Objective To investigate the effects of anti-HLA donor-specific antibodies(DSA)and desensitization for DSA+patients on engraftment of haploidentical hematopoietic stem cell transplantation(haplo-HSCT).Methods The patients who underwent haplo-HSCT and examinations for HLA antibodies and DSA in our department from March 2017 to July 2023 were recruited in this study.The effects of desensitization measure on engraftment in the DSA+patients after haplo-HSCT were analyzed.Results Among the 70 patients who underwent haplo-HSCT and test for HLA antibodies,15(21.4％)patients were DSA positive,including 7(46.7％)cases of strong positive,3(20.0％)cases of moderate positive,and 5(33.3％)cases of weak positive.The median duration for neutrophil implantation was significantly extended in the DSA+patients than the negative patients(P=0.027).For the 6 patients developed graft failure(GF),4 were DSA+which was statistically higher than the DSA-patients(P=0.025).Multivariate regression analysis showed that DSA was an independent factor affecting GF(HR=9.273,95％CI:1.505～57.124,P=0.016).Among the 10 patients(7 strong positive and 3 moderate positive DSA)received desensitization therapy,4 patients received combination desensitization,with a 100％rate of successful transplantation,and 6 received single desensitization,with 4(66.7％)experiencing GF,so the GF rate was obviously lower in the combination than the single desensitization(P=0.008).Conclusion In haplo-HSCT patients,DSA is an important factor leading to implantation delay and GF.While,single desensitization treatment has limited efficacy.In combined DSA desensitization therapy,the decrease of antibody titer should be dynamically monitored to ensure the successful implantation of stem cells and reduce GF rate.

Objective: To investigate the function of CIK (cytokine induced killer) cells cultured using ATG-F (anti-human T lymphocyte rabbit immunoglobulin-Fresenius) and IFN- γ, IL-2 system and its feasibility in clinical practice. Methods: Peripheral blood mononuclear cells (PBMCs) were isolated from healthy donors and were used to culture CIK cells by different activating antibodies; the total cell count was calculated on Day 7 and 14. The CIK cell composition, cell surface activation and proportion of inhibitory receptor molecular in ATG-F group, CD3 group and TG (Thymoglobulin) group were analyzed by Flow cytometry, and the cytotoxicity of CIK cells against K562 cells were also determined by flow cytometry at day 14 in ATG-F high-dose group, CD3 group and TG group. Results: CIK cells were successfully cultured by ATG-F, IFN-γ, IL-2 system. The proliferation rate of ATGF high-dose group was significantly higher than that in TG group (27.25±1.25 vs 16.60±1.72, P <0.01), but the proportion of CD3+ CD56+ cells showed no statistical difference compare with the CD3 group ( P >0.05). The percentage of CD3-CD56+ NK cells in ATG-F high-dose group was significantly higher than that in TG group and CD3 group [(11.19±2.60）% vs（5.66±1.00）%,（1.42± 0.51）% ， P <0.01], while the proportion of CD4+T cells was significantly lower than that in CD3, TG group [(4.35±1.47）% vs （26.88±5.01）%,（14.52±6.22）%, P <0.01]; the proportion of CD56+CD94+, CD56+CD158a+, CD56+CD158b cells was significantly higher than those in CD3 group (all P <0.01). The ATG-F high does group showed significantly higher cytotoxicity against K562 cells than that of CD3 group at the target/effect ratio of 1∶10. Conclusion: CIK cells cultured by ATG-F culture system has higher NK cell proportion than other ordinary culture system, and its activated receptor has more stronger cytotoxicity against K562 cells.

Objective To study the application value of ultrasound(US) examination for evaluating the knee joint status in the patients with hemophilia.Methods The US examination data of 44 patients (70 knee joints) with hemophilia were collected,among them 11 cases aged below 18 years old,16 knee joints completed the MRI examination,meanwhile the knee joint health status was evaluated by adopting the 2.1 version of hemophilia joint health assessment (HJHS) form.Then the correlation between the US score with the age and bleeding times and the relation between MRI score with HJHS score were analyzed.Results The severity of hemophilia arthropathy had no obvious correlation with hemophilia severity (F=0.013,P =0.987).With the age increase and bleeding frequency increase,the knee joint lesion was aggravated.The detection of early synovial thickening and cartilage change in arthropathy had no obvious difference between US and MRI examinations(P＞0.05);the obvious correlation existed among US score,MRI score and HJHS (P＜0.05).Conclusion US has an important significance for the early diagnosis of hemophilic arthropathy.

Objective To investigate the role of thrombelastography(TEG) in assessing the risk of bleeding and diagnostic value in patients with acute leukemia(AL) .Methods The TEG and PLT data were counted in 127 patients(272 sets of data) who were diagnosed with AL .Those patients were divided into two groups :group 1 (including patients with bleeding) and group 2 (in‐cluding patients with no bleeding) .The indicators(R values ,K values ,α‐angle ,MA values)and PLT count were compared between two groups .Those data with PLT<30 × 109/L of these two groups also were divided and the 4 indicators of TEG were compared between the two groups .We used the ROC curve to evaluate the sensitivity and specificity in assessing the risk of bleeding .Results According to the data in total ,the K value ,R value of the group 1 were higher than those of the group 2(P<0 .05);theα‐angle and MA value ,PLT counts of group 1 were lower than those of the group 2(P<0 .05) .In those AL patients whose PLT<30 × 109/L ,the K value of the group 1 was higher than that of the group 2(P<0 .05);theα‐Angle and MA value of the group 1 were lower than those of the group 2(P<0 .05);R values and PLT count were not different between the two groups(P>0 .05);the are‐as under the ROC curve about the PLT counts ,MA value andα‐angle were more than 0 .5 (0 .750 ,0 .740 and 0 .653) .Conclusion T EG could predict the risk of bleeding in acute leukemia patients and it could be used in clinical application .

Objective To analyze the clinical characteristics ,diagnosis and treatment of acute leukemia complicating deep ve‐nous thrombosis(DVT) to deepen the cognition on this complication .Methods The clinical data of consecutive patients with acute leukemia were performed the retrospective analysis .The occurrence situation of deep venous thrombosis was investigated and the a‐broad related literatures were reviewed .Results A total of 116 cases of acute leukemia in our department from July 2011 to March 2014 were treated ,in which 85 cases were acute myeloid leukemia and 31 cases were acute lymphoblastic leukemia;5 cases devel‐oped DVT with the proportion of 4 .31% (5/116) .Of these cases ,3 cases were acute promyelocytic leukemia and 2 cases were acute lymphoblastic leukemia .Conclusion The occurrence rate of DVT in the patients with acute promyelocytic leukemia is relatively higher ,if the patients have the corresponding symptom ,timely diagnosis and treatment should be conducted .

Objective To observe the positive rate of plasma cytomegalovirus DNA(CMV‐DNA) level after allogenic hema‐topoietic stem cell transplantation (allo‐HSCT) ,analysis and explore the risk factors related to CMV infection .Methods Choose 30 patients who had performed allo‐HSCT in our department from July 2012 to September 2014 .PCR were used regularly to detect the plasma CMV‐DNA levels in these patients .The regular monitoring times were as follow :the first month(once a week) ,the second to third month(twice a week) ,the fourth to sixth month(once a month) after allo‐HSCT respectively .The positive rates were coun‐ted in every period .Results Thirteen patients had CMV infection ,and the infection rate were 43 .3% .In the first month ,there were 4 cases (13 .3% )whose plasma CMV‐DNA levels were positive ,however ,the positive cases in the second month ,the third month , the fourth month ,the fifth month and the sixth month were 11(36 .7% ) ,2(6 .7% ) ,0 ,2(6 .7% ) and 0 respectively .Statistical data showed that it was in the second month after allo‐HSCT that the CMV‐DNA positive rate was higher than other periods .The anal‐ysis suggested that the positive rate of CMV‐DNA related to the administration of rabbit anti‐human thymocyte globulin(ATG) ,ba‐siliximab ,and the occurrence of acute graft versus host disease(GVHD) ,there were no relationship among gender ,age ,risk stratifi‐cation of primary disease ,HLA condition ,preparative project ,recovery time of neutrophile granulocyte .Conclusion It is necessary and beneficial to monitor blood CMV‐DNA level regularly and take treatment early to avoid CMV related comobidity after allo‐HSCT .

Allogeneic stem cell transplantation is the only treatment which may cure multiple myeloma (MM).The high transplantation related mortality (TRM) limits the wide clinical application of myeloablative allogeneic stem cell transplantation.Non-myeloablative allogeneic stem cell transplantation can reduce the TRM,but the risk of relapse and progress of the disease may get increased. Autononmyeloablative allogeneic stem cell tandem transplantation can reduce both the TRM and the relapse and progress of the disease. At present,there exist many new methods which may improve the effect of allogeneic stem cell transplantation for MM in clinical.

Objective To describe the demographic and clinical characteristics of patients with the diagnosis of multiple myeloma(MM)and to analyse the outcome of difierent regimens for the treatment of MM.Methods The study reviewed 332 MM cases diagnosed within the period from January 1,2002 to December 31,2002.These patients were tracked via their records to a total period of three years.Results First-line treatment:Totally 332 patients were included,among them 325(97.9%)patients received chemotherapy and 7(2.1%)patients received stem cell transplantation(SCT);Second-line treatment:197 patients were included,among them 190(96.5%)patients received chemotherapy and 7(3.6%)patients received SCT;Third-line treatment:92 patients were included,among them 88(95.7%)patients received chemotherapy and 4(4.4%)patients received SCT.Major adverse effects were follows:severe infection 19.3%,severe anaemia 19.3%,phlebothrombosis 1.2%,thrombocytopenia 16.9%,fever associated with neutropenia 18.1%.Conclusions Some curative effects can be achieved by using traditional treatment plans to treat patients suffering from MM,but new methods are expected to improve the prognosis.

Objective To prepare liposome-entrapped mitoxantrone (LEM)-GM-CSF and observe the cytotoxicity of HL-60/ADM cells treated with LEM-GM-CSF, LEM and dihydroxyanthraquinone (DHAQ) in vitro. Methods LEM was prepared by reverse phase evaporation (REV). High speed centrifugation was applied to separate LEM and dissociate DHAQ. Colorimetry was employed to determine encapsulation efficiency. The liposome structure and particle size were determined by transmission electron microscopy. GM-CSF was coupled to LEM by glutaraldehyde method. UV-spectrophotometric analysis was applied to measure the coupled efficiency. Flow cytometry was applied to determine the immunoconjugate retained efficiency. The cytotoxicity of HL60/ADM cells and interdiction efficiency of GM-CSF were investigated by MTT test. Results The encapsulation efficiency of LEM was 80%. Most liposomes were monolayer, and the particle size was 170-220 nm. Its coupled efficiency with GM-CSF was 42.3%, and the immunoconjugate retained efficiency was 74.6%. All LEM-GM-CSF, LEM and DHAQ had cytotoxicity on HL60/ADM, their cytotoxic power in decrement sequence: LEM-GM-CSF, LEM, DHAQ. After treated with LEM-GM-CSF, LEM and DHAQ for 24 h, the IC50 of HL-60/ADM was 8.73, 12.42, 27.31 ?g/ml respectively and for 48 h the IC50 were 0.62, 8.25, 12.44 ?g/ml. The inhibition rate increased in a dose-dependent manner. Conclusion The encapsulation efficiency, the coupled efficiency and the immunoconjugate retained efficiency of LEM-GM-CSF prepared by our method were satisfying. LEM-GM-CSF representing anti-leukaemia efficiency in vitro had cytotoxicity on HL60/ADM cells.

Probing into the methods and techniques of physician-patient communication is important to clinic medicine and medical education. Physician- patient shared decision is one of important aspects of physician-patient communication, 80 patients with hematologic malignancies were reviewed for classification of models of medical decision making, and the methods and techniques of physician-patient shared decision were also discussed .