Objective To evaluate the influence of granulocyte colony-stimulating factor (G-CSF) on the quantity and ratio of type 1 dendritic cells (DC1) and type 2 dendritic cells (DC2) in normal allogeneic hematopoietic stem cell graft donor peripheral blood (PB) and bone marrow (BM). Methods G-CSF treatment with 10 μg/kg per day for 5 days, the quantity, ratio of DC1 and DC2 in G-CSF primed allogeneic peripheral blood stem cell graft (G-PBSC) were detected in 11 donors, 20 donors in G-CSF primed allogeneic bone marrow stem cell graft (G-BMSC), 8 donors in unprimed PB, and 10 normal individuals in unprimed BM,respectively. by flow cytometry method. Results After treated by G-CSF, the mean BMDC2 was increased from 14.37×106/L to 29.68×106/L ( t = 2.433, P = 0.022) in control group, whereas BMDC1 count did not change (13.77×106/L vs 18.88×106L, t = 1.169, P = 0.251). The ratio of DC2 to DC1 was significantly higher in G-CSF treated donor BM (1.83±0.81 vs 1.12±0.32, t = 2.658, P =0.013). After G-CSF treatment of normal donor, the number of PBDC2 (14.92×106/L vs 26.76×106/L, t = 2.390, P = 0.029), and the ratio of DC2 to DC1 was increased (1.00±0.37 vs 2.02±1.43, t = 2.158, P = 0.044), but the number of PBDC1 was similar (14.21×106/L vs 18.02×106/L, t = 0.625, P=0.541). Conclusion G-CSF treatment of normal allogeneic HSC donor selectively increase the number of PBDC2 and BMDC2, but do not change PBDC1 and BMDC1.

Objective To investigate the clinical features and the efficient therapy of acute promyelocytic leukemia(APL)with high initial white blood cell(WBC)count.Methods The clinical features of 66 newly diagnosed APL patients with high initial WBC and 152 patients without high initial WBC from the First Affiliated Hospital of Soochow University between October 1993 and August 2006 were retrospectively analyzed.Additionally,66 patients with high WBC were divided into different groups according to the different induction therapy and the therapeutic effects were compared.Results The early death rate and the incidence of disseminated intravascular coagulation(DIC)and retinoic acid syndrome(RAS)were 30.3%,57.6% and 31.8% respectively for the group with high initial WBC,which were higher than the indexes of 7.2%,38.1% and 21.05% respectively for the group without high initial WBC(P

90 %) on months 1,2,3,6 and 12.An acute GVHD of grade Ⅱ and chronic limited GVHD developed,but improved with modification of immunosuppressive therapy.The patient has(regained) normal lives now.Conclusion NIMA-mismatched sibling with FMc may be a suitable donor for Non-TCD HLA haplo-identical HSCT.

Objective To monitor the incidence of CMV infection in different stem cell transplantation.Methods From Mar.2001 to Jul.2003,using nested-PCR,we have detected the CMV-DNA in the 55 patients in the First Affiliated Hospital to Soochow University after different stem cell transplantation and compared the incidence of infection of CMV in different stem cell transplantation. Results In the 462 blood samples,there were 285 blood sample which we detected CMV-DNA.The infection rate in all the patients whom we have studied was 33/55(60.0%);in the group of nonmyeloablative allogeneic stem cell transplantation,it was 15/17(88.2%);in the group of peripheral stem cell transplantation,it was 3/7(42.9%);in the group of unrelated bone marrow transplantation,it was 7/11(63.6%);in the group of related bone marrow transplantation it was 8/20(40.0%).The infection rate of CMV in the group of nonmyeloablative allogeneic stem cell transplantation was significantly higher than those in related bone marrow and peripheral stem cell transplantation(?~2=5.44,P0.05).Conclusion The incidence of CMV infections may be varied in different stem cell transplantation schemes.

Objective To investigate the mechanism of AS2 O3 inducing the apoptosis of myelodysplastic syndrome(MDS) cell line SKM-1 .Methods SKM-1 cells were incubated with AS2 O3 ,and then the cellular morphology was observed ,flow cytometry was used to determine the apoptosis ,RT-PCR was used to detect the expressions of Bcl-2 ,Bax and caspase-3 mRNA .Results 0 .25、0 .50 μmol/L AS2 O3 could not markedly induce the apoptosis of SKM-1 cells (P>0 .05) .But 2 .00、8 .00、32 .00 μmol/L of AS2 O3 could obviously promote the apoptosis of SKM-1 cells .With the increase of the acting time and concentration of AS2 O3 ,the apoptosis rate increased ,too(P<0 .01) ,the expressions of anti-apoptotic gene Bcl-2 mRNA decreased (P<0 .01) ,the expressions of promoting apoptosis gene Bax and caspase-3 mRNA increased (P<0 .01 ,P<0 .05) .Conclusion 2 .00、8 .00、32 .00 μmol/L of AS2O3 may promote the apoptosis of SKM-1 cells through down-regulating the expression of Bcl-2 gene and up-regulating the ex-pressions of Bax and caspase-3 genes .

To study the role of BK virus(BK polyomavirus)in the development of the hemorrhagic cystitis(HC)after hematopoietic stem cell transplantation(HSCT)and analyze the risk fators for BK viruri4a and HC.Methods From August 2006 to November 2007,blood and urine samples were collected from 80 patients undergoing HSCT.BK virus DNA was detected with PCR.Cytomegalovirus (CMV)antigen was detected with immunofluorescence histochemical examination.A control group including 20 healthy individuals was established.Results Late-onset HC occurred in 15 of the 80 HSCT patients with an incidence of 18.8%.The median onset time of HC was 44(13-150)days after transplantation.BK viruria was detected in 30 of the 80 HSCT patients(37.5%)and the positive rate of viruria in the HC patients was 86.7%(13/15).The median time of BK viruria detection in HC patients wag 23(0-56)days after transplantation,being earlier than the onset time of HC.The persistence time of BK viruria was 7(2-14) weeks,being much longer than that of HC(11 days).CMV antigen viremia was detected in 12 of the 80 transplanted patients.with a positive rate of 36.7% in patients with BK viruria and 40.0% in HC patients.Nine of the 30 HC patients developed acute graft versus host disease(Agvhd)of grade Ⅱ-Ⅳ(30.0%).BK virus was not detected in the urine of the remainimg two HC patients and the 20 control subjects as well as in all the blood samples.Univariate analysis indicated that CMV viremia and Agvhd of grade Ⅱ-Ⅳ were agsociated with the occurrence of BK viruria.Condusions BK viruria is the main cauge of the late-onset HC after HSCT.CMV infection and Agvhd may contribute to the occurrence of HC agsociatieg with BK virus.

Objective To investigate the clinical and laboratorial characteristics of patients with myelodysplastic syndrome ( MDS) and erythroid hyperplasia.Methods MDS patients whose bone marrow was hypercellular with erythroid lineage more than 50% and blasts account for less than 20% of non-erythroid cells were enrolled in this study.The ratio of mature erythrocytes to nucleated erythrocytes was no more than 20, namely MDS patients with erythroid hyperplasia ( MDS-E ).The retrospective analysis comprised 102 patients with MDS-E from the First Affiliated Hospital of Suzhou University.Clinical characteristics , karyotype , and the prognostic significance of erythroid hyperplasia were evaluated.Results A total of 48 MDS-E patients (47.1%) presented a variety of cytogenetic abnormalities.The most frequently involved chromosomes were chromosome 8 (39.5%of all abnormal karyotypes ), chromosome 7 (22.9%), followed by chromosome 5 ( 18.8%) , chromosome 1 ( 16.7%) and chromosome 20 ( 16.7%) .Hemoglobin ( Hb) level affected the prognosis by survival analysis.The overall survival ( OS) of MDS-E patients with Hb equal or more than 70 g/L was longer than that of patients less than 70 g/L ( P<0.001).Allogeneic hematopoietic stem cell transplantation (HSCT) significantly improved the OS compared with best supportive care (P<0.001) and chemotherapy (P<0.001).The extent of erythroid hyperplasia in bone marrow did not impact on prognosis ( P=0.187 ).Conclusions Compared with previous reports of MDS patients, MDS-E patients have higher level of erythroid hyperplasia , more common erythroid dyshematopoiesis , more frequent 8 and 1 chromosome abnormalities .The degree of erythroid hyperplasia is not correlated with prognosis.Allogeneic hematopoietic stem cell transplantation improves the prognosis.

Objective To compare the efficacy and safety between flumatinib and imatinib in patients with newly diagnosed chronic myeloid leukemia (CML). Methods A multi-center, randomized and parallel comparison clinical trial was conducted in 24 newly diagnosed patients with Philadelphia chromosome-positive CML-chronic phase (Ph+ CML-CP) who were treated by flumatinib 400 mg/d, 600 mg/d or imatinib for 6 cycles (24 weeks). The hematology was evaluated at pre-medication and the 2nd, 4th, 6th, 8th, 10th, 12th, 16th, 20th, 24th week of post-medication. The morphology, cytogenetics and molecular biology were evaluated at pre-medication and 12th, 24th week of post-medication. Results In terms of efficacy, the main molecular remission (MMR) rate of flumatinib 600 mg/d group was higher than that of imatinib group after 24 weeks [44.44 % (4/9) vs. 14.29 % (1/7), P=0.017]. The rate of bcr-ablIS≤10 % in flumatinib 600 mg/d group was significantly higher than that in imatinib group (P=0.002). PK/PD analysis also hinted that patients treated by flumatinib 600 mg/d was more likely to get molecular reaction in the early stage compared with those treated by flumatinib 400 mg/d. In terms of safety, there was no significant difference in grade Ⅲ-Ⅳ of adverse events among flumatinib 400 mg/d group, flumatinib 600 mg/d group and imatinib group (P >0.05). The common adverse events in flumatinib group included skin toxicity, gastrointestinal reactions and diarrhea.There was no heart and cardiovascular toxicity in flumatinib group, and incidence of edema in flumatinib group was lower than that in imatinib group. Conclusions Flumatinib is a safe and effective drug for newly diagnosed patients with Ph+ CML-CP, and 600 mg/d is the appropriate clinical starting dose. Flumatinib and imatinib have similar safety in clinic.

Objective To investigate the frequency of c-kit mutation and prognosis in t (8;21) acute myeloid leukemia (AML) patients with trisomy 4. Methods A total of 145 de novo t(8;21) AML patients from February 2005 to January 2013 were analyzed retrospectively. Detection of exons 8 and 17 mutation of c-kit by PCR and cytogenetic analysis by R-banding technologies were performed on bone marrow samples of all patients at diagnosis. Clinical data were collected and analyzed statistically. Results Among 145 t (8;21) AML patients, 12 cases (8.3 %) were trisomy 4, 91.7 % (11/12) of them were identified with c-kit mutation, which was significantly higher than that without trisomy 4 [26.3 % (35/133), P< 0.01]. The follow-up data showed that the patients with trisomy 4 were correlated with the lower overall survival (OS) rate (15 % vs 56 %, P< 0.01) and disease-free survival (DFS) rate (0 vs 51 %, P< 0.01) when compared with patients without trisomy 4. Furthermore, the subgroup of patients with both trisomy 4 and c-kit mutation had a worse OS and DFS (P< 0.05). Conclusions Trisomy 4 is associated with high frequency of c-kit mutation and demonstrates poor prognosis in t(8;21) AML patients. Trisomy 4 or it combined with c-kit gene mutation is the main influencing factor on the survival of the patients with t(8;21) AML.

Objective To study the clinical outcome of patients with fns-like tyrosine kinase-3internal tandem duplication (FLT3-ITD) positive acute myeloid leukemia (AML) treated with allogeneic hematopoietic stem cell transplantation (allo-HSCT) and to explore the potential prognostic factors to patients' survival including transplant types or disease status.Methods A total of 314 AML patients in our center from October 2006 to October 2012 were retrospectively analyzed,among whom,54 patients were defined with FLT3-ITD positive.Survival rates and treatment-related mortality were further analyzed.Results For all 54 FLT3-ITD positive patients,the 3-year overall survival (3-OS) rate was 56％ and 3-year leukemia-free survival (3-LFS) rate was 47％.The outcome of haplo-identical HSCT was similar as that of sibling donors(3-OS rate:60％ vs 54％ ; 3-LFS rate:54％ vs 45％,respectively).There were 47 patients who received transplantation in first complete remission(CR1).The other 7 patients were of disease relapse or in CR2 before transplantation.Not surprisingly,patients in CR1 had better prognosis than those in nonCR1.Conclusions Allo-HSCT is an effective treatment for AML patients with FLT3-ITD positive mutation.The survival outcome of haplo-identical HSCT was comparable with that of sibling donors.Relapse of AML was the dominant factor related to the mortality of FLT3-ITD positive AML patients after allo-HSCT.