samples. Importantly, we found that VEN synergistically enhances cell death induced by MRX-2843 in <em>FLT3</em>-ITD AML cells with acquired resistance to cytarabine (AraC) or VEN+AraC. VEN and MRX-2843 significantly reduce colony-forming capacity of <em>FLT3</em>-ITD primary AML cells. Mechanistic studies show that MRX-2843 decreases Mcl-1 and c-Myc protein levels via transcriptional regulation and combined MRX-2843 and VEN significantly decreases oxidative phosphorylation in <em>FLT3</em>-ITD AML cells. Our findings highlight a promising combination therapy against <em>FLT3</em>-ITD AML, supporting further <em>in vitro</em> and <em>in vivo</em> testing.</p></div>","PeriodicalId":18051,"journal":{"name":"Leukemia research","volume":"144 ","pages":"Article 107547"},"PeriodicalIF":2.1,"publicationDate":"2024-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141538008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Less is more: An analysis of venetoclax and hypomethylating agent post-induction treatment modifications in AML","authors":"Stephanie Boisclair ,&nbsp;Edward Zhou ,&nbsp;Phyu Naing ,&nbsp;Richa Thakur ,&nbsp;Erin Jou ,&nbsp;Bradley Goldberg ,&nbsp;Douglas E. Gladstone ,&nbsp;Steven L. Allen ,&nbsp;Jonathan E. Kolitz ,&nbsp;David W. Chitty","doi":"10.1016/j.leukres.2024.107545","DOIUrl":"10.1016/j.leukres.2024.107545","url":null,"abstract":"<div><p>Venetoclax (Ven) combined with a hypomethylating agent (HMA) enhances survival in elderly/unfit acute myeloid leukemia (AML) patients, yet often necessitates regimen modifications due to intolerance. However, it is unclear how these modifications affect patient outcome. This retrospective cohort study evaluates the impact of post-induction HMA/Ven regimen modifications on disease progression and survival. This study reviewed 142 AML patients treated with HMA/Ven within the Northwell Health System from January 2019 to December 2022. To assess the impact of post-induction regimen modifications, patients were grouped according to median days between cycles (≤34 or ≥35 days cycle intervals) and median Ven days per cycle (≤14 or ≥15 days/cycle) based on only cycle 3 and beyond. Kaplan-Meier and Cox proportional hazard regression analyses were employed for univariate and multivariate assessments, respectively. There was no significant difference in median progression-free survival (mPFS)(11.6 vs 11.8 months, p = 0.73) or median overall survival (mOS)(15.1 vs 21.8 months, p = 0.16) between cycle interval groups. However, there was a clinically and statistically significant advantage in mPFS (15.8 vs 8.7 months, p = 0.01) and mOS (24.7 vs 11.3 months, p = 0.006) for patients with a median of ≤14 Ven days/cycle compared to ≥15 Ven days/cycle. Multivariate analysis demonstrated that ≤14 days of Ven for cycle 3 and beyond was an independent predictor of decreased mortality (HR 0.18, CI 0.07–0.48, p = 0.0007). Extended cycle intervals did not adversely affect mortality while reduced Ven duration per cycle post-induction was associated with improved survival in elderly AML patients.</p></div>","PeriodicalId":18051,"journal":{"name":"Leukemia research","volume":"143 ","pages":"Article 107545"},"PeriodicalIF":2.1,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141526462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-transplant cyclophosphamide: A double-edged sword?","authors":"Alessandro Busca","doi":"10.1016/j.leukres.2024.107543","DOIUrl":"10.1016/j.leukres.2024.107543","url":null,"abstract":"","PeriodicalId":18051,"journal":{"name":"Leukemia research","volume":"143 ","pages":"Article 107543"},"PeriodicalIF":2.1,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141450832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification of clonal relationship and prognostic significance in acute myeloid leukemia patients with concomitant increase in mast cells","authors":"Zhifang Xu ,&nbsp;Ting Zhang ,&nbsp;Jian Hao ,&nbsp;Dan Liu ,&nbsp;Minglin Hong ,&nbsp;Shaotong Dong ,&nbsp;Ju Deng ,&nbsp;Fanggang Ren ,&nbsp;Yaofang Zhang ,&nbsp;Hongwei Wang","doi":"10.1016/j.leukres.2024.107539","DOIUrl":"10.1016/j.leukres.2024.107539","url":null,"abstract":"","PeriodicalId":18051,"journal":{"name":"Leukemia research","volume":"143 ","pages":"Article 107539"},"PeriodicalIF":2.1,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141469206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early dose reduction of dasatinib does not compromise clinical outcomes in patients with chronic myeloid leukemia: A comparative analysis of two prospective trials","authors":"Dong-Yeop Shin ,&nbsp;Sahee Park ,&nbsp;Eunjung Jang ,&nbsp;Jee Hyun Kong ,&nbsp;Young-Woong Won ,&nbsp;Sukjoong Oh ,&nbsp;Yunsuk Choi ,&nbsp;Jeong-A Kim ,&nbsp;Se Won Lee ,&nbsp;Yeung-Chul Mun ,&nbsp;Hawk Kim ,&nbsp;Sung-Hyun Kim ,&nbsp;Young Rok Do ,&nbsp;Jae-Yong Kwak ,&nbsp;Hyeoung-Joon Kim ,&nbsp;Dae Young Zang ,&nbsp;Sung-Nam Lim ,&nbsp;Won Sik Lee ,&nbsp;Dong-Wook Kim","doi":"10.1016/j.leukres.2024.107542","DOIUrl":"10.1016/j.leukres.2024.107542","url":null,"abstract":"<div><p>Dasatinib is a potent second-generation tyrosine kinase inhibitor (TKI) used as a first-line treatment option for patients with chronic myeloid leukemia (CML). Currently, dose modification due to adverse events (AEs) is common in patients treated with dasatinib. This study compared the outcomes of two sequential prospective trials that enrolled patients with newly diagnosed chronic phase of CML (CP-CML) and initiated dasatinib at a starting dose of 100 mg daily. In the PCR-DEPTH study, CP-CML patients who started dasatinib 100 mg daily were enrolled and followed up, while in the DAS-CHANGE study, when patients achieved early molecular response with any grade of AEs were enrolled and treated with dasatinib 80 mg once daily. A total of 102 patients (PCR-DEPTH) and 90 patients (DAS-CHANGE) were compared. Although the median value of the relative dose intensity (RDI) of dasatinib was significantly higher in PCR-DEPTH than in DAS-CHANGE (99.6 % vs. 80.1 %, p &lt;0.001), the MMR rate at 12months showed a trend toward superiority in DAS-CHANGE compared to PCR-DEPTH (77.1 % vs 65.2 %, p = 0.084). The frequencies of MR4.0 at 24 and 36 months were higher in DAS-CHANGE than in PCR-DEPTH (44.4 % vs 28.8 %, p = 0.052 and 63.6 % vs 40.3 %, p= 0.013, respectively). RDIs were not different according to the MMR, MR4.0 or MR4.5 in analyses using a pooled population. Our results suggest that early dose reduction of dasatinib does not compromise efficacy in patients achieving EMR at 3 months and could be an interventional strategy for improving long term outcomes.</p></div>","PeriodicalId":18051,"journal":{"name":"Leukemia research","volume":"143 ","pages":"Article 107542"},"PeriodicalIF":2.1,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141457791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unmutated IGHV at diagnosis in patients with early stage CLL independently predicts for shorter follow-up time to first treatment (TTFT)","authors":"Piero Galieni ,&nbsp;Emanuela Troiani,&nbsp;Paola Picardi,&nbsp;Mario Angelini,&nbsp;Francesca Mestichelli,&nbsp;Alessia Dalsass,&nbsp;Denise Maravalle,&nbsp;Elisa Camaioni,&nbsp;Catia Bigazzi,&nbsp;Patrizia Caraffa,&nbsp;Miriana Ruggieri,&nbsp;Serena Mazzotta,&nbsp;Silvia Mattioli,&nbsp;Stefano Angelini","doi":"10.1016/j.leukres.2024.107541","DOIUrl":"10.1016/j.leukres.2024.107541","url":null,"abstract":"<div><p>The mutational status of the IGHV gene is routinely assessed in patients with chronic lymphocytic leukaemia (CLL), since it is both prognostic of clinical outcome and predictive of response to treatment. This study evaluates the IGHV mutational status, assessed in newly diagnosed CLL patients, as a stand-alone predictor of time to first treatment (TTFT). We analysed the data of 236 CLL patients, diagnosed at our centre between January 2004 and September 2020, with a minimum follow-up period of 3.0 years, Binet A-B and Rai 0-II stages. IGHV was unmutated in 38.1 % and mutated in 61.9 % of cases. The univariate analysis showed a statistically significant difference (p &lt; 0.001) in TTFT based on unmutated (85.2 % at 14 years, 95 % CI = 63.3–94.5 %) or mutated (41.3 % at 14 years, 95 % CI = 29.5–51.8 %) and the need for treatment at 1, 3 and 5 years was of 20.0 % vs 4.1 % (p &lt; 0.001), 42.7 % vs 11.4 % (p &lt; 0.001) and 55.8 % vs 20.0 % (p &lt; 0.001) in unmutated and mutated IGHV patients, respectively. Multivariate analysis confirmed that unmutated IGHV status negatively affects TTFT (p &lt; 0.001), in addition to high-risk genomic aberration (p = 0.025), Rai stage I (p = 0.007) and II (p-value &lt; 0.001). The difference in TTFT based on unmutated or mutated IGHV status remains statistically significant also when considering the subgroups by the genomic aberrations and Rai stages. Our findings suggest that, with the single analysis of the IGHV mutational status at CLL diagnosis, along with clinical and laboratory data, and without karyotype and TP53 data, clinicians will have prognostic and predictive indications for the first clinical treatment and appropriate follow-up of patients.</p></div>","PeriodicalId":18051,"journal":{"name":"Leukemia research","volume":"143 ","pages":"Article 107541"},"PeriodicalIF":2.1,"publicationDate":"2024-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141408314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MD-1 downregulation is associated with reduced cell surface CD180 expression in CLL","authors":"Kurtis Edwards ,&nbsp;Maria Manoussaka ,&nbsp;Uzma Sayed ,&nbsp;Tamar Tsertsvadze ,&nbsp;Lara De Deyn ,&nbsp;Amit Nathwani ,&nbsp;John G. Gribben ,&nbsp;Sergey Krysov ,&nbsp;Emanuela V. Volpi ,&nbsp;Peter M. Lydyard ,&nbsp;Nino Porakishvili","doi":"10.1016/j.leukres.2024.107540","DOIUrl":"10.1016/j.leukres.2024.107540","url":null,"abstract":"<div><p>CD180 is a toll-like receptor that is highly expressed in complex with the MD-1 satellite molecule on the surface of B cells. In chronic lymphocytic leukaemia (CLL) however, the expression of CD180 is highly variable and overall, significantly reduced when compared to normal B cells. We have recently shown that reduced CD180 expression in CLL lymph nodes is associated with inferior overall survival. It was therefore important to better understand the causes of this downregulation through investigation of CD180 at the transcriptional and protein expression levels. Unexpectedly, we found <em>CD180</em> RNA levels in CLL cells (n = 26) were comparable to those of normal B cells (n = 13), despite heterogeneously low expression of CD180 on the cell surface. We confirmed that <em>CD180</em> RNA is translated into CD180 protein since cell surface CD180-negative cases presented with high levels of intracellular CD180 expression. Levels of <em>MD-1</em> RNA were, however, significantly downregulated in CLL compared to normal controls. Together, these data suggest that changes in CD180 cell surface expression in CLL are not due to transcriptional downregulation, but defective post-translational stabilisation of the receptor due to MD-1 downregulation.</p></div>","PeriodicalId":18051,"journal":{"name":"Leukemia research","volume":"143 ","pages":"Article 107540"},"PeriodicalIF":2.7,"publicationDate":"2024-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0145212624001061/pdfft?md5=a8e18e7bac375abeb403bedba021d4c5&pid=1-s2.0-S0145212624001061-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141396951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of leukemia-associated macrophages on the progression and therapy response of chronic lymphocytic leukemia","authors":"Hendrik Jestrabek ,&nbsp;Viktoria Kohlhas ,&nbsp;Michael Hallek ,&nbsp;Phuong-Hien Nguyen","doi":"10.1016/j.leukres.2024.107531","DOIUrl":"https://doi.org/10.1016/j.leukres.2024.107531","url":null,"abstract":"<div><p>The treatment landscape of chronic lymphocytic leukemia (CLL) has advanced remarkably over the past decade. The advent and approval of the BTK inhibitor ibrutinib and BCL-2 inhibitor venetoclax, as well as monoclonal anti-CD20 antibodies rituximab and obinutuzumab, have resulted in deep remissions and substantially improved survival outcomes for patients. However, CLL remains a complex disease with many patients still experiencing relapse and unsatisfactory treatment responses. CLL cells are highly dependent on their pro-leukemic tumor microenvironment (TME), which comprises different cellular and soluble factors. A large body of evidence suggests that CLL-associated macrophages shaped by leukemic cells play a pivotal role in maintaining CLL cell survival. In this review, we summarize the pro-survival interactions between CLL cells and macrophages, as well as the impact of the current first-line treatment agents, including ibrutinib, venetoclax, and CD20 antibodies on leukemia-associated macrophages.</p></div>","PeriodicalId":18051,"journal":{"name":"Leukemia research","volume":"143 ","pages":"Article 107531"},"PeriodicalIF":2.7,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0145212624000973/pdfft?md5=6e40b301668e29c1a72d35622b9680e4&pid=1-s2.0-S0145212624000973-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141289208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of post-transplant cyclophosphamide and splenomegaly on primary graft failure and multi-lineage cytopenia after allogeneic hematopoietic cell transplantation","authors":"Emma Zulch ,&nbsp;Yoshitaka Inoue ,&nbsp;Joseph Cioccio ,&nbsp;Kevin Rakszawski ,&nbsp;Natthapol Songdej ,&nbsp;Myles Nickolich ,&nbsp;Hong Zheng ,&nbsp;Seema Naik ,&nbsp;Witold Rybka ,&nbsp;Christopher Ehmann ,&nbsp;Jeffrey Sivik ,&nbsp;Jseph Mierski ,&nbsp;Brooke Silar ,&nbsp;Caitlin Vajdic ,&nbsp;Robert Greiner ,&nbsp;Valerie Brown ,&nbsp;Raymond Hohl ,&nbsp;David Claxton ,&nbsp;Hiroko Shike ,&nbsp;Catharine I. Paules ,&nbsp;Kentaro Minagawa","doi":"10.1016/j.leukres.2024.107530","DOIUrl":"10.1016/j.leukres.2024.107530","url":null,"abstract":"<div><p>Primary graft failure (PGF) and multi-lineage cytopenia (MLC) increase the risk of nonrelapse mortality in allogeneic hematopoietic cell transplants (HCT). We evaluated the impact of post-transplant cyclophosphamide (PTCy) and splenomegaly on PGF and MLC for hematological malignancies. This study included patients with PTCy (N=84) and conventional graft-vs.-host disease prophylaxis (N=199). The occurrence of splenomegaly varied widely, ranging from 17.1 % (acute myeloid leukemia) to 66.7 % (myeloproliferative neoplasms). Ten patients (N=8 in the PTCy and N=2 in the non- PTCy) developed PGF, and 44 patients developed MLC (both N=22). PTCy and severe splenomegaly (≥20 cm) were risk factors for PGF (odds ratio (OR): 10.40, p&lt;0.01 and 6.74, p=0.01 respectively). Moreover, severe splenomegaly was a risk factor for PGF in PTCy patients (OR: 10.20, p=0.01). PTCy (hazard ratio (HR) 2.09, p=0.02), moderate (≥15, &lt;20 cm, HR 4.36, p&lt;0.01), and severe splenomegaly (HR 3.04, p=0.01) were independent risk factors for MLC. However, in subgroup analysis in PTCy patients, only mild splenomegaly (≥12, &lt;15 cm, HR 4.62, p=0.01) was a risk factor for MLC. We recommend all patients be screened for splenomegaly before HCT, and PTCy is cautioned in those with splenomegaly.</p></div>","PeriodicalId":18051,"journal":{"name":"Leukemia research","volume":"143 ","pages":"Article 107530"},"PeriodicalIF":2.7,"publicationDate":"2024-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141274680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}