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To analyze the prognostic factors of extramedullary relapse (EMR) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in acute lymphoblastic leukemia (ALL).The clinical data of 33 relapsed patients in 95 ALL patients receiving allo-HSCT were analyzed retrospectively. The median time of relapse was 5.7 (0.7-52.3) months. Extramedullary relapse was recorded in 10 cases (10.5%), bone marrow relapse in 15 cases (15.8%), and both extramedullary and marrow relapse were seen in 8 cases (8.4%). The median time of EMR was 7.4(0.7-52.3) months. The most commonly involved organ was central nervous system, followed by testis and bone. The 3-year OS rate in EMR patients was (33.3±11.1) %. Univariate analysis showed that disease state before transplantation ( P=0.026), extramedullary infiltration before transplantation ( P=0.005), conditioning regimens ( P=0.033) and acute graft-versus-host disease(aGVHD) ( P=0.013) were significantly correlated with EMR. Multivariate analysis suggested that extramedullary infiltration ( RR=5.067, 95 %CI1.542-16.645, P=0.007) and aGVHD( RR=3.585, 95 %CI1.245-10.320, P=0.018) were independent predictive factors of EMR in ALL patients after allo-HSCT.
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As a key enzyme that catalyzes the metabolism of branched chain amino acids,branched chain amino acid transferase 1(BCAT1)is often involved in a variety of biosynthetic pathways. Reaserches show that BCAT1 is highly expressed in many kinds of malignant tumors such as leukemia,glioma,nasopharyn-geal carcinoma,gastric cancer and breast cancer,et al,suggesting a close relationship with the proliferation, invasion and metastasis of tumor cells. Thus,BCAT1 plays an important role in the genesis and progression of tumor,and may have the potential to be a new therapeutic target.
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Objective To evaluate the efficacy of unrelated donor allogeneic hematopoietic stem cell transplantation (allo-HSCT) for leukemic children .Methods Clinical data of 54 leukemic children undergoing allo-HSCT were retrospectively analyzed from May 2006 to March 2018 .According to the source of donor ,they were divided into matched sibling donor allo-HSCT group (MSD ,n = 27 ) and unrelated donor group (URD ,n= 27) .The clinical outcomes of leukemic children receiving URD allo- HSCT were assessed and those in MSD allo-HSCT group were enrolled as control .Results One patient with refractory AML was not implanted in URD group and the remaining 53 cases were successful in hematopoietic reconstitution .The time of neutrophil and platelet ,the incidence of acute graft-versus-host disease (aGVHD ) , chronic GVHD (cGVHD ) , generalized cGVHD and their transplant-related complications including pulmonary complications ,hemorrhagic cystitis between two groups were not statistically different (P> 0 .05) .The incidence of serious aGVHD ,cytomegalovirus (CMV) and EB virus (EBV) infection was significantly higher in URD group than that in MSD group (P< 0 .05) .The proportion of non-recurrent deaths in URD and MSD groups was 80％ and 31 .3％ respectively and the difference between two groups was statistically significant ( P = 0 .041) .The 3- year disease-free survival rate (DFS) of URD group and MSD group was (52 .9 ± 9 .8 )％ ,(38 .5 ± 8 .7 )％ and the overall 3-year survival rate (OS) was (57 .9 ± 9 .5)％ and (46 .5 ± 9 .7)％ respectively . The inter-group difference was not statistically significant ( P > 0 .05 ) .Conclusions In leukemic children ,although the incidence of complications post URD allo-HSCT is significantly increased , the prognosis is comparable to MSD allo-HSCT .It is a good choice when there is no suitable sibling donor .
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Objective To analyze the clinical features,efficacy and outcomes in patients with transplantation associated thrombotic microangiopathy (TA-TMA).Methods The clinical data of 9 patients who developed TA-TMA after allogeneic hematopoietic stem cell transplantation (allo-HSCT) were retrospectively analyzed from January 2011 to August 2018 in Affiliated Tumor Hospital of Zhengzhou University.Results There were 6 male and 3 female patiens with a median age of 31 (12-38) years.The median time from transplantation to TA-TMA was 76 (24-155) days.The baseline blood and biochemical parameters at diagnosis of TA-TMA included median hemoglobin (Hb) 66 (58-77) g/L,platelet (PLT) count 22 (4-38) × 109/L,serum lactic dehydrogenase (LDH) 655 (305-4 238) U/L,blood urine nitrogen (BUN)level 15.9 (4.8-26.2) mmol/L,blood creatinine (Cr) level 118 (24-380) μmol/L.The proportion of median peripheral blood schistocytes was 2.6％(1.2％-9％).All patients had positive urinary occult blood tests,and urinary protein was seen in 4 patients.Three patients had mental symptoms.Coombs tests were all negative.The main treatments of TA-TMA composed of reduction and withdrawal of calcineurin inhibitor,steroids and plasma exchange.Response was seen in 4 patients.Patients who did not response to the treatment had a higher proportion of schistocytes,more severe acute graft-versus-host disease (aGVHD),more elevated serum LDH and other transplant-related complications.Conclusions TA-TMA after allo-HSCT is a serious complication with high mortality rate.The proportion of schistocytes in peripheral blood,serum LDH level and comorbidities are prognostic factors of clinical outcome.
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Objective To compare the clinical outcome between vertebra fracture fixation plus injectable calcium sulfate vertebroplasty and simple vertebra fracture fixation in the treatment of thoracolumbar burst fracture.Methods A total of 61 patients with thoracolumbar burst fracture treated from January 2005 to December 2008 were involved and divided into two groups,ie,Group A ( treated with three-level fixation at fractured vertebra and injectable calcium sulfate vertebroplasty) and Group B ( treated with three-level fixation at fractured vertebra alone).Group A had 22 males and 10 females,at mean age of 36.8 years (21-65 years).The mean follow-up period was 15.6 months (13-27 months).Group B had 18 males and 11 females,at mean age of 38.3 years (19-70 years).The mean follow-up period was 14.7 months (12-28 months).The ratio of anterior vertebral height,Cobb angle,VAS score were compared between the two groups.Results There were no statistical differences in the aspects of age,sex,fracture segments and preoperative neurological status distribution in the two groups( P ＞0.05 ).All patients with partial neurologic deficits initially improved for 1-2 grade at the final follow-up.Blood loss and operation time in Group A were less than that in Group B (P ＜0.05 ).The ratio of anterior vertebral height and the Cobb angle showed no statistical significance (P ＞ 0.05 ),but the ratio of anterior vertebral height and the Cobb angle in Group A was less than those in Group B at the latest follow-up (P ＜0.05 ).The VAS score showed no statistical significance between the two groups at the latest followup (P ＞ 0.05 ).There was one patient with screw breakage in Group B,while there was no implant failure in Group A.Conclusion The vertebra fracture fixation plus calcium sulfate cement vertebroplasty is a safe and effective method for the treatment of thoracolumbar burst fracture as it can restore the vertebral mechanical strength,achieve and maintain kyphosis correction,decrease the instrument failure rate and loss of vertebral height.
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Objective To evaluate the feasibility and outcome of transpedicular screw fixation in fracture reduction and maintenance of reduction for thoracolumbar fractures.Methods The clinical data of 43 patients with thoracolumbar fractures admitted to Orthopedic Trauma Hospital of Qingdao from January 2003 to December 2006 were retrospectively analyzed.The inclusion criteria were as follow;sin-gle vertebral fracture involving T_(12)-L_2, integrated pedicle and no inferior endplate fracture.All patients received operation within 10 days after injury.Three-level fixation at fractured vertebra plus pedicle screw fixation was performed in 23 patients (Group A) including 15 males and 8 females, at mean age of 45 years (19-77 years).Traditional two-level fixation was done on the other 20 patients (Group B) inclu-ding 11 males and 9 females, at mean age of 42 years (22-67 years).In Group A, the transpedicular screws fixing the fractured vertebra and cephal vertebra were distracted after locking the transpedicular screw of the fracture vertebra and caudal vertebra.Results The height of the anterior edge of the cau-dal disc in Group B was 0.035 ±0.042, greater than 0.061 ±.036 in Group A, with statistical differ-ence (P < 0.05).There was no statistical difference in the changes of Cobb angle after the operation be-tween (915.8 ±7.8)°in Group A and (13.1±5.2)°in Group B.34 patients were followed up for an average period of 15 months (11-24 months) , which showed smaller Cobb angle in Group A (5.4°compared with Group B (8.9°)(P <0.05).There was one patient with screw breakage in Group A and two in Group B.Conclusion Transpedicular screws can enhance the stability of the posterior short-segment instrumentation, avoid over-distraction of the caudal discs, improve stress distribution and lessen loss of correction for some thoracolumbar fractures.