OBJECTIVE: To explore the clinical application value of metagenomic next-generation sequencing (mNGS) in pathogen detection of bloodstream infection secondary to hematologic diseases in children. METHODS: 42 children with bloodstream infections secondary to hematologic diseases admitted to the Children's Hematology and Tumor Center of the Affiliated Hospital of Guangdong Medical University from November 2021 to May 2023 were included in the study, and their clinical data, results of peripheral blood mNGS and traditional blood culture, pathogen distribution characteristics, and diagnostic efficacy of mNGS were retrospectively analyzed. RESULTS: Among the 42 children included, there were 2 cases (4.8%) of aplastic anemia (AA), 27 cases (64.3%) of acute lymphoblastic leukemia (ALL), 7 cases (16.7%) of acute myeloid leukemia (AML), 1 case (2.4%) of chronic myeloid leukemia (CML), 2 cases (4.8%) of hemophagocytic lymphohistiocytosis (HLH), 2 cases (4.8%) of non-Hodgkin lymphoma (NHL), and 1 case (2.4%) of Wiskott-Aldrich syndrome (WAS). In mNGS testing, pathogens were detected in 31 peripheral blood samples, with a positive rate of 73.8% (31/42), significantly higher than the pathogen positive rate of 16.7% (7/42) detected by traditional blood culture, and the difference was statistically significant (P < 0.05). Among the pathogen-positive cases detected by mNGS, 23 cases (74.2%) were positive for bacteria, 12 cases (38.7%) were positive for viruses, and 9 cases (29.0%) were positive for fungi. 32.2% (10/31) of the pathogen-positive samples detected by mNGS were mixed pathogens, which could not be effectively detected by traditional blood culture. CONCLUSION Peripheral blood mNGS has advantages in the detection of pathogens of bloodstream infection secondary to hematologic diseases, with a higher detection rate of pathogen positivity than traditional blood cultures. It can detect viruses, rare pathogens and mixed pathogens, and has good clinical application value.
Child ; Child, Preschool ; Female ; Humans ; Male ; Hematologic Diseases/immunology* ; High-Throughput Nucleotide Sequencing ; Metagenomics ; Retrospective Studies ; Sepsis/microbiology*

BACKGROUNDDespite substantial progress toward measles control are making in China, measles outbreaks in immunocompromised population still pose a challenge to interrupt endemic transmission. This study aimed to investigate the features of measles in pediatric hematology and oncology patients and explore the reasons behind the outbreak.

METHODSWe collected demographic, epidemiological, and clinical data of immunocompromised measles children. All suspected measles cases were laboratory-confirmed based on the presence of measles IgM and/or identification of measles RNA. The clinical data were statistically analyzed by t-test for continuous variables and Fisher's exact test for categorical variables.

RESULTSFrom March 9 to July 25 in 2015, a total of 23 children with malignancies and post hematopoietic stem cell transplantation (post-HSCT) were notified to develop measles in Shanghai. Of these 23 patients with the median age of 5.5 years (range: 11 months-14 years), 20 (87.0%) had received 1-3 doses of measles vaccine previously; all patients had fever with the median fever duration of 8 days; 21 (91.3%) had cough; 18 (78.3%) had rash; 13 (56.5%) had Koplik's spot; 13 (56.5%) had complications including pneumonia and acute liver failure; and five (21.7%) vaccinated patients died from severe pneumonia or acute liver failure. Except the first patient, all patients had hospital visits within 7-21 days before measles onset and 20 patients were likely to be exposed to each other.

CONCLUSIONSThe outcome of measles outbreak in previously vaccinated oncology and post-HSCT pediatric patients during chemotherapy and immunosuppressant medication was severe. Complete loss of protective immunity induced by measles vaccine during chemotherapy was the potential reason. Improved infection control practice was critical for the prevention of measles in malignancy patients and transplant recipients.

Adolescent ; Child ; Child, Preschool ; China ; Disease Outbreaks ; statistics & numerical data ; Female ; Hematologic Diseases ; epidemiology ; Humans ; Immunocompromised Host ; immunology ; Infant ; Male ; Measles ; epidemiology ; Neoplasms ; epidemiology

Th17 cells are a newly discovered subsets of T cells. It can specifically secrete IL-17. The RORγt and STAT3 are specific transcription factors of Th17 cells. In recent researches, it has been found that Th17 cells and their proportion increased in a variety of autoimmune diseases. This article briefly reviews Th17 cells and its relationship with the occurrence and severity of several immune-related blood diseases, including aplastic anemia, autoimmune hemolytic anemia, immune thrombo-cytopenia and immune-related pancytopenia.
Autoimmune Diseases ; Hematologic Diseases ; immunology ; Humans ; Interleukin-17 ; Nuclear Receptor Subfamily 1, Group F, Member 3 ; STAT3 Transcription Factor ; Th17 Cells ; immunology

OBJECTIVETo explore the relationship between the optical density index of serum aspergillus galactomannan (GM) assay and invasive aspergillosis (IA).

METHODSFrom Jan 2008 to Dec 2011, 825 hematological diseases patients with neutrophil count <0.5×10⁹/L⁹ by continuous blood count tests were admitted into our hospital. The optical density index of GM assay was ≥0.5 at least once. Of 825 patients, 247 cases were manifested as fever during hospitalization. The optical density index of GM antigen was detected by enzyme-linked immunosorbent assay, and the sensitivity and specificity of optical density ranged in 0.5-1.5.

RESULTSIn this study, the sensitivity and specificity of GM assay with continuous twice samples (73% and 93%, respectively) were higher than single sample (66% and 80%, respectively) when optical density index ≥1.0. 69 cases were diagnosed as proven IA with the incidence rate of 8.36%.

CONCLUSIONThe cut-off level for serum GM antigen assay should be decided as optical density index in two continuous samples of ≥1.0.

Adolescent ; Adult ; Aged ; Antigens, Fungal ; blood ; Aspergillosis ; blood ; diagnosis ; etiology ; Enzyme-Linked Immunosorbent Assay ; Female ; Hematologic Diseases ; blood ; microbiology ; Humans ; Male ; Mannans ; blood ; immunology ; Middle Aged ; Sensitivity and Specificity ; Young Adult

OBJECTIVETo investigate the regular pattern of Cytomegalovirus (CMV)-specific T cells (CTL) immune reconstitution after human leukocyte antigen (HLA) matched sibling donor allogeneic bone marrow(BM) plus peripheral blood hematopoietic stem cell (PBSC) transplantation.

METHODSCTL from seventeen patients after transplantation was detected by flow cytometry, the IFN-γ secretion ability of CTL by enzyme-linked immunospot (ELISPOT) assay, and clonal analysis of TCR Vβ subfamily by gene scan assays. The relationship between CTL reconstitution and CMV infection was studied.

RESULTSBoth number and function of recipients CTL reached to normal control level at 30 d post-transplantation. The recipients achieved a high frequency CTL with IFN-γ response and restoration of T-cell receptor β (TCR Vβ) repertoire at one year post-transplantation. CTL with the central memory CD45RO(+)CD62L(+) cell phenotype expanded in PB when CMV was reactivated. The incidence of CMV reactivation was 35.83% (17.91% - 63.10%) after transplantation, and none of them developed CMV disease.

CONCLUSIONAfter HLA matched related donor transplantation using mixed grafts, immune recovery to CMV seems to be early and fast. The incidence of CMV infection and disease are low.

Adult ; Cytomegalovirus ; immunology ; Female ; HLA Antigens ; immunology ; Hematologic Diseases ; immunology ; surgery ; Hematopoietic Stem Cell Transplantation ; Humans ; Male ; Middle Aged ; Peripheral Blood Stem Cell Transplantation ; Siblings ; T-Lymphocytes, Cytotoxic ; immunology ; Tissue Donors ; Young Adult

OBJECTIVETo explore the impact of IFN-γ + 874 polymorphisms on the outcome in HLA matched sibling HSCT.

METHODSWe used PCR-sequence-specific primer analysis (PCR-SSP) to analyze the polymorphisms of IFN-γ + 874 T/A in 80 recipient and donor pairs from October 2005 to March 2008.

RESULTSRecipients having donors who possessed IFN-γ + 874 A/A genotype had significantly earlier neutrophil recovery compared with those having donors with non-A/A genotype (15 (11 - 27) days vs 18 (12 - 30) days, P = 0.029). And IFN-γ + 874 A/A in both recipients and donors further facilitated neutrophil recovery compared with others (13 (11 - 25) days and 19 (12 - 31) days, P = 0.019). Besides, IFN-γ + 874 A/A in recipients increased the probability of grade II-IV acute graft versus disease (aGVHD) and cytomegalovirus viraemia compared with IFN-γ + 874 T/A or T/T genotype (20% vs 4% P = 0.041, 43.6% vs 16.0% P = 0.032), which lead to increased 5-year transplant-related mortality (TRM) (33.7% ± 6.8% vs 12.0% ± 6.5%, P = 0.050) and decreased 5-year event free survival (EFS) \[(58.2 ± 6.7)% vs (84.0 ± 7.3)%, P = 0.032\] compared with the latter. IFN-γ + 874 A/A in both recipients and donors also significantly increased the probability of grade II-IV aGVHD and cytomegalovirus viraemia compared with the other (21.7% vs 5.9%, P = 0.050; 45.7% vs 20.6%, P = 0.020), which caused increased 5-year TRM \[(31.6 ± 7.5)% vs (13.6 ± 6.5)%, P = 0.048\] and decreased 5-year EFS \[(56.8 ± 7.3)% vs (79.4 ± 6.9)%, P = 0.037\] compared with the other.

CONCLUSIONIn HLA-matched sibling HSCT setting, the presence of IFN-γ + 874 T allele in recipients or in both recipients and donors significantly decreased the risk of grade II-IV aGVHD and CMV infection and increased EFS. While IFN-γ + 874 A/A in donors or in both recipients and donors was associated with shorter duration to neutrophil recovery.

Adolescent ; Adult ; Alleles ; Child ; Child, Preschool ; Female ; Genotype ; HLA Antigens ; immunology ; Hematologic Diseases ; genetics ; therapy ; Hematopoietic Stem Cell Transplantation ; Humans ; Interferon-gamma ; genetics ; Male ; Middle Aged ; Polymorphism, Single Nucleotide ; Siblings ; Tissue Donors ; Transplantation, Homologous ; Treatment Outcome ; Young Adult

OBJECTIVEThrough establishing different blood deficiency animal model, to evaluate enriching blood effect changes of the drug pair of Angelicae Sinensis Radix and Chuanxiong Rhizoma and each single herb, and to explore the effect characteristics of their compatibility.

METHODThree different methods of acetyl phenylhydrazine (APH) hemolytic method, cyclophosphamide (CTX) chemical damage method, APH-CTX complex method were used respectively to copy different blood deficiency model mice. Changes of orbit blood routine, thymus index, spleen index and ATPase activity of red cell membrane of model mice were tested.

RESULTCompared with normal group, all indexes had significant differences in three model mice. The drug pair and each single herb had significant impact on most indexes of the APH-CTX complex model mice, and on the individual indexes of APH hemolytic model mice and CTX chemical damage model mice. Therefore, APH and CTX complex blood deficiency model was more suitable for the enriching blood mechanism study of the drug pair of Angelicae Sinensis Radix and Chuanxiong Rhizoma. Compared with the single herb of Angelicae Sinensis Radix and Chuanxiong Rhizoma, the drug pair of them had presented enriching blood effect at different extent with strengthening trend in regulating the invigorating blood indexes, immune organs and energy metabolic enzymes.

CONCLUSIONThe results of this research have provided scientific basis for revealing the mutual promotive composition law of the drug pair of Angelicae Sinensis Radix and Chuanxiong Rhizoma, and responded effectively the mult-link and mult-target effect characteristics of Chinese medicine bio-effect, to offer reference for the bio-effect research of the complicated substance group of Chinese medicine and traditional Chinese medicine formulae, and to supply demonstrative reference for researching the formulae compatibility law which takes the single drug-drug pair-formulae as main line.

Administration, Oral ; Angelica sinensis ; chemistry ; Animals ; Ca(2+) Mg(2+)-ATPase ; drug effects ; metabolism ; Cyclophosphamide ; pharmacology ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; chemistry ; Erythrocytes ; drug effects ; enzymology ; Female ; Hematologic Diseases ; drug therapy ; etiology ; Hemoglobins ; drug effects ; Leukocytes ; drug effects ; Medicine, Chinese Traditional ; Mice ; Models, Animal ; Phenylhydrazines ; pharmacology ; Plant Roots ; chemistry ; Random Allocation ; Rhizome ; chemistry ; Sodium-Potassium-Exchanging ATPase ; drug effects ; metabolism ; Spleen ; drug effects ; immunology ; Thymus Gland ; drug effects ; immunology

BACKGROUND: CD4+CD25+ regulatory T-cells (Tregs) play a critical role in immune responses. We explored the status of Tregs in neoplastic and autoimmune hematologic diseases. We also evaluated the technical aspects of Treg measurement in terms of sample type and detection markers. METHODS: A total of 68 subjects were enrolled: 11 with AML, 8 with MDS, 10 with autoimmune diseases, and 39 controls. Tregs were analyzed in peripheral blood (PB) and bone marrow (BM) samples from each subject. Flow cytometry and the Human Regulatory T cell Staining Kit (eBioscience, USA) for CD4, CD25, and FoxP3 (forkhead box P3) were used. RESULTS: The CD4+CD25high/CD4 and CD4+CD25highFoxP3+/CD4 populations were significantly correlated (P<0.0001). The AML and high-risk MDS groups had significantly larger CD4+CD25high/CD4 and CD4+CD25highFoxP3+/CD4 populations in PB than the autoimmune (P=0.007 and 0.012, respectively) and control groups (P=0.004 and 0.006, respectively). Comparable findings were observed in BM. The CD4+CD25highFoxP3+/CD4 population was significantly larger in PB than in BM (P=0.0003). CONCLUSIONS: This study provides comparison data for Tregs in AML, MDS, and autoimmune hematologic diseases, and would be helpful for understanding the different immunologic bases of various hematologic diseases. Treg measurement using CD4, CD25, and/or FoxP3 in PB rather than in BM seems to be practical for routine hematologic purposes. Large-scale analysis of the diagnostic role of Treg measurement is needed.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Autoimmune Diseases/diagnosis/immunology ; Bone Marrow Cells/cytology ; Female ; Flow Cytometry ; Forkhead Transcription Factors/*metabolism ; Hematologic Diseases/*diagnosis/immunology ; Humans ; Interleukin-2 Receptor alpha Subunit/*metabolism ; Leukemia, Myeloid, Acute/diagnosis/immunology ; Leukocytes, Mononuclear/cytology ; Male ; Middle Aged ; Myelodysplastic Syndromes/diagnosis/immunology ; T-Lymphocytes, Regulatory/immunology/*metabolism

This study was aimed to retrospectively analyze and compare the clinical curative efficacy of patients with hematologic malignancies after G-CSF-mobilized sibling HLA-matched (sm) peripheral blood hematopoietic stem cell transplantation (sm-allo-PBHSCT) and sm-allo-PBHSCT combined with bone marrow transplantation (BMT). 100 patients received sm-allo-HSCT in a single center from October 2001 to October to 2010, included 38 patients received sm-allo-PBHSCT and 62 patients received sm-allo-PBHSCT combined with BMT. The myeloablative or reduced intensity conditioning regimens were chosen according to the condition of patients. All patients received standard cyclosporine (CsA) and mycophenolate mofetil (MMF) as prophylaxis for GVHD. The results showed that the rapid hematopoietic reconstitution was observed in all patients. The median time of ANC ≥ 0.5 × 10(9)/L in both groups were 12 days, the median time of platelet count ≥ 20 × 10(9)/L was 15 days in sm-allo-PBHSCT group and 16 days in sm-allo-PBHSCT + BMT group. The incidence of acute GVHD, acute GVHD of III-IV grade and chronic GVHD in sm-allo-PBHSCT and sm-allo-PBHSCT + BMT groups were 37.1% and 34.2%, 7.89% and 8.06%, 36.11% and 41.38% respectively, there were no statistical differences. The relapse rates were similar in two groups (sm-allo-PBHSCT 13.16% vs sm-allo-PBHSCT + BMT 12.9%). The 3-year disease-free survivals in sm-allo-PBHSC and sm-allo-PBHSCT + BMT groups were 57.1 ± 8.7% and 61.3 ± 6.4% respectively (p = 0.852). The 2-year overall survival of high-risk patients was 41.4 ± 12.8% in sm-allo-PBHSCT group, while 60.9 ± 9.6% in sm-allo-PBHSCT + BMT group (p = 0.071). It is concluded that the rhG-CSF mobilized sibling matched allo-PBHSCT + BMT is superior to the rhG-CSF mobilized sibling matched allo-PBHSCT in increasing the overall survival of high-risk hematologic malignancies.
Adolescent ; Adult ; Aged ; Bone Marrow Transplantation ; Child ; Child, Preschool ; Female ; Granulocyte Colony-Stimulating Factor ; therapeutic use ; HLA Antigens ; immunology ; Hematologic Diseases ; immunology ; therapy ; Humans ; Male ; Middle Aged ; Peripheral Blood Stem Cell Transplantation ; Retrospective Studies ; Siblings ; Tissue Donors ; Young Adult

Jr(a) is a high-frequency antigen found in all ethnic groups. However, the clinical significance of the anti-Jr(a) antibody has remained controversial. Most studies have reported mild hemolytic disease of the newborn and fetus (HDNF) in Jr(a)-positive patients. Recently, fatal cases of HDNF have also been reported. We report the first case of HDNF caused by anti-Jr(a) alloimmunization in twins in Korea. A 33-yr-old nulliparous woman with no history of transfusion or amniocentesis was admitted at the 32nd week of gestation because of vaginal bleeding caused by placenta previa. Anti-Jr(a) antibodies were detected in a routine laboratory examination. An emergency cesarean section was performed at the 34th week of gestation, and 2 premature infant twins were delivered. Laboratory examination showed positive direct antiglobulin test and Jr(a+) phenotype in the red blood cells and the presence of anti-Jr(a) antibodies in the serum in both neonates. The infants underwent phototherapy for neonatal jaundice; this was followed by conservative management. They showed no further complications and were discharged on the 19th postpartum day. Preparative management to ensure the availability of Jr(a-) blood, via autologous donation, and close fetal monitoring must be performed even in cases of first pregnancy in Jr(a-) women.
Adult ; Blood Group Antigens/immunology ; *Blood Group Incompatibility ; Diseases in Twins/diagnosis/*immunology ; Erythroblastosis, Fetal/*diagnosis/immunology ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Isoantigens/immunology ; Jaundice, Neonatal/complications/immunology/therapy ; Male ; Phenotype ; Phototherapy ; Pregnancy ; Pregnancy Complications, Hematologic/diagnosis/*immunology ; Twins