Objective:To investigate the efficacy and safety of cladribine-based regimen for treatment of refractory/relapsed acute lymphoblastic leukemia (ALL).Methods:The clinical data of 11 patients with refractory/relapsed ALL treated with 1 course of CLAG (cladribine+cytarabine+granulocyte colony-stimulating factor) regimen from January 2018 to July 2022 were retrospectively analyzed. The efficacy and safety were summarized.Results:Among the 11 patients with refractory/relapsed ALL, there were 7 males and 4 females with a median age of 28 years (4-58 years). There were 8 cases of B-ALL, 1 case of acute mixed cell leukemia, and 2 cases of acute early precursor T-lymphocytic leukemia; 1 patient had TP53 mutation, 2 patients had NOTCH1 mutation, 2 patients had KRAS mutation, and 2 patients had NRAS mutation; 1 case had hyperdiploid chromosome and 1 patient had complex chromosome karyotype. Among the 11 patients, 4 cases received CLAG + liposomal doxorubicin,1 case received CLAG + idarubicin (IDA) + etoposide regimen, 1 case received CLAG + etoposide regimen, and 1 case received CLAG + pegaspargase injection+etoposide regimen, 1 case received CLAG + methotrexate + etoposide regimen,1 case received CLAG + liposomal doxorubicin + daratumumab regimen, 1 case received CLAG + IDA regimen,and 1 case received CLAG + chidamide. Among the 11 patients, 5 cases achieved complete remission, 1 case achieved partial remission and 5 achieved non-remission. The main adverse effects were severe myelosuppression (11 cases), agranulocytosis accompanied with fever (6 cases), septicemia (3 cases), and no treatment-related death occurred.Conclusions:cladribine-based regimen is effective in treating refractory/relapsed ALL. It has favorable safety and tolerance for patients.

Objective: To evaluate clinical outcomes of autologous (auto-HSCT) and allogeneic hematopoietic stem cell transplantation (allo-HSCT) for angioimmunoblastic T-cell lymphoma (AITL) . Methods: From June 2007 to June 2017, clinical data of AITL patients who underwent HSCT in eight hospitals were assessed retrospectively. Results: Of 19 patients, 13 male and 6 female with a median age of 50 (32-60) years old, 12 auto-HSCT and 7 allo-HSCT recipients were enrolled in this study, all donors were HLA-identical siblings. Two of allo-HSCT recipients were relapsed auto-HSCT ones. There were 5 patients (5/12) in complete response (CR) status and 7 (7/12) in partial remission (PR) status before transplantation in auto-HSCT group, and 2 (2/7) in PR status and 3 (3/7) in progression disease (PD) status before transplantation in allo-HSCT group. The median follow-up for the surviving patients was 46.5 months (range, 1-100 months) for the whole series, two patients lost in auto-HSCT group. Three patients developed acute graft-versus-host disease (aGVHD) and 5 chronic graft-versus-host disease (cGVHD) after allo-HSCT. Three patients died of primary disease and 1bleeding in auto-HSCT group. One patient died of primary disease and 2 transplantation-related mortality in allo-HSCT group. The 3-year cumulative overall survival (OS) were 56% (95%CI 32%-100%) and 57% (95%CI 30%-100%) for auto-HSCT and allo-HSCT, respectively (P=0.979) . The 3-year cumulative progression-free survival (PFS) were 34% (95%CI 14%-85%) and 57% (95%CI 30%-100%) for auto-HSCT and allo-HSCT, respectively (P=0.451) . Conclusion Both auto-HSCT and allo-HSCT were optimal choices for AITL. In clinical practice, which HSCT was better for AITL patients should be based on comprehensive factors including sensitivity to chemotherapy, risk stratification and disease status at transplantation.

Objective: To explore the efficacy and prognostic factors of hematopoietic stem cell transplantation (HSCT) for the treatment of patients with anaplastic large cell lymphoma (ALCL) . Methods: The clinical records of 33 ALCL patients after HSCT were collected and analyzed retrospectively to evaluate the rates of overall survival (OS) and recurrence after autologous (auto-HSCT) and allogeneic HSCT (allo-HSCT) and the factors influencing prognosis. Results: The median-age of this cohort of 33 ALCL cases at diagnosis was 31 (12-57) years old with a male/female ratio of 23/10, 24 cases (72.7%) were ALK⁺ and 9 ones (27.3%) ALK^-. Of them, 25 patients (19 ALK⁺ and 6 ALK^-) underwent auto-HSCT and 8 cases (5 ALK⁺ and 3ALK^-) allo-HSCT with a median follow-up of 18.7 (4.0-150.0) months. Disease states before HSCT were as follows: only 6 patients achieved CR status and received auto-HSCT, 16 patients achieved PR (14 cases by auto-HSCT and 2 ones allo-HSCT) , the rest 11 cases were refractory/relapse (5 cases by auto-HSCT and 6 ones allo-HSCT) . There were 7 cases died of disease progression (5 after auto-HSCT and 2 allo-HSCT) and 5 cases treatment-related mortality (TRM) (2 after auto-HSCT and 3 allo-HSCT) , TRM of two groups were 8.0% and 37.5%, respectively. Both the median progression-free survival (PFS) and OS were 15 months after auto-HSCT, the median PFS and OS after allo-HSCT were 3.7 (1.0-90.0) and 4.6 (1.0-90.0) months, respectively. There was no statistically significant difference in terms of survival curves between the two groups (OS and PFS, P=0.247 and P=0.317) . The 2-year OS rates in auto-HSCT and allo-HSCT groups were 72% and 50%, respectively. The 5-year OS rates in auto-HSCT and allo-HSCT groups were 36% and 25%, respectively. Conclusion ALCL treated by chemotherapy produced high rates of overall and complete responses. Chemotherapy followed by auto-HSCT remained to be good choice for patients with poor prognostic factors. High-risk patients should be considered more beneficial from allo-HSCT.