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Objective To investigate the clinical efficacy of peripheral blood stem cell transplantation from haploidentical and matched sibling donors for treatment of high-risk and refractory/relapsed acute myeloid leukemia (AML). Methods Data on the efficacy of haploidentical peripheral blood stem cell transplantation (Haplo-HSCT) with myeloablative conditioning regimen were retrospectively analyzed and compared with that of matched sibling donors' peripheral blood stem cell transplantation (MSD-HSCT) for treatment of high-risk refractory/relapsed AML in our center from January 1st, 2010 to June 30th, 2020. Results A total of 98 patients were enrolled, including 62 patients in the Haplo-HSCT group and 36 patients in MSD-HSCT group. The median age, conditioning regimen, and infusion doses of MNC and CD34+ cells were significantly different between the two groups, but no significant differences in other baseline parameters were found. Transplantation-related infectious complications and the incidence of acute and chronic graft-versus-host disease (GVHD) were also not significantly different between the two groups. The 3-year cumulative relapse in the Haplo-HSCT group was significantly lower than that in the MSD-HSCT group (16.2% vs. 41.1%, P=0.036). The 3-year DFS of the Haplo-HSCT and MSD-HSCT groups were 66.98% and 41.8%, respectively (P=0.140), and their OS were 73.37% and 51.41%, respectively (P=0.105). Conclusion The clinical efficacy of Haplo-HSCT for the treatment of high-risk and refractory/relapsed AML is similar to that of MSD-HSCT, and Haplo-HSCT may have better GVL effect.
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Objective@#To analyze the efficacy of HLA-haploidentical peripheral hematopoietic stem cell transplantation (haplo-PBSCT) following reduced intensity conditioning (RIC) regimen to treat the patients with hematological malignancies who were older than 50 years old.@*Methods@#Eighteen patients with hematological malignancies over 50 years were enrolled, including 8 male and 10 female patients. The median age of all patients was 52 (range: 50–66) years. Of them, 8 patients had acute myeloid leukemia (AML) , 2 chronic myelocytic leukemia (CML) , 5 myelodysplastic syndrome (MDS) , 2 acute lymphoblastic leukemia (ALL) , and 1 aggressive natural killer cell leukemia (ANKL) . All patients received fludarabine, cytarabine and melphalan with rabbit anti-human thymocyte globulin (FAB+rATG regimen) and transplanted with high dose non-T cell-depleted peripheral hematopoietic stem cells from donors. Enhanced graft versus host disease (GVHD) prophylaxis and infection prevention were administered.@*Results@#Fifteen days after transplantation, 16 patients achieved complete donor chimerism. One of them rejected the donor graft completely at thirty days after transplantation, and the other 2 patients had mixed chimerism 15 days after transplantation and converted to complete recipient chimerism at 30 days after transplantation. The cumulative incidence of acute GVHD (aGVHD) was 61.1% (95%CI49.6%-72.6%) . The incidence of grade Ⅱ-Ⅳ aGVHD was 35.4% (95%CI 21.1%-49.7%) , whereas grade III-IV was 13.8% (95%CI 4.7%-22.9%) . The 2-year cumulative incidence of chronic GVHD (cGVHD) rate was estimated at 38.2% (95%CI 25.5%-50.9%) . Patients were followed-up for a median of 14.5 months (range, 3-44 months) . The Kaplan Meier estimates of 2-year overall survival (OS) and disease-free survival (DFS) was 72.6% (95%CI 60.1%-85.1%) and 63.7% (95%CI 49.2%-78.2%) , respectively. The 2-year cumulative incidence of relapse and non-relapse-mortality (NRM) was 31.2% (95%CI 16.5%-45.9%) and 12.5% (95%CI 4.2%-20.8%) , respectively.@*Conclusion@#RIC-haplo-PBSCT protocol can achieve better results in patients with hematologic malignancies over 50 years old.
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Objective This study is based on the physicians'appraisal system upon HIS system to annually assess the associate chief physicians in clinical departments in the mode of attending in charge. Methods 74 doctors above the title of associate chief physician from 14 departments in such mode were selected as objects of study and evaluated upon relative requirement of the performance appraisal index system by means of brainstorming,expert consulting and so on to confirm the content,standard and scoring method of appraisal.Work efficiency index and work amount can be acquired out of HIS system, while details and problems during the assessment can be dealt together with clinical practice.Finally all index and results were collected through HIS system and total scores of relative doctor can be automatically calculated.SPSS 13.0 statistics software also can be used to descriptively analyze the frequency and percentage data.Results The total appraisal scores and scores in every grade of the 74 doctors,who are attending in charge with title above associate chief physician as well as bearing the same responsibility in both medicine and surgery department,were collected,analyzed and respectively ranked respectively.Conclusion The results of appraisal basically indicate general level of the doctors,as well as provide strong evidence for enhancing human resource management of the hospital, which will continuously improve the basis for assessment to performance of associate chief physician under mode of attending in charge,as well as collect experiences for deeply optimizing program of assessment system.
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Objective To observe clinical curative effect of the FLAG regimen combined donor lymphocyte infusion after granulocyte colony stimulating factor(G‐CSF) mobilization(G‐DLI) ,for the acute myeloid leukemia (AML) of allogeneic Peripheral blood hematopoietic stem cell trans‐plantation (allo‐HSCT) after recurrence of hematology .Methods For the patients with recur‐rence after allo‐HSCT ,giving the FLAG regimen chemotherapy when the WBC dropped to the lowest point ,followed by giving G‐DLI that infusion peripheral blood stem cell from the original donors ,to observe curative effect and survival situation .And searched the literature review through the PubMed etc .Results Through FLAG regimen combined G‐DLI ,3 cases of relapse after transplan‐tation again obtained complete remission (CR) .Case 1 :disease‐free survival (DFS) was 13 month and overall survival(OS) was 23 months after G‐DLI .The patient has been the central recurrence and remission in bone marrow ,he was dead after 23 months due to multipleorgan function failure .He occurred Ⅱ acute GVHD in Skin and Ⅰ acute GVHD in liver after G‐DLI and obtained effective control ,not chronic GVHD .Case 2 :DFS and OS were 12 months and 13 months ,as bone marrow relapse again and giving up treat‐ment ,so died a month later .Respectively ,he has limitations chronic GVHD in skin after G‐DLI .Case 3:DFS was 16 months after G‐DLI since the disease‐free survival ,had limitations GVHD in skin that was control for given small dose of immunosuppressive drugs .Conclusion Joint FLAG scheme and G‐DLI may be one of the effective treatment of postoperative recurrence of allo‐HSCT .
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<p><b>OBJECTIVE</b>To study the clinical features of acute graft-versus-host disease (aGVHD) and its risk factors for the related HLA-haploidentical non T cell-depleted in vitro peripheral hematopoietic stem cell transplantation (RHNT-PBSCT).</p><p><b>METHODS</b>From July 2002 to December 2012, 104 patients who underwent the RHNT-PBSCT were enrolled to analyze the incidences, location and its risk factors of aGVHD, compared with those of the 103 patients who received the HLA-matched sibling non T cell-depleted in vitro PBSCT (MSNT-PBSCT) in the same period.</p><p><b>RESULTS</b>(1)The cumulative incidence of aGVHD in the RHNT-PBSCT group was significantly higher than the MSNT-PBSCT group [(56.2±4.7)% vs (34±3.6)%, P<0.05], but the cumulative incidences of II-IV and III-IVgrade aGVHD had no significant difference between the two groups[(39.5±2.9)% vs (21.2±5.4)%, P>0.05; (12.6±4.1)% vs (10.8±2.4)%, P>0.05]. (2)The cumulative incidence of cutaneous aGVHD was significantly higher in RHNT-PBSCT group than that in MSNT-PBSCT group [(42.3±3.2)% vs (17.5±2.3)%, P<0.05]. The cumulative incidences of liver and gastrointestinal aGVHD between the two groups had no significant difference [(7.7±2.1)% vs (12.6±3.4)%, P>0.05; (16.3±4.5)% vs (10.3±2.5)%, P>0.05]. (3)The 3-year disease free survival (DFS) and overall survival(OS) of RHNT-PBSCT group and MSNT-PBSCT group were (63±5.5)%, (65.2±4.7)% and (74.2±5.4)%, (77.4±5)% respectively, without significance (P=0.078, P=0.052). (4)aGVHD occurrence with HLA haplotype (P=0.003) and matched loci (P=0.002) were significantly correlated by univariate analysis. Multivariate analysis showed that only the HLA typing is a risk factor for aGVHD (HR=1.891, P=0.03).</p><p><b>CONCLUSION</b>Although the incidence of total aGVHD in RHNT-PBSCT protocol is higher than that in MSNT-PBSCT, but there was no significance in severe aGVHD and cutaneous aGVHD was the common type, which indicates that RHNT-PBSCT protocol is feasible.</p>
Subject(s)
Humans , Disease-Free Survival , Graft vs Host Disease , Haplotypes , Hematopoietic Stem Cell Transplantation , Histocompatibility Testing , In Vitro Techniques , Incidence , Peripheral Blood Stem Cell Transplantation , Risk Factors , Siblings , T-LymphocytesABSTRACT
The Delphi method was called into play to determine the level-1 indicator,level-2 indicator and plus-minus indicator for evaluating clinicians of various academic titles,while the ranking method was used to determine the weight of these indicators.The Chi-square test found P＞0.05,proving this indicators system as consistent for clinicians at all levels; the t test found the majority as P＞0.05,indicating the weight of level-2 indicators for dimciam of different titles as different with partial consistence.This system is proved to be scientific,comprehensive,objective and authentic in evaluating clinicians of various levels Targeted evaluation and appraisal system guarantees quality of care and medical safety,which functions as an efficient meansfor better hospital management and better quality of care,paving the wayfor reforms in income distribution system and personnel system in the hospital.
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Objective To estimate any influence of strong pulsed magnetic fields on the expression of growth-related genes in human bladder cancer BIU-87 cells. Methods Human BIU-87 cells were cultured in vitro and randomly divided into a magnetic field group and a control group. Each group was further divided into 24 h, 48 h and 72 h sub-groups. The magnetic field group cells were exposed to an 8 T magnetic field pulsed at 15 Hz for 2 h every day. The control group cells also placed on the same environment, but not exposed to any strong, pulsed magnetic field. The expression of B cell lymphoma/leukemia gene-2 (Bcl-2) mRNA, Bax mRNA and caspase-3 mRNA was measured with RT-PCR, and flow cytometry was used to evaluate the expression of the Bcl-2, Bax and caspase-3 genes of the tumor cells in vitro. Results The expression of Bax mRNA and protein was significantly higher in the cells exposed to the magnetic field than in the control groups. The expression of Bcl-2 mRNA and protein was significantly less. The expression of caspase-3 mRNA and protein in the two groups showed no significant differences.Conclusions A strong, pulsed magnetic field can inhibit the growth of bladder tumor BIU-87 cells and promote their apoptosis. The mechanism is probably related with the magnetic field promoting Bax mRNA and protein expression and inhibiting Bcl-2 mRNA and protein expression.
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Objective To explore the pathological characteristics and prognosis of triple-negative breast cancer(TNBC).Methods The pathological data of 465 cases of operable primary breast cancer were analyzed.TNBC was immunohistochemically defined by a lack of expression of ER,PR and Her-2.The differences of pathological characteristics and prognosis between TNBC and non-TNBC were explored.Results TNBC count for about 15%(73/465)of all breast carcinomas.TNBC correlated with younger(＜50y)and premenopausal women (P＜0.05).The follow-up time of the 369 cases was truncated at January 2009,and 39 cases had recurrence or metastasis,the relapse rate of TNBC(18.3%,11/60)was higher than that of non-TNBC(9.1%,28/309,P=0.033).Conclusions The patients with TNBC were younger,and had an increased likelihood of relapse.
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Objective To summarize the progress of clinical research on triple-negative breast cancer(TNBC).Methods Domestic and international publications on the study of TNBC in recent years were collected and reviewed.Results The patients with TNBC were younger,and their prognosis was poorer.Besides operation,chemotherapy was the major therapeutic tool for them.Currently the targeted therapy for epidermal growth factor receptor and its signal conducting system was applied to clinical therapy gradually,and it might benefit the patients with TNBC.Conclusion The study on TNBC may bring a new way for therapy.