1.Monitoring of early Epstein-Barr virus reactivation and preemptive therapy after allogeneic hematopoietic stem cell transplantation
Yue LU ; Tong WU ; Xingyu CAO ; Jingbo WANG ; Yuan SUN ; Yanli ZHAO ; Wanming DA ; Shuquan JI ; Chunrong TONG ; Daopei LU
Chinese Journal of Internal Medicine 2011;50(5):383-387
Objective To investigate early Epstein-Barr virus (EBV) reactivation and the outcome of preemptive therapy after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods From January 2007 to January 2009, totally 277 patients after allo-HSCT were studied (haploidentical 116,unrelated 75, matched sibling 86). Conditioning regimens were mainly busulfan (BU) + cyclophosphamide ( CY)/fludarabine(Flu) or total body irradiation (TBI) + CY/Flu. Antihuman thymocyte globulin (ATG)was added in haploidentical and unrelated transplants. Plasma EBV DNA was monitored once to twice weekly in the first 3 months after allo-HSCT with real time quantitative polymerase chain reaction (RQ-PCR). EBV viremia was diagnosed when EBV DNA was more than 5 × 102 copies/ml but without symptoms. Acyclovir (10 mg/kg, intravenous drip, 8 h) was used for preemptive therapy and immnuo-suppressants were decreased if possible. Results Totally 33 patients ( 11.9% ) developed EBV viremia with a median time at day 44 (day 19 to day 84). The incidences of EBV viremia in the transplants from matched sibling,haploidentical, unrelated donors were 0, 15.5%, 20. 0%, respectively. There was no significant difference between haploidentical and unrelated transplants ( P = 0. 09 ), but much less EBV viremia was seen in matched sibling transplant ( P = 0. 001 ). Twenty of 33 patients ( 60. 6% ) had complete response to preemptive therapy. The median time to reach EBV DNA negative in plasma was 11 (4-56) d. The median duration of preemptive therapy was 21 (14-60) d. Both univariate and multivariate analysis indicated that haploidentical and unrelated transplants, acute graft versus host disease (GVHD) were the risk factors for EBV viremia. Two-year overall survival in the patients with EBV viremia was significantly lower than that without EBV viremia (54. 2% vs 72. 1%, P = 0. 006 ). Conclusions Our large clinical study has demonstrated that preemptive therapy with acyclovir that is guided by EBV viremia is effective in majority of the patients with high-risk for EBV reactivation after allo-HSCT, which may further decrease the risk for developing life-threatening EBV disease or post-transplantation lymphoproliferative disorder. Haploidentical and unrelated transplants, acute GVHD are the risk factors for EBV viremia which has negative impact on survival.
2.Haploidentical blood and marrow transplantation for advanced chronic myeloid leukemia
Yanli ZHAO ; Tong WU ; Yaochen ZHANG ; Xingyu CAO ; Yuming YIN ; Jingbo WANG ; Jiarui ZHOU ; Ruijuan SUN ; Yue LU ; Jianping ZHANG ; Shuquan JI ; Daopei LU
Chinese Journal of Organ Transplantation 2012;33(2):73-76
ObjectiveTo investigate the efficacy of haploidentical blood and marrow transplantation (haplo-BMT) in the treatment of advanced chronic myeloid leukemia (CML).MethodsFrom November 2002 to October 2007,35 patients with advanced CML received haplo-BMT.Eleven patients achieved the second chronic phase (CP2) after treatment with imatinib or chemotherapy or both before pre-conditioning,but there were 13 cases in accelerated phase (AP) and 11 patients in blast phase (BP) at the time of transplantation.By the last follow-up date October 31,2011,the median follow-up time among living patients was 67 months (range,49 to 100 months).ResultsThe cases of HLA-antigen mismatched between donors and recipients as 1,2,and 3 antigens were 1,12,and 22 respectively.The number of mean mononuclear cells and CD34+ cells was (7.19+ 1.37) × 108/kg and (2.54± 1.50) × 106/kg,respectively.All but one patient achieved durable hematopoietic reconstitution. Hyperacute graft-versus-host disease (GVHD) occurred in 28.6% (10/35) patients.The cumulative incidence of grade Ⅱ to Ⅳ acute GVHD was 48%.Among 27 patients who survived longer than 100 days after transplant,16 (60 %) had chronic GVHD.Fiveyear overall survival (OS) rate was 46.2% and 45.5% in CML-AP and BP (P =0.97),respectively.Five-year probability of OS rate was 81.8%,30.8% and 27.3% in patients with CML-CP2,CML-AP and BP at transplant,respectively.The OS of CML-CP2 was significantly higher than CML-AP and BP at transplant (P<0.01 ).ConclusionHaplo-BMT is a feasible therapeutic mean for patients with advanced CML who have no matched donors available.It is better to perform haplo-BMT at CML-CP2 other than CML-AP or BP.
3.Effect of early bundle therapy on prognosis of patients with sepsis and septic shock
Bing JI ; Jianliang ZHU ; Limei MA ; Huiqin YUAN ; Xingyu JIA ; Lijun LIU ; Jianjun ZHU
Chinese Journal of Emergency Medicine 2019;28(2):170-174
Objective To observe the effect of early bundle therapy on prognosis of patients with sepsis/septic shock and analyze the risk factors for death.Methods A retrospective cohort study was conducted to select patients with sepsis/septic shock at the Second Soochow University Hospital betweenJanuary 1,2016,and December 31,2016.Data pertaining to demographic variables,compliance rate of bundle therapy,and incidence of organ failure were collected.Patients were categorized into the nonsurvivor or survivor groups based on 28-day mortality.Logistic regression analysis was used to identify risk factors for 28-day mortality.Results Totally 118 sepsis/septic shock patients were included in the analysis;28-day mortality was 32.2%.Compared to the survivor group,patients in the non-survivor group were more likely to have chronic heart dysfunction and cerebrovascular disease,lower lactate clearance,lower 6-h compliance rate of bundle therapy and higher incidence of failure of one or >2 organs.Age,leukocyte,blood urea nitrogen,creatinine,brain natriuretic peptide,sequential organ failure score and acute physiological and chronic health scores Ⅱ on admission,and lactate after bundle therapy were higher than that of the survivor group.Logistical regression analysis showed that age ≥ 75 years [odds ratio (OR)1.012],6-h lactate clearance <30% (OR=1.122),chronic heart failure (OR=1.741),failure of >2 organs (OR=1.769),and 6-h compliance rate of bundle therapy (OR=1.958) were independent risk factors for 28-day mortality.Conclusions Patients with sepsis/septic shock need early diagnosis and resuscitation to improve the compliance rate of bundle therapy and reduce the mortality.
4. Effect of minimal residual disease monitoring by multiparameter flow cytometry pre-conditioning on prognosis of acute myeloid leukemia after allogeneic hematopoietic stem cell transplantation
Yue LU ; Tong WU ; Hui WANG ; Yanli ZHAO ; Xingyu CAO ; Deyan LIU ; Jianping ZHANG ; Min XIONG ; Jiarui ZHOU ; Ruijuan SUN ; Zhijie WEI ; Shuquan JI ; Daopei LU
Chinese Journal of Hematology 2017;38(2):118-123
Objective:
To investigate the effect of minimal residual disease (MRD) monitoring by multiparameter flow cytometry (MFC) pre-conditioning on prognosis of acute myeloid leukemia in first complete remission (CR1-AML) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) , and to explore the value of MRD monitoring by MFC in the prognosis evaluation on allo-HSCT in CR1-AML.
Methods:
Between April 2012 and March 2015, consecutive 186 patients with CR1-AML who underwent allo-HSCT were analyzed retrospectively. MRD in BM before conditioning was detected by eight-color MFC. Any level of residual disease was considered to be MRD positive.
Results:
①Of 186 patients, MRD was negative in 151 patients, positive in 35 patients (<1% in 25 patients and 1% to 3% in 10 patients) . ② With the median follow up of 18 (5-41) months, two-year DFS was 80.0% (95%
5.Severity and multiple indexes of jaundice in ABO hemolytic disease of fetus and newborn: a comparative analysis
Ronghua XU ; Xingyu HOU ; Chunhua XIONG ; Yaping XING ; Xuelin JI ; Xiaofeng XU ; Ping LI
Chinese Journal of Blood Transfusion 2023;36(8):693-696
【Objective】 To explore the correlation between the severity of jaundice in ABO hemolytic disease of fetus and newborn (HDFN) and multiple indicators, in order to achieve accurate diagnosis, timely treatment, and prevent complications in ABO HDFN. 【Methods】 From March 2020 to February 2023, a total of 283 ABO HDFN in our hospital were classified into mild, moderate and severe groups based on total bilirubin levels. The differences in basic data, relevant laboratory indicators and the agglutination intensity of the three hemolysis tests were analyzed and compared. 【Results】 In the severe group, 75% (12/16) were male infants, which was significantly higher compared to 37.5% (57/152) in the moderate group (P<0.05). The values (mg/dL) of transcutaneous jaundice in the mild, moderate and severe groups were:forehead 9.88±1.93 vs 12.34±2.01 vs 15.56±2.69, face 10.25±2.27 vs 13.28±2.32 vs 15.99±2.86, chest 9.67±2.16 vs 12.51±2.11 vs 15.33±2.36, respectively. The values(µmol/L) of direct bilirubin (DBIL) and indirect bilirubin (IBIL) were 9.87±2.06 vs 11.90±2.59 vs 16.12±4.73, and 159.36±37.55 vs 252.98±30.52 vs 353.76±55.68, respectively, and the differences between the mild, moderate and severe groups were statistically significant (all P<0.05) . The creatine kinase (CK) values(unit/L) of mild, moderate and severe groups were 664.15±498.26 vs 500.51 ±451.63 vs 402.63±224.27, and the difference between the mild group and the other two groups was statistically significant (P<0.05) . There was no statistically significant difference in the agglutination intensity of the three hemolysis tests among HDFN with different severity of jaundice. 【Conclusion】 Clinicians can predict the severity of jaundice in light of gender, transcutaneous jaundice, DBIL, IBIL and CK of ABO HDFN, for further and graded treatment, so as to avoid the sequelae or even life-threatening consequences caused by ABO HDFN.
6.Research on Clinical Characteristics of Metaplastic Chronic Atrophic Gastritis Patients from Complexion Diagnosis Based on Gender Difference
Jiaping CHEN ; Zhengguang DU ; Bei GUAN ; Xingyu JI ; Longchang CHEN ; Yongji WANG ; Yun MA
World Science and Technology-Modernization of Traditional Chinese Medicine 2024;26(1):129-136
Objective Based on gender differences,this paper discusses the characteristics of facial color diagnosis in male and female patients with metaplastic chronic atrophic gastritis(CAG),and explores the pathological mechanism of different gender patients from the perspective of TCM pathogenesis,so as to provide personalized reference for TCM prevention and treatment of metaplastic CAG.Methods In this study,the complexion information of patients with chronic non atrophic gastritis(CNG)and CAG was collected by MT-BX-01 four-diagnostic instrument.The color colorimetric characteristics of male and female metaplastic CAG patients and CNG patients were analyzed by case-control study.Results In female patients,the L value and a value of liver region in CAG with mild intestinal metaplasia(IM)group,moderate and severe IM were significantly lower than those in CNG group(P<0.05).In male patients,the L value of spleen region in CAG with moderate and severe IM group was significantly higher than that in CNG group(P<0.05).Conclusion There is a certain gender difference in the facial color characteristics of patients with metaplastic CAG.The facial chromaticity value of female patients with metaplastic CAG changes most significantly in the liver area,while that of male patients mainly in the spleen area.It is suggested that the incidence of female metaplastic CAG is mostly related to liver,while that of male is mostly related to spleen,which provides a personalized method for clinical diagnosis and treatment of metaplastic CAG based on gender differences.
7. Effect of NCCN (2015) risk stratification on prognosis of patients with acute myeloid leukemia after allogeneic hematopoietic stem cell transplantation
Yue LU ; Tong WU ; Yanli ZHAO ; Xingyu CAO ; Deyan LIU ; Jianping ZHANG ; Min XIONG ; Jiarui ZHOU ; Ruijuan SUN ; Zhijie WEI ; Hui WANG ; Hongxing LIU ; Tong WANG ; Chunrong TONG ; Shuquan JI ; Daopei LU
Chinese Journal of Hematology 2017;38(1):44-49
Objective:
To analyze the effect of NCCN (2015) risk stratification on prognosis of patients with acute myeloid leukemia (AML) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) .
Methods:
Retrospective analysis of 258 patients with AML in CR (186 cases in CR1, 72 cases in CR2) who underwent allogeneic HSCT in our hospital between April 2012 and March 2015 according to NCCN (2015) risk stratification. Of them, 63 cases were classified as low risk, 112 cases intermediate risk and 83 cases high risk.
Results:
①With the median follow up of 18 (5-41) months, two-year disease free surviva (DFS) in 258 patients was 78.0% (95%
8.DDB1- and CUL4-associated factor 8 plays a critical role in spermatogenesis.
Xiuli ZHANG ; Zhizhou XIA ; Xingyu LV ; Donghe LI ; Mingzhu LIU ; Ruihong ZHANG ; Tong JI ; Ping LIU ; Ruibao REN
Frontiers of Medicine 2021;15(2):302-312
Cullin-RING E3 ubiquitin ligase (CRL)-4 is a member of the large CRL family in eukaryotes. It plays important roles in a wide range of cellular processes, organismal development, and physiological and pathological conditions. DDB1- and CUL4-associated factor 8 (DCAF8) is a WD40 repeat-containing protein, which serves as a substrate receptor for CRL4. The physiological role of DCAF8 is unknown. In this study, we constructed Dcaf8 knockout mice. Homozygous mice were viable with no noticeable abnormalities. However, the fertility of Dcaf8-deficient male mice was markedly impaired, consistent with the high expression of DCAF8 in adult mouse testis. Sperm movement characteristics, including progressive motility, path velocity, progressive velocity, and track speed, were significantly lower in Dcaf8 knockout mice than in wild-type (WT) mice. However, the total motility was similar between WT and Dcaf8 knockout sperm. More than 40% of spermatids in Dcaf8 knockout mice showed pronounced morphological abnormalities with typical bent head malformation. The acrosome and nucleus of Dcaf8 knockout sperm looked similar to those of WT sperm. In vitro tests showed that the fertilization rate of Dcaf8 knockout mice was significantly reduced. The results demonstrated that DCAF8 plays a critical role in spermatogenesis, and DCAF8 is a key component of CRL4 function in the reproductive system.
Animals
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Cullin Proteins/genetics*
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DNA-Binding Proteins/genetics*
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Factor VIII
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Male
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Mice
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Mice, Knockout
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Spermatogenesis/genetics*
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Ubiquitin-Protein Ligases