1.Hot issues of hematopoietic stem cell transplantation in 39th Annual Meeting of the EBMT
Journal of Leukemia & Lymphoma 2013;22(6):325-326
The 39th Annual Meeting of the European Group for Blood and Marrow Transplantation (EBMT 2013) was held in London,UK from 7 to 10 April,2013.The meeting received more than 1000 submitted papers,covering leukemia,lymphoma,aplastic anemia,cellular and gene therapies and biology of graft-versus-host disease(GVHD).This review focuses on haploidentical hematopoietic stem cell transplantation (HSCT),improvements of conditioning regimen and early diagnosis and the management of GVHD.
2.Clinical analysis of acute kidney injury in patients with acute leukemia following myeloablative allogenetic hematopoietic cell transplantation
Yushi BAO ; Rujuan XIE ; Mei WANG ; Erlie JIANG ; Yong HUANG ; Jialin WEI ; Sizhou FENG ; Mingzhe HAN
Chinese Journal of Organ Transplantation 2010;31(10):618-620
Objective To analyze morbidity and prognosis of acute kidney injury (AKI) in patients with acute leukemia after myeloablative allogenetic hematopoietic stem cell transplantation (HSCT).Methods Renal function and related clinical data in 66 patients receiving myeloablative alloHSCT were retrospectively analyzed.Renal function was evaluated by RIFLE criteria,which defines AKI as three grades of severity-risk (AKI-R),injury (AKI-I) and failure (AKI-F).Results Thirtyseven recipients (56.1%) developed AKI at a median of 29 days after allo-HSCT,including AKI-R(19 recipients,28.8 %),AKI-I (11 recipients,16.7 %),AKI-F (7 recipients,10.6 %).Compared with baseline value,serum creatinine level in the recipients was significantly increased at the 21st day after transplantation (P<0.05).During 100 days after HSCT,the morbidity of AKI-F in recipients with HVOD and without HVOD were respectively (55.56 ± 22.22)% and (9.01 ± 4.75)% (P<0.01).The morbidity of AKI in recipients with or without increased total bilirubin was respectively (68.75 ± 24.54)% and (8.38 ± 4.17)% (P<0.01).The morbidity of AKI in recipients with or without increased CsA concentration was respectively (66.67 ± 10.29) % and (44.44 ± 8.28) % (P<0.05).100-day survival rate in recipients after myeloablative allo-HSCT without AKI,with AKI-R,AKI-I and AKI-F was respectively (89.66 ± 5.66) %,(83.88 ± 8.54) %,(81.82 ± 11.63) % and (42.86 ± 18.7) % (P<0.05).Conclusion AKI is one of the main complications in patients with acute leukemia after myeloablative allo-HSCT.The influence of different class AKI on the mortality was different.The earlier diagnosis,prophylaxis and treatment of AKI by the RIFLF criteria might increase the survival rate in recipients with HSCT.
3.Assessment and prognosis analysis of acute kidney injury in patients with chronic myelogeneous leukemia after myeloablative allogenetic hematopoietic stem cell transplantation using RIFLE criteria
Yushi BAO ; Rujuan XIE ; Mei WANG ; Erlie JIANG ; Yong HUANG ; Jialin WEI ; Sizhou FENG ; Mingzhe HAN
Chinese Journal of Nephrology 2010;26(5):330-334
Objective To assess the incidence,risk factors and mortality of acute kidney injury(AKI)in patients with chronic myelogeneous leukemia(CML)after myeloablative allogenetic hematopoietic stem cell transplantation(HSCT). Methods Renal function in 93 CML patients undergone myeloablative allo-HSCT was retrospectively analyzed by the RIFLE criteria. Results Thirty-nine patients (41.9%) developed AKI at a median of 40 days after allo-HSCT, including 24 AKI-R patients(25.8%), 10 AKI-I patients(10.8%) and 5 AKI-F patients (5.4%). The morbidity of AKI in patients with ≥Ⅲ acute graft-versus-host disease (aGVHD) and without <Ⅲ GVHD was (81.82±11.63)% and (36.59±5.32)% (P=0.0037)rospectively. The morbidity of AKI in patients with increased total bilirubin and without increased total bilirubin was (72.73±13.43)% and (37.04±5.37)%(P=0.0192) respectively. ≥Ⅲ aGVHD was peor-prognostic factor of AKI and RR was 2.773 [95%CI (1.073-7.167), P=0.035]. RR of AKI-I and AKI-F in patients with ≥Ⅲ aGVHD was 6.320195%CI (1.464-27.291), P=0.013]. The mortality within 100 days after allo-HSCT of patients with AKI was significantly different as compared to patients without AKI (P=0.001). Six-mouth survival rates of different class AKI patients after myeloablative allo-HSCT were (86.96±7.02)% (AKI-R), (70.00±14.49)% (AKI-I), 0 (AKI-F) (P=0.000)respectively. Conclusions AKI is one of the main complications in CML patients after myeloablative allo-HSCT. ≥Ⅲ aGVHD and increased total bilimbin are poor-prognostic factors of AKI, and higher morbidity of AKI-I and AKI-F can be found in patients with ≥Ⅲ aGVHD. With the deteriorated AKI, 6-month survival is decreased. RIFLE criteria is sensitive to the early diagnosis of renal function. Moreover RIFLE can monitor the progression of AKI and predict the clinical outcome.
4.Hematopoietic stem cell transplantation in combination with imatinib for treatment of Philadelphia chromosome positive acute lymphoblastic leukemia
Xin LIU ; Jialin WEI ; Yi HE ; Mei WANG ; Donglin YANG ; Yong HUANG ; Erlie JIANG ; Zhangsong YAN ; Qiaoling MA ; Lugui QIU ; Sizhou FENG ; Mingzhe HAN
Chinese Journal of Organ Transplantation 2011;32(3):132-136
Objective To analyze the outcomes and the prognostic factors of hematopoietic stem cell transplantation (HSCT) in combination with imatinib for Philadelphia chromosome positive acute lymphoblastic leukemia (Ph+ ALL). Methods All 32 patients with Ph+ ALL achieved hematologic complete remission (CR) at time of transplantation, including 27 cases in the first CR (CR1) and 5 in CR2. Nineteen patients achieved molecular remission (MR). Among 32 patients, 4 received autologous HSCT (AHSCT), and 28 allogeneic HSCT (allo-HSCT). The conditioning regimens comprised of total body irradiation (TBI), cyclophosphamide, fludarabine and cytarabine. The median number of transfused mononuclear cells was 5. 6 × 108/kg, and that of CD34+ cells was 2. 94 × 106 /kg. Thirty-one patients were administrated imatinib orally before transplantion, at a dose of 400~600 mg/day, and 16 patients after transplantation, including 7 for prevention at a dose of 300~400 mg/day and 9 for salvage treatment at a dose of 400 ~ 600 mg/day. Results Hematopoietic reconstitution was achieved in all 32 patients. Three-year estimate of overall survival (OS) was (62. 1±8. 6)%, leukemia-free survival (LFS) (59. 2 ± 8. 7)%, relapse rate (RR) (17. 7 ± 7. 2)% and transplant-related mortality (26. 2 ± 8. 0) %. All 4 undergoing AHSCT were alive, and 3 out of them were in continuous CR with durations of 14, 18 and 67 months respectively. The univariate analysis for prognosis in allo-HSCT showed that the OS of HLA-matched sibling donors group was 76. 5 %,higher than that of unrelated or haploidentical donors group (27. 3 %, P<0. 05), and so was LFS (70. 6 % vs 27. 3 %, P<0. 05). RR in patients achieving MR at time of transplantation was 5. 6 %,lower than that in those not achieving MR (40. 0 %, P<0. 05). RR in patients in CR1 at time of transplantation was 12. 5 %, lower than that in those in CR2 (50 %, P <0. 05). Conclusion Imatinib improved the outcomes of HSCT for Ph+ ALL, especially to patients achieving MR at time of transplantation and transplantation in early stage (CR1).
5.Role of IL-10 gene polymorphisms in promotor region in HLA matched sibling donor allogeneic hematopoietic stem cell transplantation
Xiaojin CAI ; Axia SONG ; Hua WANG ; Ping ZHANG ; Guixin ZHANG ; Fan YANG ; Jialin WEI ; Qiaoling MA ; Zhangsong YAN ; Erlie JIANG ; Yong HUANG ; Dongling YANG ; Mei WANG ; Yi HE ; Sizhou FENG ; Mingzhe HAN
Chinese Journal of Organ Transplantation 2012;(12):732-736
Objective To explore the impact of IL-10 gene polymorphisms on the outcome in HLA matched sibling hematopoietic stem cell transplantation (HSCT).Methods PCR-sequencespecific primer (PCR-SSP) assay was used to analyze the SNP of IL-10 in 77 recipient and donor pairs:-1082 A/G,-819 T/C,-592 C/A.Results IL-10 ATA/ATA (1082,-819,-592) genotype in recipients significantly decreased the incidence of grade Ⅱ-Ⅳ acute graft vursus-host disease (aGVHD) (6.1% vs.25.0 %,P<0.05),reduced 5-year transplant-related mortality (TRM) (10.7 %± 5.9% vs.29.7% ± 5.2%,P<0.05) and increased disease free survival (DFS) (81.8% ± 6.7% vs.56.8% ± 7.5%,P<0.05).With regard to the donor genotype,the incidence of grade Ⅱ-Ⅳ aGVHD,extensive chronic GVHD,5-year TRM and DFS had no signicant difference between IL-10 ATA/ATA and non ATA/ATA subgroup.Multivariable analysis also revealed that IL-10 non-ATA/ATA genotype in recipients and high-risk status of disease were two independent risk factors for DFS (HR =2.911,P =0.029; HR =2.686,P =0.027).Conclusion In HLA-matched sibling HSCT,the presence of recipient IL-10 ATA/ATA significantly decreased the incidence of grade Ⅱ-Ⅳ aGVHD and TRM,and increased DFS.
6. Improved outcome by optimized conditioning regimens with an increased dose of cyclophosphamide in allogeneic peripheral blood stem cell transplantation for severe aplastic anemia
Yong HUANG ; Yi HE ; Xin LIU ; Donglin YANG ; Rongli ZHANG ; Erlie JIANG ; Qiaoling MA ; Jialin WEI ; Sizhou FENG ; Mingzhe HAN
Chinese Journal of Hematology 2017;38(8):662-666
Objective:
To respectively analyze the impact of conditioning regimens with a dose-decreased cyclophosphamide (Cy) on the outcome in fully matched sibling donor (MSD) peripheral blood stem cell transplantation (PBSCT) for severe aplastic anemia (SAA) .
Methods:
Two conditioning regimens with different doses of Cy (150 mg/kg or 120 mg/kg) in combination with fludarabine (Flu) and antithymocyte globulin (ATG) for MSD-PBSCT were investigated in 51 patients with acquired SAA.
Results:
Overall survival and failure-free survival in patients received 150 mg/kg of Cy (Cy150 cohort) or 120 mg/kg (Cy120 cohort) were 93.5%
7. Allogeneic hematopoietic stem cell transplantation for treatment of refractory and relapsed acute myeloid leukemia: outcomes and prognostic factors
Xiuhua SU ; Jianfeng YAO ; Guixin ZHANG ; Yi HE ; Jialin WEI ; Qiaoling MA ; Donglin YANG ; Yong HUANG ; Weihua ZHAI ; Chen LIANG ; Gang LI ; Xin CHEN ; Sizhou FENG ; Mingzhe HAN ; Erlie JIANG
Chinese Journal of Hematology 2017;38(12):1024-1030
Objective:
To evaluate the outcomes and prognostic factors of patients with refractory and relapsed acute myeloid leukemia (AML) who received allogeneic hematopoietic stem cell transplantation (allo-HSCT) .
Methods:
The overall survival (OS) , disease free survival (DFS) , acute and chronic graft-versus-host disease (GVHD) , relapse rate (RR) , transplantation related mortality (TRM) and their related risk factors were analyzed retrospectively.
Results:
All the patients (median age 35 years, range 6 to 58) received myeloablative conditioning regimens. All patients had successful engraftment, and the median time of neutrophils engraftment was 14 days (range 9 to 25) . Of the patients who survived more than 100 days, the accumulative incidence of grade Ⅱ-Ⅳ acute GVHD and chronic GVHD (cGVHD) were 27.3% (95%
8. Effects of preexisting donor-specific HLA antibodies for graft failure in un-manipulated haploidentical hematopoietic stem cell transplantation
Rongli ZHANG ; Xiaohui ZHENG ; Lukun ZHOU ; Ying ZHANG ; Shulian CHEN ; Donglin YANG ; Erlie JIANG ; Jialin WEI ; Yong HUANG ; Qiaoling MA ; Weihua ZHAI ; Sizhou FENG ; Mingzhe HAN ; Yi HE
Chinese Journal of Hematology 2018;39(3):190-195
Objective:
To investigate the effects of donor-specific HLA antibodies(DSA) for graft failure in un-manipulated haploidentical hematopoietic stem cell transplantation(haplo-HSCT) and the feasible treatment for DSA.
Methods:
HLA antibodies were examined using the Luminex-based single Ag assay for 92 patients who were going on haplo-SCT and the correlations of graft failure and DSA among the patients who had finished SCT were analyzed.
Results:
Of the total 92 patients who were going on haplo-HSCT, sixteen (17.4%) patients were HLA Ab-positive, including six (6.5%) patients with antibodies corresponding to donor HLA Ags (DSA-positive). Among the patients who had finished the haplo-HSCT with conventional myeloablative conditioning regimen, the engraftment rate was significantly higher in DSA (-) patients than that in DSA (+) patients [92.3% (24/26)
9. Outcome of acute myeloid leukemia with FLT3-ITD mutation treated by allogeneic hematopoietic stem cell transplantation
Chen LIANG ; Erlie JIANG ; Jianfeng YAO ; Yi HE ; Rongli ZHANG ; Donglin YANG ; Qiaoling MA ; Weihua ZHAI ; Yong HUANG ; Jialin WEI ; Sizhou FENG ; Mingzhe HAN
Chinese Journal of Hematology 2018;39(8):634-640
Objective:
To evaluate the efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for the treatment of acute myeloid leukemia (AML) patients with FLT3-ITD mutation.
Methods:
From September 2008 to December 2016, 40 AML patients with FLT3-ITD mutation were enrolled in the study. The therapeutic process, outcomes and prognostic factors were retrospectively analyzed.
Results:
The median of WBC at initial diagnosis was 35.0 (range 1.7-185.0) ×109/L. The median course number of chemotherapy was 4 (range 2-7). At the time of transplantation, 34 patients were at the first complete remission (CR1) stage, and the other 6 ones were non-remission after chemotherapy. 24 patients received allogeneic transplants from an HLA-matched sibling donor, 7 cases from a HLA-matched unrelated donor, the remaining 9 ones received allograft from a haploidentical donor. The rate of 3-year overall survival (OS) and disease free survival (DFS) in all patients were both 74.3% (95%
10. Analysis of clinical efficacy of recombinant activated factor Ⅶ on bleeding in patients with hematologic disorders
Wei LIU ; Feng XUE ; Xiaofan LIU ; Erlie JIANG ; Donglin YANG ; Kaiqi LIU ; Zhijian XIAO ; Fengkui ZHANG ; Sizhou FENG ; Mingzhe HAN ; Lei ZHANG ; Renchi YANG
Chinese Journal of Hematology 2017;38(5):410-414
Objective:
To investigate the treatment efficacy of recombinant activated factor Ⅶ (rFⅦa) for bleeding among patients with hematologic disorders.
Methods:
A total of 38 times of bleeding in 31 patients with hematological disease treated with rFⅦa were analyzed retrospectively.
Results:
The clinical effective rate of rFⅦa for bleeding management in acquired hemophilia A (AHA) patients/hemophilia patients with inhibitor, acute promyelocytic leukemia (APL) patients and patients with non-APL leukemia was 90% (9/10) , 71.4% (5/7) and 60.0% (3/5) , respectively, which was higher than that in patients following HSCT (30.8%) . The clinical effective rate of rFⅦa for patients with bleeding score of 2 (100.0%) was higher than that with 3 (66.7%) and 4 (54.1%) . The effective rate of rFⅦa was 25.0% (2/5) in 5 patients with cerebral hemorrhage, 66.7% (6/9) in 9 patients with hematuria and 41.7% in 12 patients with gastrointestinal hemorrhage. The curative effect for 3 patients with joints and muscle bleeding and 5 patients with skin, nasal, pharyngeal and gum bleeding was excellent. Following HSCT, among patients with bleeding score of 4 points, high dose and repeated use of rFⅦa did not necessarily achieve a good effect. Among AHA/hemophilia patients with inhibitors and patients with acute leukemia who had bleeding score of 4 points, the use of low dose FⅦa could achieve good therapeutic effect, however the efficacy of lowest dose (22.5 μg/kg) rFⅦa was poor.
Conclusions
The hemostasis efficacy of rFⅦa is affected by various factors such as diseases, bleeding sites, bleeding score and so on. The use of rFⅦa can achieve good efficacy for bleeding management in AHA patients/hemophilia patients with inhibitor, APL patients and patients with non-APL leukemia. However the efficacy of rFⅦa for bleeding of patients after HSCT is poor. Early use of rFⅦa is important for successful hemostatic treatment. Management of underlying condition is as important as hemostatic treatment.