3.Increased risk of cardio-cerebrovascular disease after hematopoietic cell transplantation in patients with previous history.
Bo PENG ; Li-Li WANG ; Li-Ping DOU ; Fei LI ; Xiang-Shu JIN ; Lu WANG ; Ming-Yu JIA ; Yan LI ; Jian BO ; Yu ZHAO ; Hai-Yan ZHU ; Wen-Rong HUANG ; Dai-Hong LIU
Chinese Medical Journal 2021;134(12):1431-1440
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*
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Hematopoietic Stem Cell Transplantation/adverse effects*
;
Humans
;
Proportional Hazards Models
;
Retrospective Studies
;
Transplantation Conditioning
;
Transplantation, Autologous
4.Unrelated Bone Marrow Transplantation with a Reduced Toxicity Myeloablative Conditioning Regimen in Wiskott-Aldrich Syndrome.
Hyoung Jin KANG ; Hee Young SHIN ; Sun Hie KO ; Jeong Ah PARK ; Eun Kyung KIM ; Jung Woo RHIM ; Joong Gon KIM ; Hyo Seop AHN
Journal of Korean Medical Science 2008;23(1):146-148
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
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Child, Preschool
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Graft vs Host Disease/etiology
;
Humans
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Male
;
*Transplantation Conditioning
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Wiskott-Aldrich Syndrome/*surgery
6.Clinical study of cytomegalovirus infection after allogeneic hematopoietic stem cell transplantation.
Jun HE ; Bao-An CHEN ; Ming NI ; Xue WU ; Jia-Hua DING
Journal of Experimental Hematology 2014;22(5):1371-1376
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
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Cytomegalovirus Infections
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etiology
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Graft vs Host Disease
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Hematopoietic Stem Cell Transplantation
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adverse effects
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Humans
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Risk Factors
;
Transplantation Conditioning
7.Sclerodermatous chronic graft-versus-host disease after hematopoietic stem cell transplantation: incidence, clinical characteristics and risk factors.
Huan YANG ; Zhi-Tao LI ; Ren LIN ; Zhi-Ping FAN ; Fen HUANG ; Qian-Li JIANG ; Hong-Sheng ZHOU ; Qi-Fa LIU ; Jing SUN
Journal of Southern Medical University 2016;36(6):807-813
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
8.Efficacy and Safety of Allogeneic Hematopoietic Stem Cell Transplantation with Decitabine-containing Regimen in Myelodysplastic Syndromes and Myelodysplastic Syndromes Transformed Acute Myeloid Leukemia.
Yu-Xin WANG ; Yao SUN ; Jing XIE ; Na LIU ; Jiang-Wei HU ; Zhuo-Qing QIAO ; San-Chun LAN ; Long ZHAO ; Yang YANG ; Yu-Hang LI ; Bin ZHANG ; Liang-Ding HU
Journal of Experimental Hematology 2023;31(2):522-531
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
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Female
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Humans
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Decitabine
;
Retrospective Studies
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Transplantation, Homologous/adverse effects*
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Transplantation Conditioning/adverse effects*
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Myelodysplastic Syndromes/complications*
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Leukemia, Myeloid, Acute/therapy*
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Hematopoietic Stem Cell Transplantation/adverse effects*
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Chronic Disease
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Graft vs Host Disease/therapy*
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Recurrence
9.Diagnosis and treatment of 26 cases of adenovirus infection after allogeneic hematopoietic stem cell transplantation.
Fei ZHOU ; Su Ning CHEN ; De Pei WU ; Xue Feng HE
Chinese Journal of Hematology 2023;44(4):302-307
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
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Hematopoietic Stem Cell Transplantation/adverse effects*
;
Graft vs Host Disease/etiology*
;
Antilymphocyte Serum/therapeutic use*
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Transplantation, Homologous/adverse effects*
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Adenoviridae Infections/therapy*
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Transplantation Conditioning/adverse effects*
;
Retrospective Studies
10.Syndrome inappropriate ADH secretion after allogeneic hematopoietic stem cell transplantation: a case report and literature review.
Qian JIANG ; Kai-yan LIU ; Xiao-jun HUANG ; Wen-kai LU
Chinese Journal of Hematology 2006;27(2):78-81
OBJECTIVETo study the syndrome of inappropriate ADH secretion (SIADH) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) and the possible etiology.
METHODSThe clinical manifestation, laboratory examination, treatment and outcome of a patient with refractory anemia with excess blasts after allo-HSCT were presented.
RESULTSHyperacute graft-versus-host disease (GVHD) was developed in the patient after allo-HSCT followed by severe hyponatraemia (lowest serum sodium 103.7 mmol/L), natriuresis, hypo-osmolality of plasma, hyper-osmolality of urine, coma and twitch at day 17 after allo-HSCT. SIADH was diagnosed. The clinical condition was improved after restriction of water and administration of hypertonic saline, but SIADH was not controlled completely. Afterwards, graft failure was developed. Hyperacute GVHD and graft rejection occurred again after the second transplant. The patient died of secondary infection.
CONCLUSIONSIADH after allo-HSCT is a rare fatal acute complication of central nervous system. Numerous transplant-related causes are probably associated with the development of SIADH. Early accurate diagnosis and treatment promptly is of great importance.
Adolescent ; Graft vs Host Disease ; prevention & control ; Hematopoietic Stem Cell Transplantation ; adverse effects ; methods ; Humans ; Inappropriate ADH Syndrome ; etiology ; Male ; Transplantation Conditioning ; Transplantation, Homologous