Asian Continental Ancestry Group ; China ; Consensus ; Hematopoietic Stem Cell Transplantation/adverse effects* ; Humans ; Transplantation Conditioning

China ; Consensus ; Hematopoietic Stem Cell Transplantation/adverse effects* ; Hepatic Veno-Occlusive Disease/therapy* ; Humans ; Transplantation Conditioning

BACKGROUND: The impacts of previous cardio-cerebrovascular disease (pre-CCVD) on the outcomes of hematopoietic cell transplantation (HCT) are not well described. Patients with pre-CCVD may often be poor candidates for HCT. This study aimed to investigate the impact of pre-CCVD on transplant outcomes. METHODS: A retrospective study was conducted between patients with and without pre-CCVD who consecutively received allogeneic or autologous HCT between November 2013 and January 2020 with a matching of age and disease status. The cardiovascular complications and HCT outcomes of the two groups were evaluated and compared. The primary endpoints were post-transplant cardio-cerebrovascular disease (post-CCVD) and non-relapse mortality (NRM). We used a multivariable Cox proportional hazard model and the Fine-Gray competing risk regressions for analyses to estimate the hazard ratios (HRs). RESULTS: The outcomes of 23 HCT recipients with pre-CCVD were compared with those of 107 patients in the control group. No significant differences were noted in terms of engraftment, overall survival (OS) (67.00% vs. 67.90%, P = 0.983), or relapse (29.78% vs. 28.26%, P = 0.561) between the pre-CCVD group and the control group. The cumulative incidences of 2-year NRM were similar between patients with pre-CCVD and the controls (14.68% vs. 17.08%, P = 0.670). However, pre-CCVD was associated with an increased incidence of post-CCVD (HR: 12.50, 95% confidence interval [CI]: 3.88-40.30, P < 0.001), which was an independent risk factor for increased NRM (HR: 10.29, 95% CI: 3.84-27.62, P < 0.001) and inferior OS (HR: 10.29, 95% CI: 3.84-27.62, P < 0.001). CONCLUSIONS These findings suggest that the existence of pre-CCVD before transplantation might not result in increased mortality directly but superpose the toxicity of the transplantation procedure, leading to a risk of post-CCVD. Post-CCVD was a powerful predictor for high NRM and inferior OS. Further risk stratification of pre-CCVD is needed to reduce NRM in various transplantation settings.
Cerebrovascular Disorders/etiology* ; Hematopoietic Stem Cell Transplantation/adverse effects* ; Humans ; Proportional Hazards Models ; Retrospective Studies ; Transplantation Conditioning ; Transplantation, Autologous

OBJECTIVETo investigate the incidence and risk factors of sclerodermatous chronic graft-versus-host disease (ScGVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT).

METHODSThe clinical data of 259 patients undergoing allo-HSCT in Nanfang Hospital between January, 2012 and December, 2014 were analyzed.

RESULTSChronic GVHD following allo-HSCT occurred in 134 (51.7%) cases, among whom 22 patients showed sclerodermatous features at a median of 12.5 months (range 4-28 months) after the transplantation. The overall incidence of ScGVHD was 8.49% (22/259) in the recipients and 16.4% (22/134) in those with cGVHD. Univariate analysis showed that the conditioning regimen with total body irradiation (P=0.031), GVHD prophylaxis with MMF (P=0.046), presence of chronic GVHD (P=0.008), and donor lymphocyte infusion (P=0.001) were all closely associated with the occurrence of ScGVHD. Multivariate analysis identified chronic GVHD (RR=3.512, 95%CI: 1.235-9.987, P=0.018) and donor lymphocyte infusion (RR=5.217, 95%CI: 1.698-16.029, P=0.004) as the independent risk factors of ScGVHD.

CONCLUSIONScGVHD following allo-HSCT is not a common complication, and cGVHD and donor lymphocyte infusion are the independent risk factors for ScGVHD.

Graft vs Host Disease ; epidemiology ; Hematopoietic Stem Cell Transplantation ; adverse effects ; Humans ; Incidence ; Risk Factors ; Transplantation Conditioning

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

Graft vs Host Disease ; diagnosis ; therapy ; Hematopoietic Stem Cell Transplantation ; adverse effects ; Humans ; Postoperative Complications ; diagnosis ; therapy ; Transplantation Conditioning

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

Objective: To analyze the clinical characteristics and prognosis of adenovirus infection after allogeneic hematopoietic stem cell transplantation. Methods: A total of 26 patients with adenovirus infection admitted to the posttransplant ward of the First Affiliated Hospital of Soochow University from 2018 to 2022 were enrolled. Their data on baseline and clinical characteristics, treatment, and follow-up were analyzed. Results: The median patient age was 30 (22, 44) years. Twenty-two patients received related haploid stem cell transplantation, three received unrelated stem cell transplantation, and one received umbilical cord stem cell transplantation. Antithymocyte globulin was included in the conditioning regimen in 25 patients. The median time of adenovirus infection was +95 (+44, +152) days. The median peripheral blood lymphocyte count was 0.30 (0.11, 0.69) × 10(9)/L. Twelve patients had acute graft-versus-host disease. Twenty-four patients received antirejection therapies at diagnosis. Sixteen cases had combined infection with other pathogens with adenovirus infection. Eight cases were diagnosed as asymptomatic infection, and 18 were diagnosed as adenovirus disease, including pneumonia (38.89% ) , gastrointestinal disease (38.89% ) , encephalitis (33.33% ) , hepatitis (5.56% ) , and urinary tract inflammation (5.56% ) . The age of >30 years was a risk factor for adenovirus disease (P=0.03) . Eighteen patients received tapering of immunosuppression, and all 26 patients received at least one antiviral drug. Other treatments included high-dose gamma globulin and donor lymphocyte infusion. Adenovirus infection improved in 10 cases and progressed in 16 cases. The median follow-up time was 30 (7, 237) days. Twenty-two patients died. The all-cause mortality rate was (88.5±7.1) % , and the attributable mortality rate was 45.5% . There was no significant difference in the 100 d survival rate between asymptomatic infected patients and patients diagnosed with adenovirus disease (37.5% vs 22.2% , HR=1.83, 95% CI 0.66-5.04, P=0.24) . Conclusion: The age of >30 years was a risk factor for adenovirus disease. Mortality was high in patients with adenovirus infection after allogeneic hematopoietic stem cell transplantation.
Humans ; Adult ; Hematopoietic Stem Cell Transplantation/adverse effects* ; Graft vs Host Disease/etiology* ; Antilymphocyte Serum/therapeutic use* ; Transplantation, Homologous/adverse effects* ; Adenoviridae Infections/therapy* ; Transplantation Conditioning/adverse effects* ; Retrospective Studies

OBJECTIVE: To evaluate the efficacy and safety of allogeneic hematopoietic stem cell transplantation (allo-HSCT) with decitabine (Dec)-conditioning regimen in the treatment of myelodysplastic syndrome (MDS) and MDS transformed acute myeloid leukemia (MDS-AML). METHODS: The characteristics and efficacy data of 93 patients with MDS and MDS-AML who received allo-HSCT in our center from April 2013 to November 2021 were retrospectively analyzed. All patients were administered by myeloablative conditioning regimen containing Dec (25 mg/m² /d×3 d). RESULTS: Among the 93 patients, 63 males and 30 females, were diagnosed as MDS（n ＝77）, MDS-AML（n ＝16）. The incidence of I/II grade regimen-related toxicity (RRT) was 39.8%, and III grade RRT was only found in 1 patient (1%). Neutrophil engraftment was successful in 91 (97.8%) patients after a median neutrophil engraftment time of 14 (9-27) days; Successful platelet engraftment was achieved in 87 (93.5%) patients, with a median engraftment time of 18 (9-290) days. The incidence of acute graft versus host disease（aGVHD） and grade III-IV aGVHD was 44.2% and 16.2%, respectively. The incidence of chronic graft versus host disease（cGVHD） and moderate-to-severe cGVHD was 59.5% and 37.1%, respectively. Of the 93 patients, 54 (58%) developed posttransplant infections, among which lung infection (32.3%) and bloodstream infection (12.9%) were the most common. The median follow-up after transplantation was 45 (0.1-108) months. The 5-year overall survival (OS) rate, disease-free survival (DFS) rate, treatment-related mortality, and cumulative incidence of relapse were 72.7%, 68.4%, 25.1%, and 6.5%, respectively. And the 1-year graft-versus-host disease/relapse-free survival rate was 49.3%. The patients in different group of relative high-risk prognostic scoring or low-risk prognostic scoring, with or without poor-risk mutation(s), with mutations number ≥3 or <3 had similar 5-year OS rate (more than 70%). Multivariate analysis showed that the incidence of grade III-IV aGVHD was the independent risk factor affecting OS（P =0.008）and DFS (P =0.019). CONCLUSION Allo-HSCT with Dec-conditioning regimen is feasible and effective in the treatment of patients with MDS and MDS-AML, especially those in high prognostic risk and with poor-risk mutations.
Male ; Female ; Humans ; Decitabine ; Retrospective Studies ; Transplantation, Homologous/adverse effects* ; Transplantation Conditioning/adverse effects* ; Myelodysplastic Syndromes/complications* ; Leukemia, Myeloid, Acute/therapy* ; Hematopoietic Stem Cell Transplantation/adverse effects* ; Chronic Disease ; Graft vs Host Disease/therapy* ; Recurrence

OBJECTIVETo observe clinical results for reconstruction of periprosthetic fractures of hip with cortical bone plates allografts by deep-freezing and ethylene oxide treatment.

METHODSSeven patients with periprosthetic fractures of hip underwent cortical bone plates allografts by deep-freezing at -70 degrees C after being treatment of 48 degrees C ethylene oxide. And evaluate clinical outcome by examining T lymphocytes, Harris scores, X-rays photograph, and bone scintigraphy.

RESULTSThere were not activity of immune rejection and infection in all patients. Harris scores of patients increased 21, 32, 40, 40 scores at 3, 6, 12, 24 months after surgery. T-lymphocytes, antibody and immunocomplex in blood was normal postoperation. X-ray film indicated that fracture was healed at 3 months and there was partially bone conjunction between allograft strut and host bone. There was incorporation of 85% allograft strut to host bone, and 15% allograft strut was partially absorbed at 12 months after surgery. The size of femur of host was added 3 mm to 5 mm, averaged 4.3 mm at 12 months postoperation. Density of 80% allograft plates was as same as host bone after remodeling and the absorbtion of 10% allograft plates stopped at 24 months after surgery. There was thick of nuclein in the area of allograft cortical bone plates by bone scintigraphy examination at 3 months postoperation, and the thick of nuclein was stronger at 6, and 12 months after surgery.

CONCLUSIONAllograft cortical bone plates by deep frozen at -70 degrees C after being treatment of 48 degrees C ethylene oxide is suitable for mechanical fixation and biological bone transplantation, and it can increase bone reservation, augment strength of femur once the allograft strut incorporates to host bone, and avoid removing metal implant in second operation when being applied into reconstruction femoral fracture in joint replacement.

Aged ; Arthroplasty, Replacement, Hip ; adverse effects ; Bone Plates ; Bone Transplantation ; methods ; Female ; Follow-Up Studies ; Hip Fractures ; etiology ; surgery ; Humans ; Male ; Transplantation Conditioning ; methods ; Transplantation, Homologous