American Journal of Hematology最新文献

{"title":"Challenging the Adverse Label: Diverse Outcomes of ELN 2022 Adverse Cytogenetic Subgroups in Acute Myeloid Leukemia Patients Allografted in First Remission: From EBMT ALWP","authors":"Ali Bazarbachi, Jacques-Emmanuel Galimard, Iman Abou Dalle, Gérard Socié, Jurjen Versluis, Depei Wu, Matthias Eder, Hélène Labussière-Wallet, Ibrahim Yakoub-Agha, Johan Maertens, Edouard Forcade, Tobias Gedde-Dahl, Goda Choi, Cristina Castilla-Llorente, Frederic Baron, Eolia Brissot, Jordi Esteve, Arnon Nagler, Mohamad Mohty, Fabio Ciceri","doi":"10.1002/ajh.27726","DOIUrl":"https://doi.org/10.1002/ajh.27726","url":null,"abstract":"According to the European LeukemiaNet (ELN) 2022 classification, acute myeloid leukemia (AML) patients with intermediate or adverse risk are offered allogeneic hematopoietic stem cell transplantation (allo-HSCT) in first remission. In this EBMT study, we included 1735 adult AML patients with ELN-2022 adverse-risk cytogenetics allografted between 2010 and 2022 in first remission (67% de novo AML, median age 56 years). Eleven non-overlapping adverse-risk cytogenetics groups were defined. The five most frequent were: Group 1 [<i>n</i> = 394; monosomy 17 or abn(17p); 2-year leukemia-free survival (LFS) 22%, and overall survival (OS) 25%]; Group 2 [<i>n</i> = 313; complex karyotype (CK) involving monosomy 5, monosomy 7, or del(5q) without monosomy 17 or abn(17p); LFS 27%, OS 37%]; Group 3 [<i>n</i> = 201; monosomy 5, monosomy 7, or del(5q) without CK and without monosomy 17 or abn(17p); LFS: 55%, OS: 63%]; Group 4 [<i>n</i> = 256; CK without monosomal karyotype (MK) or adverse additional cytogenetic abnormalities (ACA); LFS 50%, OS 61%]; Group 5 [<i>n</i> = 213; t(v, 11q23) without adverse ACA; LFS 50%, OS 59%]. In multivariable analysis, compared to CK without adverse ACA, LFS was negatively affected by monosomy 17 or 17p abnormalities, monosomy 5, 7, or del(5q) in the presence of CK, and t(8;16). In conclusion, this study revealed a very poor outcome of allografted AML patients with monosomy 17 or 17p abnormalities or CK involving monosomy 5, monosomy 7, and del5q. Outcomes were relatively favorable for most other ELN 2022 adverse categories, including CK with or without MK other than 5, 7, and 17, indicating that allo-HSCT can overcome their poor outcome.","PeriodicalId":7724,"journal":{"name":"American Journal of Hematology","volume":"146 1","pages":""},"PeriodicalIF":12.8,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144176952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification of a CAR-Derived Clone by NGS-Based MRD After Fully Human BCMA CAR T-Cell Therapy in Multiple Myeloma","authors":"Wenqiang Yan, Jiao Chang, Chenxing Du, Yuntong Liu, Rui Lv, Hesong Zou, Tengteng Yu, Shuaishuai Zhang, Tingyu Wang, Weiwei Sui, Shuhui Deng, Yan Xu, Wenyang Huang, Shuhua Yi, Dehui Zou, Jianxiang Wang, Lugui Qiu, Yujiao Jia, Gang An","doi":"10.1002/ajh.27732","DOIUrl":"https://doi.org/10.1002/ajh.27732","url":null,"abstract":"&lt;p&gt;B cell maturation antigen (BCMA) chimeric antigen receptor (CAR)-T cell therapy has significantly improved survival outcomes in patients with relapsed or refractory multiple myeloma (RRMM), achieving unprecedented depth of response compared to conventional salvage regimens [&lt;span&gt;1-3&lt;/span&gt;]. Minimal residual disease (MRD) negativity has emerged as a strong predictor of favorable prognosis in this setting [&lt;span&gt;4&lt;/span&gt;] and is increasingly recognized as a surrogate endpoint for accelerated drug approvals of novel agents.&lt;/p&gt;\u0000&lt;p&gt;Next-generation flow cytometry (NGF) and next-generation sequencing (NGS)-based MRD assessments are the most widely adopted approaches, offering sensitivities of approximately 10&lt;sup&gt;−5&lt;/sup&gt; and 10&lt;sup&gt;−6&lt;/sup&gt;, respectively. In addition to their high sensitivity, NGS-MRD enables longitudinal tracking of clonal dynamics and the identification of potential subclonal evolution. However, the interpretation of NGS-MRD in the context of genetically engineered T cell products remains limited and poorly characterized.&lt;/p&gt;\u0000&lt;p&gt;In our center, most patients attained NGS-MRD negativity following BCMA CAR-T infusion in real-world clinical settings. Unexpectedly, in a subset of these patients, we identified a persistent novel clone sequence that was not related to the original tumor clone post-infusion. This novel clone gradually declined over time but remained detectable in serial MRD assessments. Whether this uncommon finding reflects clonal evolution, tumor relapse, secondary neoplasm, or a previously unrecognized signal derived from the CAR-T product itself remains to be determined. To investigate this phenomenon, we conducted a retrospective study utilizing a multi-modal approach to characterize the origin and clinical relevance of this novel clone.&lt;/p&gt;\u0000&lt;p&gt;We retrospectively analyzed 55 myeloma patients who received BCMA CAR-T cell therapy at our center and had at least one NGS-MRD assessment post-infusion, as part of real-world observational studies or investigator-initiated trials (IIT). Written informed consent was obtained from all patients, and the study was approved by the Ethics Committee of the Blood Diseases Hospital.&lt;/p&gt;\u0000&lt;p&gt;Fluorescence in situ hybridization (FISH) and NGF-based MRD were performed as previously described [&lt;span&gt;5&lt;/span&gt;]. NGS-MRD analysis was conducted using the Neo-MRD assay (Neoimmune, Shenzhen, China), targeting V(D)J rearrangements in IGH, IGK, and IGL genes. A two-step PCR was applied: a 28-cycle multiplex PCR to amplify V and J segments, followed by a 12-cycle universal PCR to add Illumina adaptors. Libraries were sequenced on the NovaSeq 6000 platform (paired-end, 150 bp). CDR3 sequences with fewer than three reads per million were excluded. Dominant clones were defined based on &gt; 3% clonal frequency and &gt; 0.2% nucleated cell content and were tracked across timepoints.&lt;/p&gt;\u0000&lt;p&gt;Lentiviral vector copy number (VCN) was quantified using digital droplet PCR (ddPCR) in 27 bone marrow (BM) DNA ","PeriodicalId":7724,"journal":{"name":"American Journal of Hematology","volume":"149 2 1","pages":""},"PeriodicalIF":12.8,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144176663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Benefit of Early Daratumumab Use in Multiple Myeloma is Undefined.","authors":"Ruben Van Dijck, Zoran Erjavec, John-John B Schnog","doi":"10.1002/ajh.27728","DOIUrl":"https://doi.org/10.1002/ajh.27728","url":null,"abstract":"","PeriodicalId":7724,"journal":{"name":"American Journal of Hematology","volume":" ","pages":""},"PeriodicalIF":10.1,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CPX-351 (Vyxeos) in Acute Myeloid Leukemia: Time to Move on?","authors":"Naseema Gangat, Ayalew Tefferi","doi":"10.1002/ajh.27730","DOIUrl":"https://doi.org/10.1002/ajh.27730","url":null,"abstract":"CPX-351 has similar efficacy but more toxicity compared to venetoclax+hypomethylating agent therapy.","PeriodicalId":7724,"journal":{"name":"American Journal of Hematology","volume":"134 1","pages":""},"PeriodicalIF":12.8,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144165663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mean Corpuscular Hemoglobin Modulates HbF/F-Cell and Clinical Response to Gene Therapy and Hydroxyurea in Sickle Cell Disease.","authors":"Martin H Steinberg, Abdullah Kutlar, Paola Sebastiani","doi":"10.1002/ajh.27729","DOIUrl":"https://doi.org/10.1002/ajh.27729","url":null,"abstract":"","PeriodicalId":7724,"journal":{"name":"American Journal of Hematology","volume":" ","pages":""},"PeriodicalIF":10.1,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144155523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ALK+ Large B-Cell Lymphoma With Novel ZNF296::ALK: A Morphologic Mimic of ALK+ Anaplastic Large Cell Lymphoma.","authors":"Wei J Wang,Pei Lin,John M Stewart,Guilin Tang,Shaoying Li,Sanam Loghavi,L Jeffrey Medeiros,Jie Xu","doi":"10.1002/ajh.27727","DOIUrl":"https://doi.org/10.1002/ajh.27727","url":null,"abstract":"","PeriodicalId":7724,"journal":{"name":"American Journal of Hematology","volume":"12 1","pages":""},"PeriodicalIF":12.8,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144146166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Conditioning Intensity on Clinical Outcomes of Second Allogeneic Hematopoietic Cell Transplantation for Relapse After First Transplantation.","authors":"Kazuki Yoshimura,Hideki Nakasone,Masaharu Tamaki,Hiroki Hosoi,Kazuaki Kameda,Naoyuki Uchida,Noriko Doki,Takahiro Fukuda,Satoshi Yoshihara,Yasuo Mori,Hirohisa Nakamae,Masatsugu Tanaka,Yuta Katayama,Tetsuya Eto,Yuta Hasegawa,Shuichi Ota,Satoshi Takahashi,Makoto Yoshimitsu,Fumihiko Ishimaru,Junya Kanda,Yoshiko Atsuta,Kimikazu Yakushijin","doi":"10.1002/ajh.27709","DOIUrl":"https://doi.org/10.1002/ajh.27709","url":null,"abstract":"Although second allogeneic hematopoietic cell transplantation HCT (HCT2) is a potentially curative treatment for patients relapsing after their first HCT (HCT1), it is associated with higher non-relapse mortality (NRM) compared with HCT1. Furthermore, while reduced-intensity conditioning (RIC) in HCT2 might decrease NRM, there is no consensus on which patients may benefit from RIC. We retrospectively analyzed 2478 patients who underwent HCT2 for relapse of hematologic malignancies after HCT1. In a multivariate analysis, older recipient age, short duration between HCT1 and HCT2, RIC in HCT1, HCT-CI ≥ 2, and ECOG PS ≥ 2 were associated with an increased risk of NRM. RIC in HCT2 was associated with better NRM compared to myeloablative conditioning (MAC) (hazard ratio [HR] 0.83, 95% confidence interval [CI]: 0.72-0.97; p = 0.018), but was not significantly associated with overall survival (OS) (HR 0.91, 95% CI: 0.82-1.01; p = 0.075). We observed a significant interaction for NRM between extensive cGVHD in HCT1 and the conditioning intensity of HCT2 (interaction p < 0.001), meaning that the benefit of RIC in HCT2 was seen in patients with extensive cGVHD in HCT1, but not in those without cGVHD. RIC in HCT2 was also associated with superior OS in patients with extensive cGVHD in HCT1 (HR 0.68, 95% CI: 0.49-0.93; p = 0.02), with significant interaction between the conditioning intensity and the prior history of extensive cGVHD (interaction p = 0.01). This study suggests that RIC in HCT2 reduces NRM for HCT2 and improves OS, especially in patients with a history of extensive cGVHD.","PeriodicalId":7724,"journal":{"name":"American Journal of Hematology","volume":"59 3 1","pages":""},"PeriodicalIF":12.8,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144122226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Phase 2 Trial of CPX-351 Combined With Venetoclax in Relapsed or Refractory Acute Myeloid Leukemia.","authors":"Tapan M Kadia,Wei-Ying Jen,Alex Bataller,Alexandre Bazinet,Gautam Borthakur,Elias Jabbour,Wei Qiao,Nicholas J Short,Koichi Takahashi,Ghayas C Issa,Courtney D DiNardo,Guillermo Montalban-Bravo,Naveen Pemmaraju,Andrew Tran,Vanthana Bharathi,Sanam Loghavi,Amin M Alousi,Uday Popat,Naval G Daver,Farhad Ravandi,Hagop M Kantarjian","doi":"10.1002/ajh.27723","DOIUrl":"https://doi.org/10.1002/ajh.27723","url":null,"abstract":"Outcomes in patients with relapsed/refractory (RR) AML are poor. We sought to investigate if CPX-531 in combination with venetoclax (CPX + VEN) was tolerable and effective in RR AML. This was a single institution phase 1b/2 trial of CPX + VEN. Patients aged ≥ 18 years with RR AML who were fit for intensive chemotherapy were eligible. Prior venetoclax exposure was allowed. The phase 1b portion followed a 3 + 3 design to identify the recommended phase 2 dose (RP2D) for the expansion cohort. At the starting dose level of -1, prolonged myelosuppression was observed, leading to dose level -2 (CPX-351 dosed at daunorubicin 44 mg/m2 on days 1,3, and 5 and venetoclax 300 mg days 2-8) being chosen as the RP2D. Thirty three patients with a median age of 58 years (range, 26-72) were treated. Patients were heavily pretreated, with 58% with prior venetoclax exposure, 44% in the second salvage or later, and 30% with prior stem cell transplant (SCT). Adverse cytogenetics were present in 51% of patients, with myelodysplasia-related mutations in 64%, and TP53mut in 21%. The overall response rate (ORR) was 46% (95% CI, 30-62), with a composite CR rate (CRc) of 39% (95% CI, 25-56). Patients in first salvage with wildtype TP53 had a CRc rate of 70% (95% CI, 40-89), with undetectable MRD in 71% (95% CI, 36-92) and a 2-year OS of 49% (95% CI, 23-100). Eleven (73%) responding patients underwent SCT. The 30-day mortality was 9%, with a 60-day mortality of 21%. The most common adverse events were related to myelosuppression. CPX + VEN has activity in RR AML, particularly when used in first salvage and in patients who do not harbor TP53 mutations. ClinicalTrials.gov Identifier: NCT03629171.","PeriodicalId":7724,"journal":{"name":"American Journal of Hematology","volume":"31 1","pages":""},"PeriodicalIF":12.8,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144114185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PET/CT in the Staging and Treatment Response Assessment of Patients With Extranodal Marginal Zone Lymphoma.","authors":"Juan Pablo Alderuccio,Russ A Kuker,Eduardo Edelman Saul,Michele D Stanchina,Mark K Polar,Jennifer Chapman,Wei Zhao,Rafael Hennemann Sassi,Craig H Moskowitz,Isildinha M Reis,Izidore S Lossos","doi":"10.1002/ajh.27712","DOIUrl":"https://doi.org/10.1002/ajh.27712","url":null,"abstract":"18Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is the standard imaging modality in lymphoma. The 2014 Lugano classification considers extranodal marginal zone lymphoma (EMZL) a non-FDG-avid disease, recommending contrast-enhanced CT. We reassessed the utility of PET/CT for staging workup and response assessment of EMZL. We reviewed staging and response PET/CT of 190 EMZL sites from 152 patients. Each location was counted independently for patients with > 1 extranodal site. Although not standard, we considered FDG-avid disease if SUVmax was ≥ 2, and calculated ratios between lymphoma SUVmax and mediastinal blood pool (BP index) and liver background (liver index). FDG avidity was detected in 151 (79.5%) out of 190 extranodal sites (in 117 [76.7%] out of 152 patients), with a median SUVmax of 4.5 (IQR 2.5-6.9, range 0-26.8). Locations showing FDG avidity in > 90% of extranodal sites included salivary gland, bone, lung, soft tissue, ocular adnexa, and airways. Skin was commonly non-FDG avid (93.8%). Among 22 patients with > 1 extranodal location, there was concordant FDG avidity in all sites in 18 (81.8%) patients. Considering measurable extranodal disease size > 0.5 cm, we observed significant Pearson correlation coefficients (r) between lymphoma size and SUVmax (r = 0.20, p = 0.019, n = 142), BP index (r = 0.34, p < 0.001, n = 124), and liver index (r = 0.36, p < 0.001, n = 124). We also observed improved precision in response to treatment assessment in FDG-avid EMZL tumors. This study demonstrates that EMZL is commonly an FDG-avid disease, suggesting that PET/CT should be routinely used in the staging and response assessment workup of patients with EMZL.","PeriodicalId":7724,"journal":{"name":"American Journal of Hematology","volume":"40 1","pages":""},"PeriodicalIF":12.8,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to “Efficacy and Safety of Early-Start Deferiprone in Infants and Young Children With Transfusion-Dependent Beta Thalassemia: Evidence for Iron Shuttling to Transferrin in a Randomized, Double-Blind, Placebo-Controlled, Clinical Trial (START)”","authors":"","doi":"10.1002/ajh.27703","DOIUrl":"https://doi.org/10.1002/ajh.27703","url":null,"abstract":"<p>M. S. Elalfy, M. Hamdy, A. Adly, et al., “Efficacy and Safety of Early-Start Deferiprone in Infants and Young Children With Transfusion-Dependent Beta Thalassemia: Evidence for Iron Shuttling to Transferrin in a Randomized, Double-Blind, Placebo-Controlled, Clinical Trial (START),” <i>American Journal of Hematology</i> 98, no. 9 (2023): 1415–1424, https://doi.org/10.1002/ajh.27010.</p>\u0000<p>In the acknowledgements and in the Supplemental Figure 1, the paper omits to mention the contribution made by the study sites in Indonesia and the Pediatric Hospital of Cairo. As these sites are not represented in the author's masthead, we would like to remedy this under the provision given in your correction reasons: “Acknowledgements of funder support or non-author contributors have not been included; or declarations related to ethics approval or conflicts of interest need to be added.”</p>\u0000<p>To support this, we have pasted the desired acknowledgement section below and appended the proposed Supplemental Figure 1 (the addition there being the addition of the Study Site table at the bottom).</p>\u0000<p>This correction has been discussed and approved by all authors, contributors and sponsors.</p>\u0000<p>PROPOSED NEW ACKNOWLEDGEMENTS</p>\u0000<p>The authors thank the patients and their families for participation in this study. The authors would also like to acknowledge the contributions of Professor Amal Beshlawy and her team at Pediatric Hospital of Cairo University (Cairo, Egypt) and Prof Pustika Amalia Wahidiyat and her team at Rumah Sakit Umum Pusat National Dr. Cipto Mangunkusumo (Jakarta, Indonesia), who were investigators and study sites. The study was sponsored by Chiesi Global Rare Diseases (formerly ApoPharma Inc.), Boston, MA, USA. Medical writing support was provided by Keith M. Olson, PhD, and Emily K. LaVigne, PhD, of Oxford PharmaGenesis Inc., Newtown, PA, USA, and funded by Chiesi USA Inc.</p>\u0000<div>We apologize for this error. <figure>\u0000<div><picture>\u0000<source media=\"(min-width: 1650px)\" srcset=\"/cms/asset/a39bd6df-d60b-436c-8642-54684397ca23/ajh27703-gra-0001-m.jpg\"/><img alt=\"image\" data-lg-src=\"/cms/asset/a39bd6df-d60b-436c-8642-54684397ca23/ajh27703-gra-0001-m.jpg\" loading=\"lazy\" src=\"/cms/asset/6ee718b8-7722-46d2-9a7d-785ba802c6c8/ajh27703-gra-0001-m.png\" title=\"image\"/></picture><p></p>\u0000</div>\u0000</figure>\u0000</div>","PeriodicalId":7724,"journal":{"name":"American Journal of Hematology","volume":"18 1","pages":""},"PeriodicalIF":12.8,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144104172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}