Objective:To delineate the clinical characteristics and outcomes associated with severe cardiac toxicity during the preconditioning phase of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with aplastic anemia (AA).Methods:This retrospective case series study included 31 patients with severe AA who underwent allo-HSCT and were diagnosed with severe cardiac toxicity at the Hematology Department of Peking University People′s Hospital from August 2012 to June 2022. The clinical manifestations of severe cardiac toxicity observed during the preconditioning process were assessed. Patient survival was assessed using the Kaplan-Meier method.Results:In this cohort of 31 patients, the median follow-up period was 9 days (range: 4-365 days). Severe cardiac toxicity manifested within 6 days after the initial cyclophosphamide (Cy) administration. Twenty patients died within 30 days of initiating Cy preconditioning, of which 16 patients died due to severe cardiac toxicity within 25 days. Patients whose cardiac function improved within 30 days post-preconditioning showed a median survival duration of 222 days ( n=11). Troponin I (TNI) levels in patients who died within 30 days of initiating Cy preconditioning began increasing on day 5 post-Cy, peaking sharply by day 9 after a notable rise on day 8. B-type natriuretic peptide (BNP) levels in patients who died within 30 days of initiating Cy preconditioning started to rise from day 1, stabilized between days 2 and 5, and then doubled daily from days 6 to 8, remaining elevated thereafter. Notably, the initial increases in BNP and TNI correlated with electrocardiogram (ECG) signs of low voltage and T-wave inversion in 83.87% of cases ( n=26). Most patients ( n=28, 90.32%) were administered corticosteroid therapy. In those with restored cardiac function, the ejection fraction returned to >50% within 30 days of initiating Cy preconditioning. Conclusions:Patients with severe cardiac toxicity during the preconditioning phase of allo-HSCT typically exhibit early, sustained, and marked elevations in myocardial damage markers, including BNP and TNI, accompanied by ECG abnormalities following Cy administration, with BNP often increasing first. These indicators are associated with rapid disease progression and high mortality. Prompt initiation of treatment upon clinical diagnosis is critical for improving survival outcomes.

Objective:To summarize the clinical features associated with respiratory syncytial virus (RSV) infection in patients following the hematopoietic stem cell transplant (HSCT) and exploring the risk factors for death.Methods:Patients who had RSV infection after undergoing HSCT from October 2023 to January 2024 in the hematology department of Peking University People’s Hospital were enrolled in the study. The clinical characteristics of the participating patients were summarized. The clinical characteristics of the surviving and the dying patients were compared, and the risk factors of death were analyzed by binary logistic regression.Results:Among the 43 RSV-positive HSCT patients, 20 (46.5%) were hypoxemic, six (14.0%) were admitted to the ICU for further treatment, four (9.3%) required tracheal intubation assisted ventilation, and seven patients (16.3%) died. A comparison of the clinical features of the surviving patients and the deceased patients demonstrated that the deceased patients had a lower PLT when infected with RSV [74.5 (8.0-348.0) ×10 9/L vs 15.0 (10.0-62.0) ×10 9/L, P=0.003], a higher incidence of simultaneous bacterial infections (85.7% vs 41.7%, P=0.046), and a higher rate of hematological recurrence (71.4% vs 13.9%, P=0.004). Hematological recurrence ( OR=15.500, 95% CI 2.336-102.848, P=0.005), influenza A viral infection ( OR=14.000, 95% CI 1.064-184.182, P=0.045), and low PLT at the time of RSV infection ( OR=0.945, 95% CI 0.894-0.999, P=0.048) were the factors associated with death following HSCT. Conclusion:Patients infected with RSV after undergoing HSCT have a poor prognosis, and active prevention and treatment of RSV in the autumn and winter requires urgent attention.

Objective:To investigate the incidences and risk factors of poor hematopoietic reconstitution (PHR) in patients with hematological diseases who underwent haploidentical allograft and were treated with rituximab for desensitization.Methods:Eight-three donor specific anti-HLA antibody (DSA, 2000 ≤MFI<10 000) positive patients who underwent haploidentical allograft were prospectively enrolled. Rituximab (375 mg/m 2) was used for desensitization day-3 of conditioning regimen. Incidence and factors associated with PHR, including primary poor graft function and prolonged thrombocytopenia, were investigated. Results:There were 22 males and 61 females with a median age of 39(range: 1-65) years. Kaplan-Meier analysis showed that the 100 day cumulative incidences of neutrophil and platelet engraftment were 93.0% and 90.7%, respectively. The incidences of PHR were 14.7%. The 3-year relapse rate, non-relapse mortality (NRM) rate, event-free survival (EFS), leukemia-free survival (DFS) and overall survival (OS) were 6.5%, 15.1%, 70.8%, 79.4% and 79.4%, respectively. Patients with DSA MFI<5 000 (group A, n=46) experienced lower PHR (4.4% vs. 27.5%, P=0.003), and higher 3-year EFS (79.5% vs. 59.8%, P=0.020) compared to those with DSA MFI≥5 000 (group B, n=37). Multivariate analysis showed that DSA MFI≥5 000 was correlated with PHR ( HR=6.101, P=0.021). PHR was associated with higher NRM ( HR=4.110, P=0.026), lower DFS ( HR=3.656, P=0.019) and OS ( HR=3.656, P=0.019). Conclusion:Our data suggest that high pre-transplant DSA level is a risk factor for PHR in patients with hematological diseases receiving haploidentical allograft and rituximab for desensitization.

Objective:To investigate the value of minimal residual disease (MRD) in prediction of prognosis in acute lymphoblastic leukemia (ALL) patients with or above complete remission 2 (CR2) underwent.Methods:A retrospective analysis was performed on 201 ALL patients who received allogeneic stem cell transplantation (allo-SCT) and pretransplant disease status ≥CR2 in Peking University People′s Hospital from January 2009 to December 2018. MRD was measured by multi-parameter flow cytometry at 1 month before transplantation and 1 month, 2 months, 3 months, 4 months, 6 months, 9 months or 12 months after transplantation. To investigate the influence of dynamic changes of MRD before and after transplantation on prognosis.Results:201 ALL patients, including 126 males and 75 females, with a median age of 18 years. The 3-year cumulative incidence of relapse (CIR), non-relapse mortality (NRM), leukemia-free survival (LFS) and overall survival (OS) of all cases were 34%, 16%, 50%, and 56%, respectively. Positive pre-SCT MRD patients with higher 3-year CIR (47% vs 26%, P=0.003), lower 3-year LFS (40% vs 55%, P=0.047) and OS (42% vs 60%, P=0.065) than those with negative one. Subjects with positive post-MRD had higher 3-year CIR (73% vs 22%, P<0.001) and lower 3-year LFS (28% vs 56%, P=0.005) and OS (32% vs 60%, P=0.040) compared with those with negative one. Multivariate analysis showed that both pre-MRD and post-MRD were associated with higher CIR ( HR=1.823, P=0.018; HR=3.474, P<0.001), lower LFS ( HR=1.779, P=0.007; HR=2.185, P=0.001) and OS ( HR=1.609, P=0.034; HR=1.970, P=0.001). Negative pre-and post-SCT MRD group had lower 3-year CIR (17%, 42%, 82%; P<0.001) and higher 3-year LFS (61%, 44%, 18%; P<0.001) and OS (63%, 47%, 27%; P<0.001) compared with those unrisen post-SCT MRD group, and increased post-SCT MRD group. Multivariate analysis showed that pre-and post-SCT MRD dynamics were associated with CIR, LFS and OS ( P<0.01 for all) independently. The pre-and post-SCT MRD dynamics could better distinguish CIR (C=0.669) from that of pre-SCT MRD (C=0.587) and post-SCT MRD (C=0.629). Conclusion:Our data suggest that pre-SCT MRD, post-SCT MRD and the dynamic peri-SCT MRD could be used to predict transplant outcome of ALLpatients with or above CR2 who underwent allo-SCT.

Background: Clostridium difficile infection (CDI) is the most common cause of hospital-acquired diarrhea and an important cause of death in hospitalized patients with diarrhea. However, there are not sufficient clinical researches on the risk factors of CDI. Aims: To investigate the risk factors of CDI in hospitalized patients with diarrhea. Methods: A total of 230 hospitalized diarrhea patients who received Clostridium difficile test from January 2015 to January 2019 at the Second Hospital of Hebei Medical University were collected. The patients were divided into CDI group and non-CDI group. Logistic regression analysis was performed to investigate the risk factors of CDI. Results: Compared with non-CDI group, patients in CDI group had a longer hospital stay (P<0.05) and a higher proportion of surgery in the past 6 months (P<0.05). The number of comorbidities in CDI group was higher than that in non-CDI group (P<0.05), and the ratio of gastrointestinal disease, cardiovascular disease, blood/immune system disease, nervous system disease in CDI group were higher than those in non-CDI group (P<0.05). Multivariate analysis showed the number of comorbidities (OR=3.215, 95% CI: 1.576-4.743; P=0.003), gastrointestinal disease (OR=4.135, 95% CI: 3.048-11.416; P=0.000), surgical history (OR=6.734, 95% CI: 2.692-15.849; P=0.000) and antibiotic use (OR=5.996, 95% CI: 2.173-15.481; P=0.000) were risk factors of CDI, especially the use of quinolone antibiotics (OR=4.769, 95% CI: 2.138-14.757; P=0.000). Conclusions: CDI can prolong the hospital stay of patients with diarrhea. Number of comorbidities, underlying gastrointestinal disease, recent history of surgery and antibiotic use, especially the use of quinolone antibiotics are risk factors of CDI in hospitalized patients with diarrhea.

Objective:To investigate the risk factors and clinical features of Clostridium difficile infection (CDI) in ulcerative colitis (UC) patients. Methods:Clinical data of UC patients in hospital with complete CDI screening information at Department of Gastroenterology, The Second Hospital of Hebei Medical University from January 2015 to January 2018 were analyzed retrospectively. These patients were divided into two groups according to whether they were diagnosed with CDI. Demographic characteristics and clinical features of CDI in UC patients were analyzed. Univariate and multivariate analysis were used to reveal the risk factors of CDI.Result:A total of 162 UC patients were enrolled in this study, including 84 males and 78 females. Thirty-seven UC patients (22.8%) were diagnosed with CDI. Compared with the non-CDI group, the CDI group had a higher proportion of patients who used glucocorticoids (62.2% vs. 25.6%, P<0.05) and infliximab (13.5% vs. 1.6%, P<0.05) . The multivariate logistic regression analysis showed glucocorticoids treatment was the independent risk factor of CDI in UC patients ( OR = 4.111, 95% CI: 1.581-9.131, P = 0.001) . Conclusion:Systemic treatment with glucocorticoids increases the risk of CDI in UC patients.

Inflammatory bowel disease (IBD) is a recurrent chronic non-specific intestinal inflammatory disease. Because of the poor nutritional status and immune dysfunction caused by IBD, and the therapeutic application of glucocorticoid and immunosuppressive agents in some patients, the IBD patients are at high risk of opportunistic infections. Epstein-Barr virus (EBV) is a kind of opportunistic causative virus which is common in IBD patients. EBV infection can cause the rapid disease progresses, worsen the effect of conventional medicine treatment, and induce the EBV-associated lymphoproliferative disorders. This article discusses the epidemiology, risk factors, clinical characteristics and the therapeutic strategies of IBD patients with EBV infection.

Objective:To investigate the risk factors and clinical features of Clostridium difficile infection (CDI) in ulcerative colitis (UC) patients. Methods:Clinical data of UC patients in hospital with complete CDI screening information at Department of Gastroenterology, The Second Hospital of Hebei Medical University from January 2015 to January 2018 were analyzed retrospectively. These patients were divided into two groups according to whether they were diagnosed with CDI. Demographic characteristics and clinical features of CDI in UC patients were analyzed. Univariate and multivariate analysis were used to reveal the risk factors of CDI.Result:A total of 162 UC patients were enrolled in this study, including 84 males and 78 females. Thirty-seven UC patients (22.8%) were diagnosed with CDI. Compared with the non-CDI group, the CDI group had a higher proportion of patients who used glucocorticoids (62.2% vs. 25.6%, P<0.05) and infliximab (13.5% vs. 1.6%, P<0.05) . The multivariate logistic regression analysis showed glucocorticoids treatment was the independent risk factor of CDI in UC patients ( OR = 4.111, 95% CI: 1.581-9.131, P = 0.001) . Conclusion:Systemic treatment with glucocorticoids increases the risk of CDI in UC patients.

Inflammatory bowel disease (IBD) is a recurrent chronic non-specific intestinal inflammatory disease. Because of the poor nutritional status and immune dysfunction caused by IBD, and the therapeutic application of glucocorticoid and immunosuppressive agents in some patients, the IBD patients are at high risk of opportunistic infections. Epstein-Barr virus (EBV) is a kind of opportunistic causative virus which is common in IBD patients. EBV infection can cause the rapid disease progresses, worsen the effect of conventional medicine treatment, and induce the EBV-associated lymphoproliferative disorders. This article discusses the epidemiology, risk factors, clinical characteristics and the therapeutic strategies of IBD patients with EBV infection.

Objective: To analyze the clinical features and risk factors of ulcerative colitis (UC)complicated with Epstein-Barr(EB)-viremia and the effect of antiviral therapy on the remission of the symptoms. Methods: From April 2014 to January 2018, data of 239 UC patients hospitalized at the Department of Gastroenterology of Second Hospital of Hebei Medical University were collected. The patients were divided into EB-viremia group (trial group, n=43) and non-EB-viremia group (control group, n=196) according to EB virus-DNA detection. The general condition, clinical characteristics and therapeutic efficacy of the two groups were compared. The risk factors and the effect of antiviral therapy on the remission of symptoms of UC complicated with EB-viremia were analyzed. Chi-square test and logistic analysis were used for statistical analysis. Results: There were no significant differences in gender, age, clinical type, lesion range, the proportion of patients treated with 5-aminosalicylic acid or corticosteroids, the percentage of patients with diarrhea and bloody stool, the proportion of patients with spontaneous bleeding, platy ulcer and longitudinal ulcer under colonoscopy, the course of disease or Mayo score between the trial group and control group (all P>0.05). The proportions of patients with smoking history and severe disease, treatment with azathioprine and 6-mertocapurine (6-MP), treatrnent with infliximab, symptoms of fever or abdominal pain and deep and large ulcer under colonoscopy in the trial group were all higher than those in the control group, and the differences were all statistically significant (χ²=5.304, 6.608, 6.718, 6.939, 8.783, 4.493 and 5.425, all P<0.05). The results of multivariate logistic regression analysis showed that smoking history and treatment with azathioprine and 6-MP were risk factors of UC complicated with EB-viremia (OR=2.801 and 9.343, 95%CI 1.170 to 6.703 and 1.749 to 49.922, P=0.021 and 0.009). The improvement rates of the trial group and control group were 79.1%(34/43) and 95.4%(187/196), respectively. There was a significant difference in the improvement rate between the two groups (χ²=10.551, P=0.001). In the trial group, 12 patients (27.9%) received ganciclovir treatment, fonr patients (9.3%) had foscarnet sodium treatment, 21 patients (48.8%) were treated with the combination of these two medications and six cases (14.0%) did not received any antiviral treatment. After three weeks, the improvement cases of the above regimens were 8, 4, 16 and 6, respectively. There were no statistically significant differences in the improvement rate of patients with and without antiviral treatment, further more, no difference was found in the improvement rate of patients with different antiviral treatments (all P>0.05). Conclusions Smoking history and purine treatment are risk factors of UC complicated with EB-viremia.