Chronic graft-versus-host disease (cGVHD) continues to be a major complication in long-term survivors after allogeneic hematopoietic stem cell transplantation and is the principal cause of morbidity and non-relapse mortality. With the new approaches in the immune mechanisms of cGVHD, the diagnosis, prophylaxis and treatment of cGVHD are involved. This review summarises the current progress of research on cGVHD.
Chronic Disease ; Female ; Graft vs Host Disease ; diagnosis ; etiology ; therapy ; Humans ; Male ; Prognosis ; Risk Factors

Graft vs Host Disease ; etiology ; Humans ; Liver Transplantation ; adverse effects ; Retrospective Studies

OBJECTIVETo study the role of interleukin (IL)-10 in acute-graft-versus-host disease (aGVHD) and graft rejection.

METHODSSerum concentrations of IL-10 in 28 patients who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) were measured by enzymed-linked immunosorbent assay (ELISA). IL-10 gene expression in peripheral mononuclear cells was measured by reverse-transcriptase polymerase chain reaction (RT-PCR) after transplantation.

RESULTSSeven patients developed grade I GVHD, 7 patients developed grade II-IV GVHD, 4 patients had graft rejection. Before transplantation, the concentrations of IL-10 were higher in patients who later did not developed aGVHD. After transplantation, IL-10 levels increased in patients without aGVHD, but decreased in patients with aGVHD or graft rejection. And IL-10mRNA was more frequent in patients without aGVHD compared to those with aGVHD.

CONCLUSIONSIL-10 plays a negative role in the development of aGVHD and graft rejection.

Acute Disease ; Adult ; Child ; Graft Rejection ; etiology ; Graft vs Host Disease ; etiology ; Humans ; Interleukin-10 ; blood ; genetics ; physiology ; Middle Aged ; RNA, Messenger ; analysis

Wiskott-Aldrich syndrome (WAS) is an X-linked congenital immune-deficiency syndrome, and bone marrow transplantation (BMT) has become a curative modality. However, the transplant with the alternative donor needed more intensive conditioning with increased treatment-related toxicities. Recently, fludarabine-based reduced toxicity myeloablative conditioning regimens have been developed for adult myeloid malignancies with promising results of good engraftment and low treatment-related toxicities. To increase the engraftment potential without serious complications, a boy with WAS received successful unrelated BMT with a reduced toxicity myeloablative conditioning regimen composed of fludarabine (40 mg/m(2) on days -8, -7, -6, -5, -4, -3), busulfan (0.8 mg/kg i. v. q 6 hr on days -6, -5, -4, -3), and thymoglobulin (2.5 mg/kg on days -4, -3, -2). This novel conditioning regimen could improve the outcome of allogeneic transplantation for other non-malignant diseases such as congenital immune-deficiency syndromes or metabolic storage diseases.
*Bone Marrow Transplantation/adverse effects ; Child, Preschool ; Graft vs Host Disease/etiology ; Humans ; Male ; *Transplantation Conditioning ; Wiskott-Aldrich Syndrome/*surgery

Adult ; Graft vs Host Disease ; etiology ; Hematopoietic Stem Cell Transplantation ; adverse effects ; methods ; Hemoglobinuria, Paroxysmal ; therapy ; Humans ; Male

To explore feasibility and efficacy of unrelated HLA matched donor marrow transplantation in treatment of myelodysplastic syndrome, one case (male, 31 years old) of myelodysplastic syndrome-refractory cytopenia with multilineage dysplasia (MDS-RCMD) has been received unrelated HLA-matched donor transplantation. Busulfan, cyclophosphamide, Ara-C, MeCCNU and antithymocyte globulin (ATG) were used for preparative regimen. Mycophenolate mofetile, cyclosporin A and short-term methotrexate were used for graft-versus-host disease prophylaxis. The results showed that neutrophil of > 0.5 x 10(9)/L, platelet of 58 x 10(9)/L and hemoglobin of 114 g/L were observed at 10, 20 days and 3 months respectively post transplantation. Disease-free survival without GVHD was 9 months. In conclusion, unrelated HLA matched donor marrow transplantation is an effective approach for treatment of patients with MDS.
Adult ; Bone Marrow Transplantation ; Follow-Up Studies ; Graft vs Host Disease ; etiology ; Hematopoiesis ; Histocompatibility Testing ; Humans ; Male ; Myelodysplastic Syndromes ; therapy

This study was purposed to investigate the cytomegalovirus (CMV) infection and its related factors after allogenic hematopoietic stem cell transplantation (allo-HSCT). A total of 108 patients who received allo-HSCT in zhongda hospital from January 1, 2004 to March 31, 2014 were enrolled in this study. The CMV infection rate and the median time when the CMV-DNA was positive for the first time, and the risk factors related with CMV infection, CMV disease distribution and mortality after allo-HSCT were analyzed. The results showed that the infection rate of CMV was 52.78% (57/108), the median time of CMV infection was 44 d, especially during 30 d-100 d after transplantation. The univariate analysis showed that CMV infection rate was related with the HLA-identical situation between the donor and the recipient, and whether the use of anti-human thymus globulin(ATG) in conditioning regimen, neutropenic period after transplantation exceeded 10 d and graft-versus-host disease (GVHD). Multivariate analysis showed that CMV infection rate was related with neutropenic period longer than 10 d after transplantation and graft-versus-host disease (GVHD). The mortality of the patients with CMV disease was 58.82% (10/17), in which the mortality of CMV interstitial pneumonia was highest. The CMV infection was one of the most commonly happened infection after allo-HSCT. It is concluded that to reduce the incidence of CMV disease and mortality, the best choice of allo-HSCT is HLA-identical donor, ATG should be used during the conditioning process, and neutropenic period should be reduced less than 10 days. Moreover, it is necessary to strengthen the preemptive therapy of CMV infection actively.
Allografts ; Cytomegalovirus Infections ; etiology ; Graft vs Host Disease ; Hematopoietic Stem Cell Transplantation ; adverse effects ; Humans ; Risk Factors ; Transplantation Conditioning

Objective: To investigate the incidence, risk factors and survival of bronchiolitis obliterans syndrome (BOS) in patients who had undergone haplo-hematopoietic stem cell transplantation (haplo-HSCT) . Methods: This study retrospectively analyzed clinical data of 444 consecutive patients who underwent haplo-HSCT and survived at least 100 days after transplantation in the First Affiliated Hospital of Soochow University between January 2013 and December 2015. Results: By the end of follow-up on January 1, 2018, 25 patients (5.63%) had BOS (BOS group) . The median onset time of BOS was 448 (165-845) d post transplantation, the 1-year, 2-year and 3-year cumulative incidence of BOS was 1.6% (95%CI 1.5%-1.6%) , 4.8% (95%CI 4.7%-4.8%) and 5.8% (95%CI 5.7%-5.8%) , respectively. Among patients with chronic graft-versus-host disease (cGVHD) , the cumulative incidence at the same intervals was 2.8% (95%CI 2.7%-2.8%) , 9.5% (95%CI 9.4%-9.5%) and 11.5% (95%CI 11.4%-11.6%) , respectively. In the multivariate analysis, the risk factors for BOS were high-risk primary disease, Ⅱ-Ⅳ aGVHD and preceding cGVHD with other organs. The 3-year overall survival (OS) was lower among patients with than those without BOS, but the difference was not significant [71.8% (95%CI 53.9%-89.6%) vs 72.4% (95%CI 68.1%-76.7%) , P=0.400]. Overall 1-year, 3-year survival of patients with BOS from the time of diagnosis was 78.4% (95%CI 61.5%-95.3%) and 37.0% (95%CI 2.5%-71.5%) , respectively, significantly less than those without (93.9% and 89.3%, from day 448 after transplantation, respectively, P<0.001) . Furthermore, we found a significantly higher incidence of transplantation-related mortality (TRM) in patients with compared with patients without BOS (28.2% vs 10.9%, P<0.001) . The main risk factor for OS of BOS patients was the severity of pulmonary impairment at the time of diagnosis. Patients who developed severe BOS had a worse OS than those with moderate and mild BOS (P=0.049) . Conclusion: BOS is a severe pulmonary complication of haplo-HSCT. High-risk primary disease, Ⅱ-Ⅳ aGVHD and preceding cGVHD were independent risk factors for BOS. Patients who developed BOS had a worse OS than those without BOS. The main risk factor for OS of BOS patients was the severity of pulmonary impairment.
Bronchiolitis Obliterans/etiology* ; Graft vs Host Disease ; Hematopoietic Stem Cell Transplantation/adverse effects* ; Humans ; Lung ; Retrospective Studies

Graft-versus-host disease (GVHD) is the most common complication after allogeneic hematopoietic stem cell transplantation, and also an important factor affecting the survival and quality of life in patients after transplantation. Currently, immunosuppressive therapy is commonly used for GVHD, but the curative effect is not ideal. How to effectively prevent and treat GVHD is one of the difficulties to be solved urgently in the field of transplantation. In this paper, we summarize the latest progress in pathogenesis, prevention and treatment of GVHD with Chinese medicine (CM). We hope it will provide ideas and methods for exploring the mechanism and establishing a new comprehensive therapy for GVHD with CM.
Allografts ; Graft vs Host Disease ; drug therapy ; etiology ; Hematopoietic Stem Cell Transplantation ; adverse effects ; Humans ; Medicine, Chinese Traditional ; Quality of Life

OBJECTIVE: To analyze the risk factors affecting hemorrhagic cystitis(HC) after allogeneic hematopoietic stem cell transplantation(allo-HSCT). METHODS: The clinical data of 153 patients underwent allogeneic hematopoietic stem cell transplantation in the First Affiliated Hospital of Xi'an Jiaotong University from January 2010 to December 2018 were selected and retrospectively analyzed. The incidence, median time and treatment outcome of HC should be observed. Multivariate analysis was used to observe the risk factors of HC in patients, including sex, age, diagnosis, disease status before transplantation, transplantation type, ATG and CTX in the pretreatment scheme, stem cell source, neutrophil and platelet implantation time; CMV, EBV and BKV infection, and acute graft-versus-host disease(aGVHD). RESULTS: Among 153 patients underwent allogeneic hematopoietic stem cell transplantation, 25 (16.34%) patients had HC, the median occurance time was 31 days, all patients achieved complete remission after treatment, no bladder irritation and bladder contracture were left. The results of univariate and multivariate Logistic regression analysis showed that the type of transplantation, ATG, CMV viremia before treatment, aGVHD (r=1.036, 3.234, 3.298 and 2.817, respectively) were the independent risk factors of HC. CONCLUSION The urinary BKV detections in the patients with HC are positive, mainly occured during the period from day +13 to days +56. HLA haplotype, pretreatment including ATG, and CMV viremia, and aGVHD are the independent risk factors for HC after allo-HSCT.
Cystitis/etiology* ; Graft vs Host Disease ; Hematopoietic Stem Cell Transplantation/adverse effects* ; Humans ; Retrospective Studies ; Risk Factors